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NRI 15-150 – HSR&D Study

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NRI 15-150
Effects of a Mindfulness Intervention Delivered within Diabetes Education on Diabetes-related Outcomes in Military Veterans
Monica M. DiNardo PhD ARNP CDE
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, PA
Funding Period: July 2016 - June 2020

BACKGROUND/RATIONALE:
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.

OBJECTIVE(S):
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.

METHODS:
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.

FINDINGS/RESULTS:
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.

IMPACT:
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.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Diabetes and Related Disorders
DRE: Treatment - Observational, TRL - Applied/Translational
Keywords: none
MeSH Terms: none

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