Health Services Research & Development

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HSR&D In Progress

April 2019

In This Issue: Improving Care for Veterans with Diabetes
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Effects of Mindfulness Intervention and Disease Education among Veterans with Diabetes

Feature Article


In pilot work, study investigators developed a brief stress management intervention known as Mind-STRIDE (Mindful Stress Management In Diabetes Education), which contains mindfulness training and home practice and is easily integrated into existing diabetes self-management education.

Diabetes self-management (DSM) is essential for glycemic control and prevention of potentially life-threatening and disabling complications such as severe hypoglycemia, kidney failure, acute coronary syndrome, and stroke. Importantly, 40% of individuals with diabetes suffer from diabetes-related distress that interferes with their ability to sustain healthy self-management behaviors – and may be particularly problematic for Veterans who are at higher risk for mental health comorbidities (i.e., depression, PTSD). Diabetes self-management education (DSME) has traditionally contained little content or skill-building directly related to stress management, leaving this critical component of diabetes self-management largely unaddressed in DSME. In pilot work, study investigators developed a brief stress management intervention known as Mind-STRIDE (Mindful Stress Management In Diabetes Education), which contains mindfulness training and home practice and is easily integrated into existing diabetes self-management education.

While investigators have previously demonstrated the feasibility, patient acceptability, and initial efficacy of Mind-STRIDE, its effects on diabetes-related psychological and physiological patient outcomes remain unknown. Thus, the main objective of this ongoing (2016–2019) randomized controlled trial is to determine the efficacy of Mind-STRIDE for improving diabetes-related distress, diabetes self-efficacy, DSM, and metabolic control – and to characterize distinctive Veteran experiences with diabetes-related distress and Mind-STRIDE. Investigators will ultimately recruit and randomly assign 126 Veterans at a large urban VA medical center to one of two study conditions: 1) an experimental group that receives routine diabetes education plus Mind-STRIDE, or 2) a usual care group that receives diabetes education alone. Diabetes-related distress, diabetes self-efficacy, and DSM will be measured using self-report questionnaires. Metabolic control (Hemoglobin A1c) will be assessed using standard laboratory procedures. Data will be collected at baseline, 12 weeks, and 24 weeks. Telephone interviews will be conducted at 15 weeks post-intervention in a subset of participants from the experimental group.

Findings: Data collection is ongoing, but preliminary feedback from telephone interviews conducted with experimental group participants suggests that Veterans are satisfied with the Mind-STRIDE program and have integrated it into both their diabetes care and other aspects of their lives where stress reduction is needed.

Impact: Mind-STRIDE is expected to offer VA providers a new evidence-based, patient-centered approach that provides a bridge from the clinic to home and supports positive diabetes self-management behaviors.

Principal Investigator: Monica DiNardo, PhD, ARNP, CDE, is part of HSR&D’s Center for Health Equity Research & Promotion (CHERP) in Pittsburgh, PA.

Publications:

DiNardo M, Saba S, Greco C, et al. A Mindful approach to diabetes self-management education and support for Veterans. The Diabetes Educator. December 2017;43(6):608-20.

View project abstract.

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