AADE 14

ORLANDO – Evidence increasingly supports plant-based nutrition for preventing diabetes or improving outcomes in those with diabetes.

The Adventist Health Study-2 (AHS-2), for example, demonstrated that a plant-based eating pattern – defined as ad libitum whole grains, legumes, fruits, and vegetables, and avoidance of all animal products, added oils, and high-fat foods – reduced the incidence of type 2 diabetes. The prospective cohort study involving more than 96,000 adults demonstrated that body mass index and the incidence of diabetes increased in tandem with the amount of animal products in the diet, according to Meghan Jardine, who reviewed the recent literature on plant-based nutrition in a poster presented at the annual meeting of the American Association of Diabetes Educators.

Courtesy of National Cancer Institute

The prevalence of type 2 diabetes among nonvegetarians, semivegetarians, pescovegetarians, lacto-ovovegetarians, and vegans in that study was 7.6%, 6.1%, 4.9%, 3.2%, and 2.9%, respectively, and BMI for each of those groups was 28.8, 27.3, 26.3, 25.7, and 23.6 kg/m², respectively, said Ms. Jardine, a registered and licensed dietician, certified diabetes educator, and diabetes education coordinator at Parkland Health and Hospital System, Dallas.

AHS-2 also demonstrated increased longevity in those who followed a plant-based eating pattern, with men living 9.5 years longer and women living 6.1 years longer than their meat-eating counterparts (JAMA 2013;173:1230-8).

In addition, a National Institutes of Health study demonstrated that a low-fat vegan diet led to significantly greater improvements in glycemic and lipid control than did a conventional diabetes diet in patients with type 2 diabetes.

Hemoglobin A_1c levels in 49 patients on the low-fat vegan diet improved from 8.06 to 7.65 at 74 weeks, but while the levels in 50 patients on the conventional diabetes diet initially improved from 7.93 to about 7.7 at 11 weeks, at 74 weeks they had increased to 7.94 (Diabetes Care 2006;29:1777-83).

Among the other findings that Ms. Jardine mentioned were those from "a remarkable study" in which 17 of 21 patients with sharp, burning pain characteristic of distal polyneuropathy experienced complete pain relief after initiating a low-fat, high-fiber, vegan diet along with a daily 30-minute walk, and findings from several studies that have suggested that plant-based eating preserved renal function.

Moreover, a plant-based eating pattern has been shown to reverse coronary artery disease and improve magnesium intake (which reduces insulin resistance), and the high fiber intake associated with plant-based eating improves glucose control and decreases mortality from circulatory, digestive, and inflammatory disease, she said.

Two recent studies demonstrated that meat consumption substantially increases the risk of type 2 diabetes. Even just a half serving per day increase was associated with a 48% increase over 4 years in one study (JAMA Intern. Med. 2013;173:1328-35).

Ms. Jardine noted that the Academy of Nutrition and Dietetics position is that "appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain disease," and that such diets have been found to be "highly acceptable in diverse populations with various disease states" (Diabetes Educ. 2010:36:33-48).

She warned that patients with diabetes who are on medications and who begin to follow a plant-based eating pattern should be instructed about how to recognize and treat hypoglycemia, as adjustments to medications that lower glucose, blood pressure, and cholesterol may be needed.

Ms. Jardine reported having no disclosures.

ORLANDO – Evidence increasingly supports plant-based nutrition for preventing diabetes or improving outcomes in those with diabetes.

The Adventist Health Study-2 (AHS-2), for example, demonstrated that a plant-based eating pattern – defined as ad libitum whole grains, legumes, fruits, and vegetables, and avoidance of all animal products, added oils, and high-fat foods – reduced the incidence of type 2 diabetes. The prospective cohort study involving more than 96,000 adults demonstrated that body mass index and the incidence of diabetes increased in tandem with the amount of animal products in the diet, according to Meghan Jardine, who reviewed the recent literature on plant-based nutrition in a poster presented at the annual meeting of the American Association of Diabetes Educators.

