The Effects of a Mindfulness-Based Intervention on Emotional Distress, Quality-of-Life, and HbA1c in Outpatients With Diabetes (DiaMind)

A randomized controlled trial

  1. François Pouwer, PHD1
  1. 1Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
  2. 2Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
  3. 3Department of Internal Medicine, Máxima Medical Center, Eindhoven, the Netherlands
  4. 4Department of Internal Medicine, TweeSteden Hospital, Tilburg, the Netherlands
  5. 5Department of Internal Medicine, St. Anna Hospital, Geldrop, the Netherlands
  1. Corresponding author: Ivan Nyklíček, i.nyklicek{at}


OBJECTIVE Emotional distress is common in outpatients with diabetes, affecting ∼20–40% of the patients. The aim of this study was to determine the effectiveness of group therapy with Mindfulness-Based Cognitive Therapy (MBCT), relative to usual care, for patients with diabetes with regard to reducing emotional distress and improving health-related quality-of-life and glycemic control.

RESEARCH DESIGN AND METHODS In the present randomized controlled trial, 139 outpatients with diabetes (type 1 or type 2) and low levels of emotional well-being were randomized to MBCT (n = 70) or a waiting list group (n = 69). Primary outcomes were perceived stress (Perceived Stress Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), mood (Profiles of Mood States), and diabetes-specific distress (Problem Areas In Diabetes). Secondary outcomes were health-related quality-of-life (12-Item Short-Form Health Survey), and glycemic control (HbA1c). Assessments were conducted at baseline and at 4 and 8 weeks of follow-up.

RESULTS Compared with control, MBCT was more effective in reducing stress (P < 0.001, Cohen d = 0.70), depressive symptoms (P = 0.006, d = 0.59), and anxiety (P = 0.019, d = 0.44). In addition, MBCT was more effective in improving quality-of-life (mental: P = 0.003, d = 0.55; physical: P = 0.032, d = 0.40). We found no significant effect on HbA1c or diabetes-specific distress, although patients with elevated diabetes distress in the MBCT group tended to show a decrease in diabetes distress (P = 0.07, d = 0.70) compared with the control group.

CONCLUSIONS Compared with usual care, MBCT resulted in a reduction of emotional distress and an increase in health-related quality-of-life in diabetic patients who had lower levels of emotional well-being.

  • Received July 24, 2012.
  • Accepted September 14, 2012.

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  1. Diabetes Care
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