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Cited by 59Mindfulness and Compassion InterventionsDiabetes Management and EducationDiabetes Treatment and Management

Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis

Open access
Ni, Yun‐xia, Ma, Lin, Li, Ji‐ping·2021·Journal of Diabetes Investigation
DOI 10.1111/jdi.13439PMC PMC8169362
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Abstract

Aims/Introduction: Psychological therapies have showed benefits for both glycemic control and psychological outcomes in people with diabetes. However, the effects of mindfulness‐based intervention (MBI) on glycemic control and psychological outcomes are inconsistent across studies, and the evidence for MBI has not been summarized. We aimed to identify the effects of MBI on glycemic control and psychological outcomes in people with diabetes by carrying out a systematic review and meta‐analysis. Materials and Methods: Six databases (Pubmed, Embase, CINAHL, Cochrane, Web of science and PsycINFO) were searched from inception to October 2019. Randomized controlled trials of MBI for people with type 1 and type 2 diabetes were included. Two authors independently extracted relevant data and assessed the risk of bias, with a third reviewer as arbitrator. Subgroup analyses and sensitivity analyses were also carried out. Results: Eight studies with 841 participants met the eligibility criteria. Meta‐analysis showed that MBI can slightly improve glycosylated hemoglobin (HbA1c; −0.25%, 95% confidence interval [CI] −0.43 to −0.07) and diabetes‐related distress (−5.81, 95% CI −10.10 to −1.52) contribute to a moderate effect size in reducing depression (standardized mean difference −0.56, 95% CI −0.82 to −0.30) and stress (standardized mean difference −0.53, CI −0.75 to −0.31). Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8% and follow‐up duration >6 months. Mixed effects were observed for anxiety. Conclusions: MBI appears to have benefits on HbA1c, depression, stress and diabetes‐related distress in people with diabetes. More rigorous studies with longer follow‐up duration are warranted to establish the full potential of MBI.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of eight RCTs (841 participants) found that mindfulness-based intervention (MBI) slightly improved HbA1c and diabetes-related distress and moderately reduced depression and stress in people with diabetes. Anxiety results were mixed, and the authors call for more rigorous, longer-term studies.

Key findings

  • MBI slightly reduced HbA1c: mean difference −0.25% (95% CI −0.43 to −0.07; P = 0.006), with no substantial heterogeneity (I² = 0%; P = 0.92).
  • MBI had moderate effects on depression (SMD −0.56, 95% CI −0.82 to −0.30; P < 0.0001; I² = 59%) and stress (SMD −0.53, 95% CI −0.75 to −0.31; P < 0.00001; heterogeneity by Q-test P = 0.08, I² = 47%).
  • Diabetes-related distress was reduced: MD −5.81 (95% CI −10.10 to −1.52; P = 0.008; I² = 28%).
  • Subgroup analyses found greater HbA1c reductions with baseline HbA1c <8% (−0.26%, 95% CI −0.47 to −0.05) and follow-up >6 months (−0.28, 95% CI −0.52 to −0.04); anxiety findings were mixed, with two studies reporting significant reduction and three finding no significant difference.

Methods

  • Systematic review and meta-analysis registered in PROSPERO (CRD42020159088) and reported per PRISMA; six databases (PubMed, Embase, CINAHL, Cochrane, Web of Science, PsycINFO) were searched from inception to 16 October 2019.
  • Included randomized controlled trials of adults >18 years with type 1 or type 2 diabetes, where MBI was a major component, compared with usual care, wait-list control, no intervention, or health education without a mindfulness component; excluded gestational diabetes/prediabetes, mixed interventions, and dialectical behavior therapy or acceptance and commitment therapy.
  • Eight studies with 841 participants were included; random-effects meta-analysis used mean difference for HbA1c and distress and standardized mean difference for depression, stress, and anxiety, with subgroup and sensitivity analyses; anxiety was narratively synthesized because of varying effect measures.

Limitations

  • The paper states that most included studies failed to blind participants and intervention providers, increasing risk of performance bias; most studies had small samples, which may exaggerate effect sizes; and the review could not draw conclusions on sex-specific effects, diabetes type-specific effects, or the most beneficial/preferred MBI format.
  • The paper also notes a language restriction to English, which may introduce language bias, and that funnel plots were not carried out because fewer than 10 trials were available.
  • Evident from the text: anxiety could not be pooled due to different scales, heterogeneity was present for depression, stress, and diabetes-related distress, and no included study reported outcomes only in people with type 1 diabetes.

