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Effects of Mindfulness on Psychological Distress and HbA1c in People with Diabetes

Abstract

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.

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References

  • Agardh, E., Allebeck, P., Hallqvist, J., Moradi, T., & Sidorchuk, A. (2011). Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. International Journal of Epidemiology, 40(3), 804–818.

    Article  PubMed  Google Scholar 

  • Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetes Medicine, 23(11), 1165–1173.

    Article  Google Scholar 

  • Alpert, B. S. (2007). Validation of the Welch Allyn Spot Vital Signs blood pressure device according to the ANSI/AAMI SP10: 2002. Accuracy and cost-efficiency successfully combined. Blood Pressure Monitoring, 12(5), 345–347.

    Article  PubMed  Google Scholar 

  • Altschuler, A., Rosenbaum, E., Gordon, P., Canales, S., & Avins, A. L. (2012). Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life—a pilot feasibility study. Support Care Cancer, 20(6), 1291–1297.

    Article  PubMed  Google Scholar 

  • Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care, 24(6), 1069–1078.

    Article  PubMed  Google Scholar 

  • Bener, A., Al-Hamaq, A. O. A. A., & Dafeeah, E. E. (2011). High prevalence of depression, anxiety and stress symptoms among diabetes mellitus patients. The Open Psychiatry Journal, 5, 5–12.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, K. W. R., & Richard, M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.

    Article  PubMed  Google Scholar 

  • Brown, E. S., Varghese, F. P., & McEwen, B. S. (2004). Association of depression with medical illness: does cortisol play a role? Biological Psychiatry, 55(1), 1–9.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • Champaneri, S., Wand, G. G., Malhotra, S. S., Casagrande, S. S., & Golden, S. H. (2010). Biological basis of depression in adults with diabetes. Current Diabetes Reports, 10(6), 396–405.

    Article  PubMed  Google Scholar 

  • Charlson, M. E., Ales, K. E., Pompei, P., & MacKenzie, C. R. (1987). A new method of classification of prognostic comorbidity for longitudinal studies: development and validation. Journal of Chronic Disease, 40, 373–383.

    Article  Google Scholar 

  • Cresswell, D. J., & Lindsay, E. K. (2014). How does minfulness training affect health? A mindfulness stress buffering account. Current Directions in Psychological Science, 23(6), 401–407.

    Article  Google Scholar 

  • de Groot, M., Anderson, R., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). Association of depression and diabetes complications: a meta-analysis. Psychosomatic Medicine, 63(4), 619–630.

    Article  PubMed  Google Scholar 

  • Demarzo, M. M. P., Cebolla, A., & Garcia-Campayo, M. D. (2015). The implementation of mindfulness in healthcare systems: a theoretical analysis. General Hospital Psychiatry, 37, 166–171.

    Article  PubMed  Google Scholar 

  • Donath, M. Y., & Shoelson, S. E. (2011). Type 2 diabetes as an inflammatory disease. Nature Reviews Immunology, 11, 98–107.

    Article  PubMed  Google Scholar 

  • Egede, L. (2005). Effect of depression on self-management behaviors and health outcomes in adults with type 2 diabetes. Current Diabetes Review, 1(3), 235–243.

    Article  Google Scholar 

  • Egede, L. E., & Dismuke, C. E. (2012). Serious psychological distress and diabetes: a review of the literature. Current Psychiatry Reports, 14(1), 15–22.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fisher, L., Glasgow, R., Mullan, J., Skaff, M., & Polonsky, W. (2008b). Development of a brief diabetes distress screening instrument. Annals of Family Medicine, 6(3), 246–252.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gloster, A. T., Rhoades, H. M., Novy, D., Klotsche, J., Senior, A., Kunik, M., Wilson, N., & Stanley, M. A. (2008). Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. Journal of Affective Disordorders, 10(3), 248–259.

    Article  Google Scholar 

  • Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Journal of Consultulting and Clinical Psychology, 75(2), 336–343.

    Article  Google Scholar 

  • Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2002). Prevalence of anxiety in adults with diabetes: a systematic review. Journal of Psychosomatic Research, 53(6), 1053–1060.

    Article  PubMed  Google Scholar 

  • Grossman, P. N. L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  • Hofmann, S., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

    Article  PubMed  PubMed Central  Google 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.

  • Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: part, present and future. Clinical Psychology Science and Practice, 10, 144–156.

    Article  Google Scholar 

  • Katon, W., von Korff, M., Ciechanowski, P., Russo, J., Lin, E., Simon, G., Ludman, E., Walker, E., Bush, T., & Young, B. (2004). Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care, 27(4), 914–920.

    Article  PubMed  Google Scholar 

  • Katon, W. J., Rutter, C., Simon, G., Lin, E. H., Ludman, E., Ciechanowski, P., Kinder, L., Young, B., & Von Korff, M. (2005). The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care, 28(11), 2668–2672.