Courtesy of National Cancer Institute

The prevalence of type 2 diabetes among nonvegetarians, semivegetarians, pescovegetarians, lacto-ovovegetarians, and vegans in that study was 7.6%, 6.1%, 4.9%, 3.2%, and 2.9%, respectively, and BMI for each of those groups was 28.8, 27.3, 26.3, 25.7, and 23.6 kg/m², respectively, said Ms. Jardine, a registered and licensed dietician, certified diabetes educator, and diabetes education coordinator at Parkland Health and Hospital System, Dallas.

AHS-2 also demonstrated increased longevity in those who followed a plant-based eating pattern, with men living 9.5 years longer and women living 6.1 years longer than their meat-eating counterparts (JAMA 2013;173:1230-8).

In addition, a National Institutes of Health study demonstrated that a low-fat vegan diet led to significantly greater improvements in glycemic and lipid control than did a conventional diabetes diet in patients with type 2 diabetes.

Hemoglobin A_1c levels in 49 patients on the low-fat vegan diet improved from 8.06 to 7.65 at 74 weeks, but while the levels in 50 patients on the conventional diabetes diet initially improved from 7.93 to about 7.7 at 11 weeks, at 74 weeks they had increased to 7.94 (Diabetes Care 2006;29:1777-83).

Among the other findings that Ms. Jardine mentioned were those from "a remarkable study" in which 17 of 21 patients with sharp, burning pain characteristic of distal polyneuropathy experienced complete pain relief after initiating a low-fat, high-fiber, vegan diet along with a daily 30-minute walk, and findings from several studies that have suggested that plant-based eating preserved renal function.

Moreover, a plant-based eating pattern has been shown to reverse coronary artery disease and improve magnesium intake (which reduces insulin resistance), and the high fiber intake associated with plant-based eating improves glucose control and decreases mortality from circulatory, digestive, and inflammatory disease, she said.

Two recent studies demonstrated that meat consumption substantially increases the risk of type 2 diabetes. Even just a half serving per day increase was associated with a 48% increase over 4 years in one study (JAMA Intern. Med. 2013;173:1328-35).

Ms. Jardine noted that the Academy of Nutrition and Dietetics position is that "appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain disease," and that such diets have been found to be "highly acceptable in diverse populations with various disease states" (Diabetes Educ. 2010:36:33-48).

She warned that patients with diabetes who are on medications and who begin to follow a plant-based eating pattern should be instructed about how to recognize and treat hypoglycemia, as adjustments to medications that lower glucose, blood pressure, and cholesterol may be needed.

Ms. Jardine reported having no disclosures.

ORLANDO – Evidence increasingly supports plant-based nutrition for preventing diabetes or improving outcomes in those with diabetes.

The Adventist Health Study-2 (AHS-2), for example, demonstrated that a plant-based eating pattern – defined as ad libitum whole grains, legumes, fruits, and vegetables, and avoidance of all animal products, added oils, and high-fat foods – reduced the incidence of type 2 diabetes. The prospective cohort study involving more than 96,000 adults demonstrated that body mass index and the incidence of diabetes increased in tandem with the amount of animal products in the diet, according to Meghan Jardine, who reviewed the recent literature on plant-based nutrition in a poster presented at the annual meeting of the American Association of Diabetes Educators.

Courtesy of National Cancer Institute

The prevalence of type 2 diabetes among nonvegetarians, semivegetarians, pescovegetarians, lacto-ovovegetarians, and vegans in that study was 7.6%, 6.1%, 4.9%, 3.2%, and 2.9%, respectively, and BMI for each of those groups was 28.8, 27.3, 26.3, 25.7, and 23.6 kg/m², respectively, said Ms. Jardine, a registered and licensed dietician, certified diabetes educator, and diabetes education coordinator at Parkland Health and Hospital System, Dallas.

