Comparison of the effects of Korean mindfulness-based stress reduction, walking, and patient education in diabetes mellitus

Mindfulness training for cardiovascular health in type 2 diabetes: A critical review

Mindfulness training has gained increasing attention as a potential intervention to improve cardiovascular health, particularly in populations with chronic conditions, such as type 2 diabetes. Given the heightened cardiovascular risk associated with type 2 diabetes, identifying effective non-pharmacological strategies to mitigate these risks is crucial. This critical review assessed the current evidence on the impact of mindfulness training on cardiovascular health in individuals with type 2 diabetes. A comprehensive literature search was conducted using the PubMed database, and studies were selected based on stringent inclusion and exclusion criteria. The search strategy was meticulously designed to filter out high-quality articles and ensure that only the most relevant and rigorous studies were included in the analysis. The findings from this review suggest that while mindfulness training has the potential to improve cardiovascular health in individuals with type 2 diabetes, evidence remains mixed. Some studies have reported significant improvements in cardiovascular markers, such as blood pressure and inflammation, while others have shown limited or no effects. This variability highlights the need for further research to better understand the mechanisms underlying these outcomes and identify the most effective mindfulness interventions for this population. In conclusion, mindfulness training appears to be a promising approach for enhancing cardiovascular health in Type 2 diabetes patients, yet the current evidence is inconclusive. Future research should focus on standardizing mindfulness interventions, conducting larger clinical trials, and exploring the long-term benefits of these interventions on cardiovascular outcomes in high-risk populations.

The effectiveness of psychological interventions on diabetes distress and glycemic level in adults with type 2 diabetes: a systematic review and meta-analysis

AIMS

The treatment of diabetes distress plays an important role in diabetes care; however, no meta-analysis has been performed to synthesize the short- and long-term effects of psychological interventions tailored for diabetes distress in people with type 2 diabetes. We aim to evaluate the evidence on tailored psychological interventions for diabetes distress as the primary outcome, focusing on individuals with type 2 diabetes.

METHODS

Two reviewers independently searched eight databases from their inception to September 2024. EndNote X9 was used to screen records. The Revised Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias. The GRADE system was used to assess the overall certainty of the evidence. A random effect model was used to determine the mean difference or standardized mean difference with 95% CIs. Subgroup analyses based on several intervention characteristics and sensitivity analyses were also conducted.

RESULTS

Totally, 22,279 records were yielded, and we finally included 18 studies in our systematic review. The meta-analysis included data from 16 studies representing 1639 participants. Interventions types included mindfulness-based and cognitive behavioral therapy, among others. Duration of interventions ranged from 4 weeks to 6 months. We found that psychological interventions that measured diabetes distress significantly reduced diabetes distress in the short-term in people with type 2 diabetes (SMD= -0.56; 95% CI= -0.90, -0.22; p = 0.001). Subgroup analysis indicated that this effect could be enhanced when delivered in a group format, by psychologist, using a technology component, or including participants having elevated baseline diabetes distress. However, the short- and long-term effects on HbA1c were non-significant, with results showing (MD = 0.02; 95% CI = -0.23 to 0.26; p = 0.89) and (MD = -0.27; 95% CI = -0.64 to 0.10; p = 0.15), respectively. The long-term effect on diabetes distress was also non-significant (SMD = -0.45; 95% CI = -0.93 to 0.03; p = 0.07).

CONCLUSIONS

Psychological interventions tailored for diabetes distress in people with type 2 diabetes are effective in reducing the level of diabetes distress immediately after the intervention. More trials are still needed to further enrich the evidence in this area.

Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases

The connection between chronic psychological stress and the onset of various diseases, including diabetes, HIV, cancer, and cardiovascular conditions, is well documented. This review synthesizes current research on the neurological, immune, hormonal, and genetic pathways through which stress influences disease progression, affecting multiple body systems: nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary. Central to this review is an evaluation of 16 Behavioral Stress Reduction Programs (BSRPs) across over 200 studies, assessing their effectiveness in mitigating stress-related health outcomes. While our findings suggest that BSRPs have the potential to enhance the effectiveness of medical therapies and reverse disease progression, the variability in study designs, sample sizes, and methodologies raises questions about the generalizability and robustness of these results. Future research should focus on long-term, large-scale studies with rigorous methodologies to validate the effectiveness of BSRPs.

Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes: A Systematic Literature Review and Meta-analysis

BACKGROUND

Diabetes complications are prevalent and cause adverse effects on the physical, psychological, and economic status of adult patients with type 2 diabetes. Meditation may positively affect self-management and, in turn, reduce diabetes complications. However, the systematic examination of the effects of meditation without additional components on self-management in this population have been rarely examined.

PURPOSE

The aim of this study was to examine the effects of meditation interventions on self-management (ie, control of glucose, blood pressure, cholesterol, and obesity and self-management) among adult patients with type 2 diabetes in randomized controlled trials.

METHODS

In this systematic review and meta-analysis, 6 electronic databases were searched using major keywords of meditation , diabetes , and self-management during March 2022.

RESULTS

Eight studies (9 articles) using mindfulness-based meditation were included. The meta-analysis showed that meditation improved hemoglobin A 1c (effect size = -0.75; 95% confidence interval, -1.30 to -0.21; P = .007) but not fasting blood glucose. Only a few studies examined meditation effects on other types of self-management (eg, blood pressure, body mass index, cholesterol, diet, exercise, foot care, and monitoring of blood glucose), and the effects were inconsistent. In 1 study, meditation improved diabetes self-management.

CONCLUSIONS

Mindfulness-based meditation reduced hemoglobin A 1c levels in adult patients with type 2 diabetes but did not consistently improve other types of self-management in a few studies examined. This may imply the need for additional intervention components to improve different types of self-management. Further studies are needed to examine the effects of different types of meditations with additional components on different types of self-management.

The effectiveness of mindfulness-based stress reduction (MBSR) on the mental health, HbA1C, and mindfulness of diabetes patients: A systematic review and meta-analysis of randomised controlled trials

The clinically standardised mindfulness-based stress reduction (MBSR) has been utilised as an intervention for improving mental health among diabetes patients The present study aimed to assess the effectiveness of mindfulness-based stress reduction (MBSR) on the mental health, haemoglobin A1c (HbA1C), and mindfulness of diabetes patients. A systematic review and meta-analysis approach was employed to review randomised controlled trials published in the English language between the inception of eight databases to July 2022. Eleven articles from 10 studies, with a combined sample size of 718 participants, were included in the systematic review, and nine studies were included in the meta-analysis. In the meta-analysis, outcomes at post-intervention and follow-up were compared between the MBSR intervention and control groups with an adjustment of the baseline values. The results showed that MBSR demonstrated effects at post-intervention and follow-up (in a period between one to 12 months with a mean length of 4.3 months) in reducing anxiety and depressive symptoms, and enhancing mindfulness, with large effect sizes. However, the effect of MBSR on reducing stress was observed at follow-up, but not at post-intervention. Effects of MBSR on HbA1C were not detected at post-intervention and follow-up. The findings suggest that MBSR appears to be an effective treatment for improving mental health conditions and mindfulness in people with diabetes. The measurement of cortisol is recommended to be used as a biological measure to evaluate the effectiveness of MBSR in diabetes patients in future research.

The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses

Background: Previous research has demonstrated the effectiveness of mindfulness interventions in improving glycemic control. By enhancing attention control, emotion regulation, and self-awareness, mindfulness shows promise in managing the lifestyle factors associated with cardiovascular disease risk. However, the impact of mindfulness on glycemic control in people with diabetes remains unclear. This overview aims to summarize the current evidence of the impact of mindfulness interventions on glycemic control in people with diabetes and propose suggestions for future research. Methods: The author searched electronic databases (PubMed/MEDLINE, Embase, and Cochrane Library) to identify relevant systematic reviews and meta-analyses. The current evidence regarding the effects of mindfulness on glycemic control in people with diabetes was summarized. Results: This review evaluated a total of five systematic reviews and meta-analyses of randomized controlled trials (RCTs). Mindfulness interventions show potential for improving glycemic control as measured by hemoglobin A1c (HbA1c) levels, as well as reducing stress, depression, and anxiety in people with diabetes. Four out of five systematic reviews and meta-analyses reported a significant reduction in HbA1c levels by approximately 0.3%. However, the available studies lacked adequate description of key characteristics of study subjects, such as body mass index, medication, and disease conditions, which are essential for assessing the impact of mindfulness on glycemic control. Moreover, there was significant heterogeneity in the intervention methods employed across the included RCTs. Conclusions: Mindfulness interventions are effective in improving glycemic control in people with type 2 diabetes. However, the overall quality of the reviewed studies raises uncertainty regarding the effectiveness of mindfulness as a treatment for people with diabetes. Further research is necessary to elucidate the biological effects of mindfulness on physiological, neurological, and endocrinological functions in humans.