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

Integrity signals

Registry

Crossref · 10.1111/jdi.13439

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 49 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    MBI reduces diabetes-related distress in people with diabetes, with a pooled mean difference of −5.81 (95% CI −10.10 to −1.52).

    “diabetes‐related distress (−5.81, 95% CI −10.10 to −1.52)”
    • Also stated in: § Effects of MBI on outcomes · plain
      “The overall pooled results showed a statistical significance in reducing distress (MD −5.81, 95% CI −10.10 to −1.52; P = 0.008), with heterogeneity between studies (I 2 = 28%; P = 0.23; Figure 2d).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.
  • Findingown data

    MBI has a moderate effect size in reducing stress in people with diabetes, with SMD −0.53 (95% CI −0.75 to −0.31).

    “and stress (standardized mean difference −0.53, CI −0.75 to −0.31)”
    • Also stated in: § Effects of MBI on outcomes · plain
      “The overall pooled effect size for stress was moderate (SMD −0.53, CI −0.75 to −0.31; P < 0.00001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.
  • Findingown data

    MBI has a moderate effect size in reducing depression in people with diabetes, with SMD −0.56 (95% CI −0.82 to −0.30).

    “contribute to a moderate effect size in reducing depression (standardized mean difference −0.56, 95% CI −0.82 to −0.30)”
    • Also stated in: § Effects of MBI on outcomes · plain
      “The overall pooled effect size for depression was moderate (SMD −0.56, 95% CI −0.82 to −0.30; P < 0.0001; Figure 2b).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.
  • Findingown data

    Eight studies with 841 participants met the eligibility criteria and were included in the review.

    “Eight studies with 841 participants met the eligibility criteria.”
    • Also stated in: § Study selection and characteristics · plain
      “Finally, 11 articles describing eight different studies with 841 participants were selected for inclusion in the review 12 , 13 , 14 , 15 , 42 .”
    Quote in the paperSubstantial claim
  • Findingown data

    In the subgroup with baseline HbA1c ≥8%, MBI reduced depression (SMD −0.49, 95% CI −0.98 to −0.01).

    “| ≥8% | 5 | –0.49(−0.98, −0.01) | 0.05 | 73% | 0.006 |”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.
  • The quote only partly states this claim. 2
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 24

  • The quote only partly states this claim.

    Findingown data

    Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8%.

    “Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8% and follow‐up duration >6 months.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.

  • May combine two claims.

    Findingown data

    MBI has mixed effects on anxiety in people with diabetes: two studies reported significant reduction, and three found no significant differences.

    “Mixed effects were observed for anxiety.”
    • Also stated in: § Effects of MBI on outcomes · plain
      “Two studies reported significant reduction of anxiety in the mindfulness group compared with the control group 12 , 42 . Three studies found no significant differences in anxiety between the MBI and control group 13 , 24 , 27 .”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.

  • May combine two claims.

    Findingown data

    MBI slightly improves HbA1c in people with diabetes, with a pooled mean reduction of 0.25% (95% CI −0.43 to −0.07).

    “Meta‐analysis showed that MBI can slightly improve glycosylated hemoglobin (HbA1c; −0.25%, 95% confidence interval [CI] −0.43 to −0.07)”
    • Also stated in: § Effects of MBI on outcomes · plain
      “After pooling, the mean reduction in HbA1c was 0.25% (95% CI −0.43 to −0.07; P = 0.006), with no substantial heterogeneity between studies (I 2 = 0%; P = 0.92; Figure 2a).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.

  • The quote only partly states this claim.

    Findingown data

    Subgroup analyses showed greater HbA1c reductions in subgroups with follow-up duration >6 months.

    “Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8% and follow‐up duration >6 months.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.

  • May combine two claims.

    Findingown data

    Removing one study delivering intervention through compact disc explained all of the substantial heterogeneity for diabetes-related distress (I2 = 0%; P = 0.43), but did not change the significance or the direction of the effect (MD −7.44, 95% CI −11.58 to −3.29; P = 0.0004).