AHS-2 also demonstrated increased longevity in those who followed a plant-based eating pattern, with men living 9.5 years longer and women living 6.1 years longer than their meat-eating counterparts (JAMA 2013;173:1230-8).

In addition, a National Institutes of Health study demonstrated that a low-fat vegan diet led to significantly greater improvements in glycemic and lipid control than did a conventional diabetes diet in patients with type 2 diabetes.

Hemoglobin A_1c levels in 49 patients on the low-fat vegan diet improved from 8.06 to 7.65 at 74 weeks, but while the levels in 50 patients on the conventional diabetes diet initially improved from 7.93 to about 7.7 at 11 weeks, at 74 weeks they had increased to 7.94 (Diabetes Care 2006;29:1777-83).

Among the other findings that Ms. Jardine mentioned were those from "a remarkable study" in which 17 of 21 patients with sharp, burning pain characteristic of distal polyneuropathy experienced complete pain relief after initiating a low-fat, high-fiber, vegan diet along with a daily 30-minute walk, and findings from several studies that have suggested that plant-based eating preserved renal function.

Moreover, a plant-based eating pattern has been shown to reverse coronary artery disease and improve magnesium intake (which reduces insulin resistance), and the high fiber intake associated with plant-based eating improves glucose control and decreases mortality from circulatory, digestive, and inflammatory disease, she said.

Two recent studies demonstrated that meat consumption substantially increases the risk of type 2 diabetes. Even just a half serving per day increase was associated with a 48% increase over 4 years in one study (JAMA Intern. Med. 2013;173:1328-35).

Ms. Jardine noted that the Academy of Nutrition and Dietetics position is that "appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain disease," and that such diets have been found to be "highly acceptable in diverse populations with various disease states" (Diabetes Educ. 2010:36:33-48).

She warned that patients with diabetes who are on medications and who begin to follow a plant-based eating pattern should be instructed about how to recognize and treat hypoglycemia, as adjustments to medications that lower glucose, blood pressure, and cholesterol may be needed.

Ms. Jardine reported having no disclosures.

ORLANDO – A new online tool designed to guide patients who had inadequately controlled type 2 diabetes in making decisions about their self-care got high marks from users during pilot clinical testing.

The patient decision aid (PDA), which was developed with input from patients, clinicians, and an expert panel using a process guided by the International Patient Decision Aid Standards (IPDAS) Collaboration, received an average survey score of 73.31 out of 100 for preparing users for decision making, based on post-test responses from 10 patients. Decision self-efficacy survey scores improved from 84.32 at baseline to 94.32 post test, knowledge (about diabetes and treatment) scores improved from 56.41 to 74.00, and decisional conflict scores improved from 47.32 to 29.11, Alicia C. Shillington, Ph.D., R.N., reported in a poster at the annual meeting of the American Association of Diabetes Educators.

Two-week post-test scores for knowledge and decisional conflict showed sustained benefit, with slight improvement to 74.90 and 26.79, respectively, according to Dr. Shillington of EPI-Q Inc., Oak Brook, Ill.

The final PDA was first tested in two patient focus groups, then in the 10 patients in the pilot study. The patients had type 2 diabetes and were taking metformin. They were evaluated prior to receiving the PDA, immediately after, and again at a 2-week follow-up.

All clinicians who tested the PDA endorsed it, and the vast majority (90%-100% on all measures) said the PDA could help facilitate key aspects of shared decision making (SDM). For example, they said the PDA could help patients understand the risks and benefits of adding a second diabetic medication, identify the importance patients place on those risks and benefits, prepare for the follow-up consultation visit, be involved in decision making as much as they desire, and make more informed decisions.

In addition, the PDA could help clinicians understand the issues that are most important to the patient, tailor counseling to patient preferences for decision participation, positively facilitate the follow-up consultation, positively affect the patient-physician relationship, improve the way time is spent during the follow-up consultation visit, and improve the quality of the follow-up consultation visit.

