The Effects of a Mindfulness-Based Intervention on Emotional Distress, Quality of Life, and HbA1c in Outpatients With Diabetes (DiaMind)

Abstract

OBJECTIVEEmotional distress is common in outpatients with diabetes, affecting ∼20–40% of the patients. The aim of this study was to determine the effectiveness of group therapy with Mindfulness-Based Cognitive Therapy (MBCT), relative to usual care, for patients with diabetes with regard to reducing emotional distress and improving health-related quality of life and glycemic control.RESEARCH DESIGN AND METHODSIn the present randomized controlled trial, 139 outpatients with diabetes (type 1 or type 2) and low levels of emotional well-being were randomized to MBCT (n = 70) or a waiting list group (n = 69). Primary outcomes were perceived stress (Perceived Stress Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), mood (Profiles of Mood States), and diabetes-specific distress (Problem Areas In Diabetes). Secondary outcomes were health-related quality of life (12-Item Short-Form Health Survey), and glycemic control (HbA1c). Assessments were conducted at baseline and at 4 and 8 weeks of follow-up.RESULTSCompared with control, MBCT was more effective in reducing stress (P < 0.001, Cohen d = 0.70), depressive symptoms (P = 0.006, d = 0.59), and anxiety (P = 0.019, d = 0.44). In addition, MBCT was more effective in improving quality of life (mental: P = 0.003, d = 0.55; physical: P = 0.032, d = 0.40). We found no significant effect on HbA1c or diabetes-specific distress, although patients with elevated diabetes distress in the MBCT group tended to show a decrease in diabetes distress (P = 0.07, d = 0.70) compared with the control group.CONCLUSIONSCompared with usual care, MBCT resulted in a reduction of emotional distress and an increase in health-related quality of life in diabetic patients who had lower levels of emotional well-being.

Individual Mindfulness-Based Cognitive Therapy and Cognitive Behavior Therapy for Treating Depressive Symptoms in Patients With Diabetes: Results of a Randomized Controlled Trial

“…This finding is concordant with two previous RCTs on MBCT (10) and CBT (19) that did not find an effect on glycemic control. A recent review and meta-analysis studied the impact of psychosocial interventions on both psychological and physical health in patients with diabetes (39).…”

“…It is clinically relevant to observe that both MBCT and CBT significantly increase well-being and reduce anxiety and diabetes-related distress. These findings are consistent with previous research showing that psychological interventions focusing on depressive symptoms can also improve anxiety and quality of life (10,20). Results are also in line with previous studies in patients with diabetes investigating either MBCT or CBT, also showing reductions in diabetes-related distress (14,19).…”

“…Third, attrition rates in both MBCT and CBT were high, as only ;70% of the randomized participants completed treatment. These attrition rates are consistent with previous studies targeting distressed patients with diabetes (10,19). Screening a consecutive sample may have accounted for the dropout rate, as the majority of participants did not seek treatment themselves, but instead were approached and offered treatment.…”

“…Fourth, a substantial group of patients who met the inclusion criteria refused to participate in the study because of no need for psychological treatment. Our inclusion rate is comparable to other studies using a consecutive sample method (10,40). As patients were blinded to the content of the treatment, we do not assume that refusal to participation was content related.…”

“…However, little is known about the applicability and effectiveness of MBCT in patients with diabetes. So far, only one randomized controlled trial (RCT) has investigated the effects of MBCT in patients with diabetes, demonstrating a reduction of depressive symptoms and anxiety as well as an increase in quality of life (10).…”