    “Removing one study delivering intervention through compact disc 27 explained all of the substantial heterogeneity for diabetes‐related distress (I 2 = 0%; P = 0.43), but did not change the significance or the direction of the effect (MD −7.44, 95% CI −11.58 to −3.29; P = 0.0004).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no substantial heterogeneity for depression (I2 = 0%; P = 0.69) and stress (I2 = 0%; P = 0.97) in studies with baseline psychological disorder.

    “with no substantial heterogeneity for both depression (I 2 = 0%; P = 0.69) and stress (I 2 = 0%; P = 0.97).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Removing one study with longer duration of intervention time (>8 weeks) partially explained the substantial heterogeneity for depression (I2 = 16%; P = 0.31), but not the significance or the direction of the effect (SMD −0.65, 95% CI −0.83 to −0.47; P < 0.00001).

    “Removing one study 24 with longer duration of intervention time (>8 weeks) partially explained the substantial heterogeneity for depression (I 2 = 16%; P = 0.31), but not the significance or the direction of the effect (SMD −0.65, 95% CI −0.83 to −0.47; P < 0.00001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    MBI can slightly improve HbA1c and diabetes-related distress, and lead to a moderate reduction in depression and stress.

    “The present review showed that MBI can slightly improve HbA1c and diabetes‐related distress, and lead to a moderate reduction in depression and stress.”
    • Also stated in: § DISCUSSION · plain
      “In conclusion, the present review shows that MBI can slightly improve HbA1c and diabetes‐related distress, leading to a moderate effect size in reducing depression and stress.”
    • Also stated in: § DISCUSSION · plain
      “In terms of psychological outcomes, depression, stress and diabetes‐related distress were significantly improved.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Combining studies with a longer follow-up duration (>6 months) showed a larger HbA1c reduction (MD −0.28, 95%CI −0.52 to −0.04; P = 0.006) than those with a shorter duration (≤6 months; SMD −0.21, 95% CI −0.48 to 0.06; P = 0.13).

    “Combining studies with a longer follow‐up duration (>6 months) showed a larger HbA1c reduction (MD −0.28, 95%CI −0.52 to −0.04; P = 0.006) than those with a shorter duration (≤6 months; SMD −0.21, 95% CI −0.48 to 0.06; P = 0.13).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Seven studies measured HbA1c, and only one study reported a reduction of HbA1c in participants accepting MBI.

    “Seven studies measured HbA1c 12 , 14 , 15 , 26 , 27 , 33 , 42 , and only one study reported a reduction of HbA1c in participants accepting MBI 15 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Kopf S, Oikonomou D, Hartmann M, et al. Effects of stress reduction on cardiovascular risk factors in type 2 diabetes patients with early kidney disease – results of a randomized controlled trial (HEIDIS). Exp Clin Endocrinol Diabetes 2014; 122: 341– 349. 24798861 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The effects of MBI on HbA1c were confirmed, although the effect size was small.

    “An important finding of the present review was that the effects of MBI on HbA1c were confirmed, although the effect size was small.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    MBI appears to have benefits on HbA1c, depression, stress and diabetes-related distress in people with diabetes.

    “MBI appears to have benefits on HbA1c, depression, stress and diabetes‐related distress in people with diabetes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.
    • Rests on an assumption: The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.
    • Rests on an assumption: The pooled sample of included studies is representative of people with diabetes generally.

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

    Premisecitation

    The American Diabetes Association "Standards of Medical Care in Diabetes‐2020" included psychosocial care as a part of recommended therapy in diabetes management.

    “The American Diabetes Association “Standards of Medical Care in Diabetes‐2020” included psychosocial care as a part of recommended therapy in diabetes management 7 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] American Diabetes Association. 5. Facilitating behavior change and well‐being to improve health outcomes: Standards of medical care in diabetes‐2020. Diabetes Care 2020; 43(Suppl 1): S48– S65. 31862748

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Psychosocial care is an essential component of successful diabetes management.

    “Hence, psychosocial care has been considered an essential component of successful diabetes management.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    MBI has been successfully implemented to improve psychological health and coping skills in a range of clinical populations, including chronic disease, pain disorders and cancer.

    “In recent years, MBI has been successfully implemented to improve psychological health and coping skills 8 in a range of clinical populations, including chronic disease 9 , pain disorders 10 and cancer 11 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] Roemer L, Williston SK, Rollins LG. Mindfulness and emotion regulation. Curr Opin Psychol 2015; 3: 52– 57.

