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Cited by 96Diabetes Management and EducationPsychological Well-being and Life SatisfactionMindfulness and Compassion Interventions

Well-being interventions for individuals with diabetes: A systematic review

Open access
Massey, Christina N., Feig, Emily H., Duque-Serrano, Laura, Wexler, Deborah, Moskowitz, Judith Tedlie, Huffman, Jeff C.·2019·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2018.11.014PMC PMC6370485
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Abstract

In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 34 articles from 30 studies (N=1,635) found that well-being interventions for people with Type 1 or Type 2 diabetes show promise, especially for depression and some psychological outcomes. However, evidence for physical health outcomes such as HbA1c is inconsistent, and the literature does not yet identify which specific interventions are most effective.

Key findings

  • Across 34 articles from 30 studies, interventions included 4 positive psychology, 18 mindfulness-based, 6 acceptance and commitment therapy (ACT), 4 resilience-based, and 2 other studies; quality ratings were 12% high, 62% moderate, and 27% poor.
  • Depression was the most commonly assessed psychological outcome and improved significantly in 14/19 studies; among mindfulness-based studies, 11/12 found significant depression reductions, 10 of which were controlled.
  • HbA1c was the most common physical outcome, with 6/16 studies finding a significant post-intervention effect, three of which were uncontrolled; health behavior adherence improved significantly in 4/10 studies, including two controlled studies.
  • Mindfulness-based studies found stress reductions in 4/5 studies, anxiety/diabetes-related distress reductions in 3/6 studies, and HbA1c reductions in 4/8 studies, but only two HbA1c findings were controlled.

Methods

  • PRISMA-guided systematic review searching PubMed, PsycINFO, and Scopus from database inception through October 2017, including peer-reviewed manuscripts in English, Spanish, or Persian.
  • Inclusion required participants diagnosed with diabetes, an intervention designed to promote well-being rather than reduce a negative construct, and a prospective study design; case studies, case reports, and abstracts were excluded.
  • Two authors independently assessed quality and risk of bias using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, resolving discrepancies by discussion.

Limitations

  • Stated by the authors: studies in other languages or databases may have been missed; variability in studies, interventions, and outcomes precluded quantitative analysis; overlapping intervention components limited comparisons across categories; individual study limitations and low overall quality constrain conclusions; publication bias could not be accounted for.
  • Evident from the text: small sample size (N<50) was common, only four studies were rated high quality, outcome measures were inconsistent, and many studies were uncontrolled, making effect estimates variable and unstable.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.diabres.2018.11.014

Cites

77 of 77 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 95 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The positive psychology studies examined few positive psychological outcomes.

    “Few positive psychological outcomes were examined in these studies.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The review found 34 articles from 30 studies that met all inclusion criteria.

    “We identified 34 articles from 30 studies meeting all inclusion criteria (some articles reported different outcomes within the same study and were included as unique selections).”
    Quote in the paperNot a substantial claim
  • Findingown data

    No studies of gestational diabetes were found.

    “No studies of gestational diabetes were identified.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Control conditions differed substantially across the studies.

    “Control conditions varied significantly across studies.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In positive psychology studies that tested significance, no health-related outcome showed significant findings, including glucose monitoring, medication adherence, or physical activity.

    “In studies that tested for statistical significance, there were no significant findings for any health-related outcome, including glucose monitoring, medication adherence, or physical activity.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 10
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The included articles comprised four positive psychology, 18 mindfulness-based, six ACT, four resilience-based, and one each on emotional intelligence and positive self-concept.

    “These consisted of four PP articles [41–44], 18 mindfulness-based articles [45–62], six ACT articles [38, 63–67], four resilience-based articles [68–71], and single studies targeting emotional intelligence [72] and positive self-concept [73]”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [41] Cohn MA, Pietrucha ME, Saslow LR, Hult JR, Moskowitz JT. An online positive affect skills intervention reduces depression in adults with type 2 diabetes. The journal of positive psychology. 2014; 9: 523– 34. 25214877 PMC4157680 source

      Not checked in the free run.

