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Wang M, Liu Q, Zhu Z, Guo X, Hu X, Cheng L. Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2024; 21:454-466. [PMID: 38546159 DOI: 10.1111/wvn.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is a psychotherapy technique, which promotes psychological flexibility and enables patients to change behaviors based on value-directed goals. However, the beneficial effects of ACT on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, and psychological burden are still unclear among patients with type 2 diabetes mellitus (T2DM). AIMS This study aimed to systematically synthesize scientific evidence to determine the effectiveness of ACT among patients with T2DM on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, and psychological burden and identify the optimal characteristics of effective interventions. METHODS Nine electronic databases were searched to identify eligible studies of randomized controlled trials from inception to June 2023. Two reviewers independently assessed the study eligibility, extracted the data, and performed the quality appraisal using the Cochrane Risk of Bias 2 Tool. The meta-analysis was conducted using Review Manager 5.3. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Ten studies involving 712 participants were included. ACT demonstrated significant improvements on patients' glycemic control (mean difference [MD]: 0.95%; p < .001), self-care behaviors (MD: 1.86; p = .03), diabetes acceptance (MD: 7.80; p < .001), self-efficacy (standardized mean difference [SMD]: 1.04; p < .001), anxiety (SMD: -1.15; p = .006), and depression (SMD: -1.10; p = .04). However, favorable but nonsignificant improvements were found in diabetes distress. Subgroup analyses demonstrated that ACT offered more than five sessions using individualized format, with theoretical underpinnings and professional input from multidisciplinary therapists are recommended to yield better results on glycemic control and self-care behaviors. LINKING EVIDENCE TO ACTION Acceptance and commitment therapy could generate beneficial effectiveness on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, anxiety, and depression among patients with T2DM. Large-scale trials with rigorous design and representative samples are warranted to strengthen the current evidence.
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Affiliation(s)
- Miaomiao Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
- School of Medicine, Sias University, Zhengzhou, Henan, China
| | - Qiao Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhengrong Zhu
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaodi Guo
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiling Hu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Cheng
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
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Figueroa C, Ayala A, Trejo LA, Ramos B, Briz CL, Noriega I, Chávez A. Measuring the Effectiveness of a Multicomponent Program to Manage Academic Stress through a Resilience to Stress Index. SENSORS (BASEL, SWITZERLAND) 2023; 23:2650. [PMID: 36904856 PMCID: PMC10007324 DOI: 10.3390/s23052650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
In this work, we evaluate the effectiveness of a multicomponent program that includes psychoeducation in academic stress, mindfulness training, and biofeedback-assisted mindfulness, while enhancing the Resilience to Stress Index (RSI) of students through the control of autonomic recovery from psychological stress. Participants are university students enrolled in a program of excellence and are granted an academic scholarship. The dataset consists of an intentional sample of 38 undergraduate students with high academic performance, 71% (27) women, 29% (11) men, and 0% (0) non-binary, with an average age of 20 years. The group belongs to the "Leaders of Tomorrow" scholarship program from Tecnológico de Monterrey University, in Mexico. The program is structured in 16 individual sessions during an eight-week period, divided into three phases: pre-test evaluation, training program, and post-test evaluation. During the evaluation test, an assessment of the psychophysiological stress profile is performed while the participants undergo a stress test; it includes simultaneous recording of skin conductance, breathing rate, blood volume pulse, heart rate, and heart rate variability. Based on the pre-test and post-test psychophysiological variables, an RSI is computed under the assumption that changes in physiological signals due to stress can be compared against a calibration stage. The results show that approximately 66% of the participants improved their academic stress management after the multicomponent intervention program. A Welch's t-test showed a difference in mean RSI scores (t = -2.30, p = 0.025) between the pre-test and post-test phases. Our findings show that the multicomponent program promoted positive changes in the RSI and in the management of the psychophysiological responses to academic stress.