      Not checked in the free run.

    • cites [9] Victorson D, Kentor M, Maletich C, et al. Mindfulness meditation to promote wellness and manage chronic disease: A systematic review and meta‐analysis of mindfulness‐based randomized controlled trials relevant to lifestyle medicine. Am J Lifestyle Med 2014; 9: 185– 211. source

      Not checked in the free run.

    • cites [10] Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness‐based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA 2016; 315: 1240– 1249. 27002445 PMC4914381 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In that meta-analysis, mixed interventions were not excluded, making it difficult to draw reliable conclusions on the specific effects of MBI due to contamination.

    “It is worth noting that the mixed interventions were not excluded in that meta‐analysis, making it difficult to draw reliable conclusions on the specific effects of MBI due to the contamination.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    Another study blinded the MBI provider.

    “One study documented participants’ blinding 13 , and another study blinded the MBI provider 27 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Pearson S, Wills K, Woods M, et al. Effects of mindfulness on psychological distress and HbA(1c) in people with diabetes. Mindfulness 2018; 9: 1615– 1626.

      Not checked in the free run.

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

    Study design and conductown data

    Two authors independently assessed quality using the Cochrane risk of bias tool.

    “Two authors independently assessed quality using the Cochrane risk of bias tool, which included the items of random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data, selective reporting, and other bias.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Data from included studies were independently extracted by two authors using a standardized data extraction form guided by the Cochrane Handbook.

    “Data from the included studies were independently extracted by two authors using a standardized data extraction form guided by the Cochrane Handbook 32 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Higgins JPH, Thomas J, Chandler J, et al.Cochrane handbook for systematic reviews of interventions version 6.0 (updated July 2019). 2019; www.training.cochrane.org/handbook. Accessed December 19, 2019.

      Not checked in the free run.

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

    Study design and conductnone given

    Two authors independently extracted relevant data and assessed risk of bias, with a third reviewer as arbitrator.

    “Two authors independently extracted relevant data and assessed the risk of bias, with a third reviewer as arbitrator.”
    • Also stated in: § Study selection · plain
      “Two authors independently searched the literature and assessed the studies. Any disagreements were resolved through discussion with a third reviewer.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Five studies carried out intention-to-treat analysis.

    “Five studies carried out intention‐to‐treat analysis, Six studies 12 , 13 , 14 , 27 , 33 , 41 reported attrition rates of <20%, and two studies 26 , 40 reported attrition rates of >20%, but no significant difference between groups regarding attrition rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The effects of MBI on both psychological outcomes and glycemic control among people with diabetes are mixed, especially for glycemic control.

    “Although MBI is considered as a promising therapy for psychosocial problems 28 , 29 , and has become increasingly popular and available in recent years, the effects on both psychological outcomes and glycemic control among people with diabetes are mixed 30 , especially for glycemic control 12 , 14 , 15 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [30] Bogusch LM, O’Brien WH. The effects of mindfulness‐based interventions on diabetes‐related distress, quality of life, and metabolic control among persons with diabetes: A meta‐analytic review. Behav Med (Washington, DC). 2019; 45: 19– 29. 29617221

      Not checked in the free run.

    • cites [12] van Son J, Nyklicek I, Pop VJ, et al. The effects of a mindfulness‐based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind). Diabetes Care 2013; 36: 823– 830. 23193218 PMC3609486 source

      Not checked in the free run.

    • cites [14] Nathan HJ, Poulin P, Wozny D, et al. Randomized trial of the effect of mindfulness‐based stress reduction on pain‐related disability, pain intensity, health‐related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clin Diabet 2017; 35: 294– 304. PMC5734176 29263572 source

      Not checked in the free run.

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

    Study design and conductown data

    Three studies published or registered a protocol and reported all prespecified outcomes.

    “Three studies published or registered a protocol and reported all prespecified outcomes (Table 2).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Four studies carried out allocation concealment.

    “Seven studies detailed their random sequence generation process, and four studies carried out allocation concealment 12 , 14 , 27 , 40 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [12] van Son J, Nyklicek I, Pop VJ, et al. The effects of a mindfulness‐based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind). Diabetes Care 2013; 36: 823– 830. 23193218 PMC3609486 source

      Not checked in the free run.