    • cites [42] Jaser SS, Patel N, Linsky R, Whittemore R. Development of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes. Journal of pediatric health care: official publication of National Association of Pediatric Nurse Associates & Practitioners. 2014; 28: 478– 85. PMC4273905 24786582

      Not checked in the free run.

    • cites [43] DuBois CM, Millstein RA, Celano CM, Wexler DJ, Huffman JC. Feasibility and Acceptability of a Positive Psychological Intervention for Patients With Type 2 Diabetes. The primary care companion for CNS disorders. 2016; 18. PMC5035810 27733954 source

      Not checked in the free run.

    • cites [44] Nowlan JS, Wuthrich VM, Rapee RM, Kinsella JM, Barker G. A Comparison of Single-Session Positive Reappraisal, Cognitive Restructuring and Supportive Counselling for Older Adults with Type 2 Diabetes. Cogn Ther Res. 2016; 40: 216– 29.

      Not checked in the free run.

    • cites [45] Dreger LC, Mackenzie C, McLeod B. Feasibility of a Mindfulness-Based Intervention for Aboriginal Adults with Type 2 Diabetes. Mindfulness. 2015; 6: 264– 80.

      Not checked in the free run.

    • cites [46] Haenen S NIvSJPVPF Mindfulness facets as differential mediators of short and long-term effects of Mindfulness-Based Cognitive Therapy in diabetes outpatients: findings from the DiaMind randomized trial. Journal of psychosomatic research. 2016; 85: 44. 27212669 source

      Not checked in the free run.

    • cites [47] Jung HY, Lee H, Park J. Comparison of the effects of Korean mindfulness-based stress reduction, walking, and patient education in diabetes mellitus. Nursing & health sciences. 2015; 17: 516– 25. 26275164

      Not checked in the free run.

    • cites [48] Miller CK, Kristeller JL, Headings A, Nagaraja H. 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: the official publication of the Society for Public Health Education. 2014; 41: 145– 54. 23855018 PMC4217158 source

      Not checked in the free run.

    • cites [49] Rungreangkulkij S, Wongtakee W, Thongyot S. Buddhist group therapy for diabetes patients with depressive symptoms. Archives of psychiatric nursing. 2011; 25: 195– 205. 21621733

      Not checked in the free run.

    • cites [50] Schroevers MJ, Tovote KA, Keers JC, Links TP, Sanderman R, Fleer J. Individual Mindfulness-Based Cognitive Therapy for People with Diabetes: a Pilot Randomized Controlled Trial. Mindfulness. 2013; 6: 99– 110.

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Twenty-three articles included only type 2 diabetes patients, two only type 1, and nine both types.

    “Twenty-three of the 34 articles included only patients with T2D; two included only individuals with T1D; the remaining nine included individuals with T1D or T2D.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Four studies (12%) were rated high quality, 21 (62%) moderate, and nine (27%) poor.

    “Overall, 12% (n=4) of studies were rated as high quality, 62% (n=21) as moderate quality, and 27% (n=9) as poor quality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most articles (25) used group-based interventions, and all but four were delivered in person.

    “Most articles (n=25) described group-based interventions, and all but four interventions were delivered in person, with others using texting, internet, or phone-based delivery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The studies enrolled 1,635 participants, including 103 adolescents.

    “In total, the identified studies included 1,635 participants, 103 of whom were adolescents.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Depression was measured in three of four positive psychology studies; among the two controlled studies, only one showed significant change.

    “Otherwise, depression was measured in three of four PP studies. Among the two controlled studies, depression significantly changed in only one that examined the efficacy of an online, self-paced PP intervention [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Cohn MA, Pietrucha ME, Saslow LR, Hult JR, Moskowitz JT. An online positive affect skills intervention reduces depression in adults with type 2 diabetes. The journal of positive psychology. 2014; 9: 523– 34. 25214877 PMC4157680 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Anxiety was measured in two positive psychology studies; the only controlled one found no significant change.

