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Mindfulness may be an unmet need in diabetes care
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We’ve been hearing more about mindfulness and its application to health care — for both patients and physicians. At the institution where I teach, the University of California, San Diego, we include a 5-minute settling exercise before each Practice of Medicine small-group session. As we discuss and remind our students, the goal is not to teach meditation, but to invite these future physicians to bring more awareness to their days and engage more fully in the present. I’ll delve into more on mindfulness with physicians and trainees in a future column. As this practice was unveiled last year in our facilitators’ retreat, I wondered whether mindfulness training in patients has been examined, specifically in those living with diabetes.
Lower stress levels
One clinical trial, the DiaMind study conducted by van Son and colleagues, investigated the impact of 8 weeks of mindfulness practice on HbA1c, quality of life, and emotional distress in 139 individuals living with type 1 or type 2 diabetes who were experiencing emotional distress. The authors assessed mindfulness-based cognitive therapy (MBCT), which promotes mindfulness, defined as “the self-regulation of one’s attention focusing on direct experience, while adopting a curious, open and accepting attitude toward these experiences, especially one’s psychological processes, such as thoughts and feelings.”
The investigators randomly assigned the participants to either the MBCT group or a control group that was placed on a waiting list for this modality (they were provided the mindfulness training 6 months after the MBCT group underwent it). For the primary outcome, the effect of the intervention on emotional distress, which included distress specific to diabetes, general stress, symptoms of anxiety and depression, MBCT showed significant improvement for all but diabetes-specific distress.
Edward C. Chao
The results were mixed for the secondary outcomes of effect on HbA1c and quality of life; investigators found no significant effect on the former, but observed a significant increase for the latter. Issues such as selection bias and a substantial number of participants with unavailable HbA1c values during the study period are among the limitations.
A six-month follow-up study by this team demonstrated sustained improvements in the above outcomes.
Possibility of reduced HbA1c
In another study, conducted by Tovote and colleagues, 94 patients with diabetes and comorbid depression were randomly assigned to cognitive behavior therapy (CBT) or a waiting-list control group. In contrast to the DiaMind study, this trial disclosed significant effects on diabetes-related distress. Similarly, there was no impact on HbA1c, but participants experienced greater decreases in the symptoms of anxiety and depression.
In a pilot study of a mindfulness-based stress reduction program, Rosenzweig and colleagues found a 0.48% decrease in HbA1c at 1 month among the study participants, but the sample size was small.
Though the number of studies is small, I believe that the impact of mindfulness on patients with diabetes — indeed, in all patients and in those who have the privilege of caring for them — is a crucial topic that should be further explored.
References:
- van Son J, et al. Diabetes Care. 2013;doi:10.2337/dc12-1477.
- van Son J, et al. J Psychosom Res. 2014;doi:10.1016/j.jpsychores.2014.03.013.
- Tovote KA, et al. Diabetes Care. 2014;doi:10.2337/dc13-2918.
- Rosenzweig S, et al. Altern Ther Health Med. 2007;13:36-38.
For more information:
- Edward C. Chao, DO, is Associate Professor of Clinical Medicine at the University of California, San Diego, and Staff Physician at VA Medical Center, San Diego.
Disclosure:
- Chao reports no relevant financial relationships.