PDAs are SDM tools that can help patients make treatment choices that are consistent with their values and preferences, Dr. Shillington said, noting that the American Diabetes Association "embraces SDM in selecting antihyperglycemic treatment."

The new PDA, which achieved the highest quality rating from the IPDAS, includes an introduction that covers the reason patients have reached a particular decision point (for example, they are not achieving adequate glycemic control with metformin and lifestyle changes). Next, patients are presented with their options, including various benefits and side effects for different medications.

Patients can then provide feedback via questionnaires that allow them to communicate long-term goals and the relative importance of factors such as the degree of blood sugar reduction, avoiding blood glucose lability, maintaining or losing weight, achieving a convenient dosing schedule, and avoiding injections. Responses on this section are available to clinicians.

Finally, a summary is provided, including a fact sheet that reiterates the risks and benefits of each class of medication in a balanced and unbiased manner; and an option is given for the patient to print the information.

The PDA is currently being evaluated in a randomized controlled validation study involving 220 patients. A Spanish version has also been developed and is in testing to expand access, Dr. Shillington said.

"PDAs for type 2 diabetes mellitus can potentially promote patient-centered care and improve self-management behaviors. Access to high-quality, well-developed SDM tools is needed and may improve the quality of care and better align care with individual patient values," she concluded.

Dr. Shillington reported having no disclosures.

ORLANDO – A new online tool designed to guide patients who had inadequately controlled type 2 diabetes in making decisions about their self-care got high marks from users during pilot clinical testing.

The patient decision aid (PDA), which was developed with input from patients, clinicians, and an expert panel using a process guided by the International Patient Decision Aid Standards (IPDAS) Collaboration, received an average survey score of 73.31 out of 100 for preparing users for decision making, based on post-test responses from 10 patients. Decision self-efficacy survey scores improved from 84.32 at baseline to 94.32 post test, knowledge (about diabetes and treatment) scores improved from 56.41 to 74.00, and decisional conflict scores improved from 47.32 to 29.11, Alicia C. Shillington, Ph.D., R.N., reported in a poster at the annual meeting of the American Association of Diabetes Educators.

Two-week post-test scores for knowledge and decisional conflict showed sustained benefit, with slight improvement to 74.90 and 26.79, respectively, according to Dr. Shillington of EPI-Q Inc., Oak Brook, Ill.

The final PDA was first tested in two patient focus groups, then in the 10 patients in the pilot study. The patients had type 2 diabetes and were taking metformin. They were evaluated prior to receiving the PDA, immediately after, and again at a 2-week follow-up.

All clinicians who tested the PDA endorsed it, and the vast majority (90%-100% on all measures) said the PDA could help facilitate key aspects of shared decision making (SDM). For example, they said the PDA could help patients understand the risks and benefits of adding a second diabetic medication, identify the importance patients place on those risks and benefits, prepare for the follow-up consultation visit, be involved in decision making as much as they desire, and make more informed decisions.

In addition, the PDA could help clinicians understand the issues that are most important to the patient, tailor counseling to patient preferences for decision participation, positively facilitate the follow-up consultation, positively affect the patient-physician relationship, improve the way time is spent during the follow-up consultation visit, and improve the quality of the follow-up consultation visit.

PDAs are SDM tools that can help patients make treatment choices that are consistent with their values and preferences, Dr. Shillington said, noting that the American Diabetes Association "embraces SDM in selecting antihyperglycemic treatment."

The new PDA, which achieved the highest quality rating from the IPDAS, includes an introduction that covers the reason patients have reached a particular decision point (for example, they are not achieving adequate glycemic control with metformin and lifestyle changes). Next, patients are presented with their options, including various benefits and side effects for different medications.

Patients can then provide feedback via questionnaires that allow them to communicate long-term goals and the relative importance of factors such as the degree of blood sugar reduction, avoiding blood glucose lability, maintaining or losing weight, achieving a convenient dosing schedule, and avoiding injections. Responses on this section are available to clinicians.