    “Anxiety was measured in two studies; however, only one used a control group, and it found no statistically significant changes in anxiety [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] DuBois CM, Millstein RA, Celano CM, Wexler DJ, Huffman JC. Feasibility and Acceptability of a Positive Psychological Intervention for Patients With Type 2 Diabetes. The primary care companion for CNS disorders. 2016; 18. PMC5035810 27733954 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Findingown data

    All positive psychology studies used self-report for physical health outcomes.

    “All PP studies relied on self-report for physical health outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Of 12 mindfulness studies measuring depression, 11 found significant symptom reductions, and 10 of these were controlled.

    “Similarly, of the 12 studies measuring changes in depression, 11 found significant symptom reductions [48–51, 53, 54, 56–58, 60, 62], 10 of which were controlled studies.”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [48] Miller CK, Kristeller JL, Headings A, Nagaraja H. 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: the official publication of the Society for Public Health Education. 2014; 41: 145– 54. 23855018 PMC4217158 source

      Not checked in the free run.

    • cites [49] Rungreangkulkij S, Wongtakee W, Thongyot S. Buddhist group therapy for diabetes patients with depressive symptoms. Archives of psychiatric nursing. 2011; 25: 195– 205. 21621733

      Not checked in the free run.

    • cites [50] Schroevers MJ, Tovote KA, Keers JC, Links TP, Sanderman R, Fleer J. Individual Mindfulness-Based Cognitive Therapy for People with Diabetes: a Pilot Randomized Controlled Trial. Mindfulness. 2013; 6: 99– 110.

      Not checked in the free run.

    • cites [51] Friis AM, Johnson MH, Cutfield RG, Consedine NS. Kindness Matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress, and HbA1c Among Patients With Diabetes. Diabetes care. 2016; 39: 1963– 71. 27335319

      Not checked in the free run.

    • cites [53] Hartmann M, Kopf S, Kircher C, Faude-Lang V, Djuric Z, Augstein F, 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. 2012; 35: 945– 7. 22338101 PMC3329807 source

      Not checked in the free run.

    • cites [54] Rosenzweig S, Reibel DK, Greeson JM, Edman JS, Jasser SA, McMearty KD, Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative therapies in health and medicine. 2007; 13: 36– 8. 17900040

      Not checked in the free run.

    • cites [56] Tovote KA, Fleer J, Snippe E, Peeters AC, Emmelkamp PM, Sanderman R, 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. 2014; 37: 2427– 34. 24898301 source

      Not checked in the free run.

    • cites [57] Tovote KA, Schroevers MJ, Snippe E, Emmelkamp PMG, Links TP, Sanderman R, What works best for whom? Cognitive Behavior Therapy and Mindfulness-Based Cognitive Therapy for depressive symptoms in patients with diabetes. PloS one. 2017; 12: e0179941. 28662208 PMC5491069

      Not checked in the free run.

    • cites [58] van Son J, Nyklicek I, Pop VJ, Blonk MC, Erdtsieck RJ, Spooren PF, 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. 2013; 36: 823– 30. 23193218 PMC3609486 source

      Not checked in the free run.

    • cites [60] Wagner JA, Bermudez-Millan A, Damio G, Segura-Perez S, Chhabra J, Vergara C, A randomized, controlled trial of a stress management intervention for Latinos with type 2 diabetes delivered by community health workers: Outcomes for psychological wellbeing, glycemic control, and cortisol. Diabetes research and clinical practice. 2016; 120: 162– 70. 27568646 PMC5037043 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    General health or physical health status was measured in three mindfulness studies but changed significantly in only one.

    “General health/physical health status was examined in three studies but only significantly changed in one [45, 52].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [45] Dreger LC, Mackenzie C, McLeod B. Feasibility of a Mindfulness-Based Intervention for Aboriginal Adults with Type 2 Diabetes. Mindfulness. 2015; 6: 264– 80.

