Effects of Mindfulness on Psychological Distress and HbA1c in People with Diabetes
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Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition that is associated with a high degree of psychological distress. The aim of this study was to evaluate the effectiveness of a novel approach to delivering an intervention of mindfulness practice (IMP) to a patient population with a demonstrated need for psychological support. The novel approach utilised a self-directed audio compact disc (CD) recording of mindfulness practice. In this randomised controlled trial, 67 participants with T2DM (mean age = 59.4, standard deviation = 12.4), attending outpatient clinics, were randomised to an IMP (n = 31) or a control (n = 36) group. Participants completed written questionnaires at baseline and again at 8- and 12-week follow-ups. Primary outcome measures included depression, anxiety and stress (21-item Depression, Anxiety and Stress Scale) and diabetes-specific emotional problems (Problem Areas in Diabetes Survey (PAID)). Secondary outcome measures included diabetes self-management using the Summary of Diabetes Self-Care Activities Scale (SDSCA), systolic and diastolic blood pressure and HbA1c. Participants receiving the IMP reported significant reductions in depression (p = 0.02) and stress (p = 0.03) when compared with the control group. At the 12-week follow-up, there was an overall reduction in depression by 4.1 units and stress by 3.4 units in the IMP group relative to the control group. There was an overall improvement in blood glucose monitoring; however, this was not significant (p = 0.06). HbA1c measures decreased significantly over the 12-week follow-up by 0.48 units (time × group interaction: p = 0.02). The current study has shown that an easily accessible self-directed IMP was effective in improving psychological symptoms of depression and stress, blood glucose monitoring and HbA1c.
KeywordsDiabetes Mindfulness Randomised controlled trial Blood glucose Depression
The authors would like to thank the School of Medicine, University of Tasmania, for funding this project.
SP designed and executed the study, assisted with some data analysis, and wrote the paper. KW performed the main data analysis and collaborated with the writing of the paper. MW collaborated with the execution of the study and with the writing and editing of the paper. EW collaborated with the design, execution, writing and editing of the study.
This research was supported by funding from the University of Tasmania, School of Medicine, Research and Development grant.
Compliance with Ethical Standards
All procedures performed in this study which involved human participants were in accordance with the ethical standards of the University of Tasmania’s Human Ethics Research Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Helsinki Declaration and its later amendments. All participants in the study gave written informed consent prior to their participation in the study.
Conflict of Interest
The authors declare that they have no conflict of interest.
- Berk, M., Williamms, L. J., Jacka, F. N., O’Neil, A., Pasco, J. A., Moylan, S., Allen, N. B., Stuart, A. L., Hayley, A. C., Byrne, M., & Maes, M. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine, 11, 200.CrossRefPubMedPubMedCentralGoogle Scholar
- Burns, R. J., Deschenes, S. S., & Schmitz, N. (2015). Cyclical relationship between depressive symptoms ans diabetes distress in people with type 2 diabetes mellitus: results from the Montreal Evaluation of Diabetes Treatment Cohort Study. Diabetic Medicine, 32(10), 1272–1278.CrossRefPubMedGoogle Scholar
- Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Glasgow, R., & Masharani, U. (2008a). The longitudinal study of the affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabetic Medicine, 25(9), 1096–1101.CrossRefPubMedPubMedCentralGoogle Scholar
- Folb, N., Lund, C., Fairall, L. R., Timmerman, V., Levitt, N. S., Steyn, K., & Bachmann, M. O. (2015). Socioeconomic predictors and consequences of depression among primary care attenders with non-communicable diseases in the Western Cape, South Africa: cohort study within a randomised trial. BMC Public Health, 15, 1194.CrossRefPubMedPubMedCentralGoogle Scholar
- Hartmann, M., Kopf, S., Kircher, C., Faude-Lang, V., Djuric, Z., Augstein, F., Friederich, H. C., Kieser, M., Bierhaus, A., Humpert, P. M., Herzog, W., & Nawroth, P. P. (2012). Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients: design and first results of a randomized controlled trial (the Heidelberger Diabetes and Stress-study). Diabetes Care, 35(5), 945–947.CrossRefPubMedPubMedCentralGoogle Scholar
- Hermanns, N., Kulzer, B., Krichbaum, M., Kubiak, T., & Haak, T. (2006). How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment. Diabetologia, 49(3), 469–477.CrossRefPubMedGoogle Scholar
- International Diabetes Federation. (2015). IDF diabetes atlas (7th ed.). Brussels: International Diabetes Federation.Google Scholar
- International Diabetes Federation. (2017). Recommendations for managing type 2 diabetes in primary care. www.idf.org/managing-type2-diabetes.
- Kessler, R. C., Andrews, G., Colpe, L. J., & Hiripi, E. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 956–959.Google Scholar
- Keyworth, C., Knopp, J., Roughley, K., Dickens, C., Bold, S., & Coventry, P. (2014). A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behavoural Medicine, 40(2), 53–64.CrossRefGoogle Scholar
- Lovibond, S. H. L., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychological Foundation.Google Scholar
- Nouwen, A., Nefs, G., Caramlau, I., Connock, M., Winkley, K., Lloyd, C. E., Peyrot, M., Pouwer, F., & and for the European Depression in Diabetes (EDID) Research Consortium. (2011). Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European depression in diabetes (EDID) research consortium. Diabetes Care, 34(3), 752–762.CrossRefPubMedPubMedCentralGoogle Scholar
- Pouwer, F., Geelhoed-Duijvestijn, P. H., Tack, C. J., Bazelmans, E., Beekman, A. J., Heine, R. J., & Snoek, F. J. (2010). Prevalence of comorbid depression is high in out-patients with type 1 and type 2 diabetes mellitus. Results from three outpatient clinics in the Netherlands. Diabetic Medicine, 27(2), 217–224.CrossRefPubMedGoogle Scholar
- Rosenzweig, S., Reibel, D. K., Greeson, J. M., Edman, J. S., Jasser, S. A., McMearty, K. D., & Goldstein, B. J. (2007). Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative Therapies in Health and Medicine, 13(5), 36–38.PubMedGoogle Scholar
- Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C., Emmelkamp, P. M., Sanderman, R., Links, T. P., & Schroevers, M. J. (2014). Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care, 37(9), 2427–2434.CrossRefPubMedGoogle Scholar
- Tovote, K. A., Schroevers, M. J., Snippe, E., Sanderman, R., Links, T. P., Emmelkamp, P. M., & Fleer, J. (2015). Long-term effects of individual mindfulness-based cognitive therapy and cognitive behavior therapy for depressive symptoms in patients with diabetes: a randomized trial. Psychotherapy and Psychosomatics, 84(3), 186–187.CrossRefPubMedGoogle Scholar
- van Son, J., Nyklícek, I., Pop, V. J., Blonk, M. C., Erdtsieck, R. J., Spooren, P. F., Toorians, A. W., & Pouwer, F. (2013). The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care, 36(4), 823–830.CrossRefPubMedPubMedCentralGoogle Scholar
- van Son, J., Nyklíček, I., Pop, V. J., Blonk, M. C., Erdtsieck, R. J., & Pouwer, F. (2014). Mindfulness-based cognitive therapy for people with diabetes and emotional problems: long-term follow-up findings from the DiaMind randomized controlled trial. Journal of Psychosomatic Research, 77(1), 81–84.CrossRefPubMedGoogle Scholar