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Affiliation(s)
- Carlos Figueroa
- School of Health, Tecnologico de Monterrey, Ciudad de México 14380, Mexico
| | - Andrés Ayala
- Vicerrectoría de Innovación Educativa y Normatividad Académica, Tecnologico de Monterrey, Monterrey 64849, Mexico
| | - Luis A. Trejo
- School of Engineering and Sciences, Tecnologico de Monterrey, Atizapán 52926, Mexico
| | - Bertha Ramos
- Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México 09230, Mexico
| | - Clara L. Briz
- Psychology Department, University of Los Andes, Bogotá 11605, Colombia
| | - Isabella Noriega
- School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey 64849, Mexico
| | - Alejandro Chávez
- School of Health, Tecnologico de Monterrey, Ciudad de México 14380, Mexico
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Huang LC, Lin CL, Chang YT, Chen RY, Bai CH. Gender Impact on Diabetes Distress Focus at Medical Communication Concerns, Life and Interpersonal Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15678. [PMID: 36497755 PMCID: PMC9737495 DOI: 10.3390/ijerph192315678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION along with the rapidly aging population in many countries around the world, the global prevalence of diabetes and suffering from diabetes-related depression have risen in middle-aged and elderly adults. However, given that psychological stress is deeply influenced by culture, gender inequality in these statistics is often exhibited and increases with age. The aim of this study was to explore the gender difference in diabetes distress among middle-aged and elderly diabetic patients. METHODS 395 participants from four hospitals were recruited for a cross-sectional survey. The Taiwan Diabetes Distress Scale (TDDS) was used to measure diabetes distress. Linear regression was conducted to assess the gender difference in different types of diabetes distress. RESULTS there was significant gender difference in each diabetes distress domain. In particular, men who had received diabetes education in the past six months seemed to be more concerned about diabetes complications and felt pressured to communicate with doctors. In addition, women seemed to be more affected by diabetes distress because of their marital status, especially for married women. CONCLUSIONS diabetes distress seems to have significant gender differences; however, more longitudinal research is needed on the causal relationship between gender and diabetes distress.
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Affiliation(s)
- Li-Chi Huang
- Endocrinology & Metabolism, Cathay General Hospital, Taipei 106438, Taiwan
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Ching-Ling Lin
- Endocrinology & Metabolism, Cathay General Hospital, Taipei 106438, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Yao-Tsung Chang
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Ruey-Yu Chen
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
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Xu J, Mei M, Sun H, Chen X, Zhu W, Song J. Meditation programs for adults with type 2 diabetes mellitus: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31459. [PMID: 36451396 PMCID: PMC9704959 DOI: 10.1097/md.0000000000031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is intimately linked to chronic stress. Meditation programs belong to mind-body therapies, which could benefit patients' disease management. Though some clinical trials have proved that meditation programs have the ability to improve level of blood glucose quality of life, body mass index and blood indexes related to metabolism in individuals with type 2 diabetes mellitus, the efficacy of meditation programs needs further confirmation. Thus we will conduct this systematic evaluation and meta-analysis to summarize and analyze all the results included to obtain reliable evidence. METHODS We will search several English and Chinese databases for relevant clinical trials published up to July 2021, and randomized controlled trials or controlled trials among adults with type 2 diabetes mellitus are included. Two reviewers will extract data and assess the quality of included studies independently. The main outcomes of this research are glycosylated hemoglobin level and fasting blood glucose level. The secondary outcomes are high-density lipoprotein, low-density lipoprotein, body mass index, remission of depression and anxiety, and quality of life. Stata v.14.0 and Review Manager V5.3 will be used to synthesize and analyze all data included. RESULTS Grading of Recommendations Assessment, Development, and Evaluation will be used to evaluate the quality of the assessments. Our study will be disseminated through publications in peer-reviewed journals. CONCLUSION This systematic review is the first to analyze the efficacy of different types of meditation for type 2 diabetes mellitus, which could provide evidence for the use of mediation programs as non-drug approaches. TRIAL REGISTRATION NUMBER PROSPERO CRD42021274508.
