Cited by 161Diabetes Management and EducationMindfulness and Compassion InterventionsNutrition, Health and Food Behavior

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Comparison of a Mindful Eating Intervention to a Diabetes Self-Management Intervention Among Adults With Type 2 Diabetes: A Randomized Controlled Trial

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Miller, Carla K., Kristeller, Jean L., Headings, Amy, Nagaraja, Haikady·2014·Health Education & Behavior

DOI 10.1177/1090198113493092PMC PMC4217158

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Abstract

Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues, improving eating regulation and dietary patterns, reducing symptoms of depression and anxiety, and promoting weight loss. Diabetes self-management education (DSME), which addresses knowledge, self-efficacy, and outcome expectations for improving food choices, also may be an effective intervention for diabetes self-care. Yet few studies have compared the impact of mindful eating to a DSME-based treatment approach on patient outcomes. Adults 35 to 65 years old with type 2 diabetes for ≥1 year not requiring insulin therapy were recruited from the community and randomly assigned to treatment group. The impact of a group-based 3-month mindful eating intervention (MB-EAT-D; n = 27) to a group-based 3-month DSME “Smart Choices” (SC) intervention ( n = 25) postintervention and at 3-month follow-up was evaluated. Repeated-measures ANOVA with contrast analysis compared change in outcomes across time. There was no significant difference between groups in weight change. Significant improvement in depressive symptoms, outcome expectations, nutrition and eating-related self-efficacy, and cognitive control and disinhibition of control regarding eating behaviors occurred for both groups (all p < .0125) at 3-month follow-up. The SC group had greater increase in nutrition knowledge and self-efficacy than the MB-EAT-D group (all p < .05) at 3-month follow-up. MB-EAT-D had significant increase in mindfulness, whereas the SC group had significant increase in fruit and vegetable consumption at study end (all p < .0125). Both SC and MB-EAT-D were effective treatments for diabetes self-management. The availability of mindful eating and DSME-based approaches offers patients greater choices in meeting their self-care needs.