Finally, a summary is provided, including a fact sheet that reiterates the risks and benefits of each class of medication in a balanced and unbiased manner; and an option is given for the patient to print the information.

The PDA is currently being evaluated in a randomized controlled validation study involving 220 patients. A Spanish version has also been developed and is in testing to expand access, Dr. Shillington said.

"PDAs for type 2 diabetes mellitus can potentially promote patient-centered care and improve self-management behaviors. Access to high-quality, well-developed SDM tools is needed and may improve the quality of care and better align care with individual patient values," she concluded.

Dr. Shillington reported having no disclosures.

ORLANDO – A new online tool designed to guide patients who had inadequately controlled type 2 diabetes in making decisions about their self-care got high marks from users during pilot clinical testing.

The patient decision aid (PDA), which was developed with input from patients, clinicians, and an expert panel using a process guided by the International Patient Decision Aid Standards (IPDAS) Collaboration, received an average survey score of 73.31 out of 100 for preparing users for decision making, based on post-test responses from 10 patients. Decision self-efficacy survey scores improved from 84.32 at baseline to 94.32 post test, knowledge (about diabetes and treatment) scores improved from 56.41 to 74.00, and decisional conflict scores improved from 47.32 to 29.11, Alicia C. Shillington, Ph.D., R.N., reported in a poster at the annual meeting of the American Association of Diabetes Educators.

Two-week post-test scores for knowledge and decisional conflict showed sustained benefit, with slight improvement to 74.90 and 26.79, respectively, according to Dr. Shillington of EPI-Q Inc., Oak Brook, Ill.

The final PDA was first tested in two patient focus groups, then in the 10 patients in the pilot study. The patients had type 2 diabetes and were taking metformin. They were evaluated prior to receiving the PDA, immediately after, and again at a 2-week follow-up.

All clinicians who tested the PDA endorsed it, and the vast majority (90%-100% on all measures) said the PDA could help facilitate key aspects of shared decision making (SDM). For example, they said the PDA could help patients understand the risks and benefits of adding a second diabetic medication, identify the importance patients place on those risks and benefits, prepare for the follow-up consultation visit, be involved in decision making as much as they desire, and make more informed decisions.

In addition, the PDA could help clinicians understand the issues that are most important to the patient, tailor counseling to patient preferences for decision participation, positively facilitate the follow-up consultation, positively affect the patient-physician relationship, improve the way time is spent during the follow-up consultation visit, and improve the quality of the follow-up consultation visit.

PDAs are SDM tools that can help patients make treatment choices that are consistent with their values and preferences, Dr. Shillington said, noting that the American Diabetes Association "embraces SDM in selecting antihyperglycemic treatment."

The new PDA, which achieved the highest quality rating from the IPDAS, includes an introduction that covers the reason patients have reached a particular decision point (for example, they are not achieving adequate glycemic control with metformin and lifestyle changes). Next, patients are presented with their options, including various benefits and side effects for different medications.

Patients can then provide feedback via questionnaires that allow them to communicate long-term goals and the relative importance of factors such as the degree of blood sugar reduction, avoiding blood glucose lability, maintaining or losing weight, achieving a convenient dosing schedule, and avoiding injections. Responses on this section are available to clinicians.

Finally, a summary is provided, including a fact sheet that reiterates the risks and benefits of each class of medication in a balanced and unbiased manner; and an option is given for the patient to print the information.

The PDA is currently being evaluated in a randomized controlled validation study involving 220 patients. A Spanish version has also been developed and is in testing to expand access, Dr. Shillington said.

"PDAs for type 2 diabetes mellitus can potentially promote patient-centered care and improve self-management behaviors. Access to high-quality, well-developed SDM tools is needed and may improve the quality of care and better align care with individual patient values," she concluded.

Dr. Shillington reported having no disclosures.

ORLANDO – They weren’t asked to sit in the lotus pose or study with the monks. Rather, a small group of older veterans were introduced to simple mindfulness meditation, and in a short period, they began doing a better job of managing the stress related to their diabetes and lowered their hemoglobin A_1c levels.

