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Cited by 32Mindfulness and Compassion InterventionsDiabetes Management and EducationDiabetes Treatment and Management

Evaluation of the effects of 12 weeks mindfulness-based stress reduction on glycemic control and mental health indices in women with diabetes mellitus type 2

Open access
Nikkhah Ravari, Omid, Mousavi, Seyedeh Zeinab, Babak, Anahita·2020·Advanced Biomedical Research
DOI 10.4103/abr.abr_133_20PMC PMC7792882
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Abstract

Background: Diabetes mellitus is one of the major health problems in the world. Stress and mental illnesses adversely affect glycemic control. In most patients, a multidisciplinary approach including physical activity, healthy diet, and stress management is required for glycemic control. Mindfulness-based stress reduction (MBSR) is a structured group program that reduces emotional distress through self-awareness and assuming the responsibility for individual choices, and results in increased effective health behaviors. Here, we aimed to evaluate the effects of mindfulness meditation on glycemic control and mental health in patients with type 2 diabetes. Materials and Methods: This randomized clinical trial study was performed in 2018 in Isfahan city. A total number of 108 patients with diabetes mellitus type 2 were selected and allocated randomly to two groups, intervention (12 weeks MBSR program) and control (routine care). Depression, anxiety, and stress scores regarding to depression, anxiety, and stress Scale - 21 questionnaire and also amounts of fasting blood sugar (FBS) and hemoglobin A1C (HbA1C) were assessed and analyzed using independent t -test, paired t -test, Mann–Whitney U-test, and Chi-square, before and 13 weeks after educational programs. Results: The means of HbA1C, FBS, and depression, anxiety, and stress scores improved significantly after intervention in the MBSR group. Except FBS levels, all outcome variable scores' mean change was significant between the two groups. Conclusions: In general, this study revealed that mindfulness meditation could be helpful in improving the quality of mental health and lowering glycemic control indices in patients with type 2 diabetes mellitus.

AI snapshot

Written from the paper’s full text.

TL;DR

In a randomized trial of 101 women with type 2 diabetes in Isfahan, a 12-week mindfulness-based stress reduction (MBSR) program plus routine care improved HbA1c and depression, anxiety, and stress scores compared with routine care alone. FBS improved within the MBSR group, but the between-group change in FBS was not statistically significant.

Key findings

  • Within the MBSR group, all outcomes improved significantly from before to after intervention: HbA1c decreased from 8.2±0.72 to 7.09±0.65 (P<0.001), FBS from 175.35±34.76 to 146.32±22.34 (P<0.001), depression from 17.15±6.94 to 13.69±8.07 (P<0.001), anxiety from 17.15±7.33 to 13.09±7.67 (P<0.001), and stress from 21.11±8.23 to 17.36±8.51 (P<0.001).
  • Between-group mean changes favored MBSR for HbA1c (1.1±0.08 vs 0.68±0.1, P=0.007), depression (3.45±0.53 vs 0.44±0.54, P<0.001), anxiety (3.98±0.65 vs 0.05±0.56, P<0.001), and stress (3.75±0.57 vs 0.39±0.44, P<0.001).
  • FBS mean change did not differ significantly between groups (29.03±4.6 vs 23.75±3.67, P=0.11). The control group also showed significant within-group reductions in HbA1c and FBS (both P<0.001), but not in depression, anxiety, or stress (P=0.41, 0.92, and 0.37, respectively).

Methods

  • Randomized controlled clinical trial conducted in Isfahan among 108 women with type 2 diabetes; after dropouts, 101 were analyzed (50 MBSR, 51 control). Inclusion required women aged 30–59 years with type 2 diabetes for at least 6 months and HbA1c between 7% and 9%.
  • The intervention group received eight weekly 2-hour group mindfulness sessions plus 4 weeks of home practice; the control group received routine diabetes care. Outcomes were measured before and at the 13th week using the DASS-21 questionnaire, FBS, and HbA1c.
  • Analyses used independent t-test, paired t-test, Mann–Whitney U-test, and Chi-square, with significance set at 0.05.

Limitations

  • Stated: the study could not control some lifestyle components such as nutrition and physical activity; the self-report nature of the DASS-21 and participants’ literacy levels meant responses were not expected to be accurate enough.
  • Evident from the text: the sample was restricted to women aged 30–59 years at a single health center, follow-up was short (13 weeks), and the control group also improved in glycemic indices, suggesting factors other than mental health may affect glycemic control.