      Not checked in the free run.

    • cites [52] Gainey A, Himathongkam T, Tanaka H, Suksom D. Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes. Complementary therapies in medicine. 2016; 26: 92– 7. 27261988 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Of five mindfulness studies measuring stress, four found significant reductions, but only three of those were controlled.

    “Of the five studies that examined stress as an outcome, four found a significant reduction following the intervention [45, 53, 58, 62], although only three [53, 58, 62] of these were controlled studies.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [45] Dreger LC, Mackenzie C, McLeod B. Feasibility of a Mindfulness-Based Intervention for Aboriginal Adults with Type 2 Diabetes. Mindfulness. 2015; 6: 264– 80.

      Not checked in the free run.

    • cites [53] Hartmann M, Kopf S, Kircher C, Faude-Lang V, Djuric Z, Augstein F, 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. 2012; 35: 945– 7. 22338101 PMC3329807 source

      Not checked in the free run.

    • cites [58] van Son J, Nyklicek I, Pop VJ, Blonk MC, Erdtsieck RJ, Spooren PF, 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. 2013; 36: 823– 30. 23193218 PMC3609486 source

      Not checked in the free run.

    • cites [62] Sasikumar Latheef F. Effects of mindfulness based stress reduction (MBSR) on stress, depression and mindfulness among type 2 diabetics - A randomized pilot study. Indian J Trad Knowl. 2017; 16: 654– 9.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Three of four positive psychology studies measured positive affect, but only one found a significant improvement, with a small effect size.

    “Three out of four PP studies measured positive affect, with only one finding significant improvement (with small effect size)[44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Nowlan JS, Wuthrich VM, Rapee RM, Kinsella JM, Barker G. A Comparison of Single-Session Positive Reappraisal, Cognitive Restructuring and Supportive Counselling for Older Adults with Type 2 Diabetes. Cogn Ther Res. 2016; 40: 216– 29.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One positive psychology study measured optimism and gratitude but did not test for significance.

    “The constructs of optimism and gratitude were also measured in one study (which did not test for significance)[43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] DuBois CM, Millstein RA, Celano CM, Wexler DJ, Huffman JC. Feasibility and Acceptability of a Positive Psychological Intervention for Patients With Type 2 Diabetes. The primary care companion for CNS disorders. 2016; 18. PMC5035810 27733954 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In mindfulness-based studies, stress, diabetes-related distress, depression, and anxiety were the most frequently studied and most consistently reduced after intervention.

    “Of the remaining outcomes, stress, diabetes-related distress, depression, and anxiety were most often studied and were most consistently reduced post-intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of eight mindfulness studies measuring HBA1C, four found significant post-intervention reductions, but only two compared changes with a control condition.

    “Of the eight mindfulness-based studies that measured HBA1C, the most commonly studied physical outcome, four found a significant reduction post-intervention [45, 51, 52, 54], but only two compared changes to a control condition [51, 52].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [45] Dreger LC, Mackenzie C, McLeod B. Feasibility of a Mindfulness-Based Intervention for Aboriginal Adults with Type 2 Diabetes. Mindfulness. 2015; 6: 264– 80.

      Not checked in the free run.

    • cites [51] Friis AM, Johnson MH, Cutfield RG, Consedine NS. Kindness Matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress, and HbA1c Among Patients With Diabetes. Diabetes care. 2016; 39: 1963– 71. 27335319

      Not checked in the free run.

    • cites [52] Gainey A, Himathongkam T, Tanaka H, Suksom D. Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes. Complementary therapies in medicine. 2016; 26: 92– 7. 27261988 source

      Not checked in the free run.

    • cites [54] Rosenzweig S, Reibel DK, Greeson JM, Edman JS, Jasser SA, McMearty KD, Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative therapies in health and medicine. 2007; 13: 36– 8. 17900040

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In mindfulness-based studies, significant improvements occurred in self-efficacy, self-compassion, well-being, mental health-related quality of life, and positive affect.