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Affiliation(s)
- Jiayu Xu
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Manxue Mei
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoxiang Sun
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaofang Chen
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei Zhu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondences: Wei Zhu, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China (e-mail: ) and Jianping Song, Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China (e-mail: )
| | - Jianping Song
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondences: Wei Zhu, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China (e-mail: ) and Jianping Song, Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China (e-mail: )
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Jenkinson E, Knoop I, Hudson JL, Moss‐Morris R, Hackett RA. The effectiveness of cognitive behavioural therapy and third-wave cognitive behavioural interventions on diabetes-related distress: A systematic review and meta-analysis. Diabet Med 2022; 39:e14948. [PMID: 36031793 PMCID: PMC9826380 DOI: 10.1111/dme.14948] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
AIM Diabetes-related distress is common in diabetes and has implications for well-being. Cognitive behavioural therapy (CBT) and third-wave CBT hold promise as treatments for diabetes-related distress, although previous findings are inconclusive. We aimed to conduct a systematic review with meta-analysis to understand the efficacy of these interventions in treating diabetes-related distress, while also assessing the associative benefits of these interventions on depression, anxiety and glycaemic control. We also aimed to conduct a narrative synthesis, and subgroup analyses to identify intervention components most useful in treating diabetes-related distress. METHOD We searched seven electronic databases from inception to April 2021. Data extraction was independently performed by two reviewers. Methodological quality was assessed. The protocol was registered with the Prospective Register Of Systematic Reviews (PROSPERO): CRD42021240628. RESULTS We included 22 randomised controlled trials investigating the efficacy of CBT and third-wave CBT interventions on diabetes-related distress. CBT for diabetes-related distress significantly reduced distress (SMD = -0.278, p = 0.010) and depression (SMD = -0.604, p = 0.016). Third-wave CBT for diabetes-related distress significantly reduced anxiety (SMD = -0.451, p = 0.034). No significant effect of either intervention on glycated haemoglobin was observed. CBT interventions that included a digital component, were delivered by a psychological practitioner, and included behavioural activation bolstered the effects on diabetes-related distress. CONCLUSIONS CBT aiming to target diabetes-related distress is beneficial for distress and depression. Third-wave CBT for diabetes-related distress is beneficial for anxiety. More work is needed to optimise interventions to improve both mental and physical health outcomes in people with diabetes.
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Affiliation(s)
- Emma Jenkinson
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Iris Knoop
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Joanna L. Hudson
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rona Moss‐Morris
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Ruth A. Hackett
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Ee CC, Armour M, Piya MK, McMorrow R, Al-Kanini I, Sabag A. Mindfulness-based interventions for adults with type 2 diabetes mellitus. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2021. [DOI: 10.1002/14651858.cd014881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carolyn C Ee
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| | - Mike Armour
- NICM Health Research Institute; Western Sydney University; Penrith Australia
| | - Milan K Piya
- School of Medicine; Western Sydney University; Campbelltown Australia
| | - Rita McMorrow
- The Department of General Practice; The University of Melbourne; Melbourne Australia
| | - Ieman Al-Kanini
- School of Medicine, Western Sydney University; Penrith Australia
| | - Angelo Sabag
- NICM Health Research Institute; Western Sydney University; Penrith Australia
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Guo J, Wang H, Ge L, Valimaki M, Wiley J, Whittemore R. Effectiveness of a nurse-led mindfulness stress-reduction intervention on diabetes distress, diabetes self-management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial. Res Nurs Health 2021; 45:46-58. [PMID: 34741544 DOI: 10.1002/nur.22195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/05/2021] [Accepted: 10/24/2021] [Indexed: 11/09/2022]
Abstract
People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hongjuan Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lin Ge
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,Department of endocrinology, The Second People's Hospital of Hunan Province, Changsha, Hunan, China
| | - Maritta Valimaki
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - James Wiley
- Department of Family and Community Medicine, Institute for Health Policy Research, University of California, San Francisco, California, USA
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O'Brien WH, Wang S, Varga AV, Xu H, Sims T, Horan K, Lim CX. Predicting personal protective equipment use, trauma symptoms, and physical symptoms in the USA during the early weeks of the COVID-19 lockdown (April 9-18, 2020). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021; 21:37-47. [PMID: 34031641 PMCID: PMC8133802 DOI: 10.1016/j.jcbs.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic created a complex psychological environment for Americans. In this study, 450 MTurk workers completed measures of sociodemographic characteristics, perceived risk for COVID-19, general perceived vulnerability to disease, intolerance of uncertainty, and psychological flexibility. These variables were used to predict COVID-19 preventive health behaviors (PPE use), psychological distress, and physical symptoms. The surveys were completed between April 9, 2020 and April 18, 2020 which is a period that corresponded to the first 2-3 weeks of lockdown for most participants. A demographically diverse sample of participants was recruited. A substantial number of participants reported a reduction employment status and 69% were in self-isolation. Participants reported a high degree of perceived vulnerability to COVID-19. PPE mask wearing was variable: 16% "not at all," 20% "some of the time," 42% "a good part of the time," and 26 "most of the time." Using clinical cutoff on the post-trauma scale, 70% of the sample would be considered to have symptoms consistent with PTSD. Physical symptom reporting was also high. Intolerance of uncertainty and psychological inflexibility were significant predictors of psychological distress and physical symptoms. Psychological flexibility moderated the relationship between intolerance of uncertainty and psychological distress/physical symptoms. The relationship between intolerance of uncertainty and psychological distress/physical symptoms was stronger among participants with lower levels of psychological flexibility. These findings indicate psychological flexibility can reduce distress associated with COVID-19. Additionally, these results support the workability of the Unified Flexibility and Mindfulness Model as a framework for studying health behavior.