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

Integrity signals

Registry

Crossref · 10.4103/abr.abr_133_20

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 15 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The mean change in fasting blood sugar (FBS) was not significantly different between the mindfulness-based stress reduction and control groups.

    “Except FBS levels, all outcome variable scores' mean change was significant between the two groups.”
    • Also stated in: § Results · plain
      “Based on findings shown in Table 3, except FBS levels, all outcome variable scores' mean change was significant between the two groups.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the control group, fasting blood sugar (FBS) and HbA1c decreased after intervention.

    “FBS and HbA1c were also decreased in the control group; however, the amount of reduction was significantly higher in the intervention group.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The mean change in anxiety scores was significantly different between the mindfulness-based stress reduction and control groups.

    “Except FBS levels, all outcome variable scores' mean change was significant between the two groups.”
    • Also stated in: § Results · plain
      “Based on findings shown in Table 3, except FBS levels, all outcome variable scores' mean change was significant between the two groups.”
    Quote in the paperSubstantial claim
  • Findingown data

    In women with type 2 diabetes, 12 weeks of mindfulness-based stress reduction significantly improved HbA1c.

    “The means of HbA1C, FBS, and depression, anxiety, and stress scores improved significantly after intervention in the MBSR group.”
    • Also stated in: § Results · plain
      “As shown in Table 2, all mental health and glycemic control indices improved significantly after intervention in the intervention group.”
    Quote in the paperSubstantial claim
  • Findingown data

    The amount of reduction in fasting blood sugar (FBS) was significantly higher in the intervention group than in the control group.

    “FBS and HbA1c were also decreased in the control group; however, the amount of reduction was significantly higher in the intervention group.”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Findingown data

    This study revealed an improvement in glycemic and mental health indices in patients with type 2 diabetes following mindfulness training.

    “This study revealed an improvement in the glycemic and mental health indices in patients with type 2 diabetes following mindfulness training.”
    • Also stated in: § Conclusions: · hedged
      “In general, this study revealed that mindfulness meditation could be helpful in improving the quality of mental health and lowering glycemic control indices in patients with type 2 diabetes mellitus.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In women with type 2 diabetes, 12 weeks of mindfulness-based stress reduction significantly improved fasting blood sugar (FBS).

    “The means of HbA1C, FBS, and depression, anxiety, and stress scores improved significantly after intervention in the MBSR group.”
    • Also stated in: § Results · plain
      “As shown in Table 2, all mental health and glycemic control indices improved significantly after intervention in the intervention group.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The dropout exclusion rate at the stage of analysis was 6.48%, yielding a final sample of 101 patients.

    “Following enrollment, the dropout exclusion rate at the stage of analysis was 6.48%, yielding a final sample of 101 patients.”
    • Also stated in: § Results · plain
      “One hundred and eight patients participated in this study; three patients from the control group and four patients from the intervention group left the study. Finally, 50 and 51 patients were analyzed in the intervention and control group, respectively.”
    Quote in the paperNot a substantial claim

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

    Interpretationown data

    Routine care for diabetics in health care centers is well done.

    “It can be said that routine care for diabetics in health care centers is well done.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Many other factors, including lifestyle, affect blood sugar, but the study was not able to control some lifestyle components such as nutrition and physical activity.

    “Many other factors, including lifestyle, affect blood sugar, but we were not able to control some of the lifestyle components such as nutrition and physical activity in this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Studies by Hartmann et al. and van Son et al. revealed that although mindfulness training reduces anxiety and stress and improves patients' quality of life, it has no significant effect on blood sugar indices, including HbA1C.

    “However, studies conducted by Hartmann et al. and van Son et al. revealed that although mindfulness training reduces anxiety and stress and improves patients' quality of life, it has no significant effect on blood sugar indices, including HbA1C.[1026]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1026]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Another review on stress management techniques showed that mindfulness can significantly influence patients' coping with their disease and better disease management in various diseases such as cancer, cardiovascular diseases, diabetes mellitus, and chronic pain.