    “Of the well-being outcomes, significant changes were seen in self-efficacy [48], self-compassion [51], well-being [45, 56], mental health-related quality of life [58], and positive affect [59].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [48] Miller CK, Kristeller JL, Headings A, Nagaraja H. 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: the official publication of the Society for Public Health Education. 2014; 41: 145– 54. 23855018 PMC4217158 source

      Not checked in the free run.

    • cites [51] Friis AM, Johnson MH, Cutfield RG, Consedine NS. Kindness Matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress, and HbA1c Among Patients With Diabetes. Diabetes care. 2016; 39: 1963– 71. 27335319

      Not checked in the free run.

    • cites [45] Dreger LC, Mackenzie C, McLeod B. Feasibility of a Mindfulness-Based Intervention for Aboriginal Adults with Type 2 Diabetes. Mindfulness. 2015; 6: 264– 80.

      Not checked in the free run.

    • cites [56] Tovote KA, Fleer J, Snippe E, Peeters AC, Emmelkamp PM, Sanderman R, 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. 2014; 37: 2427– 34. 24898301 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In ACT studies, significant changes were found for perceived stress and guilt.

    “Of the other outcomes studied, significant changes were found in perceived stress [59] and guilt.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Wagner J, Bermudez-Millan A, Damio G, Segura-Perez S, Chhabra J, Vergara C, Community health workers assisting Latinos manage stress and diabetes (CALMS-D): rationale, intervention design, implementation, and process outcomes. Translational behavioral medicine. 2015; 5: 415– 24. 26622914 PMC4656228

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Among intervention types, depression was most consistently studied in and most substantially affected by mindfulness-based interventions.

    “Across intervention types, depression was most consistently studied in, and substantially affected by, mindfulness-based interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Voseckova and colleagues tested an intervention to strengthen positive self-concept and perceived self-efficacy in type 2 diabetes patients; neither psychological state nor hardiness improved significantly.

    “Voseckova and colleagues examined an intervention aiming to strengthen positive self-concept and perceived self-efficacy in individuals with T2D [73]. Neither study outcome (psychological state or hardiness), showed significant improvement post-intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Voseckova A, Truhlarova Z, Janebova R, Kuca K. Activation group program for elderly diabetic patients. Social work in health care. 2017; 56: 13– 27. 27845614

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    One ACT study that did not find a significant HBA1C reduction did find a significant decrease in the number of participants with HBA1C below 7.0.

    “One study that did not find a significant reduction in HBA1C post-intervention did find a significant decrease in number of participants with an HBA1C below 7.0 [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Journal of consulting and clinical psychology. 2007; 75: 336– 43. 17469891 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Depression was the most commonly assessed psychological outcome and improved significantly after intervention in 14 of 19 studies.

    “In fact, depression was the most commonly assessed psychological outcome and was significantly improved post-intervention in 14/19 studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Only one resilience study found a significant pre-post decrease in HBA1C, and it had no control group.

    “Only one found a significant pre-post decrease in HBA1C [69], with no control group for comparison.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Steinhardt MA, Mamerow MM, Brown SA, Jolly CA. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy. The Diabetes educator. 2009; 35: 274– 84. 19204102 PMC3001398 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    One resilience study reported a significant change in positive meaning, and another uncontrolled study found a significant increase in diabetes empowerment.

    “A significant change in positive meaning was reported in one study [68], and diabetes empowerment increased significantly in another uncontrolled study [69].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [68] Steinhardt MA, Brown SA, Dubois SK, Harrison L Jr., Lehrer HM, Jaggars SS. A resilience intervention in African-American adults with type 2 diabetes. American journal of health behavior. 2015; 39: 507– 18. 26018099 PMC8117176

      Not checked in the free run.