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Affiliation(s)
| | - Shan Wang
- Duke Kunshan University, Suzhou, China
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Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull 2021; 138:41-57. [PMID: 33884400 PMCID: PMC8083197 DOI: 10.1093/bmb/ldab005] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/27/2020] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This is an overall review on mindfulness-based interventions (MBIs). SOURCES OF DATA We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations. AREAS OF AGREEMENT MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions. AREAS OF CONTROVERSY Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations. GROWING POINTS Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed. AREAS TIMELY FOR DEVELOPING RESEARCH More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.
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Affiliation(s)
- Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric K P Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eva C W Mak
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C Y Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ni Y, Ma L, Li J. Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: A systematic review and meta-analysis. J Diabetes Investig 2021; 12:1092-1103. [PMID: 33064926 PMCID: PMC8169362 DOI: 10.1111/jdi.13439] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Yun‐xia Ni
- West China School of Nursing/Department of NursingWest China HospitalSichuan UniversityChengduChina
| | - Lin Ma
- West China School of Nursing/Department of EndocrinologyWest China HospitalSichuan UniversityChengduChina
| | - Ji‐ping Li
- West China School of Nursing/Department of NursingWest China HospitalSichuan UniversityChengduChina
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Ngan HY, Chong YY, Chien WT. Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis. Diabet Med 2021; 38:e14525. [PMID: 33438251 DOI: 10.1111/dme.14525] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
AIM For people with type 2 diabetes, self management and fear of disease complication often cause psychological distress. Mindfulness and acceptance might be beneficial for reducing diabetes-related distress and glycaemic level. We systematically review the effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in community-dwelling adults with type 2 diabetes. METHODS Seven electronic databases (English and Chinese) were searched comprehensively from inception to June 2020. Data extraction and methodological quality assessment were independently performed by two reviewers using Grading of Recommendations, Assessment, Development and Evaluations criteria. RESULTS Nine RCTs (801 participants) examining the effects of acceptance and commitment therapy, mindfulness-based cognitive therapy, mindfulness-based stress reduction and self-directed mindfulness practice were included. In the reviewed RCTs, the majority of participants (mean age: 50-66 years, average disease duration: 4-10 years) had suboptimal diabetes control (HbA1c >7.0%, 53 mmol/mol). Compared with controls, the interventions significantly reduced diabetes distress (standardised mean difference, SMD = -0.37, 95% confidence intervals, CI: -0.63, -0.12; p < 0.01) and HbA1c (mean difference, MD = -0.35, 95% CI: -0.67, -0.04; p = 0.03) up to 1-month post-intervention. However, the underpowered studies may have led to overestimation, the interventions for diabetes distress and HbA1c were heterogeneous. CONCLUSIONS Within evidenced-based diabetes education programmes, mindfulness- and acceptance-based approaches may reduce distress and HbA1c levels and promote self care in people with type 2 diabetes. Further controlled trials are recommended to examine the clinical effectiveness of such programmes for people with type 2 diabetes of diverse clinical, cultural and socio-demographic backgrounds.
