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DiNardo MM, Greco C, Phares AD, Beyer NM, Youk AO, Obrosky DS, Morone NE, Owen JE, Saba SK, Suss SJ, Siminerio L. Effects of an integrated mindfulness intervention for veterans with diabetes distress: a randomized controlled trial. BMJ Open Diabetes Res Care 2022; 10:10/2/e002631. [PMID: 35346971 PMCID: PMC8961140 DOI: 10.1136/bmjdrc-2021-002631] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/27/2022] [Indexed: 11/04/2022] Open
Abstract
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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Affiliation(s)
- Monica M DiNardo
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Carol Greco
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Complementary Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Angela D Phares
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Nicole M Beyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Ada O Youk
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - D Scott Obrosky
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Natalia E Morone
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jason E Owen
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Shaddy K Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Stephen J Suss
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Linda Siminerio
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Betancourt JA, Granados PS, Pacheco GJ, Reagan J, Shanmugam R, Topinka JB, Beauvais BM, Ramamonjiarivelo ZH, Fulton LV. Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019. Healthcare (Basel) 2021; 9:healthcare9050604. [PMID: 34070037 PMCID: PMC8158130 DOI: 10.3390/healthcare9050604] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023] Open
Abstract
The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity. These elevated demands from military operations placed upon a small subset of the population may be resulting in a group of individuals more at-risk for a variety of debilitating health conditions. To better understand how the U.S Veterans health outcomes compared to non-Veterans, this study utilized the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset to examine 10 different self-reported morbidities. Yearly age-adjusted, population estimates from 2003 to 2019 were used for Veteran vs. non-Veteran. Complex weights were used to evaluate the panel series for each morbidity overweight/obesity, heart disease, stroke, skin cancer, cancer, COPD, arthritis, mental health, kidney disease, and diabetes. General linear models (GLM’s) were created using 2019 data only to investigate any possible explanatory variables associated with these morbidities. The time series analysis showed that Veterans have disproportionately higher self-reported rates of each morbidity with the exception of mental health issues and heart disease. The GLM showed that when taking into account all the variables, Veterans disproportionately self-reported a higher amount of every morbidity with the exception of mental health. These data present an overall poor state of the health of the average U.S. Veteran. Our study findings suggest that when taken as a whole, these morbidities among Veterans could prompt the U.S. Department of Veteran Affairs (VA) to help develop more effective health interventions aimed at improving the overall health of the Veterans.
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DiNardo MM, Phares AD, Jones HE, Beyer NM, Suss SJ, McInnes S, Rodriguez KL. Veterans' Experiences With Diabetes: A Qualitative Analysis. DIABETES EDUCATOR 2020; 46:607-616. [PMID: 33100191 DOI: 10.1177/0145721720965498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the study was to explore an understanding of the psychosocial-behavioral impact of diabetes self-management among veterans with diabetes. METHODS Twenty-six veterans participated in 1 of 9 focus groups that were conducted following a group diabetes self-management education class and prior to a mindfulness intervention as part of a feasibility pilot study. Discussions were guided by open-ended questions that addressed the overarching research question, "How do attitudes and experiences with diabetes inform psychosocial-educational approaches to diabetes self-management education and care for veterans?" Focus groups were audio-recorded and transcribed. The data was then independently coded and thematically analyzed by 2 coders. RESULTS Five main themes that reflect veterans' perceptions of their experiences with diabetes and diabetes self-management were identified: (1) distress and negative emotions, (2) social isolation, (3) perceived lack of control, (4) attitudes toward diabetes support, and (5) desire for information about stress, diabetes, health, and behavior. CONCLUSIONS Veterans experience emotional distress and have unmet psychosocial needs related to diabetes self-management. Insight gained from these veteran perspectives suggests a framework for integrating psycho-educational interventions like mindfulness into diabetes care that emphasize stress reduction, person-centered communication, and opportunities for peer support.
