Mindfulness, Acceptance-Based Diabetes Education May Reduce Distress & Glycemic Levels

The benefits of mindfulness and acceptance-based interventions in patients with type 2 diabetes. 

Effective diabetes management requires patients with type 2 diabetes (T2D) to perform their daily self-care, including blood glucose monitoring, medication self-management, a healthy diet, and physical activity. Self-care is imperative for managing stable glucose levels. However, the fear of disease complications and requirements for self-management for type 2 diabetes (T2D) patients often cause psychological distress. According to recent findings published in Diabetic Medicine, a mindfulness and acceptance approach to diabetes education programs may be beneficial for reducing diabetes‐related distress and glycemic level in patients with T2D. Diabetes-specific aversive feelings and negative emotions perceived by the affected individuals are defined as diabetes distress.  

Recent cross-sectional and longitudinal studies identified two pathways by which diabetes distress might affect self-management and glycemic levels. One is self-efficacy in illness management, which affects a person’s motivation for performing self-management. Second, diabetes distress can promote self-care avoidance behaviors, such as selectively avoiding diabetes care-specific tasks that frequently produce emotional distress. A meta-analysis reviewed the effects of mindfulness and acceptance‐based interventions on diabetes distress and glycemic level in community‐dwelling adults with T2D. A database search was conducted through June 2020 for randomized controlled trials. The intervention included training to relieve emotional distress by encouraging mindful skills such as focusing on the present moment, raising awareness, and enhancing acceptance. In addition, studies in which usual care diabetes education was applied to the control group of adults with T2D, with no limitation on the duration of illness and a primary outcome of diabetes distress and glycemic level ( fasting glucose or HbA1c level ) were included. The secondary outcomes included diabetes self-management.  

Nine studies with 801 participants were included in this meta-analysis study. Seven studies included people with T2D and two included participants with type 1 diabetes (T1D) and T2D. Of the nine studies, seven conducted group-based and therapy-led interventions, five evaluated mindfulness interventions, and four evaluated acceptance and commitment therapy. The mindfulness-based cognitive therapy was consistently eight weeks, whereas the acceptance and commitment therapy programs varied from one day to eight or ten weekly sessions. In addition, a comparison of various baseline measurements, or those obtained up to 6 months post-intervention, was conducted to determine the effects of the interventions. 

The only four studies (involving 319 participants) that involved mindfulness or acceptance-based interventions had a significant reduction in diabetes distress which significantly outweighed those of usual care diabetes education (standardized mean difference, -0.37; 95% CI, -0.62 to -0.12 P <.01). The results were similar in the analysis of three studies involving 306 participants for changes in HbA1c levels up to 1-months post-intervention. Mindfulness and acceptance-based interventions outweighed those of usual care in reducing HbA1c ( standardized mean difference (SMD), -0.35; 95% CI, -0.67 to -0.04; P < .03. However, the three to six months post interventions were not significant. The meta-analysis of three studies that focused on the mindfulness-based therapy had reductions in the symptoms of anxiety ( SMD= -0.41, 95% CI: -0.66 to -0.15; P = 0.002) and depression  (SMD = −0.53, 95% CI: −0.82, −0.25, p ≤  0.001) immediately after the intervention, compared with usual care. The intervention did not have a significant effect on stress.  

The positive effects observed on diabetes distress and HbA1c levels in the meta-analyses were derived from short-term (8-10 weeks) interventions, indicating a low level of statistic heterogeneity. The findings show significantly positive short-term effects of mindfulness and acceptance-based programs on diabetes distress, HbA1c, and other psychological outcomes in patients with T2D. There is a need for further research to examine the long-term effects of the interventions in more extensive and diverse samples of the population. 

Practice Pearls: 

• Mindfulness and acceptance-based interventions for patients with diabetes have short-term beneficial effects on diabetes distress, HbA1c, depressive and anxiety symptoms. 
• There is a need for future studies to examine the long-term effects of the intervention’s protocols. 
• Self-care is imperative for managing stable glucose levels. 

Ngan, Hau Yi et al. Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis. Diabetic medicine; April 2021. 

Brenda Oppong, PharmD Candidate, LECOM School of Pharmacy