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Affiliation(s)
- Hau Yi Ngan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Fattahi C, Hamada K, Chiang M, Kosuru S, Polavarapu M, Sitthichai R, Fan X. A narrative review of mindfulness-based therapy for schizophrenia, co-occurring substance use and comorbid cardiometabolic problems. Psychiatry Res 2021; 296:113707. [PMID: 33421838 DOI: 10.1016/j.psychres.2021.113707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
Mindfulness-based therapy (MBT) has gained attention in recent years as a promising treatment for patients with schizophrenia for whom traditional interventions are not effective. Research demonstrates improvements in psychotic symptoms, emotion regulation, and other areas including re-hospitalization rates and insight into illness following MBT interventions. Yet MBT studies have not carefully reported results in patients with schizophrenia and co-occurring substance use or comorbid medical problems, bringing into question the generalizability of these findings. This narrative review explores the literature regarding the use of mindfulness-based interventions for patients with schizophrenia as well as for patients with substance use disorder, cardiovascular disease, obesity, and diabetes. Findings suggest that MBTs can improve craving in substance use disorder, eating related behaviors in obesity, diabetes-related distress, and metabolic regulation in patients with diabetes. Increased insula and anterior cingulate cortex volumes and activities following MBTs might be associated with the potential benefit of MBTs in patients with schizophrenia. Our review provides a foundational basis in support of the need for future studies evaluating the safety and efficacy of MBTs for schizophrenia with co-occurring substance use disorder and/or comorbid cardiometabolic problems.
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Affiliation(s)
- Cameron Fattahi
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Kareem Hamada
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Mathew Chiang
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Sindu Kosuru
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Mona Polavarapu
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Rangsun Sitthichai
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Xiaoduo Fan
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States.
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13
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Davoudi M, Allame Z, Niya RT, Taheri AA, Ahmadi SM. The synergistic effect of vitamin D supplement and mindfulness training on pain severity, pain-related disability and neuropathy-specific quality of life dimensions in painful diabetic neuropathy: a randomized clinical trial with placebo-controlled. J Diabetes Metab Disord 2021; 20:49-58. [PMID: 34222059 DOI: 10.1007/s40200-020-00700-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022]
Abstract
Purpose This study aimed to examine the synergistic effect of Vitamin D (VD) Supplement and mindfulness on neuropathic pain severity, Pain-Related Disability and Neuropathy-Specific Quality of Life (QOL) dimensions in painful diabetic neuropathy. Methods In this randomized controlled trial, 225 patients with painful diabetic neuropathy were randomly allocated to five groups: (1) mindfulness and placebo, (2) placebo, (3) mindfulness, (4) VD, and (5) mindfulness and VD. Mindfulness training includes twelve sessions, and VD patients received a daily four thousand IU oral dosage (four capsules) with 28,000 IU vitamin D weekly for 12 weeks. Laboratory analyses, Sun exposure time, Vitamin D intake, BMI and physical activity were measured in pre-test and post-test. Pain-Related Disability measured with The Pain Disability Index (PDI). For other outcome variables, Neuropathy, a Specific QOL questionnaire and Neuropathic pain severity scale were utilized. Data were analyzed using one-way repeated-measures analysis of variance (ANOVA), Scheffe Post-hoc test and paired sample t-test. Results In baseline, measures were not different among the groups. At the end-of-treatment, results showed improvement in all groups except the "placebo only" group for outcome variables. There was no difference between VD and mindfulness groups (within and not combined with placebo) in posttest. However, "VD + mindfulness" has a greater improvement rather than VD and mindfulness groups (P < 0.05). Moreover, both protocols have no significant effects on FBS, BMI and energy intakes (P > 0.05). Conclusion Combining VD and mindfulness can reduce pain severity and pain-related disability, so with these changes, patients experience improve in their quality of life.
