A Mindful Approach to Diabetes Self-management Education with Stress Reduction and Healthy Coping for US Veterans with Diabetes

Negative emotional states impact the performance of diabetes self-care behaviors and may jeopardize metabolic control leading to acute and chronic complications. In addition, daily self-care demands commonly result in diabetes-related distress, adding to disease burden. Healthy coping is recognized as being essential to successful diabetes self-management, but little is offered during routine diabetes education to cultivate this key self-care behavioral outcome. Approximately 40% of the US population uses some form of Complementary and Alternative Medicine. The study of Mindfulness Meditation in chronic health conditions including diabetes is an emerging science. We conducted two pilot studies of Mindfulness in relation to measures of stress and glycemic control in individuals with diabetes who are at increased risk for complications of stress: women and US Veterans. In a preliminary mixed-methods pilot study of Mindfulness-Based Stress Reduction in six women with type 2 diabetes, two qualitative themes emerged: 1) improved coping, and 2) connecting mind and body. Quantitative analysis showed positive pre-post changes in Mindfulness, perceived stress, diabetes-related distress, and Hba1c that demonstrated moderate to large effect sizes. A MINDFUL APPROACH TO DIABETES SELF-MANAGEMENT EDUCATION WITH STRESS REDUCTION AND HEALTHY COPING FOR US VETERANS WITH DIABETES Monica Marten DiNardo Ph.D. University of Pittsburgh, 2013 University of Pittsburgh, [year] v A second study of US Veterans with diabetes (n=35) who were recruited from a Diabetes Education program within the Veterans Affairs Healthcare System found a high rate of retention (71%) and satisfaction among participants who received the Mindfulness intervention. Ninety-two percent of Veterans who participated in the 90-minute mindfulness training class and 30- minute booster session plus home Mindfulness practice over a 3-month period would recommend the class to other people with diabetes. Nonparametric repeated measures analysis of variance found significant improvements in diabetes-related distress, and in 3-facets of mindfulness (observing, describing and acting with awareness). Pairwise comparisons showed a significant improvement in diabetes self-management behaviors and attainment of goals that correlated positively with measures of diabetes-related coping and negatively with diabetes-related distress. Hba1c decreased significantly from baseline to 3 months (8.35% 1.6; 7.31% SD 1.22; z=-2.154, p=.03; d=.73). These findings support the feasibility, acceptability, and possible benefits of a Mindfulness-based program offered as part of routine diabetes education for Veterans with diabetes, and warrant further study