Mind- and Body-Based Interventions Improve Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Aims/Hypothesis: Only 51% of patients with type 2 diabetes achieve the hemoglobin A1c (HbA1c) <7% target. Mind and body practices have been increasingly used to improve glycemic control among patients with type 2 diabetes, but studies show inconsistent efficacy. The authors conducted a systematic review and meta-analysis to assess the association between mind and body practices, and mean change in HbA1c and fasting blood glucose (FBG) in patients with type 2 diabetes. Methods: The authors conducted a literature search of Ovid MEDLINE, Embase, and ClinicalTrials.gov seeking through June 10, 2022, published articles on mind and body practices and type 2 diabetes. Two reviewers independently appraised full text of articles. Only intervention studies were included. Reviewers extracted data for meta-analysis. Restricted maximum likelihood random-effects modeling was used to calculate the mean differences and summary effect sizes. The authors assessed heterogeneity using Cochran's Q and I² statistics. Funnel plots were generated for each outcome to gauge publication bias. Weighted linear models were used to conduct study-level meta-regression analyses of practice frequency. Results: The authors identified 587 articles with 28 meeting the inclusion criteria. A statistically significant and clinically relevant mean reduction in HbA1c of -0.84% (95% confidence interval [CI]: -1.10% to -0.58%; p < 0.0001) was estimated. Reduction was observed in all intervention subgroups: mindfulness-based stress reduction: -0.48% (95% CI: -0.72% to -0.23%; p = 0.03), qigong: -0.66% (95% CI: -1.18% to -0.14%; p = 0.01), and yoga: -1.00% (95% CI: -1.38% to -0.63%; p < 0.0001). Meta-regression revealed that for every additional day of yoga practice per week, the raw mean HbA1c differed by -0.22% (95% CI: -0.44% to -0.003%; p = 0.046) over the study period. FBG significantly improved following mind and body practices, with overall mean difference of -22.81 mg/dL (95% CI: -33.07 to -12.55 mg/dL; p < 0.0001). However, no significant association was found between the frequency of weekly yoga practice and change in FBG over the study period. Conclusions/Interpretation: Mind and body practices are strongly associated with improvement in glycemic control in patients with type 2 diabetes. The overall mean reduction in HbA1c and FBG was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes. Additional analyses revealed that the mean decrease in HbA1c was greater in studies requiring larger number of yoga practice sessions each week.

Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes

PURPOSE OF REVIEW

Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D.

RECENT FINDINGS

Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.

Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials

Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.

Effects of Yoga Therapy and Walking Therapy in Reducing Blood Sugar Levels on Diabetes Mellitus Patients in the Community

BACKGROUND: The increasing of diabetes mellitus cases in Indonesia may be due to changes in people’s lifestyles, which is lack of exercise. Factors that may contribute to the high prevalence of diabetes mellitus sufferers other than genetics are exacerbated by environmental factors. Exercise interventions have been effective in counterbalancing diabetes complications. Yoga exerts a beneficial effect on insulin kinetics and the resulting lipid profile. Yoga helps redistribute body fat and reduces obesity which may lead to insulin resistance. In addition, other types of physical activity that can be done by diabetes mellitus patients are adequate morning walking while having scenery leisure for 30 min or more. AIM: This study was conducted to determine the effect of yoga therapy and walking therapy on diabetes mellitus patients in the community. METHODS: Quantitative research using randomized control trial, conducted in Gedongan Village, Baki Subdistrict, Sukoharjo Regency, involving 54 samples divided into three groups. Inclusion criteria: Patients with type 2 diabetes mellitus, fasting glucose levels of 126 mg/dl, no complication, and no insulin therapy or diabetes medication. The outcome measured was fasting blood sugar levels. The intervention group performed therapy for 12 weeks with a duration of 3 times a week. RESULTS: The average fasting sugar levels in the yoga group pre (217.00) post (187.72) p (0.001), the walking group averaged pre (209.89) post (193.83) p (0.001), and the control group averaged pre (221.50) post (225.17) p (0.067). CONCLUSION: There was an effect of yoga therapy and walking therapy on reducing fasting glucose levels.

Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: A systematic review and meta-analysis

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.

The effect of spiritual care on quality of life of patients with amputation caused by diabetes type 2: a clinical trial

OBJECTIVES

This study aimed to investigate effect of a spiritual care on quality of life of patients with amputation caused by diabetes type 2.

METHODS

The current study was a clinical trial. Fifty four patients with amputation caused by diabetes type 2 referred to Al-Zahra hospital at Isfahan was allocated to two case and control groups. Spiritual care training including transcendental meditation (T.M) technique was established for case group. Participants in case group performed four weeks of meditation technique following participating in sessions of meditation technique training. Data gathering was done using a standard tool to assess quality of life in patients with diabetes (diabetes quality of life: DQOL). Data was analyzed using SPSS software.

RESULTS

Mean score of quality of life in the four areas of quality of life was not significantly different among case and control groups at baseline, however, mean score of quality of life in case group (2.25 ± 0.56) was significantly better than control group (2.52 ± 0.38) after intervention (p<0.001).

CONCLUSIONS

Given findings of the study, it seems that spiritual care can improve quality of life of patients with amputation caused by diabetes type 2.

Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis

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 (HbA_1c >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 HbA_1c (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 HbA_1c were heterogeneous.

CONCLUSIONS

Within evidenced-based diabetes education programmes, mindfulness- and acceptance-based approaches may reduce distress and HbA_1c 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.

Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Meta-Analysis

BACKGROUND

The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient's lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping the patients with the necessary coping and self-care techniques may be an important step in managing diabetes.

OBJECTIVE

To evaluate the effect of interventions using established mindfulness-based protocols on glycemic control of individuals with T2DM.

METHODS

Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in English, Spanish and Portuguese languages.

STUDY SELECTION

Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected.

DATA EXTRACTION

Two authors independently assessed the risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence).

CONCLUSION

Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness have no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, large-scale trials are needed to evaluate the contribution of mindfulness to glycemic control in clinical practice. PROSPERO Registration ID: RD42020161940.

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

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.

Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis

Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels. In the present meta-analysis we tested whether effects are larger for those who might be in need of such stress reduction programs due to a risk for elevated cortisol levels as compared to no-risk samples. We included RCTs that measured change in cortisol levels. Based on 10 studies using blood samples meditation interventions had a significant, medium effect from pre-to post-test compared to the control group. Upon closer inspection, this effect was only present for at-risk samples, that is, patients with a somatic illness. In the 21 studies using saliva samples the effect was small and not significant, but there was a marginally significant effect for groups living in stressful life situations. This pattern may suggest that that meditation interventions are most beneficial for at-risk populations. These interventions might provide people with strategies of stress management that can contribute to well-being. Preliminary results suggest that benefits of meditation interventions might not fade with time.

Effects of exercise training combined with psychological intervention compared to exercise training alone in prediabetes subjects

BACKGROUND

Prior research has confirmed the efficacy of exercise training (ET) in patients with prediabetes. However, whether the effectiveness of a combination of exercise and psychological intervention (EP) is better than ET alone in prediabetes in terms of physiological function, psychological status and glycometabolism has rarely been investigated.

METHODS

Forty newly diagnosed prediabetes patients (65.3 ± 8.1 years) took part in the study. Subjects were divided into a pure ET group and a combined EP group. Interventions were conducted in 40-50-min sessions twice weekly for 32 weeks. Physiological, psychological and biochemical indicator measurements were taken after pre-, mid- and post-interventions, respectively.

RESULTS

The main finding confirmed a significant improvement in systolic blood pressure, diastolic blood pressure (DBP) and heart rate, high-density lipoprotein, fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) from pre- to mid- and post-test differentially in both groups (P < 0.05) by post hoc analyses. The EP group has a greater magnitude of improvement of DBP than the ET group. Significant differences were observed in FPG at mid-intervention and total cholesterol at post-intervention between the ET and EP groups. Self-Rating Anxiety Scale (SAS) scores of EP group were significantly less than ET group after post-intervention.