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Affiliation(s)
- Mohammadreza Davoudi
- Department of clinical psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Allame
- Department of clinical psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Amir Abbas Taheri
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyyed Mojtaba Ahmadi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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14
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Boucher E, Moskowitz JT, Kackloudis GM, Stafford JL, Kwok I, Parks AC. Immediate and Long-Term Effects of an 8-Week Digital Mental Health Intervention on Adults With Poorly Managed Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18578. [PMID: 32749998 PMCID: PMC7435623 DOI: 10.2196/18578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 01/02/2023] Open
Abstract
Background Diabetes is a leading cause of years of life lost and accounts for approximately one-fourth of health care dollars spent in the United States. Many of these costs are related to poor medication adherence and lack of self-care behaviors and are thus preventable. Depression, which is more prevalent among people with diabetes than in the general population, predicts poorer management of one’s diabetes, whereas positive affect predicts engaging in more positive health behaviors. Consequently, interventions that improve depression and positive affect may also improve diabetes-related outcomes among people with diabetes. Although preliminary research on the impact of such interventions among people with diabetes is promising, these studies focused primarily on in-person interventions, have had small samples, and lack long-term follow-up. Objective This study aims to examine the short- and long-term effects of a digital therapeutic platform focused on mental health among adults with poorly managed type 2 diabetes and elevated levels of depression. Methods This is a randomized controlled trial in which adults with a type 2 diabetes diagnosis, elevated hemoglobin A1c (HbA1c) levels (≧7), and moderate to severe depressive symptoms will be randomly assigned to a positive emotion regulation skills intervention group or a sham digital intervention with only psychoeducational content. The study will take place over 14 months, including the 8-week intervention (or control) delivered via a digital therapeutic platform (Happify Health) and follow-up assessments at 3, 6, and 12 months postintervention. Throughout the intervention and for 1 week at each postintervention follow-up, participants will complete daily assessments of diabetes-related distress, diabetes regimen adherence, and mood. Our primary outcome, HbA1c, will be self-reported every 3 months throughout the study. Secondary and exploratory outcomes will be assessed at baseline; at 8 weeks; and at 3, 6, and 12 months postintervention. Results Recruitment is expected to begin in June 2020. Participants will begin the study as they are recruited and will finish in waves. The final wave of data collection from the 8-week intervention is expected for winter 2020, with the completion of the 12-month follow-up in winter 2021. Conclusions Although previous research suggests that in-person psychological interventions have promising effects on both psychological and physical outcomes among adults with diabetes, digital interventions can be advantageous because they are easily scalable and reduce many barriers that prevent people from seeking treatment. This trial will provide important information about the effects of a digital mental health intervention among adults with type 2 diabetes, assessing both short- and long-term effects of this intervention on HbA1c, depressive symptoms, and other diabetes-specific outcomes. If successful, this may introduce a scalable intervention that would help reduce some of the preventable costs associated with diabetes. Trial Registration ClinicalTrials.gov NCT04068805; https://clinicaltrials.gov/ct2/show/NCT04068805. International Registered Report Identifier (IRRID) PRR1-10.2196/18578
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Affiliation(s)
| | - Judith T Moskowitz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | | | - Ian Kwok
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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15
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Nagel KE, Dearth-Wesley T, Herman AN, Smith HG, Gandica RG, Golden LH, Weil HFC, Whitaker RC. The association between dispositional mindfulness and glycemic control in type 1 diabetes during early adulthood: Differences by age and adverse childhood experiences. Pediatr Diabetes 2020; 21:681-691. [PMID: 32090426 DOI: 10.1111/pedi.13000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 02/18/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The study objective was to determine whether higher levels of dispositional mindfulness were associated with lower HbA1c levels among young adults with type 1 diabetes (T1D) and whether this association differed by age or exposure to adverse childhood experiences (ACEs). METHODS An online cross-sectional survey, called T1 Flourish, was completed in 2017 by 423 of 743 (56.9%) young adults (19-31 years) with T1D receiving outpatient care at a diabetes specialty clinic in New York City. HbA1c levels were abstracted from medical records. Respondents were categorized by age, high and low dispositional mindfulness (median split on Cognitive and Affective Mindfulness Scale-Revised), and exposure to any of 10 ACEs. RESULTS Respondents had a mean (SD) HbA1c of 64 (18) mmol/mol [8.0 (1.7)%]; 59.3% were female and 69.4% were non-Hispanic white. The covariate-adjusted association between dispositional mindfulness and HbA1c differed by age group and ACEs. Among 27- to 31-year-olds, those with high mindfulness had HbA1c levels that were 8 mmol/mol [0.7%] lower (95% confidence interval, 2-13 mmol/mol [0.2-1.2%]) than those with low mindfulness, and this association tended to be stronger in those with ≥1 ACEs. Weaker, non-significant associations in the same direction occurred in 23- to 26-year-olds. Among 19- to 22-year-olds, those with high mindfulness and no ACEs tended to have higher HbA1c levels. CONCLUSIONS In young adults with T1D, higher mindfulness was significantly associated with lower HbA1c only among 27- to 31-year-olds. In early adulthood, the impact of mindfulness-based interventions on glycemic control may vary by age and childhood trauma history.
