Mindfulness training benefits U.S. veterans with diabetes

Many people who have diabetes suffer from diabetes-related distress, meaning they have persistent feelings of unease and worry regarding the daily demands of the disease and possibility of having serious complications. Diabetes-related distress is associated with poorer self-management and negative effects of the disease. The researchers analyzed whether including mindfulness training as part of the veterans' diabetes self-management education (DSME) helped them cope with diabetes-related distress.

"The veterans were much more receptive to mindfulness training than we anticipated," said Monica M. DiNardo, Ph.D., principal investigator, diabetes educator, nurse practitioner and health scientist at the VA Pittsburgh Healthcare System. "We were surprised at the dramatic decrease in diabetes-related stress. The veterans said the more mindful they were, the better they were able to manage their diabetes."

The study included 28 veterans with Type 1 and Type 2 diabetes who participated in the Mind-STRIDE program at VA Pittsburgh, which stands for Mindful Stress Reduction In Diabetes Education. The program presented information on what stress does to the body and how mindfulness training can help reduce stress, and provided practical training in mindful stress reduction techniques. The participants learned how to:

• Be "more present"

• Improve their body awareness

• Separate thoughts, emotions and body sensations

• Develop focused attention

They were directed to practice the techniques of focused breathing and mindful movement for 15 minutes every day for three months, and were given a CD to guide them through the exercises at home.

Dr. DiNardo and her colleagues used scientifically validated questionnaires to measure diabetes-related distress and diabetes self-management behaviors, which were completed by the veterans before the class, one month after the class and three months later. During those times, researchers also conducted A1C tests before the class and then at three months to measure the three-month average concentration of glucose (sugar) in the blood, a reflection of how well the diabetes is being controlled. (Ideally those levels should be below 7.)

After three months, on average, the veterans' diabetes-related distress decreased by 41 percent, and their A1C levels fell from 8.3 to 7.3, a significant drop. Their management of diabetes improved, meaning they were meeting more AADE-7™ self-care behavioral goals of healthy eating, being active, monitoring, taking medication, problem solving, healthy coping and reducing risks.

"We got lots of positive comments from the veterans," said Dr. DiNardo. "Some said they were originally skeptical, but tried it and it worked. Others said they found it gave them a different way to approach their thinking about diabetes that helped them feel better about themselves."

Diabetes is a significant problem in the U.S. veteran population. More than 25 percent of the 1 million veterans who have received care through the Veterans Administration have diabetes.

More than 29 million Americans -- nearly one in 10 -- have diabetes, a disorder in which the body doesn't effectively process glucose, which provides the body fuel for energy and growth. If diabetes isn't treated, it can lead to serious health issues such as heart disease, blindness and kidney problems. In Type 1 diabetes, the body doesn't produce insulin, which processes glucose. In Type 2 diabetes, the body doesn't produce enough insulin, or doesn't react properly to the insulin it does produce. More than 90 percent of people with diabetes have Type 2. Diabetes can't be cured, but can be managed with medication and lifestyle changes.