CONCLUSION

Our results suggest that EP might be a promising method lead to more apparent long-term effects on glycometabolism and psychological status for prediabetes patients. Other domains were improved by both interventions, but no typical pattern could be identified. Its underlying mechanisms need further study, and directions for future research are suggested.

Effects of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy in People With Diabetes: A Systematic Review and Meta-Analysis

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.

Effectiveness of a guided online mindfulness-focused intervention in a student population: Study protocol for a randomised control trial

BACKGROUND

Previous studies show that university students experience higher psychological stress than the general population, resulting in increased vulnerability for mental disorders for the student population. Online mindfulness interventions will be delivered to students as a potentially promising and more flexible approach compared to face-to-face interventions with the aim of improving their mental health. This study purposes to investigate the effectiveness of a guided online mindfulness-focused intervention for university students by using both self-reported and psychobiological measures.

METHODS AND ANALYSES

In this multicentre, two-armed randomised controlled trial with a parallel design, a guided version of the online mindfulness-focused intervention 'StudiCare Mindfulness' will be compared with a waitlist control group. In total, 120 participants will be recruited at different universities (of Applied Sciences) in (Neu-) Ulm. Data will be assessed prior to randomisation, after eight weeks (post-intervention) and six months after randomisation (follow-up). The primary outcome measure is mindfulness. The secondary outcome measures include depression, anxiety and stress levels, well-being, interoceptive sensibility, emotion regulation and alexithymia. Psychobiological parameters comprise interoceptive accuracy, hair cortisol and FKBP5 genotype. Sociodemographic variables, treatment expectations, side and adverse side effects, as well as intervention satisfaction and adherence will be assessed. All data analyses will be conducted according to the intention-to-treat principle.

ETHICS AND DISSEMINATION

All study procedures have been approved by the Ethics Committee of Ulm University (application No. 48/18). The findings will be disseminated widely through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

DRKS00014701.

Effectiveness of stress-relieving strategies in regulating patterns of cortisol secretion and promoting brain health

Stress leads to ill-health and disease, and with today's fast-pace western society, engaging in strategies to relieve stress is crucial for good health across the life-course. Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being. It is thought that patterns of cortisol secretion, which are regulated by the brain, are a key mediator of stress-disease and well-being-health links. Measurement of cortisol in saliva is a non-invasive and ecologically valid tool for detecting early changes in brain health, as well as evaluating the effectiveness of strategies in relieving stress and improving brain health as well as monitoring stress-related brain changes. This chapter will review the evidence that engaging in stress-relieving strategies promotes regulation and/or restoration of patterns of cortisol secretion. If such strategies are found to be effective in healthy populations, they could potentially inform ways of promoting brain health and the prevention or delay of clinical disorders involving disorders in the brain (e.g., Parkinson's disease) and symptoms experienced with such disorders. To inform this field of research, recommendations are provided for the use of salivary cortisol as a marker of early monitoring of brain health and effectiveness of stress-alleviating interventions.

Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis

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.

The Effects of Mindfulness-Based Interventions on Diabetes-Related Distress, Quality of Life, and Metabolic Control Among Persons with Diabetes: A Meta-Analytic Review

Mindfulness-based interventions (MBIs) have improved psychological outcomes for multiple chronic health conditions, including diabetes. A meta-analytic review of the literature was conducted on all located studies (n = 14) investigating MBIs that targeted diabetes-related distress (DRD) and diabetes-related outcomes among people with Type 1 and Type 2 diabetes. PsychInfo, PubMed, Medline, and Web of Science were searched for MBIs that were designed to improve DRD and other secondary outcomes, including quality of life and measures of metabolic control. A meta-analysis of these outcomes uncovered small-to-moderate effect sizes for intervention studies measuring pretreatment to posttreatment changes in DRD and metabolic control among treatment group participants. However, the pretreatment to follow-up comparisons for DRD and metabolic control were small and unreliable. For control groups, all pre-treatment to post-treatment and pre-treatment to follow-up comparisons were unreliable for all outcomes. A moderate effect size for treatment-control comparisons was found for intervention studies measuring quality of life outcomes at posttreatment, but not at follow-up comparisons. All other effect sizes for treatment-control comparisons were unreliable. Limitations and implications for MBIs among individuals with diabetes are discussed.