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Affiliation(s)
- Kathryn E Nagel
- Columbia-Bassett Program, Cooperstown, New York, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Tracy Dearth-Wesley
- Columbia-Bassett Program, Cooperstown, New York, USA.,Bassett Research Institute, Cooperstown, New York, USA.,Bassett Medical Center, Cooperstown, New York, USA
| | - Allison N Herman
- Columbia-Bassett Program, Cooperstown, New York, USA.,Bassett Research Institute, Cooperstown, New York, USA.,Bassett Medical Center, Cooperstown, New York, USA
| | - Hannah G Smith
- Columbia-Bassett Program, Cooperstown, New York, USA.,Bassett Research Institute, Cooperstown, New York, USA.,Bassett Medical Center, Cooperstown, New York, USA
| | - Rachelle G Gandica
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,The Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren H Golden
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,The Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Henry F C Weil
- Columbia-Bassett Program, Cooperstown, New York, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Bassett Medical Center, Cooperstown, New York, USA
| | - Robert C Whitaker
- Columbia-Bassett Program, Cooperstown, New York, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Bassett Research Institute, Cooperstown, New York, USA.,Bassett Medical Center, Cooperstown, New York, USA
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16
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Ni Y, Ma L, Li J. Effects of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy in People With Diabetes: A Systematic Review and Meta-Analysis. J Nurs Scholarsh 2020; 52:379-388. [PMID: 32406186 DOI: 10.1111/jnu.12560] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on depression, quality of life (QoL), and glycosylated hemoglobin (HbA1c) in people with diabetes. DESIGN A systematic literature review and meta-analysis was conducted. METHODS Eight databases (PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], Cochrane, PsycINFO, and three Chinese databases) were searched for relevant studies from inception to December 2019. Only randomized controlled trials (RCTs) of MBSR and MBCT interventions for people with type 1 and type 2 diabetes were included. FINDINGS Nine studies described in 11 articles were included in the review. Meta-analysis showed a significant effect favoring MBSR and MBCT on depression (standardized mean difference -0.84; 95% confidence interval [CI] -1.16 to -0.51; p < .0001), the mental health composite score of QoL (mean difference [MD] 7.06; 95% CI 5.09 to 9.03; p < .00001), and HbA1c (MD -0.28; 95% CI -0.47 to -0.09; p = .004). However, effects on the physical health composite score of QoL have not been found. CONCLUSIONS MBSR and MBCT are beneficial in improving depression, the mental health composite score of QoL, and HbA1c in people with diabetes. More well-designed trials using longer follow-up measurements are needed. CLINICAL RELEVANCE MBSR and MBCT could be considered as effective complementary treatment alternatives for people with diabetes.
