Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients: design and first results of a randomized controlled trial (the Heidelberger Diabetes and Stress-study)
Mechthild Hartmann, Stefan Kopf, Claudia Kircher, Verena Faude-Lang, Zdenka Djuric, Florian Augstein, Hans-Christoph Friederich, Meinhard Kieser, Angelika Bierhaus, Per M Humpert, Wolfgang Herzog, Peter P Nawroth, Mechthild Hartmann, Stefan Kopf, Claudia Kircher, Verena Faude-Lang, Zdenka Djuric, Florian Augstein, Hans-Christoph Friederich, Meinhard Kieser, Angelika Bierhaus, Per M Humpert, Wolfgang Herzog, Peter P Nawroth
Abstract
Objective: To determine whether a mindfulness-based stress reduction (MBSR) intervention is effective for reducing psychosocial distress (i.e., depression, psychosocial stress) and the progression of nephropathy (i.e., albuminuria) and for improving the subjective health status of patients with type 2 diabetes.
Research design and methods: Patients with type 2 diabetes and microalbuminuria were randomized to a mindfulness-based intervention (n = 53) or a treatment-as-usual control (n = 57) group. The study is designed to investigate long-term outcomes over a period of 5 years. We present data up to the first year of follow-up (FU).
Results: At FU, the MBSR group showed lower levels of depression (d = 0.71) and improved health status (d = 0.54) compared with the control group. No significant differences in albuminuria were found. Per-protocol analysis also showed higher stress reduction in the intervention group (d = 0.64).
Conclusions: MBSR intervention achieved a prolonged reduction in psychosocial distress. The effects on albuminuria will be followed up further.
Trial registration: ClinicalTrials.gov NCT00263419.
References
- Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069–1078
- Pouwer F, Kupper N, Adriaanse MC. Does emotional stress cause type 2 diabetes mellitus? A review from the European Depression in Diabetes (EDID) Research Consortium. Discov Med 2010;9:112–118
- de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001;63:619–630
- Lin EH, Rutter CM, Katon W, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 2010;33:264–269
- Bierhaus A, Wolf J, Andrassy M, et al. A mechanism converting psychosocial stress into mononuclear cell activation. Proc Natl Acad Sci USA 2003;100:1920–1925
- Bierhaus A, Nawroth PP. Multiple levels of regulation determine the role of the receptor for AGE (RAGE) as common soil in inflammation, immune responses and diabetes mellitus and its complications. Diabetologia 2009;52:2251–2263
- Rosenzweig S, Reibel DK, Greeson JM, et al. Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Altern Ther Health Med 2007;13:36–38
- Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. J Consult Clin Psychol 2007;75:336–343
- Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 2004;57:35–43
- Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res 2010;68:539–544
- Kabat-Zinn J. Full Catastrophy Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York, Delacorte, 1990
- Faude-Lang V, Hartmann M, Schmidt EM, Humpert P, Nawroth P, Herzog W. Acceptance- and mindfulness-based group intervention in advanced type 2 diabetes patients: therapeutic concept and practical experiences. Psychother Psychosom Med Psychol 2010;60:185–189 [in German]
- Spitzer RL, Williams JBW, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol 2000;183:759–769
- Ware JE, Jr, Gandek B, Kosinski M, et al. The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998;51:1167–1170
Source: PubMed