Well-being interventions for individuals with diabetes: A systematic review

In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures.

Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes-distress

AIMS

The clinical relevance of diabetes-distress is increasingly recognized, but little is known about the efficacy of interventions specifically targeted to treat elevated diabetes-distress. Therefore, this systematic review sought to determine the efficacy of psychological interventions aimed at treating elevated diabetes-distress in people with Type 1 or Type 2 diabetes.

METHODS

We systematically searched literature from five databases. Randomized controlled trials (RCTs) with an English abstract, describing the results of a psychological intervention in adults with diabetes were included. Articles were eligible for inclusion if the primary outcome was diabetes-distress measured by the Problem Areas in Diabetes Scale (PAID-5/PAID-20) or the Diabetes Distress Scale (DDS-17). Only mean group diabetes-distress values above cut-off at baseline or the results of a subgroup above cut-off (PAID-5 ≥ 8, PAID-20 ≥ 40 or DDS-17 ≥ 3) were included.

RESULTS

The search yielded 8907 articles. After removing 2800 duplicates, 6107 articles remained. Titles and abstracts were screened, leaving 394 potential articles of interest, nine of which were RCTs. In a random-effects meta-analysis, the pooled effect size for diabetes-distress was 0.48 (Cohen's d), Z = 3.91, P < 0.0001. Statistical heterogeneity was I² = 46.67% (confidence intervals 45.06% to 48.28%). Diabetes-tailored psychological interventions reduced HbA1c (Cohen's d = 0.57), whereas mindfulness-based interventions did not (Cohen's d = 0.11).

CONCLUSIONS

This systematic review shows that specifically diabetes-tailored psychological interventions are effective in reducing elevated diabetes-distress and HbA1c . More rigorous studies are warranted to establish the full potential of these interventions. PROSPERO database registration ID: CRD42017075290.

Mind-Body Interactions and Mindfulness Meditation in Diabetes

Diabetes is associated with significant psychological distress. It is, therefore, important to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease and diabetes. The practice of meditation is associated with reduction in stress and negative emotions and improvements in patient attitude, health-related behaviour and coping skills. There is increased parasympathetic activity with reduction in sympathetic vascular tone, stress hormones and inflammatory markers. Additionally, several studies evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated modest improvements in body weight, glycaemic control and blood pressure. Thus, mindfulness meditation-based intervention can lead to improvements across all domains of holistic care – biological, psychological and social. Though most of these studies have been of short duration and included small numbers of patients, meditation strategies can be useful adjunctive techniques to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing.

Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis

Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.

Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis

BACKGROUND AND OBJECTIVES

Practices that include yoga asanas and mindfulness-based stress reduction for the management of stress are increasingly popular; however, the neurobiological effects of these practices on stress reactivity are not well understood. Many studies investigating the effects of such practices fail to include an active control group. Given the frequency with which people are selecting such interventions as a form of self-management, it is important to determine their effectiveness. Thus, this review investigates the effects of practices that include yoga asanas, with and without mindfulness-based stress reduction, compared to an active control, on physiological markers of stress.

MATERIALS AND METHODS

A systematic review and meta-analysis of randomised controlled trials published in English compared practices that included yoga asanas, with and without mindfulness-based stress reduction, to an active control, on stress-related physiological measures. The review focused on studies that measured physiological parameters such as blood pressure, heart rate, cortisol and peripheral cytokine expression. MEDLINE, AMED, CINAHL, PsycINFO, SocINDEX, PubMed, and Scopus were searched in May 2016 and updated in December 2016. Randomised controlled trials were included if they assessed at least one of the following outcomes: heart rate, blood pressure, heart rate variability, mean arterial pressure, C-reactive protein, interleukins or cortisol. Risk of bias assessments included sequence generation, allocation concealment, blinding of assessors, incomplete outcome data, selective outcome reporting and other sources of bias. Meta-analysis was undertaken using Comprehensive Meta-Analysis Software Version 3. Sensitivity analyses were performed using 'one-study-removed' analysis. Subgroup analysis was conducted for different yoga and control group types, including mindfulness-based stress reduction versus non-mindfulness-based stress reduction based interventions, different populations, length of intervention, and method of data analysis. A random-effects model was used in all analyses.