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“Paying attention to these two factors has been shown to lead to healthier eating [7].”
Background
Role of gastronomy and new technologies in shaping healthy diets
Pérez‐Rodrigo, C., & Bartrina, J. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-820057-5.00002-9 · Cited by 15
The Relationship between Adults’ Perceptions, Attitudes of COVID-19, Intuitive Eating, and Mindful Eating Behaviors
Şanlıer, N., Kocabaş, Ş., Ulusoy, H. G., & Çelik, B. (2021) · Ecology of Food and Nutrition · doi:10.1080/03670244.2021.1968849 · Cited by 14
Value-based eating habits; exploring religio-cultural nutritional behavior norms
Pourabbasi, A., Ahangar, A. A., & Nouriyengejeh, S. (2021) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-021-00728-z · Cited by 13
The Impact of a Community-Based Food Education Program on Nutrition-Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial
Vasconcelos, C. E. G. D. C., Almeida, A., Cabral, M., Ramos, E., & Mendes, R. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16132403 · Cited by 12
“[41,42] also tracked participant’s attendance.”
Method
An evaluation of mainstream type 2 diabetes educational programmes in relation to the needs of people with intellectual disabilities: A systematic review of the literature
Maine, A., Brown, M. J., Dickson, A., & Truesdale, M. (2018) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.12544 · Cited by 10
“7%) which met all of the TSC criteria (Miller et al., 2014; Wu et al., 2011).”
BackgroundInfluential
Exploring Mindful Eating and Weight Status Among Underserved Youth and Their Parents Living in Public Housing
Goodwin, R., Lucio, J. D., Vega‐López, S., & Bruening, M. M. (2017) · Mindfulness · doi:10.1007/s12671-016-0674-x · Cited by 10
Acceptability and Suitability of Mindfulness Training for Diabetes Management in an Indigenous Community
Dreger, L. C., Mackenzie, C. S., & McLeod, B. (2014) · Mindfulness · doi:10.1007/s12671-014-0332-0 · Cited by 9
Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19
Ugarte, C. A., Cruzat‐Mandich, C., Quiñones, Á., Díaz-Tendero, D., Gallegos, M., Gil, A. A., & Cepeda‐Benito, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1101120 · Cited by 7
Reliability and validity of the abbreviated version of the Mindful Eating Questionnaire in Turkish adults
Kaya, S., Açık, M., Coşkun, A. B., & Yılmaz, F. Ç. (2024) · Revista de Nutrição · doi:10.1590/1678-9865202437e230084 · Cited by 10
“It was shown that a mindful eating intervention in patients with type 2 diabetes gives better results in meeting the self-care needs of the patients [18].”
Background
Effectiveness of a Health Literacy and Diabetes Self‐Management Education (DSME) Improvement Program for People With Type 2 Diabetes Mellitus: A Community‐Based Quasiexperimental Study in Thailand
Abdulsalam, F. I., Srichaijaroonpong, S., Phoosuwan, N., & Phoosuwan, N. (2025) · Journal of Diabetes Research · doi:10.1155/jdr/2640702 · Cited by 15
Age and fasting blood sugar levels are associated factors for mindful eating among Type 2 diabetes mellitus patients during COVID-19 pandemic confinement
Chamhuri, N. H., Tohit, N. M., Azzeri, A. B., Chamhuri, N., & Alias, S. R. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274327 · Cited by 8
“On the other hand, a randomised controlled trial (RCT) that compared MB-EAT with standard diabetes self-management (DSMA) demonstrated that depressive symptoms, self-efficacy of eating, and HbA1c levels improved significantly from baseline levels in both groups [14].”
Background
Mindful Eating as a Tool for Diabetes Prevention and Management: A Review of Potential Mechanisms of Action
Muñoz-Mireles, G., Mantzios, M., Schellinger, J. N., Messiah, S. E., & Marroquín, E. (2023) · Mindfulness · doi:10.1007/s12671-023-02236-y · Cited by 8
Impact of diabetes education and self-management support on the 4D series of diabetes patients
Luan, L.-L., Jiao, Y., He, Y.-F., Huang, Z., Liu, L., & Huang, Z.-S. (2017) · Biomedical Research-tokyo · Cited by 7
Examining Impacts of Mindfulness in Requesting Job Accommodations for Individuals With Disabilities
Vance, S., Campbell, A. L., & Dong, S. (2016) · Rehabilitation Counseling Bulletin · doi:10.1177/0034355216683673 · Cited by 7
What Are You Hungry for? The 9 Hunger Mindful Eating Online Randomized Controlled Trial
Peitz, D., & Warschburger, P. (2023) · Mindfulness · doi:10.1007/s12671-023-02263-9 · Cited by 6
“Positive effects have also been found in different subgroups, such as in persons with diabetes (Miller et al., 2014), and low-income over-weight women in primary health care (Salvo et al., 2022).”
Informing the Design of Individualized Self-Management Regimens from the Human, Data, and Machine Learning Perspectives
Pichon, A., Urteaga, I., Mamykina, L., & Elhadad, N. (2025) · ACM Transactions on Computer-Human Interaction · doi:10.1145/3717063 · Cited by 7
“Faced with often generic guidance, individuals are left with the burden of translating this information into their day-to-day lives [30, 57, 102, 105, 111].”
The Challenges of Eating Well for People Living with Cystic Fibrosis: an Interview Study Exploring the Use of Mindful Eating Approaches and Behaviours to Support Optimal Nutritional Status
Egan, H. H., Keyte, R., & Mantzios, M. (2022) · International Journal of Behavioral Medicine · doi:10.1007/s12529-022-10057-x · Cited by 6
“The positive outcomes have also led to several programmes targeting mindful eating, such as the Mindfulness-Based Eating Awareness Training (MB-EAT) [31] and the Mindful Eating and Living (MEAL) [32], where people suffering from other chronic conditions such as type 2 diabetes [33], chronic kidney disease [34] and obe…”
Background
Mindful Eating and Current Glycemic Control in Patients With Type 2 Diabetes
Erbakan, A. N., Bahadır, M. A., Gonen, O., & Kaya, F. N. (2024) · Cureus · doi:10.7759/cureus.57198 · Cited by 6
“In a study conducted by Miller et al., both mindful eating and diabetes self-management education (DMSE) were found to be effective interventions for enhancing eating regulation and dietary patterns, and reducing symptoms of depression and anxiety in adults with T2DM [14].”
