Effects of Mindfulness-Based Stress Reduction on Insulin-Treated Diabetes

Abstract

Patients with type 1 (T1D) and type 2 diabetes (T2D) on insulin experience significant diabetes related distress (DD) which is known to negatively impact overall health and ability to self-manage the disease. Mindfulness Based Stress Reduction (MBSR) is an 8-week in-person group-taught program that has been shown to be effective in improving outcomes in chronic diseases. However, MBSR research in diabetes has been limited and has not included complex diabetes. We hypothesized that MBSR would lower DD and improve glycemic control in patients with uncontrolled insulin-treated diabetes. We conducted a nonrandomized pilot feasibility study of MBSR in insulin-treated patients with A1c above goal. Subjects completed the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) surveys at baseline, 3 months, and 6 months post intervention. Of 335 patients screened, 10 were enrolled. Patient characteristics included mean age 50.8 years; 60% female; 100% white non-Hispanic; mean baseline A1c= 8.6% +/-0.8. Duration of diabetes was 14 years +/-9; 30% T1D, 70% T2D; 100% on insulin; 70% injected insulin at least 3 times per day. Subjects attended 26 hours of in-class contact. Nine subjects completed the study; one was excluded due to interim pregnancy. All had decreased total DDS scores. There were statistically significant reductions in two DDS domains: emotional (-1.2, p=0.01) and regimen-related distress (-1.2, p=0.004). At 6 months, the mean A1c reduction was -0.4% +/- 0.9. The reduction in PAID score correlated with A1c reduction (r= 0.5). In conclusion, uncontrolled insulin treated diabetes patients who participated in MBSR experienced a sustainable improvement in emotional and regimen-related distress which was accompanied by lower A1c. Results suggest the need for a large clinical trial designed to optimize accessibility to a broader population of patients and to test the cost-effectiveness of this nonpharmacologic intervention. Disclosure R. Rein: None. M. Searl: None. S. Bhandari: None. K.E. Cote: None. I. Hashmi: None. K.L. Del Valle: None. M.E. McDonnell: None.