RESULTS

Forty two studies were included in the meta-analysis. Interventions that included yoga asanas were associated with reduced evening cortisol, waking cortisol, ambulatory systolic blood pressure, resting heart rate, high frequency heart rate variability, fasting blood glucose, cholesterol and low density lipoprotein, compared to active control. However, the reported interventions were heterogeneous.

CONCLUSIONS

Practices that include yoga asanas appear to be associated with improved regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system in various populations.

Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

BACKGROUND

Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours and disease control. Improving DRD in adults with T2DM could enhance psychological well-being, health-related quality of life, self-care abilities and disease control, also reducing depressive symptoms.

OBJECTIVES

To assess the effects of psychological interventions for diabetes-related distress in adults with T2DM.

SEARCH METHODS

We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, BASE, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was December 2014 for BASE and 21 September 2016 for all other databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) on the effects of psychological interventions for DRD in adults (18 years and older) with T2DM. We included trials if they compared different psychological interventions or compared a psychological intervention with usual care. Primary outcomes were DRD, health-related quality of life (HRQoL) and adverse events. Secondary outcomes were self-efficacy, glycosylated haemoglobin A1c (HbA1c), blood pressure, diabetes-related complications, all-cause mortality and socioeconomic effects.

DATA COLLECTION AND ANALYSIS

Two review authors independently identified publications for inclusion and extracted data. We classified interventions according to their focus on emotion, cognition or emotion-cognition. We performed random-effects meta-analyses to compute overall estimates.

MAIN RESULTS

We identified 30 RCTs with 9177 participants. Sixteen trials were parallel two-arm RCTs, and seven were three-arm parallel trials. There were also seven cluster-randomised trials: two had four arms, and the remaining five had two arms. The median duration of the intervention was six months (range 1 week to 24 months), and the median follow-up period was 12 months (range 0 to 12 months). The trials included a wide spectrum of interventions and were both individual- and group-based.A meta-analysis of all psychological interventions combined versus usual care showed no firm effect on DRD (standardised mean difference (SMD) -0.07; 95% CI -0.16 to 0.03; P = 0.17; 3315 participants; 12 trials; low-quality evidence), HRQoL (SMD 0.01; 95% CI -0.09 to 0.11; P = 0.87; 1932 participants; 5 trials; low-quality evidence), all-cause mortality (11 per 1000 versus 11 per 1000; risk ratio (RR) 1.01; 95% CI 0.17 to 6.03; P = 0.99; 1376 participants; 3 trials; low-quality evidence) or adverse events (17 per 1000 versus 41 per 1000; RR 2.40; 95% CI 0.78 to 7.39; P = 0.13; 438 participants; 3 trials; low-quality evidence). We saw small beneficial effects on self-efficacy and HbA1c at medium-term follow-up (6 to 12 months): on self-efficacy the SMD was 0.15 (95% CI 0.00 to 0.30; P = 0.05; 2675 participants; 6 trials; low-quality evidence) in favour of psychological interventions; on HbA1c there was a mean difference (MD) of -0.14% (95% CI -0.27 to 0.00; P = 0.05; 3165 participants; 11 trials; low-quality evidence) in favour of psychological interventions. Our included trials did not report diabetes-related complications or socioeconomic effects.Many trials were small and were at high risk of bias for incomplete outcome data as well as possible performance and detection biases in the subjective questionnaire-based outcomes assessment, and some appeared to be at risk of selective reporting. There are four trials awaiting further classification. These are parallel RCTs with cognition-focused and emotion-cognition focused interventions. There are another 18 ongoing trials, likely focusing on emotion-cognition or cognition, assessing interventions such as diabetes self-management support, telephone-based cognitive behavioural therapy, stress management and a web application for problem solving in diabetes management. Most of these trials have a community setting and are based in the USA.

AUTHORS' CONCLUSIONS

Low-quality evidence showed that none of the psychological interventions would improve DRD more than usual care. Low-quality evidence is available for improved self-efficacy and HbA1c after psychological interventions. This means that we are uncertain about the effects of psychological interventions on these outcomes. However, psychological interventions probably have no substantial adverse events compared to usual care. More high-quality research with emotion-focused programmes, in non-US and non-European settings and in low- and middle-income countries, is needed.

Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework

A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.