Disclosures: The authors report no relevant financial disclosures.
April 19, 2021
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Mindfulness, acceptance-based diabetes education may reduce distress, lower HbA1c

Disclosures: The authors report no relevant financial disclosures.
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Mindfulness- and acceptance-based approaches to diabetes education may lower diabetes distress and HbA1c more than usual care for adults with type 2 diabetes, according to findings published in Diabetic Medicine.

“The results of our meta-analysis indicate that mindfulness- and acceptance-based interventions may more effectively reduce diabetes distress and HbA1c levels than diabetes education or treatment as usual, both immediately and up to 1-month post-intervention, with small to medium effect sizes,” Wai Tong Chien, BN (Hons), PGDip (NEd), MPhil, PhD, RMN, RTN, FAAN, FHKAN, director of the Nethersole School of Nursing at the Chinese University of Hong Kong, and colleagues wrote. “This novel finding clarifies the current inconclusive evidence regarding the clinical effectiveness of mindfulness- and acceptance-based interventions for both diabetes distress and HbA1c.”

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Researchers conducted a database search through June 2020 for randomized controlled trials that included mindfulness- or acceptance-based interventions for community-dwelling adults with type 2 diabetes. All studies had a usual care diabetes education group as the control cohort and had diabetes distress or glycemic level as a primary outcome.

Researchers included nine studies involving 801 participants in the meta-analysis. Seven studies included only people with type 2 diabetes, whereas two had participants with both type 1 and type 2 diabetes. Of the nine studies, four examined acceptance and commitment therapy, and the remaining five evaluated mindfulness interventions. Group-based and therapy-led interventions were conducted in seven of the nine studies.

In meta-analysis of four studies involving 319 participants, adults participating in mindfulness- or acceptance-based interventions had a significant reduction in diabetes distress compared with the control cohort (standardized mean difference, –0.37; 95% CI, –0.62 to –0.12; P < .01). A meta-analysis of three studies involving 306 participants revealed similar results for changes in glycemic level, with those participating in mindfulness- or acceptance-based programs having greater reductions in HbA1c up to 1 month after intervention compared with adults receiving usual care (standardized mean difference, –0.35; 95% CI, –0.67 to –0.04; P < .03). There was no significant difference between the intervention and control groups 3 to 6 months after intervention.

Meta-analysis of three studies focused on mindfulness programs revealed the intervention groups had reductions in anxiety (standardized mean difference, –0.41; 95% CI, –0.66 to –0.15; P = .002) and depression (standardized mean difference, –0.53; 95% CI, –0.82 to –0.25; P < .001) immediately after the intervention compared with the control cohorts. The interventions did not have a significant effect on stress. No significant difference in diabetes self-management was found between the intervention and control groups 3 to 6 months after intervention.

“The short-term positive effects observed in our meta-analyses might be overestimated because of the pooling of the included studies with small sample sizes, which were underpowered to detect individual intervention effects,” the researchers wrote.

More randomized controlled trials are needed to better examine the effects of both mindfulness- and acceptance-based interventions in the future, according to the researchers. Additionally, they said future studies should examine the impact of interventions on larger and more diverse study populations.