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Affiliation(s)
- Yunxia Ni
- Nurse, West China Hospital/West China School of Nursing, Sichuan University, Sichuan Province, Chengdu, China
| | - Lin Ma
- Nurse, West China Hospital/West China School of Nursing, Sichuan University, Sichuan Province, Chengdu, China
| | - Jiping Li
- Nurse, Department of Nursing, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
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Zarifsanaiey N, Jamalian K, Bazrafcan L, Keshavarzy F, Shahraki HR. The effects of mindfulness training on the level of happiness and blood sugar in diabetes patients. J Diabetes Metab Disord 2020; 19:311-317. [PMID: 32550181 DOI: 10.1007/s40200-020-00510-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/24/2020] [Indexed: 01/24/2023]
Abstract
Purpose The present study aimed at investigating the effect of mindfulness training on the level of happiness and blood glucose in diabetic patients in Zarghan city, Iran. Methods This quasi-experimental study was conducted in 2018 in Fars province, Iran. 136 diabetic patients who were eligible (had diabetes for more than one year, older than 18 years, willingness to participate in the research, and reside in Zarqan city) were selected based on convenience sampling method. Next the participants were randomly divided into two groups, each comprising 68 individuals. Both of the study samples and statistical analyser were blinded to intervention group (mindfulness training) and control group (without intervention). Before and three month after the intervention the patients' levels of happiness (based on Oxford Happiness Questionnaire), fasting blood sugar (FBS) and Glycated Hemoglobin test (HbA1c) were measured. Results The results indicated that after the sessions, the level of happiness in the Intervention group was significantly higher than the control group (p value <0.001). Also, the level of blood glucose and HbA1c after the sessions was significantly lower in the Intervention group compared to the control group (p value<0.001, p value = 0.004). After the intervention, there was a significant correlation between mean blood glucose levels and mean HbA1c levels in the Intervention group and their level of happiness (p value<0.01 and p value<0.001). Conclusion The findings revealed that the mindfulness-based educational intervention can increase happiness in people with diabetes and regulate their blood glucose.
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Affiliation(s)
- Nahid Zarifsanaiey
- Department of E-learning, Virtual School, Comprehensive Center of Excellence for e-Learning in Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Medical Education, Virtual university of Medical Sciences, Tehran, Iran
| | | | - Leila Bazrafcan
- Clinical Education Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hadi Raeisi Shahraki
- Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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18
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Guo J, Wang H, Luo J, Guo Y, Xie Y, Lei B, Wiley J, Whittemore R. Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis. BMJ Open Diabetes Res Care 2019; 7:e000757. [PMID: 31908794 PMCID: PMC6936501 DOI: 10.1136/bmjdrc-2019-000757] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/18/2019] [Accepted: 11/09/2019] [Indexed: 12/24/2022] Open
Abstract
To review the evidence and determine the factors influencing the effect of mindfulness-based interventions (MBI) on diabetes distress. A systematic search of nine databases (PubMed, Cochrane Library, Web of Science, PsycINFO, Embase, China Knowledge Resource Integrated, VIP Data, SinoMed Data, and Wan Fang Data) was conducted. Randomized controlled trials of MBIs for adults with diabetes that evaluated the effect of the interventions on diabetes distress were retrieved. Meta-analysis was conducted by using Review Manager V.5.3, a Cochrane Collaboration tool. Subgroup analyses were conducted for exploring factors influencing the effect of MBIs on diabetes distress. A total of 10 articles, consisting of eight studies with 649 participants, were included. The results from subgroup analyses on the studies revealed five factors that influenced the effect of MBIs on diabetes distress compared with control group. Participants with elevated baseline diabetes distress showed a moderate effect size of 0.48 of decreasing diabetes distress when receiving MBIs (p=0.005); the MBIs based on mindfulness-based stress reduction therapy alleviated diabetes distress of the participants with a large effect size of 0.58 (p<0.0001); the MBIs delivered in group format decreased the diabetes distress with a moderate effect size of 0.36 (p=0.03); the MBIs with home practice assignment alleviated the diabetes distress with a moderate effect size of 0.42 (p=0.05). The long-term rather than short-term effect of MBIs on diabetes distress reduction has been identified with large effect size of 0.56 (p=0.04). MBIs improve outcomes in adults with diabetes who have elevated diabetes distress at baseline, using mindfulness-based stress reduction therapy, using a group format to deliver the intervention, and assigning home practice. MBIs improve diabetes distress significantly more at long-term follow-up compared with short-term follow-up. MBIs could be considered as an adjunct treatment in adults with diabetes to reduce diabetes distress.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hongjuan Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yi Guo
- School of Life Science, Central South University, Changsha, Hunan, China
| | - Yun Xie
- School of Foreign Languages, Central South University, Changsha, Hunan, China
| | - Beimei Lei
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - James Wiley
- Department of Family and Community Medicine and Institute for Health Policy Research, University of California, San Francisco, California, USA
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