More importantly, most said they enjoyed meditating, according to Monica DiNardo, Ph.D.

By the end of the 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, the participants’ diabetes-related stress had dropped by 41% and their HbA_1c had dropped by roughly 1%.

The study was small – 28 patients – and it was not controlled, "so we really can’t draw generalizations from this," said Dr. DiNardo, who presented the study at the annual meeting of the American Association of Diabetes Educators. What it does show, she said, is that introducing the program wasn’t a distraction to the diabetes education process.

Helping patients manage diabetes-related stress is important, especially in the veteran population, where a quarter, or nearly a 1 million individuals, have diabetes.

And while healthy coping is one of seven self-care behaviors recommended by the AADE7 framework, many persons with diabetes don’t receive training for healthy coping strategies to deal with the stress that usually comes along with having diabetes.

"There’s a need to incorporate practical, evidence-based programs into diabetes self-management education (DSME) to fill this gap," said Dr. DiNardo, a diabetes nurse practitioner and an educator at the VA Pittsburgh.

To assess the feasibility of implementing a brief mindfulness intervention within diabetes self-management education, Dr. DiNardo and her colleagues created an intervention called Mind-STRIDE (Mindfulness Stress Reduction in Diabetes Education).

The research team used several assessment tools, including the Five Facet Mindfulness Questionnaire, Perceived Stress Scale, and Problem Areas in Diabetes Scale (to measure diabetes-related stress) to measure the changes over time.

The 28 veterans, who were on average 60 years old, were enrolled in DSME. The majority had type 2 diabetes and their HbA_1c levels were higher than 7%. Also, half of the group was college educated, nearly 70% were married, and 60% were retired or disabled.

The group received a 90-minute training in mindfulness following their DSME session. Participants were given a CD, recorded by Dr. DiNardo, to practice with at home. They were also given practice diaries. They received a 30-minute booster session 1 month later.

Twenty of the 28 individuals stayed in the study; 11 completed their practice diaries. All said they found the intervention interesting and easy to understand, and almost all said that they learned something new and planned to continue practicing mindfulness.

Results after 3 months showed that there was a significant negative correlation between awareness and nonjudgment – two elements of the five-facet mindfulness – and diabetes-related stress. In contrast, the two facets showed a significant positive correlation with coping abilities. There were also significant positive correlations between the two facets and diabetes self management and the total AADE7 score.

Dr. DiNardo speculated that the meditation helped participants remove the self-judgment attached to having the disease and gain the ability to be aware of the disease and how to cope with it.

When assessing baseline to 3-month gain and effect size for various assessments, all showed changes in a "hopeful" direction, said Dr. DiNardo.

The most significant trend over the 3-month period was the 40% drop in diabetes-related stress (difference in raw scores), measured by the Problem Areas in Diabetes Scale. Meanwhile, awareness and coping ability increased slightly during the study period.

Dr. DiNardo said that the cost associated with implementing the program was minimal, and the only requirement was access to someone who knew mindfulness meditation.

"We need innovative therapy to promote healthy behaviors for patients with diabetes," she said. Mind-body therapies have the potential to serve as a bridge between the clinic and home and give patients yet another tool to manage their diabetes.

Dr. DiNardo had no financial disclosures. The study was supported by a grant from AADE.

[email protected]

On Twitter @naseemmiller

ORLANDO – They weren’t asked to sit in the lotus pose or study with the monks. Rather, a small group of older veterans were introduced to simple mindfulness meditation, and in a short period, they began doing a better job of managing the stress related to their diabetes and lowered their hemoglobin A_1c levels.

More importantly, most said they enjoyed meditating, according to Monica DiNardo, Ph.D.

By the end of the 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, the participants’ diabetes-related stress had dropped by 41% and their HbA_1c had dropped by roughly 1%.