    • cites [14] Nathan HJ, Poulin P, Wozny D, et al. Randomized trial of the effect of mindfulness‐based stress reduction on pain‐related disability, pain intensity, health‐related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clin Diabet 2017; 35: 294– 304. PMC5734176 29263572 source

      Not checked in the free run.

    • cites [27] Pearson S, Wills K, Woods M, et al. Effects of mindfulness on psychological distress and HbA(1c) in people with diabetes. Mindfulness 2018; 9: 1615– 1626.

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Existing reviews on MBI for people with diabetes are limited, and do not provide firm conclusions on its effectiveness on HbA1c, depression, stress, anxiety and diabetes-related distress.

    “In addition, existing reviews on MBI for people with diabetes are limited, and do not provide firm conclusions on its effectiveness on glycosylated hemoglobin (HbA1c), depression, stress, anxiety and diabetes‐related distress.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    One study documented participants' blinding.

    “One study documented participants’ blinding 13 , and another study blinded the MBI provider 27 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Tovote KA, Fleer J, Snippe E, et al. 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– 2434. 24898301 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A few studies suggested that MBI might have a favorable effect on glycemic control in people with diabetes.

    “In addition, a few studies suggested that MBI might have a favorable effect on glycemic control in people with diabetes 15 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Kopf S, Oikonomou D, Hartmann M, et al. Effects of stress reduction on cardiovascular risk factors in type 2 diabetes patients with early kidney disease – results of a randomized controlled trial (HEIDIS). Exp Clin Endocrinol Diabetes 2014; 122: 341– 349. 24798861 source

      Not checked in the free run.

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

    Premisecitation

    One systematic review showed that MBI appeared to have psychological benefits reducing depression, anxiety and distress symptoms, but no glycemic control benefits were observed.

    “One systematic review showed that MBI appeared to have psychological benefits reducing depression, anxiety and distress symptoms, but no glycemic control benefits were observed 31 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Noordali F, Cumming J, Thompson JL. Effectiveness of Mindfulness‐based interventions on physiological and psychological complications in adults with diabetes: A systematic review. J Health Psychol 2017; 22: 965– 983. 26721631

      Not checked in the free run.

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

    Study design and conductnone given

    The two authors reviewed the collected data twice to ensure extraction accuracy.

    “These two authors reviewed the collected data twice to ensure extraction accuracy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    MBI increases levels of mindfulness and non-judgmental acceptance, and decreases negative reactivity and repetitive negative thinking, which in turn lead to positive outcomes.

    “MBI increases levels of mindfulness and non‐judgmental acceptance, and decreases negative reactivity and repetitive negative thinking, which in turn lead to positive outcomes 22 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Gu J, Strauss C, Bond R, et al. How do mindfulness‐based cognitive therapy and mindfulness‐based stress reduction improve mental health and wellbeing? A systematic review and meta‐analysis of mediation studies. Clin Psychol Rev 2015; 37: 1– 12. 25689576 source

      Not checked in the free run.

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

    Premisecitation

    Diabetes as a disease affects both body and mind, requiring considerable physical, emotional, and psychological accommodation and coping.

    “It is known that diabetes as a disease affects both body and mind, requiring considerable physical, emotional, and psychological accommodation and coping 21 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Whitebird RR, Kreitzer MJ, O’Connor PJ. Mindfulness‐based stress reduction and diabetes. Diabet Spect 2009; 22: 226– 230. PMC2909138 20657669

      Not checked in the free run.

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

    Premisecitation

    Previous studies supposed that psychological interventions, such as cognitive behavioral therapy and problem solving, improved glycemic control in people with diabetes through improving adherence to medical care and the ability to manage negative emotions.

    “Previous studies supposed that psychological interventions, such as cognitive behavioral therapy (CBT) and problem solving, improved glycemic control in people with diabetes through improving adherence to medical care and the ability to manage negative emotions 16 , 17 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [16] Viana LV, Gomes MB, Zajdenverg L, et al. Brazilian Type 1 Diabetes Study G. Interventions to improve patients’ compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta‐analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions. Trials 2016; 17: 94. 26888087 PMC4758163 source

      Not checked in the free run.

