One million Veterans (25%) who receive health care through Veterans Health Administration (VHA) have diabetes and are therefore responsible for daily diabetes self-management (DSM). 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 (DRD) that interferes with their ability to sustain healthy self-management behaviors, and may be particularly problematic for Veterans who are at higher risk for comorbid negative emotional states such as depression and post-traumatic stress disorder.
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 our pilot work, we have developed a brief stress management intervention known as Mind-STRIDE, which contains mindfulness training and home practice and is easily integrated into existing DSME. While we 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. There is, therefore, a critical need to determine the efficacy of this targeted mindfulness intervention for improving DRD, diabetes self-efficacy, DSM behaviors, and metabolic control of Veterans with diabetes in order to offer comprehensive, evidence-based DSME that improves Veteran-centric diabetes outcomes.
The objectives of this study are to determine the efficacy of Mind-STRIDE for improving DRD, diabetes self-efficacy, DSM, and metabolic control, and to characterize distinctive Veteran experiences with DRD and Mind-STRIDE.
To achieve these objectives, we will conduct a randomized controlled trial of 126 Veterans at a large VA medical center in southwest PA. Participants will be assigned to one of two study conditions: an experimental group that receives routine diabetes education plus Mind-STRIDE, or to a usual care group that receives diabetes education alone. DRD, diabetes self-efficacy, and DSM will be assessed through 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, and will be analyzed using mixed-effects models. Telephone interviews will be conducted at 15-weeks post-intervention in a subset of participants from the experimental group, and will be analyzed using modified Grounded Theory methods. Quantitative and qualitative findings will be compared and interpreted using Convergent Parallel Design.
The sample of participants recruited thus far (n=62) is mostly older, white male Veterans with a diagnosis of type 1 or type 2 diabetes. The average PAID score (Problem Areas in Diabetes, a measure of DRD) for the sample thus far at baseline is 36.8/100, generally indicating high levels of DRD, and the average hemoglobin A1c value at baseline is 8.7%, indicating poor glycemic control. Data collection is ongoing, but preliminary feedback from the qualitative telephone interviews conducted with experimental group participants suggests that participants are satisfied with the Mind-STRIDE training program and have integrated it into both their diabetes care and other aspects of their lives where stress reduction is needed.
By examining the acceptance and effects of Mind-STRIDE among Veterans who have diabetes, the VA will benefit from new evidence-based, patient-centered approaches that support self-care and provide a bridge from the clinic to home.
Data collection is ongoing. There are no further anticipated impacts to describe at this time.
- DiNardo MM, Phares AD, Jones HE, Beyer NM, Suss SJ, McInnes S, Rodriguez KL. Veterans' Experiences With Diabetes: A Qualitative Analysis. The Diabetes educator. 2020 Dec 1; 46(6):607-616.