The study was small – 28 patients – and it was not controlled, "so we really can’t draw generalizations from this," said Dr. DiNardo, who presented the study at the annual meeting of the American Association of Diabetes Educators. What it does show, she said, is that introducing the program wasn’t a distraction to the diabetes education process.

Helping patients manage diabetes-related stress is important, especially in the veteran population, where a quarter, or nearly a 1 million individuals, have diabetes.

And while healthy coping is one of seven self-care behaviors recommended by the AADE7 framework, many persons with diabetes don’t receive training for healthy coping strategies to deal with the stress that usually comes along with having diabetes.

"There’s a need to incorporate practical, evidence-based programs into diabetes self-management education (DSME) to fill this gap," said Dr. DiNardo, a diabetes nurse practitioner and an educator at the VA Pittsburgh.

To assess the feasibility of implementing a brief mindfulness intervention within diabetes self-management education, Dr. DiNardo and her colleagues created an intervention called Mind-STRIDE (Mindfulness Stress Reduction in Diabetes Education).

The research team used several assessment tools, including the Five Facet Mindfulness Questionnaire, Perceived Stress Scale, and Problem Areas in Diabetes Scale (to measure diabetes-related stress) to measure the changes over time.

The 28 veterans, who were on average 60 years old, were enrolled in DSME. The majority had type 2 diabetes and their HbA_1c levels were higher than 7%. Also, half of the group was college educated, nearly 70% were married, and 60% were retired or disabled.

The group received a 90-minute training in mindfulness following their DSME session. Participants were given a CD, recorded by Dr. DiNardo, to practice with at home. They were also given practice diaries. They received a 30-minute booster session 1 month later.

Twenty of the 28 individuals stayed in the study; 11 completed their practice diaries. All said they found the intervention interesting and easy to understand, and almost all said that they learned something new and planned to continue practicing mindfulness.

Results after 3 months showed that there was a significant negative correlation between awareness and nonjudgment – two elements of the five-facet mindfulness – and diabetes-related stress. In contrast, the two facets showed a significant positive correlation with coping abilities. There were also significant positive correlations between the two facets and diabetes self management and the total AADE7 score.

Dr. DiNardo speculated that the meditation helped participants remove the self-judgment attached to having the disease and gain the ability to be aware of the disease and how to cope with it.

When assessing baseline to 3-month gain and effect size for various assessments, all showed changes in a "hopeful" direction, said Dr. DiNardo.

The most significant trend over the 3-month period was the 40% drop in diabetes-related stress (difference in raw scores), measured by the Problem Areas in Diabetes Scale. Meanwhile, awareness and coping ability increased slightly during the study period.

Dr. DiNardo said that the cost associated with implementing the program was minimal, and the only requirement was access to someone who knew mindfulness meditation.

"We need innovative therapy to promote healthy behaviors for patients with diabetes," she said. Mind-body therapies have the potential to serve as a bridge between the clinic and home and give patients yet another tool to manage their diabetes.

Dr. DiNardo had no financial disclosures. The study was supported by a grant from AADE.

[email protected]

On Twitter @naseemmiller

ORLANDO – They weren’t asked to sit in the lotus pose or study with the monks. Rather, a small group of older veterans were introduced to simple mindfulness meditation, and in a short period, they began doing a better job of managing the stress related to their diabetes and lowered their hemoglobin A_1c levels.

More importantly, most said they enjoyed meditating, according to Monica DiNardo, Ph.D.

By the end of the 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, the participants’ diabetes-related stress had dropped by 41% and their HbA_1c had dropped by roughly 1%.

The study was small – 28 patients – and it was not controlled, "so we really can’t draw generalizations from this," said Dr. DiNardo, who presented the study at the annual meeting of the American Association of Diabetes Educators. What it does show, she said, is that introducing the program wasn’t a distraction to the diabetes education process.

Helping patients manage diabetes-related stress is important, especially in the veteran population, where a quarter, or nearly a 1 million individuals, have diabetes.