    “Another review study on stress management techniques showed that mindfulness can significantly influence the patients' coping with their disease and better disease management in various diseases such as cancer, cardiovascular diseases, diabetes mellitus, and chronic pain.[5]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Varvogli L Darviri C Stress management techniques: Evidence-based procedures that reduce stress and promote health Health Sci J 2011 5 74

      Not checked in the free run.

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

    Interpretationnone given

    The findings of all these studies are consistent with those of our study.

    “The findings of all these studies are consistent with those of our study.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Boehm et al. showed that good mental health status might positively influence diabetes and its control and reduce its complications.

    “Boehm et al. also showed that good mental health status might positively influence diabetes and its control and reduce its complications.[22]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Boehm JK Trudel-Fitzgerald C Kivimaki M Kubzansky LD The prospective association between positive psychological well-being and diabetes Health Psychol 2015 34 1013 21 25603420 PMC5008848

      Not checked in the free run.

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

    Study design and conductreasoning

    Due to the self-report nature of the questionnaire and the literacy level of participants, the responses were not expected to be accurate enough.

    “due to the self-report nature of the questionnaire on the one hand and the literacy level of the participants, on the other hand, the responses were not expected to be accurate enough.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Medication alone is not enough for glycemic control in most patients; a multidisciplinary approach including physical activity, healthy diet, and stress management is required.

    “Medication alone is not enough for glycemic control in most patients; therefore, a multidisciplinary approach including physical activity, healthy diet, and stress management is required.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The validity and reliability of the DASS-21 questionnaire were confirmed in the Iranian population.

    “The validity and reliability of this questionnaire were confirmed in the Iranian population.[16]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Sahebi A Asghari MJ Salari R Validation of depression anxiety and stress scale (DASS-21) for Iranian population Iranian Psychology 2005 1 4 50 60

      Not checked in the free run.

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

    Premisecitation

    Mindfulness-based stress reduction is a structured group program that reduces emotional distress through self-awareness and assuming responsibility for individual choices, and results in increased effective health behaviors.

    “Over time, this method reduces emotional distress through self-awareness and assuming the responsibility for individual choices, and results in increased effective health behaviors.[910]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [910]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Mindfulness-based therapy through stress management, improving mental health status and lifestyle, and encouraging patients to make better use of their medications might positively influence diabetes mellitus control.

    “It can be acknowledged that mindfulness-based therapy through stress management, improving mental health status and lifestyle, and encouraging patients to make better use of their medications might positively influence diabetes mellitus control.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Random allocation of blocks 1 and 5 to the intervention and control groups was used to prevent contamination.

    “In order to prevent contamination, using random number table, blocks 1 and 5 were randomly allocated to the intervention and control groups, respectively.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Goyal et al. investigated 3515 patients in 47 studies and concluded that mindfulness training can reduce patients' stress and anxiety and regulate their negative behaviors.

    “The focus of the study conducted by Goyal et al., in 2014 was on the effect of mindfulness sessions on mental health. They investigated 3515 patients in 47 studies and concluded that this training can reduce patients' stress and anxiety and regulate their negative behaviors.[23]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Goyal M Singh S Sibinga EM Gould NF Rowland-Seymour A Sharma R Meditation programs for psychological stress and well-being: A systematic review and meta-analysis JAMA Intern Med 2014 174 357 68 24395196 PMC4142584 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Stress and mental illnesses adversely affect glycemic control.

    “Stress and mental illnesses also adversely affect glycemic control.[2]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Whitebird RR Kreitzer MJ Vazquez-Benitez G Enstad CJ Reducing diabetes distress and improving self-management with mindfulness Soc Work Health Care 2018 57 48 65 29064772 PMC9083374

      Not checked in the free run.

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

    Premisecitation

    A review by Merkes revealed positive therapeutic effects of mindfulness for chronic pain, rheumatoid arthritis, type 2 diabetes mellitus, chronic fatigue syndrome, and cardiovascular disease, without side effects.

    “A review study conducted by Merkes revealed the positive therapeutic effects of mindfulness for disorders such as chronic pain, rheumatoid arthritis, type 2 diabetes mellitus, chronic fatigue syndrome, and cardiovascular disease, without having any side effects and negative consequences.[11]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Merkes M Mindfulness-based stress reduction for people with chronic diseases Aust J Prim Health 2010 16 200 10 20815988

      Not checked in the free run.

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

    Study design and conductown data

    The trial was registered in the Iranian Clinical Trials Registry with registration number IRCT2019090813044527N1.