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Affiliation(s)
- Monica M DiNardo
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Angela D Phares
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Harleigh E Jones
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Nicole M Beyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Stephen J Suss
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Shauna McInnes
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Batch BC, Brown CS, Goldstein KM, Danus S, Sperber NR, Bosworth HB. Women Veterans Experience with the VA MOVE! Weight Management Program. WOMEN'S HEALTH REPORTS 2020; 1:65-72. [PMID: 33786475 PMCID: PMC7784794 DOI: 10.1089/whr.2019.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Obesity prevalence is higher in women veterans overall than their civilian counterparts considering 44% of women veterans are obese. Thus, there is a critical need to understand the facilitators and barriers to women veterans' participation in weight management programs. The objective of this study is to explore facilitators and barriers to weight loss for women veterans enrolled in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (VA MOVE!) weight management program and gather feedback on the design and delivery of the MOVE! program. Materials and Methods: Primary qualitative data were collected from women veterans who completed at least one MOVE! visit via semistructured telephone interviews. Two authors independently reviewed transcripts for data-derived codes. A content analysis approach was used within the software to code the transcripts. Results: The mean age of participants was 52 years. Sixty-eight percent (N = 17/25) were black, and 52% (N = 13/25) lived >64 kilometers from the location of the MOVE! program. Facilitators to participation included both intrinsic (e.g., drive to become healthy) and extrinsic (e.g., drive to improve laboratories) motivating factors. Women expressed difficulty with learning in a group setting and applying lessons to their everyday lives. Others reported the setup of group classes triggered their post-traumatic stress disorder and prevented them from fully participating in the program. Additional barriers included distance traveled to group sessions and lack of access to exercise space. Conclusions: Our results illuminate barriers and facilitators to engagement in the MOVE! program. Many of the barriers highlighted by these women veterans mirror barriers civilian women face, highlighting the possibility that our results could be applied to other programs designed to target weight loss in women.
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Affiliation(s)
- Bryan C Batch
- Division of Endocrinology, Department of Medicine, Durham VA Medical Center, Durham, North Carolina.,Division of Endocrinology, Metabolism and Nutrition, Duke University, Durham, North Carolina
| | - Candace S Brown
- Department of Public Health Sciences, UNC-Charlotte, North Carolina.,Motivated Cognition and Aging Brain Laboratory, Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Karen M Goldstein
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Susanne Danus
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Nina R Sperber
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Hayden B Bosworth
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, School of Nursing, Duke University, Durham, North Carolina
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Thomas DD, Waring ME, Ameli O, Reisman JI, Vimalananda VG. Patient Characteristics Associated with Receipt of Prescription Weight-Management Medications Among Veterans Participating in MOVE! Obesity (Silver Spring) 2019; 27:1168-1176. [PMID: 31090207 PMCID: PMC6591039 DOI: 10.1002/oby.22503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/15/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Weight-management medications (WMM) are recommended for the treatment of obesity. This study examined characteristics associated with initial receipt of WMM among eligible veterans in the first year following enrollment in the Veterans Health Administration (VHA) MOVE! behavioral weight-management program. METHODS We conducted a retrospective cohort study of VHA patients with obesity or overweight and obesity-related comorbidities who enrolled in MOVE! from October 2013 to September 2016 (N = 153,939). Multivariable logistic regression models estimated predictors of having a filled prescription for WMM and for orlistat. RESULTS A total of 1.1% of these veterans received WMM. The most common WMM included orlistat (70.4%), phentermine/topiramate (11.2%), and bupropion/naltrexone (9.7%). Female sex, higher BMI, obstructive sleep apnea, osteoarthritis, depression, lower back pain, and alcohol abuse were associated with greater odds of use of WMM, whereas age over 65 years, Hispanic ethnicity, and required co-payments were associated with lower odds. Among patients receiving WMM, older age, black race, female sex, higher BMI, cardiovascular disease, lower back pain, and congestive heart failure were associated with use of orlistat versus any other WMM. CONCLUSIONS Of patients engaged in MOVE! in the VHA, 1.1% received WMM. WMM are underutilized among veterans. Additional research is needed to understand barriers to incorporating WMM into comprehensive obesity treatment plans.
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Affiliation(s)
- Dylan D. Thomas
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine; Boston University School of Medicine. Boston, MA
| | - Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut. Storrs, CT
| | - Omid Ameli
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center. Bedford, MA
| | - Joel I. Reisman
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center. Bedford, MA
| | - Varsha G. Vimalananda
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine; Boston University School of Medicine. Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center. Bedford, MA
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