Changes Induced by Mind-Body Intervention Including Epigenetic Marks and Its Effects on Diabetes

Barriers and Facilitators to Incorporating an Integrative Mind-Body Intervention in Youth With Type 2 Diabetes

Objective

There has been little to no qualitative research done with adolescents and young adults (AYA) with type 2 diabetes (T2D) that can guide creation of interventions for this demographic. Using qualitative research methods, a novel mind-body intervention called Intervention for Early Onset Type 2 Diabetes (INTEND) has been developed for AYA aged 15 to 20 years, with the goal of improving self-management and coping skills, by enhancing routine care with augmented education coupled with mind-body skills.

Method

Qualitative interviews with AYA 15 to 20 years of age with T2D, their parents, and professionals caring specifically for this population were done through a focus group model. Transcripts were created, depersonalized, and coded using a Consensual Qualitative Research (CQR) method. Identified themes then guided the creation of course materials that included education about self-management of T2D and how to use the 4 mind-body technique toward self-care and regulation.

Results

The qualitative approach used in the development of this intervention revealed important findings in understanding key barriers faced by this group, key facilitators that improve their quality of life, and core components of an intervention that would be acceptable to them.

Conclusion

Results of this qualitative study helped craft an intervention tool that can subsequently be deployed and evaluated for effectiveness. Findings of the qualitative research model allow us to better understand the lived experience of AYA living with T2D.

Clinical guidance

•Stigma of type 2 diabetes in adolescents may interfere with patients' ability to adequately adhere to treatment recommendations•Clinicians need to identify social supports for adolescents with type 2 diabetes•Identifying family members and including them in treatment plans may help adolescents with type 2 diabetes.

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.

The effect of yoga therapy directed by virtual training on depression of adolescent girls with type 1 diabetes: a randomized controlled trial

Background

Recently, the depression-alleviating impact of yoga therapy was documented among patients with type 2 diabetes; nonetheless, whether this consequence is similar in individuals with type 1 diabetes (T1D) is still unclear. Therefore, this trial sought to investigate the potential impact of yoga therapy on the depression of adolescents with T1D.

Methods

This randomized controlled trial recruited 62 girls with T1D, aged 12-17 years, from January to June 2020. The participants were randomly allocated to equal experimental and control arms (31 per group) through a block randomization approach. The routine care was implemented in two study arms, while the experimental arm additionally received yoga therapy directed by virtual training for eight consecutive weeks (one session per week). Maria Kovacs Children's Depression Inventory was completed at baseline and the end of the 8-week intervention.

Results

The mean of the depression total score was significantly lower in the experimental arm in comparison with the control arm at the trial end (9.38 ± 8.44 vs. 12.77 ± 6.96, p = 0.014). Also, the reduction in mean change from the baseline to the trial end was significantly more in the experimental arm (- 5.25 ± 1.13 vs. - 0.80 ± 1.00, p = 0.013).

Conclusions

The administration of yoga therapy directed by virtual training seems to be potentially effective in reducing depression among adolescent girls with T1D. However, further long-term trials with a larger sample size are needed to shed light on the obtained findings and address the intervention's efficacy on glycemic outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01245-x.

A self-management plus mind body intervention for adolescents and young adults with type 2 diabetes: Trial design and methodological report

BACKGROUND

The onset of type 2 diabetes (T2D) is increasingly common in adolescents and young adults (AYAs). Improving self-management skills and the mental health of this population is important, but understudied.

METHODS

The goal of this research was to develop a mind-body intervention which could serve as an adjunctive therapy to support AYAs with T2D (INTEND intervention). Toward that end, we used an iterative process, including use of focus groups, advisory board, and cognitive semi-structured interviews with patients, parents of patient and clinical providers, to understand the gaps in the current information provided to AYAs with T2D. Based on the data gathered from the focus groups and interviews, we enhanced an existing self-management intervention for adults with T2D to include an additional mind body intervention for AYAs with T2D. The INTEND intervention will be piloted in a group of AYAs with T2D.

RESULTS

This report describes the methodology and design of the InterveNTion for Early oNset type 2 Diabetes (INTEND) study. The details of this single arm pre-post pilot feasibility trial are described.

DISCUSSION

If successful, the INTEND approach has the potential to advance care for vulnerable youth with T2D.

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.

Role of Yoga in Minimizing Stress and Anxiety in Women Experiencing Dysmenorrhea

Primary dysmenorrhea is characterized by recurring, crampy lower abdominal pain occurring during menstruation in the absence of pelvic pathology. It is the most common gynaecological complaint among adolescents. According to the literature, young females with primary dysmenorrhea experience stress, anxiety, lower-back pain, and depression. Yoga is widely practiced to improve health and promote relaxation. It includes breath regulation, simple meditation, and practicing particular body postures. Regular Yoga practice can serve as an adjunct to the primary treatment of dysmenorrhea symptoms. This study focuses on the impacts and benefits of yoga in young females with dysmenorrhea and associated physiological changes.

Epigenomic impacts of meditative practices

Meditative practices (MPs) are an inherent lifestyle and healing practice employed in Eastern medicine and spirituality. Integrating MPs into world mainstream medicine (WMM) requires effective empirical investigation of psychophysiological impacts. Epigenomic regulation is a probable mechanism of action that is empirically assessable. Recently, WMM-styled studies have screened the epigenomic impacts of MPs with early encouraging results. This article discusses the variety of MPs extant across three major Eastern religio-spiritual-healing traditions and their integration into WMM via the lens of epigenomic modulation. MPs unanimously report positive impacts on stress-reduction pathways, known to be epigenomically sensitive. Early high-resolution assays show MPs are potent in altering the epigenome - dynamically and by inducing long-term changes. This suggests the importance of integrating MPs into WMM.

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.