Mindfulness-based Cognitive Therapy to Improve Emotional Wellbeing and Glycaemic Control in Diabetes (MILESTONE)

May 8, 2018 updated by: University of Aberdeen

Exploring the Effectiveness of Mindfulness-based Cognitive Therapy to Improve Emotional Wellbeing and Glycaemic Control Among Adults With Diabetes

Type 1 and 2 diabetes are challenging conditions to manage. Anxiety and depression are common among this group and are associated with poorer diabetes control. No trials have been conducted to ascertain the effectiveness of psychological interventions designed to alleviate significant levels of anxiety and/or depression and improve glycaemic control among those with diabetes who have significant difficulties with their emotional wellbeing and diabetes control.

The aim of this project is to establish if it is feasible to run a multi-site randomised controlled trial in Scotland exploring whether an 8-week mindfulness and self-management based intervention programme decreases anxiety and/or depression, and improves diabetes control. This feasibility study, based on the MRC framework for assessing feasibility and piloting methods, will assess the relative strengths and weaknesses of the intervention and study design, and pave the way for a larger and definitive trial.

Study Overview

Status

Completed

Detailed Description

This is a feasibility trial informed by the MRC guidelines. It is a small RCT, where participants are randomised to either the MBCT intervention or waiting list control. Participants will be receiving their diabetes care in Aberdeen and Glasgow, and randomisation will occur at each site. The participants who are allocated to the waiting list control group will receive the MBCT intervention 3 months after the intervention group complete their MBCT programme.

The investigators will recruit participants using posters and leaflets, word of mouth from diabetes professionals, and from writing to those who are eligible. All of these methods are simply to raise awareness of the study. The intervention requires considerable commitment from participants (as indicated below) and this will be fully explained and explored. It will be up to potential participants to make initial contact with the research team, at which point they will be invited to the diabetes outpatient clinic for a discussion about what the project entails, the nature of mindfulness, and to go through the usual consent procedure.

In the cases of those people who agree to participate, the investigators will write to their GP and to their diabetes consultant to let them know that their patient has enrolled in the study, and provide brief information about the project.

The MBCT intervention is manualised and delivered to groups. The aim of the MBCT intervention is to increase mindfulness skills and to facilitate their use in relation to emotional wellbeing and diabetes self-management. Participants will attend on 8 occasions, once per week, for 2 hours. These meetings will have a standard structure. First, participants will describe their efforts to practice mindfulness at home over the previous week, followed by discussion of an educational topic relevant to the aims of the course. Finally, the group will do a mindfulness practice together, and the home practice for the following week will be set. In-between meetings, participants are asked to practice mindfulness by listening to an audio file or CD for about 30 minutes per day.

The research assistants will administer brief, self-report inventories at baseline; post-treatment and at 3 months follow-up to establish participants' level of mindfulness (Cognitive and Affective Mindfulness Scale-Revised);

  1. diabetes-specific distress (Problem Areas in Diabetes; PAID);
  2. anxiety and depression (Hospital Anxiety and Depression Scale; HADS);
  3. positive emotional wellbeing (Warwick-Edinburgh Mental Wellbeing Scale);
  4. satisfaction with treatment provision (Diabetes Treatment Satisfaction Questionnaire);
  5. health-related quality of life (EQ-5D-5L),
  6. and the Fear of Hypoglycaemia Scale.
  7. During the intervention, the investigators will also ask participants to keep a diary of the number of times they completed the formal mindfulness exercises or these will be recorded using an specially designed app, and keep a record of attendance at group sessions.

Moreover, the investigators will request details of the frequency of severe hypoglycaemia (defined as occasion they needed help to correct blood glucose levels); mild-moderate (self-corrected) hypoglycaemia, and the number of admissions for diabetic ketoacidosis in the 6 months preceding the beginning of the MBCT course and for the period between the end of treatment and follow-up. The investigators will record the baseline HbA1c values and again obtain this at the 3 month follow-up point. Finally, participants will be asked to keep a diary of their health care use (for example, GP visits; calls to the diabetes specialist nurses; visits to secondary care diabetes health professional, and so on) during the previous 6 months at baseline and 3 months prior to follow-up. In addition, NHS Scotland; NHS Grampian, and NHS Glasgow electronic systems (eg, SCI-Diabetes and SCI-Store) will be used to obtain an accurate account of contact with secondary health professions.