    • cites [17] Uchendu C, Blake H. Effectiveness of cognitive‐behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: A systematic review and meta‐analysis of randomized controlled trials. Diabetic Med 2017; 34: 328– 339. 27472405 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that meta-analysis, diabetes-related distress was the primary outcome, and other common psychological outcomes (depression, stress and anxiety) were not tested.

    “In addition, diabetes‐related distress was the primary outcome in that meta‐analysis, other common psychological outcomes (i.e., depression, stress and anxiety) were not tested.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Bogusch LM, O’Brien WH. The effects of mindfulness‐based interventions on diabetes‐related distress, quality of life, and metabolic control among persons with diabetes: A meta‐analytic review. Behav Med (Washington, DC). 2019; 45: 19– 29. 29617221

      Not checked in the free run.

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

    Study design and conductown data

    Three studies blinded the outcome assessors and were rated a low risk of detection bias.

    “Three studies blinded the outcome assessors and were rated a low risk of detection bias 14 , 27 , 40 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Nathan HJ, Poulin P, Wozny D, et al. Randomized trial of the effect of mindfulness‐based stress reduction on pain‐related disability, pain intensity, health‐related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clin Diabet 2017; 35: 294– 304. PMC5734176 29263572 source

      Not checked in the free run.

    • cites [27] Pearson S, Wills K, Woods M, et al. Effects of mindfulness on psychological distress and HbA(1c) in people with diabetes. Mindfulness 2018; 9: 1615– 1626.

      Not checked in the free run.

    • cites [40] 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 Sci 2015; 17: 516– 525. 26275164

      Not checked in the free run.

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

    Study design and conductnone given

    This study followed the PRISMA statement and checklist.

    “This study followed the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA) statement and checklist.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The protocol of this review was registered in PROSPERO (CRD42020159088).

    “The protocol of this review was registered in PROSPERO (CRD42020159088).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Seven studies detailed their random sequence generation process.

    “Seven studies detailed their random sequence generation process, and four studies carried out allocation concealment 12 , 14 , 27 , 40 .”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The American Diabetes Association recommends less-stringent glycemic goals (HbA1c <8%) for older adults.

    “as recommended by the American Diabetes Association 44 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] American Diabetes A. 12. Older adults: Standards of medical care in diabetes‐2020. Diabetes Care 2020; 43(Suppl 1): S152– S162. 31862755

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The present review did not draw conclusions on sex-specific effects, diabetes type-specific effects, and the format of MBI sessions that were most beneficial and preferred by people with diabetes due to lack of relevant trials.

    “Third, due to a lack relevant trials, the present review did not draw conclusions on sex‐specific effects, diabetes type‐specific effects, and the format of MBI sessions that were most beneficial and preferred by people with diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Most included studies consisted of small samples, which might have resulted in exaggerated effect sizes and thus biased the results, making it difficult to draw a robust conclusion.

    “Second, besides a small number of trials, most included studies consisted of small samples, which might have resulted in exaggerated effect sizes and thus biased the results 52 , making it difficult to draw a robust conclusion.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Schmidt CB, van Loon BJP, Vergouwen ACM, et al. Systematic review and meta‐analysis of psychological interventions in people with diabetes and elevated diabetes‐distress. Diabet Med 2018. 29896760 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MBI emphasized redirecting participants' attention toward the present moment, but CBT focused on reappraising and modifying thought content.

    “MBI emphasized redirecting participants’ attention toward the present moment, but CBT focused on reappraising and modifying thought content 48 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Arch JJ, Ayers CR, Baker A, et al. Randomized clinical trial of adapted mindfulness‐based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behav Res Ther 2013; 51: 185– 196. 23419887 source

      Not checked in the free run.

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

    Study design and conductnone given

    The subgroup and sensitivity analyses further added to the strength of this study.

    “The subgroup and sensitivity analyses further added to the strength of this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Five of the included studies measured anxiety using five different scales, making it difficult to quantify the magnitude of effects in anxiety.

    “Mixed effects were found for anxiety, as five of the included studies measured anxiety using five different scales, making it difficult to quantify the magnitude of effects in anxiety.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A strength was that only RCTs were included, to guarantee the quality of evidence.

    “A strength was that we only included RCTs, to guarantee the quality of evidence.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A previous meta-analysis of diabetes psychosocial interventions showed a greater effect in participants with poor baseline HbA1c levels.