Influential
Les thérapies émotionnelles dans les problématiques de surpoids ou d’obésité
Sweerts, S. J., Apfeldorfer, G., Kureta‐Vanoli, K., & Romo, L. (2019) · L Encéphale · doi:10.1016/j.encep.2019.02.009 · Cited by 6
Advancing the assessment of mindful eating: Exploring the psychometric properties and validating the mindful eating behaviour scale in English
Mantzios, M., Egan, H. H., Wallis, D. J., & Wood, J. S. (2022) · Nutrition and Health · doi:10.1177/02601060221116164 · Cited by 6
The association of self-efficacy and hospitalization rates in people with type-2 diabetes: A prospective cohort study
Zhao, H., Johnson, J. A., Sayah, F. A., Soprovich, A., & Eurich, D. T. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.07.011 · Cited by 6
Conceptual Congruence in Mindfulness-Based Weight Loss Intervention Studies
Schultz, M. B. (2018) · Mindfulness · doi:10.1007/s12671-017-0860-5 · Cited by 5
“Only one study reported a statistical power analysis (Miller et al. 2014).”
Background
Disordered Eating in Emerging Adults: A Narrative Review and Recommendations for Prevention
El-Jor, C., Hallez, Q., Filippone, L., Flaudias, V., & Shankland, R. (2025) · Emerging Adulthood · doi:10.1177/21676968251318056 · Cited by 8
“Mindfulness-based interventions also improve participants ’ distress tolerance skills (Chacko et al., 2016; Miller et al., 2014), which would then help them better manage food cravings and stress-induced binge eating episodes (Kristeller et al., 2014).”
Effectiveness of Mindfulness-Based Interventions with Respect to Psychological and Biomedical Outcomes in Young People with Type 1 Diabetes: A Systematic Review
Gutiérrez‐Domingo, T., Farhane‐Medina, N. Z., Villaécija, J., Vivas, S., Tabernero, C., Castillo‐Mayén, R., & Luque, B. (2024) · Healthcare · doi:10.3390/healthcare12181876 · Cited by 6
Integrative Medicine for Patients with Diabetes and Mental Health Disorders: A Narrative Review
Kassem, S., Samuels, N., & Ben‐Arye, E. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01623-7 · Cited by 5
“In an RCT exploring the effect of a mindful eating inter - vention, compared with a diabetes self-management intervention, Miller et al. found a significant improvement in depressive symptoms in both groups [63].”
Structural equation modeling of dispositional mindfulness, internal environmental factors, external environmental factors, and self-care behaviors in people with type 2 diabetes
Tsai, C.-C., Chan, H., Lien, W.-L., Chu, H.-Y., & Chen, M. (2024) · Applied Nursing Research · doi:10.1016/j.apnr.2024.151799 · Cited by 5
Whole-person Integrative Eating: A Program for Treating Overeating, Overweight, and Obesity.
Kesten, D., & Scherwitz, L. W. (2015) · PubMed Central · Cited by 5
Mindful Eating is More Effective to Beat Emotional Eating than Nutrition Education and Diet: A Randomized Controlled Study
İNÖZÜ, İ., & Köse, G. (2023) · Acibadem Universitesi Saglik Bilimleri Dergisi · doi:10.31067/acusaglik.1340369 · Cited by 4
Evaluating reliable and clinically significant changes in health outcomes of a mindfulness-based cognitive defusion training program among older adults with mild cognitive impairment: a randomized controlled trial
Ren, Y., Wu, B., Ge, C., Shi, L., Zhang, C., Zhu, M., Zhao, D., & Wang, L. (2025) · Age and Ageing · doi:10.1093/ageing/afaf069 · Cited by 4
“Additionally, the M-bCCDT program may enhance participants’ mindfulness awareness, with eﬀect persisting at the 20 weeks, extending previous research that shows MBIs improve mindfulness awareness [47].”
From Bench to Bedside
Sato, A. F., & Fahrenkamp, A. J. (2016) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2016.02.003 · Cited by 4
Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus
Rodrigues, D. A. C., Marcadenti, A., Machado, R. H. V., Bersch-Ferreira, Â. C., Gherardi‐Donato, E. C. D. S., Quinhoneiro, D. C. G., de Almeida, J. C., Souza, V. S., de Souza, S. R., Busnello, F. M., et al. (2024) · Appetite · doi:10.1016/j.appet.2024.107228 · Cited by 8
Diet Quality and Comparison of Plant-Based Versus Omnivore Diets in Identical Twins: A Secondary Analysis of the Twins Nutrition Study (TwiNS)
Zeitlin, A. B., Ward, C., Cooper, A. O. M., Landry, M. J., Krenek, A. M., Durand, L. R., Cunanan, K. M., Robinson, J. L., Dant, C. C., & Gardner, C. D. (2025) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2025.107549 · Cited by 3
Emotional Eating Patterns, Nutritional Status, and the Risk of Developing Type 2 Diabetes Among University Students: A Preliminary Assessment
Jiménez-Cano, V. M., Gómez-Luque, A., Alonso, V. R., Ramírez-Durán, M. D. V., Basilio-Fernández, B., Alfageme-García, P., Ruiz, S. H., Fabregat-Fernández, J., & Torres-Pérez, A. (2025) · Healthcare · doi:10.3390/healthcare13172186 · Cited by 5
“However, other studies present contrasting evidence: Carri è re et al. [37] and Miller et al. [33] demonstrated that interventions focused on mindful eating and emotional regulation can improve dietary habits and metabolic indicators, including glycemic control in adults at high risk or with a…”
Effectiveness of Diabetes Self-management Education Against Diet Behavior in Patients Type 2 Diabetes Mellitus: A Literature Review
Suardi, S., Razak, A., Amiruddin, R., Ishak, H., Salmah, U., & Maria, I. L. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.6033 · Cited by 7
“Several DSME interventions are capable of providing effective change in promoting behavior change [19].”
Background
Repercussões das abordagens mindful eating e intuitive eating na saúde de indivíduos adultos: revisão integrativa
Silva, A. F. D. S., Japúr, C. C., Silva, T. A., Motarelli, J. H. F., Buttros, T. S., & Penaforte, F. R. D. O. (2021) · Revista Família Ciclos de Vida e Saúde no Contexto Social · doi:10.18554/refacs.v9i4.5006 · Cited by 3
“Miller et al. (2014)29 Estados Unidos 52 indivíduos (27 alocados no grupo Treinamento de Consciência Alimentar Baseado em Mindfulness adaptado para diabetes (MBEATD); e 25 no grupo Smart Choices - SC).”
Background