    • cites [69] Steinhardt MA, Mamerow MM, Brown SA, Jolly CA. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy. The Diabetes educator. 2009; 35: 274– 84. 19204102 PMC3001398 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Many interventions produced significant improvements in outcomes such as depression and stress, which are not necessarily well-being constructs.

    “Many interventions yielded significant improvements in outcomes that are not necessarily well-being constructs but nonetheless are meaningful to patients (e.g., depression, stress)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HBA1C was the most common physical health outcome, with 6 of 16 studies (three uncontrolled) finding a significant post-intervention effect.

    “Regarding physical health outcomes, HBA1C was the most common outcome measured, with 6/16 studies (three of which were uncontrolled) finding a significant post-intervention effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    One resilience study found significant improvement in diabetes knowledge, a decrease in fasting blood glucose, and improvement in HDL cholesterol.

    “One found significant improvement in diabetes knowledge, a decrease in fasting blood glucose, and improvement in HDL cholesterol [68].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Steinhardt MA, Brown SA, Dubois SK, Harrison L Jr., Lehrer HM, Jaggars SS. A resilience intervention in African-American adults with type 2 diabetes. American journal of health behavior. 2015; 39: 507– 18. 26018099 PMC8117176

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    HBA1C was the most commonly measured physical health outcome in resilience studies, assessed in three studies.

    “The most commonly measured physical health outcome was HBA1C, assessed in three studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Another resilience study found a significant decrease in physical activity barriers, but the effect was small and no longer significant at six-month follow-up.

    “Another found a significant decrease in physical activity barriers, though the effect size was small and no longer significant at six-month follow-up [70].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Bradshaw BG, Richardson GE, Kumpfer K, Carlson J, Stanchfield J, Overall J, Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. The Diabetes educator. 2007; 33: 650– 9. 17684166 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Two ACT studies measured ACT-related processes, and both found significant post-intervention improvements compared with control.

    “Additionally, ACT-related processes, which include acceptance, mindfulness, and values, were measured in two studies, both of which found significant improvements post-intervention compared to the control group [38, 63].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Journal of consulting and clinical psychology. 2007; 75: 336– 43. 17469891 source

      Not checked in the free run.

    • cites [63] Shayeghian Z, Hassanabadi H, Aguilar-Vafaie ME, Amiri P, Besharat MA. A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles. PloS one. 2016; 11: e0166599. 27907074 PMC5132195

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Two resilience studies included coping strategies, perceived stress, and depression as outcomes, but none showed significant changes.

    “Coping strategies, perceived stress, and depression were included as outcomes in two studies [68, 69], but no significant changes were reported in these outcomes.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [68] Steinhardt MA, Brown SA, Dubois SK, Harrison L Jr., Lehrer HM, Jaggars SS. A resilience intervention in African-American adults with type 2 diabetes. American journal of health behavior. 2015; 39: 507– 18. 26018099 PMC8117176

      Not checked in the free run.

    • cites [69] Steinhardt MA, Mamerow MM, Brown SA, Jolly CA. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy. The Diabetes educator. 2009; 35: 274– 84. 19204102 PMC3001398 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Only one resilience study found significant improvement in resilience, and this occurred only at six-month follow-up, not immediately after intervention.

    “However, only one study found a significant improvement in resilience post-intervention [70], and this significant change only occurred at the six-month follow-up and not immediately post-intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Bradshaw BG, Richardson GE, Kumpfer K, Carlson J, Stanchfield J, Overall J, Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. The Diabetes educator. 2007; 33: 650– 9. 17684166 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Yalcin and colleagues found significant post-intervention improvements in emotional intelligence, well-being, and quality of life compared with a wait-list control in type 2 diabetes patients.