The research assistants will also conduct one-to-one qualitative interviews with 10-15 participants, with equal numbers (for example, 6) from the MBCT group about 1 month after the end of the intervention. Interviews will be conducted with participants located in Aberdeen and Glasgow. These semi-structured interviews will focus on patients' views on why they volunteered; their expectations of the intervention; the acceptability of the intervention and measures; perceived benefits, and any difficulties they experienced during their participation. The investigators will also be keen to hear their thoughts on key characteristics of the facilitators; how best to attract potential participants in a future definitive trial, and ways to overcome any pragmatic difficulties, they experienced. The investigators will also attempt to contact all study drop-outs for a brief (5-10 minute) telephone interview on reasons for drop-out. This will include those who drop out prior to participation in the groups, those who drop out during group sessions, and those who complete group participation but fail to complete follow-up measures. Consent to contact for this reason will be obtained on entry to the study and this has proved acceptable in a current MBCT feasibility study using volunteer recruits. Analysis of qualitative data will be theoretically informed by Normalisation Process Theory (NPT) which specifically addresses the identification of barriers and facilitators to up-take of interventions or processes of change.

Standard demographic information including socio-economic status will be collected as will the co-existence of other conditions (co-morbidity). The investigators will also record standard diabetes health information such as time since diagnosis; any complications present, and any changes in medication between baseline and follow-up. The Scottish Index of Multiple Deprivation (SIMD) will be ascertained from participants' postcodes. The study will end on the date that the last data are collected.

Study Type

Interventional

Enrollment (Actual)

29

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Aberdeen, United Kingdom, AB25 2ZD
        • University of Aberdeen

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adults (over the age of 18 years)
  • Type 1 or Type 2 diabetes, diagnosed at least 1 year ago
  • Mild to moderate levels of anxiety and/or depression (ie, HADS scores of ≥ 8)
  • Most recent HbA1c value of ≥ 75 mmol/mol (Type 1) or ≥ 61 mmol/mol (Type 2).

Exclusion Criteria:

  • Severe mental health problems (such as severe depression with suicidal ideation, psychosis, personality disorder)
  • Terminal illness
  • Inability to give informed consent in English
  • Inability to understand written and spoken English.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: MBCT Intervention
Participants in the Mindfulness-based Cognitive Therapy Intervention arm will receive an 8-week programme in mindfulness-based cognitive therapy
The MBCT intervention is manualised and delivered to groups. The aim of the MBCT intervention is to increase mindfulness skills and to facilitate their use in relation to emotional wellbeing and diabetes self-management. Participants will attend on 8 occasions, once per week, for 2 hours. These meetings will have a standard structure. First, participants will describe their efforts to practice mindfulness at home over the previous week, followed by discussion of an educational topic relevant to the aims of the course. Finally, the group will do a mindfulness practice together, and the home practice for the following week will be set. In-between meetings, participants are asked to practice mindfulness by listening to an audio file or CD for about 30 minutes per day.
Other Names:
  • MBCT
No Intervention: Waiting List Control
The participants who are allocated to the waiting list control group will receive usual care. They will receive the MBCT intervention 3 months after the intervention group complete their MBCT programme.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Recruitment/Retention Rates
Time Frame: 20 months
This study aims to establish if a large scale, definitive RCT of a specifically designed mindfulness-based group intervention, with self-management activation embedded within the programme structure, for adults with diabetes and significant emotional distress, is feasible, justified, and potentially cost-effective. The primary outcome, which will decide whether or not a full trial is feasible, will be based on rates of recruitment and retention of participants.
20 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acceptability
Time Frame: 20 months
A secondary outcome, which will also influence whether or not a full trial is feasible, will be based on qualitative data collected from participants about their experience of the intervention and of taking part in the trial.
20 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Andrew Keen, PhD, NHS Grampian

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 30, 2015

Primary Completion (Actual)

December 1, 2017

Study Completion (Actual)

December 1, 2017

Study Registration Dates

First Submitted

November 4, 2015

First Submitted That Met QC Criteria

November 5, 2015

First Posted (Estimate)

November 9, 2015

Study Record Updates

Last Update Posted (Actual)

May 9, 2018

Last Update Submitted That Met QC Criteria

May 8, 2018

Last Verified

October 1, 2017

More Information

Terms related to this study

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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