Authors: Miller, C. K., Kristeller, J. L., Headings, A., & Nagaraja, H.
Affiliations: The Ohio State University (US)
Indiana State University (US)
ORCID: Miller, Carla K.
Kristeller, Jean L.
Nagaraja, Haikady
Venue: Health Education & Behavior
Publisher: SAGE Publications
Published: 2013-07-12
Volume: 41
Issue: 2
Pages: 145-154
ISSN: 1090-1981 (ISSN-L)
1552-6127
DOI: 10.1177/1090198113493092
PMC: PMC4217158
OpenAlex: W2105834280
Cited by: 161
References: 54
Citations by year: 2026: 11 · 2025: 15 · 2024: 15 · 2023: 9 · 2022: 11 · 2021: 17 · 2020: 18 · 2019: 11 · 2018: 10 · 2017: 12 · 2016: 12 · 2015: 18 · 2014: 1
FWCI: 8.14
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Health Education & Behavior (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (R21DK084330)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords: mindful eating, diabetes self-management education, type 2 diabetes, dietary habits, self-efficacy, nutrition knowledge, outcome expectations, depressive symptoms, cognitive control, disinhibition, fruit and vegetable intake, weight change, mindfulness
MeSH terms: Adult, Aged, Choice Behavior, Diabetes Mellitus, Type 2, Feeding Behavior, Female, Humans, Male, Middle Aged, Self Care, Weight Loss, Self Efficacy, Nutritional Sciences, Mindfulness

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Comparison of a Mindful Eating Intervention to a Diabetes Self-Management Intervention Among Adults With Type 2 Diabetes: A Randomized Controlled Trial

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