And while healthy coping is one of seven self-care behaviors recommended by the AADE7 framework, many persons with diabetes don’t receive training for healthy coping strategies to deal with the stress that usually comes along with having diabetes.

"There’s a need to incorporate practical, evidence-based programs into diabetes self-management education (DSME) to fill this gap," said Dr. DiNardo, a diabetes nurse practitioner and an educator at the VA Pittsburgh.

To assess the feasibility of implementing a brief mindfulness intervention within diabetes self-management education, Dr. DiNardo and her colleagues created an intervention called Mind-STRIDE (Mindfulness Stress Reduction in Diabetes Education).

The research team used several assessment tools, including the Five Facet Mindfulness Questionnaire, Perceived Stress Scale, and Problem Areas in Diabetes Scale (to measure diabetes-related stress) to measure the changes over time.

The 28 veterans, who were on average 60 years old, were enrolled in DSME. The majority had type 2 diabetes and their HbA_1c levels were higher than 7%. Also, half of the group was college educated, nearly 70% were married, and 60% were retired or disabled.

The group received a 90-minute training in mindfulness following their DSME session. Participants were given a CD, recorded by Dr. DiNardo, to practice with at home. They were also given practice diaries. They received a 30-minute booster session 1 month later.

Twenty of the 28 individuals stayed in the study; 11 completed their practice diaries. All said they found the intervention interesting and easy to understand, and almost all said that they learned something new and planned to continue practicing mindfulness.

Results after 3 months showed that there was a significant negative correlation between awareness and nonjudgment – two elements of the five-facet mindfulness – and diabetes-related stress. In contrast, the two facets showed a significant positive correlation with coping abilities. There were also significant positive correlations between the two facets and diabetes self management and the total AADE7 score.

Dr. DiNardo speculated that the meditation helped participants remove the self-judgment attached to having the disease and gain the ability to be aware of the disease and how to cope with it.

When assessing baseline to 3-month gain and effect size for various assessments, all showed changes in a "hopeful" direction, said Dr. DiNardo.

The most significant trend over the 3-month period was the 40% drop in diabetes-related stress (difference in raw scores), measured by the Problem Areas in Diabetes Scale. Meanwhile, awareness and coping ability increased slightly during the study period.

Dr. DiNardo said that the cost associated with implementing the program was minimal, and the only requirement was access to someone who knew mindfulness meditation.

"We need innovative therapy to promote healthy behaviors for patients with diabetes," she said. Mind-body therapies have the potential to serve as a bridge between the clinic and home and give patients yet another tool to manage their diabetes.

Dr. DiNardo had no financial disclosures. The study was supported by a grant from AADE.

[email protected]

On Twitter @naseemmiller

ORLANDO – A small, 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, showed that teaching patients mindfulness meditation was associated with a 41% drop in their diabetes-related stress, and a roughly 1% drop in their hemoglobin A_1c.

In a video interview, Monica DiNardo, Ph.D., a nurse practitioner and diabetes educator at the VA Pittsburgh, discusses the study’s findings and the implications on caring for patients with diabetes.

[email protected]

On Twitter @naseemmiller

ORLANDO – A small, 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, showed that teaching patients mindfulness meditation was associated with a 41% drop in their diabetes-related stress, and a roughly 1% drop in their hemoglobin A_1c.

In a video interview, Monica DiNardo, Ph.D., a nurse practitioner and diabetes educator at the VA Pittsburgh, discusses the study’s findings and the implications on caring for patients with diabetes.

[email protected]

On Twitter @naseemmiller

ORLANDO – A small, 3-month feasibility study, conducted at the Veterans Affairs Pittsburgh Healthcare System, showed that teaching patients mindfulness meditation was associated with a 41% drop in their diabetes-related stress, and a roughly 1% drop in their hemoglobin A_1c.

In a video interview, Monica DiNardo, Ph.D., a nurse practitioner and diabetes educator at the VA Pittsburgh, discusses the study’s findings and the implications on caring for patients with diabetes.

[email protected]

On Twitter @naseemmiller