    “The trial was registered in the Iranian Clinical Trials Registry, with registration number IRCT2019090813044527N1.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Mindfulness, as a behavioral therapy technique, aims to reduce stress in patients and increase acceptance.

    “Among these psychological interventions, mindfulness, as a behavioral therapy technique, aims to reduce stress in patients and increase acceptance.[25]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Sudhir PM Advances in psychological interventions for lifestyle disorders: Overview of interventions in cardiovascular disorder and type 2 diabetes mellitus Curr Opin Psychiatry 2017 30 346 51 28682800

      Not checked in the free run.

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

    Study design and conductown data

    The study had at least 80% power to detect an effect size of 20% at a significance level of 0.05, assuming a 10% attrition rate.

    “For sample size calculation, we assumed an attrition rate of 10%, effect size of 20% with at least 80% power and statistical significance level at 0.05.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A systematic review by Noordali et al. revealed conflicting results about the effect of mindfulness-based stress reduction on HbA1c but more confident results in terms of mental health improvement.

    “A systematic review conducted by Noordali et al. revealed conflicting results about the effect of MBSR on HbA1c but more confident results in terms of mental health improvement.[27]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 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 83 26721631

      Not checked in the free run.

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

    Premisecitation

    Cash and Whittingham highlighted the importance of mindfulness in reducing stress, anxiety, and depression, as well as improving patients' psychological quality.

    “The study by Cash and Whittingham also highlighted the importance of mindfulness in reducing stress, anxiety, and depression, as well as improving patients' psychological quality.[24]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Cash M Whittingham K What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related symptomatology? Mindfulness 2010 1 177 82 source

      Not checked in the free run.

23 of 23

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.

  • Control-group baseline stress mean differs between tables

    Minor

    Table 1 reports a control-group baseline stress mean of 19.2, whereas Table 2 reports 19.72 for the same baseline measure. This is not a difference explained by rounding to one decimal place.

  • Control-group stress change does not match its before-and-after means

    Minor

    Table 2 reports control-group stress means of 19.72 before and 18.73 after intervention, a change of 0.99 rather than the 0.39 reported in Table 3.

    Reported 0.39 · recomputed 0.99

  • Education counts exceed the stated sample size

    Minor

    The education categories total 107 participants, rather than the 101 stated for Table 1.

    Reported 101 · recomputed 107

  • Discussion claims a significant FBS difference that Table 3 does not show

    Minor

    The discussion says the reduction in FBS and HbA1c was significantly higher in the intervention group, but Table 3 reports P=0.11 for the between-group FBS change, above the paper's 0.05 significance level.

  • Study year differs between sections

    Minor

    The abstract says the study was performed in 2018, while the methods say it was conducted in 2019.

  • Marital-status counts exceed the stated sample size

    Minor

    The marital-status categories total 105 participants, but Table 1 states n=101.

    Reported 101 · recomputed 105

  • Job counts exceed the stated sample size

    Minor

    The job categories total 104 participants, rather than the 101 stated for Table 1.

    Reported 101 · recomputed 104

7 of 7

Cites

Flagged first, then by citations

4 of the 30 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Sahebi, 2005, Validation of depression anxiety and stress scale (DASS-21) for Iranian population, Iranian Psychology, 1, 50

Cited by

Sorted by citations

Related

Authors
Nikkhah Ravari, O., Mousavi, S. Z., & Babak, A.
Affiliations
  • Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Isfahan University of Medical Sciences (IR)
Corresponding author
Babak, Anahita
ORCID
Babak, Anahita
Venue
Advanced Biomedical Research
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-01
Volume
9
Issue
1
Pages
61-61
ISSN
2277-9175 (ISSN-L)
DOI
10.4103/abr.abr_133_20
PMC
PMC7792882
OpenAlex
W3097755293
Semantic Scholar
d5bad7162bd7ca45610aaff61bbb0fad5308d938
Cited by
32
References
30
Citations by year
2026: 4 · 2025: 10 · 2024: 7 · 2023: 8 · 2022: 2 · 2021: 1
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Advanced Biomedical Research (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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 stress reduction, type 2 diabetes, glycemic control, mental health, depression, anxiety, stress, mindfulness meditation, HbA1c, fasting blood glucose, women

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