    Article  PubMed  Google Scholar 

  • Kelly, S. J., & Ismail, M. (2015). Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes. Annual Review of Public Health, 36, 441–462.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chaleau, M., Paquin, K., & Hofmann, S. G. (2013). Minfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33, 763–771.

    Article  PubMed  Google Scholar 

  • Lloyd, C. E., Dyert, P. H., & Barnett, A. H. (2000). Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabetic Medicine, 17(3), 198–202.

    Article  PubMed  Google Scholar 

  • Loucks, E. B., Gilman, S. E., Britton, W. B., Gutman, R., Eaton, C. B., & Buka, S. L. (2016). Associations of mindfulness with glucose regulation and diabetes. American Journal of Health Behavior, 40(2), 258–267(210).

    Article  PubMed  PubMed Central  Google Scholar 

  • Lovibond, S. H. L., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychological Foundation.

    Google Scholar 

  • Mezuk, B., Eaton, W. W., Albrecht, S., & Golden, S. H. (2008). Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care, 31(12), 2383–2390.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, K., Kristeller, J. L., Headings, A., & Nagaraja, H. (2014). Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a randomized controlled trial. Health Education & Behavior, 41(2), 145–154.

    Article  Google Scholar 

  • Nouwen, A., Winkley, K., Twisk, J., Lloyd, C. E., Peyrot, M., Ismail, K., & Pouwer, F. (2010). Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia, 53(12), 2480–2486.

    Article  PubMed  PubMed Central  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.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Leary, K., O’Neill, S., & Dockray, S. (2016). A systematic review of the effects of mindfulness interventions on cortisol. Journal of Health Psychology, 21(9), 2108–2121.

    Article  PubMed  Google Scholar 

  • Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., & Schwartz, C. E. (1995). Assessment of diabetes-related distress. Diabetes Care, 18(6), 754–760.

    Article  PubMed  Google Scholar 

  • Pouwer, F., Beekman, A. T., Lubach, C., & Snoek, F. J. (2006). Nurses’ recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus. Patient Education and Counseling, 60(2), 235–240.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • Rajput, R., Gehlawat, P., Gehlan, D., Gupta, R., & Rajput, M. (2016). Prevalence and predictors of depression and anxiety in patients of diabetes mellitus in a tertiary care center. Indian Journal of Endocrinology and Metabolism, 20(6), 746–751.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reddy, P., Ford, D., & Dunbar, J. A. (2010). Improving the quality of diabetes care in general practice. Australian Journal of Rural Health, 18(5), 187–193.

    Article  PubMed  Google Scholar 

  • Ronk, F. R., Korman, J. R., Hooke, G. R., & Page, A. C. (2013). Assessing clinical significance of treatment outcomes using the DASS-21. Psychological Assessment, 25(4), 1103–1110.

    Article  PubMed  Google 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.

    PubMed  Google Scholar 

  • Sanchez-Mora, C., Rodrıguez-Oliva, M. S., Fernandez-Riejos, P., Mateo, J., Polo-Padillo, J., Goberna, R., & Sanchez-Margalet, V. (2011). Evaluation of two HbA1c point-of-care analyzers. Clinical Chemistry and Laboratory Medicine, 49(4), 653–657.

    Article  PubMed  Google Scholar 

  • Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care, 23(7), 943–950.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  • Wang, X., Bao, W., Liu, J., Ouyang, Y. Y., Wang, D., Rong, S., Xiao, X., Shan, Z. L., Zhang, Y., Yao, P., & Liu, L. G. (2013). Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care, 36(1), 166–175.

    Article  PubMed  Google Scholar 

  • Warnecke, E., Quinn, S., Ogden, K., Towle, N., & Nelson, M. R. (2011). A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Medical Education, 45(4), 381–388.

    Article  PubMed  Google Scholar 

  • Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997). The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care, 20(5), 760–766.

    Article  PubMed  Google Scholar 

  • Welch, G. W., Weinger, K., Anderson, B., & Polonsky, W. H. (2003). Responsiveness of the Problem Areas In Diabetes (PAID) questionnaire. Diabetes Medicine, 20(1), 69–72.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the School of Medicine, University of Tasmania, for funding this project.

Funding

This research was supported by funding from the University of Tasmania, School of Medicine, Research and Development grant.

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Contributions

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.

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Correspondence to Sue Pearson.

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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.

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The authors declare that they have no conflict of interest.

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Pearson, S., Wills, K., Woods, M. et al. Effects of Mindfulness on Psychological Distress and HbA1c in People with Diabetes. Mindfulness 9, 1615–1626 (2018). https://doi.org/10.1007/s12671-018-0908-1

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Keywords

  • Diabetes
  • Mindfulness
  • Randomised controlled trial
  • Blood glucose
  • Depression