Conference Coverage
ORLANDO – They weren’t asked to sit in the lotus pose or study with the monks. Rather, a small group of older veterans were introduced to simple mindfulness meditation, and in a short period, they began doing a better job of managing the stress related to their diabetes and lowered their hemoglobin A 1c levels.
More importantly, most said they enjoyed meditating, according to Monica DiNardo, Ph.D.
By the end of the 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, the participants’ diabetes-related stress had dropped by 41% and their HbA 1c had dropped by roughly 1%.
The study was small – 28 patients – and it was not controlled, "so we really can’t draw generalizations from this," said Dr. DiNardo, who presented the study at the annual meeting of the American Association of Diabetes Educators. What it does show, she said, is that introducing the program wasn’t a distraction to the diabetes education process.
Helping patients manage diabetes-related stress is important, especially in the veteran population, where a quarter, or nearly a 1 million individuals, have diabetes.
And while healthy coping is one of seven self-care behaviors recommended by the AADE7 framework , many persons with diabetes don’t receive training for healthy coping strategies to deal with the stress that usually comes along with having diabetes.
"There’s a need to incorporate practical, evidence-based programs into diabetes self-management education (DSME) to fill this gap," said Dr. DiNardo, a diabetes nurse practitioner and an educator at the VA Pittsburgh.
To assess the feasibility of implementing a brief mindfulness intervention within diabetes self-management education, Dr. DiNardo and her colleagues created an intervention called Mind-STRIDE (Mindfulness Stress Reduction in Diabetes Education).
The research team used several assessment tools, including the Five Facet Mindfulness Questionnaire, Perceived Stress Scale, and Problem Areas in Diabetes Scale (to measure diabetes-related stress) to measure the changes over time.
The 28 veterans, who were on average 60 years old, were enrolled in DSME. The majority had type 2 diabetes and their HbA 1c levels were higher than 7%. Also, half of the group was college educated, nearly 70% were married, and 60% were retired or disabled.
The group received a 90-minute training in mindfulness following their DSME session. Participants were given a CD, recorded by Dr. DiNardo, to practice with at home. They were also given practice diaries. They received a 30-minute booster session 1 month later.
Twenty of the 28 individuals stayed in the study; 11 completed their practice diaries. All said they found the intervention interesting and easy to understand, and almost all said that they learned something new and planned to continue practicing mindfulness.
Results after 3 months showed that there was a significant negative correlation between awareness and nonjudgment – two elements of the five-facet mindfulness – and diabetes-related stress. In contrast, the two facets showed a significant positive correlation with coping abilities. There were also significant positive correlations between the two facets and diabetes self management and the total AADE7 score.
Dr. DiNardo speculated that the meditation helped participants remove the self-judgment attached to having the disease and gain the ability to be aware of the disease and how to cope with it.
When assessing baseline to 3-month gain and effect size for various assessments, all showed changes in a "hopeful" direction, said Dr. DiNardo.
The most significant trend over the 3-month period was the 40% drop in diabetes-related stress (difference in raw scores), measured by the Problem Areas in Diabetes Scale. Meanwhile, awareness and coping ability increased slightly during the study period.
Dr. DiNardo said that the cost associated with implementing the program was minimal, and the only requirement was access to someone who knew mindfulness meditation.
"We need innovative therapy to promote healthy behaviors for patients with diabetes," she said. Mind-body therapies have the potential to serve as a bridge between the clinic and home and give patients yet another tool to manage their diabetes.
Dr. DiNardo had no financial disclosures. The study was supported by a grant from AADE.
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