    “A previous meta‐analysis of diabetes psychosocial interventions showed a greater effect in participants with poor baseline HbA1c levels 35 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Harkness E, Macdonald W, Valderas J, et al. Identifying psychosocial interventions that improve both physical and mental health in patients with diabetes: a systematic review and meta‐analysis. Diabetes Care 2010; 33: 926– 930. 20351228 PMC2845054 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Most included studies failed to blind the participants and the intervention provider; this might increase the risk of performance bias.

    “First, most included studies failed to blind the participants and the intervention provider; this might increase the risk of performance bias.”
    Quote in the paperNot a substantial claim
46 of 46

  • The paper relies on this without support.

    The various mindfulness-based interventions included (MBSR, MBCT, mindful eating, combination of MBSR and MBCT, and unspecific MBI) are sufficiently similar to be pooled as a single MBI class.

    “Studies carried out various forms of mindfulness‐based intervention, including MBSR (3 studies), MBCT (2 studies), mindful eating (1 study), combination of MBSR and MBCT (1 study), and unspecific mindfulness‐based intervention (1 study).”

  • The paper relies on this without support.

    The control conditions used across the included studies are sufficiently comparable to be pooled as a common control.

    “When a study included multiple control arms, we utilized the control arm with the best matched comparison (i.e., waiting‐list control, patient education group).”

  • The paper relies on this without support.

    The pooled sample of included studies is representative of people with diabetes generally.

    “Four studies had a mixture of type 1 and type 2 diabetes patients; four studies only included type 2 diabetes patients.”
    “MBI appears to have benefits on HbA1c, depression, stress and diabetes‐related distress in people with diabetes.”
3 of 3

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?

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.

  • Depression subgroup confidence interval is not centered on its estimate

    Major

    For participants without a baseline psychological disorder, the reported 95% CI has a midpoint of −0.475 rather than the reported estimate of −0.37. The interval also excludes zero, whereas the row reports P = 0.13.

    Reported -0.37 · recomputed -0.475

  • Anxiety scale count changes from four to five

    Minor

    The results list four anxiety measurement tools, while the discussion says the included studies used five different scales.

  • Six-month follow-up falls into different subgroups

    Minor

    Table 3 labels the longer-follow-up HbA1c subgroup as ≥6 months, but the text describes it as >6 months. These definitions differ for studies assessed at exactly six months.

  • Stress subgroup confidence intervals disagree

    Minor

    The text and Table 3 give different confidence intervals for stress among participants without a baseline psychological disorder. The interval in the text does not even contain its stated estimate of −0.37.

  • Distress is called heterogeneous despite not meeting the stated criterion

    Minor

    The methods define heterogeneity using I2 > 50% and a Q-test P-value < 0.10. The distress result meets neither threshold but is described as having heterogeneity between studies.

5 of 5

Cites

Flagged first, then by citations

1 of the 51 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. SegalZindel V MarkJ WilliamsG TeasdaleJohn D.Mindfulness‐Based Cognitive Therapy for Depression Second Edition.New York London:The Guilford Press;2018.
  2. 10.1111/dme.13195 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Ni, Y., Ma, L., & Li, J.
Affiliations
  • West China School of Nursing/Department of Nursing West China Hospital Sichuan University Chengdu China
  • Sichuan University (CN)
Corresponding author
Li, Ji‐ping
ORCID
Venue
Journal of Diabetes Investigation
Publisher
Wiley
Published
2020-11-22
Volume
12
Issue
6
Pages
1092-1103
ISSN
  • 2040-1116 (ISSN-L)
  • 2040-1124
DOI
10.1111/jdi.13439
PMC
PMC8169362
OpenAlex
W3092694349
Semantic Scholar
460db43bbc330ab1f972b49b25c60c0c2107e341
Cited by
59
References
51
Citations by year
2026: 6 · 2025: 13 · 2024: 24 · 2023: 7 · 2022: 4 · 2021: 4 · 2020: 1
FWCI
0.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Diabetes Investigation (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Sichuan University
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
mindfulness-based interventions, diabetes mellitus, glycemic control, HbA1c, diabetes distress, depression, stress, anxiety, type 1 diabetes, type 2 diabetes, psychological outcomes
MeSH terms
Glycemic Control, Aged, Anxiety, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Stress, Psychological, Treatment Outcome, Mindfulness

About these checks

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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