    “They found significant improvements post-intervention in emotional intelligence, well-being, and quality of life compared to a wait-list control.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] Yalcin BM, Karahan TF, Ozcelik M, Igde FA. The effects of an emotional intelligence program on the quality of life and well-being of patients with type 2 diabetes mellitus. The Diabetes educator. 2008; 34: 1013– 24. 19075083

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Well-being constructs are distinct from depression, and their positive effects occur independently of depression and anxiety.

    “Collectively termed “well-being constructs,” these indicators are not simply the flip-side of depression [12, 13], and their beneficial effects have been demonstrated independently from the adverse effects of depression and anxiety [14, 15].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [12] Ryff CD, Dienberg Love G, Urry HL, Muller D, Rosenkranz MA, Friedman EM, Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychotherapy and psychosomatics. 2006; 75: 85– 95. 16508343 source

      Not checked in the free run.

    • cites [13] Dubois CM, Beach SR, Kashdan TB, Nyer MB, Park ER, Celano CM, Positive psychological attributes and cardiac outcomes: associations, mechanisms, and interventions. Psychosomatics. 2012; 53: 303– 18. 22748749

      Not checked in the free run.

    • cites [14] Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosomatic medicine. 2008; 70: 741– 56. 18725425 source

      Not checked in the free run.

    • cites [15] Huffman JC, Beale EE, Celano CM, Beach SR, Belcher AM, Moore SV, Effects of Optimism and Gratitude on Physical Activity, Biomarkers, and Readmissions After an Acute Coronary Syndrome: The Gratitude Research in Acute Coronary Events Study. Circulation Cardiovascular quality and outcomes. 2016; 9: 55– 63. 26646818 PMC4720551 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review was conducted and reported according to PRISMA guidelines.

    “The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) [34] guidelines and criteria were followed when conducting and reporting this review.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009; 6: e1000097. 19621072 PMC2707599 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Positive psychology programs improve psychological and health outcomes in people with chronic conditions like heart disease, hypertension, and HIV.

    “PP programs have also been found to improve psychological and health outcomes in individuals with chronic medical conditions such as heart disease, hypertension, and HIV [26–31].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [26] Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. Journal of psychosomatic research. 2010; 68: 539– 44. 20488270 source

      Not checked in the free run.

    • cites [27] Moskowitz JT, Carrico AW, Duncan LG, Cohn MA, Cheung EO, Batchelder A, Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. Journal of consulting and clinical psychology. 2017; 85: 409– 23. 28333512 PMC5398944 source

      Not checked in the free run.

    • cites [28] Moskowitz JT, Hult JR, Duncan LG, Cohn MA, Maurer S, Bussolari C, A positive affect intervention for people experiencing health-related stress: development and nonrandomized pilot test. Journal of health psychology. 2012; 17: 676– 92. 22021272 PMC3498769 source

      Not checked in the free run.

    • cites [29] Ogedegbe GO, Boutin-Foster C, Wells MT, Allegrante JP, Isen AM, Jobe JB, A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. Archives of internal medicine. 2012; 172: 322– 6. 22269592 PMC4669680 source

      Not checked in the free run.

    • cites [30] Peterson JC, Charlson ME, Hoffman Z, Wells MT, Wong SC, Hollenberg JP, A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention. Archives of internal medicine. 2012; 172: 329– 36. 22269589 PMC3717982 source

      Not checked in the free run.

    • cites [31] Huffman JC, Millstein RA, Mastromauro CA, Moore SV, Celano CM, Bedoya CA, A Positive Psychology Intervention for Patients with an Acute Coronary Syndrome: Treatment Development and Proof-of-Concept Trial. Journal of happiness studies. 2016; 17: 1985– 2006. 28082831 PMC5222616

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Two authors independently assessed each article's quality and risk of bias using the EPHPP tool, with disagreements resolved through discussion.

    “Two authors independently reviewed each article for quality and risk of bias using the Effective Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies [40], resolving discrepancies in ratings via review and discussion.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Effective Public Health Practice Project. Quality Assessment Tool For Quantitative Studies. Hamilton, ON: Effective Public Health Practice Project; 1998.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Mindfulness-based interventions consistently reduce anxiety, depression, and stress.

