Effects of an integrated mindfulness intervention for veterans with diabetes distress: a randomized controlled trial
Open accessAbstract
INTRODUCTION: US military veterans have disproportionately high rates of diabetes and diabetes-related morbidity in addition to being at risk of comorbid stress-related conditions. This study aimed to examine the effects of a technology-supported mindfulness intervention integrated into usual diabetes care and education on psychological and biobehavioral outcomes. RESEARCH DESIGN AND METHODS: Veterans (N=132) with type 1 or 2 diabetes participated in this two-arm randomized controlled efficacy trial. The intervention arm received a one-session mindfulness intervention integrated into a pre-existing program of diabetes self-management education and support (DSMES) plus one booster session and 24 weeks of home practice supported by a mobile application. The control arm received one 3-hour comprehensive DSMES group session. The primary outcome was change in diabetes distress (DD). The secondary outcomes were diabetes self-care behaviors, diabetes self-efficacy, post-traumatic stress disorder (PTSD), depression, mindfulness, hemoglobin A1C (HbA1C), body weight, and blood pressure. Assessments were conducted at baseline, 12 weeks, and 24 weeks. Participant satisfaction and engagement in home practice were assessed in the intervention group at 12 and 24 weeks. RESULTS: Intention-to-treat group by time analyses showed a statistically significant improvement in DD in both arms without significant intervention effect from baseline to 24 weeks. Examination of distal effects on DD between weeks 12 and 24 showed significantly greater improvement in the intervention arm. Improvement in DD was greater when baseline HbA1C was <8.5%. A significant intervention effect was also shown for general dietary behaviors. The secondary outcomes diabetes self-efficacy, PTSD, depression, and HbA1C significantly improved in both arms without significant intervention effects. Mindfulness and body weight were unchanged in either group. CONCLUSIONS: A technology-supported mindfulness intervention integrated with DSMES showed stronger distal effects on DD compared with DSMES control. Examination of longer-term outcomes, underlying mechanisms, and the feasibility of virtual delivery is warranted. TRIAL REGISTRATION NUMBER: NCT02928952.
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In adults with type 2 diabetes in the Veterans Affairs system, integrating a single session of mindfulness intervention into DSMES followed by a booster session and mobile app-based home practice over 24 weeks produced benefits, with the strongest effects on diabetes distress.
“Among adults with type 2 diabetes in the Veterans Affairs system, an RCT demonstrated benefits of integrating a single session of mindfulness intervention into DSMES, followed by a booster session and mobile app-based home practice over 24 weeks, with the strongest effects on diabetes distress ( 370).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [370]
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- Authors
- DiNardo, M. M., Greco, C., Phares, A. D., Beyer, N. M., Youk, A. O., Obrosky, D. S., Morone, N. E., Owen, J. E., Saba, S. K., Suss, S. J., & Siminerio, L.
- Affiliations
- VA Pittsburgh Healthcare System (US)
- University of Pittsburgh (US)
- Boston University (US)
- VA Palo Alto Health Care System (US)
- University of Southern California (US)
- Corresponding author
- DiNardo, Monica M
- ORCID
- Venue
- BMJ Open Diabetes Research & Care
- Publisher
- BMJ
- Published
- 2022-03
- Volume
- 10
- Issue
- 2
- Pages
- e002631
- ISSN
- 2052-4897 (ISSN-L)
- PMC
- PMC8961140
- OpenAlex
- W4220997939
- Cited by
- 30
- References
- 46
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 12 · 2023: 5 · 2022: 1
- FWCI
- 5.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Health Services Research and Development (NRI 15-150)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- mindfulness-based interventions, diabetes distress, veterans, type 1 diabetes, type 2 diabetes, diabetes self-management education and support, mobile application, HbA1c, diabetes self-efficacy, post-traumatic stress disorder, depression, dietary behavior
- MeSH terms
- Body Weight, Diabetes Mellitus, Glycated Hemoglobin, Humans, Veterans, Mindfulness
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