    “a meta-analysis examining 209 studies of these interventions showed consistent improvements in anxiety, depression, and stress [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, Mindfulness-based therapy: a comprehensive meta-analysis. Clinical psychology review. 2013; 33: 763– 71. 23796855 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Positive psychology interventions boost well-being and reduce depression in healthy individuals.

    “A recent meta-analysis in over 5000 healthy participants revealed these interventions increase well-being and decrease depression [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC public health. 2013; 13: 119. 23390882 PMC3599475 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Studies in other languages or databases may have been missed.

    “First, studies in different languages or databases may have been missed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The interventions were often simple, short, and potentially cost-effective.

    “and did so using often simple, short, and potentially cost-effective interventions”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Well-being interventions are simple and relatively easy to deliver in many cases.

    “and they are simple and relatively easily delivered in many cases”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Additional studies, especially those with negative results, may have been conducted but not published.

    “Finally, additional studies (especially those with negative results) may have been performed but not published”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Limitations of individual studies and relatively low overall study quality restrict the conclusions that can be drawn about intervention impact.

    “Fourth, limitations of individual studies (and relatively low overall study quality) limits conclusions that can be drawn about intervention impact.”
    Quote in the paperSubstantial claim
43 of 43

  • The paper relies on this without support.

    No prior synthesis of well-being intervention literature in diabetes exists.

    “Despite these many potential benefits, we are aware of no prior synthesis of the literature on well-being interventions in diabetes.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Currently, only two systematic reviews on mindfulness-based interventions included cardiovascular risk factors such as blood pressure, and these were narrative reviews, not meta-analyses.

    “Currently, only two systematic reviews on mindfulness‐based interventions. MBIs included cardiovascular risk factors such as blood pressure (Massey 2019; Noordali 2017) and these were narrative reviews, not meta‐analyses.”

    From Mindfulness-based interventions for adults with type 2 diabetes mellitus (2021) · cites this paper as Massey 2019

    The Results section on mindfulness-based interventions includes blood pressure among the physical outcomes reviewed. The Discussion says variation among studies precluded more quantitative analysis, supporting the description of this review as narrative rather than a meta-analysis. This paper does not establish that only two such systematic reviews existed; its scope is well-being interventions for people with diabetes, not mindfulness-based interventions generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity.

    “Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology.”

    From Use of the Chatbot “Vivibot” to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial (2019) · cites this paper as [10]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • ACT outcomes cite articles classified as mindfulness-based

    Minor

    The ACT results attribute significant reductions in depression and perceived stress to articles [58] and [59], but the study-characteristics section classifies both articles as mindfulness-based, not ACT.

1 of 1

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Related

Authors
Massey, C. N., Feig, E. H., Duque-Serrano, L., Wexler, D., Moskowitz, J. T., & Huffman, J. C.
Affiliations
  • Harvard University (US)
  • Northwestern University (US)
Corresponding author
Massey, Christina N.
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2019-01
Volume
147
Pages
118-133
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2018.11.014
PMC
PMC6370485
OpenAlex
W2903346000
Semantic Scholar
c9bf8b71102b79fc2e8373148fe36b21dde29a32
Cited by
96
References
77
Citations by year
2026: 4 · 2025: 14 · 2024: 15 · 2023: 13 · 2022: 13 · 2021: 12 · 2020: 17 · 2019: 7 · 2012: 1
FWCI
1.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • NIH (R21DK109313-01)
  • American Diabetes Association (1-17-ICTS-099)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
well-being interventions, diabetes mellitus, type 1 diabetes, type 2 diabetes, positive psychology interventions, mindfulness-based interventions, resilience interventions, psychological well-being, optimism, positive affect, self-efficacy, diabetes self-care, glycemic control, psychological distress, physical health outcomes
MeSH terms
Diabetes Mellitus, Type 2, Humans, Self Care

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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