Effects of mindfulness‐ and acceptance‐based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta‐analysis
Hau Yi Ngan, Yuen Yu Chong, Wai Tong Chien
Abstract
Abstract Aim For people with type 2 diabetes, self management and fear of disease complication often cause psychological distress. Mindfulness and acceptance might be beneficial for reducing diabetes‐related distress and glycaemic level. We systematically review the effects of mindfulness‐ and acceptance‐based interventions on diabetes distress and glycaemic level in community‐dwelling adults with type 2 diabetes. Methods Seven electronic databases (English and Chinese) were searched comprehensively from inception to June 2020. Data extraction and methodological quality assessment were independently performed by two reviewers using Grading of Recommendations, Assessment, Development and Evaluations criteria. Results Nine RCTs (801 participants) examining the effects of acceptance and commitment therapy, mindfulness‐based cognitive therapy, mindfulness‐based stress reduction and self‐directed mindfulness practice were included. In the reviewed RCTs, the majority of participants (mean age: 50–66 years, average disease duration: 4–10 years) had suboptimal diabetes control (HbA 1c >7.0%, 53 mmol/mol). Compared with controls, the interventions significantly reduced diabetes distress (standardised mean difference, SMD = −0.37, 95% confidence intervals, CI: −0.63, −0.12; p < 0.01) and HbA 1c (mean difference, MD = −0.35, 95% CI: −0.67, −0.04; p = 0.03) up to 1‐month post‐intervention. However, the underpowered studies may have led to overestimation, the interventions for diabetes distress and HbA 1c were heterogeneous. Conclusions Within evidenced‐based diabetes education programmes, mindfulness‐ and acceptance‐based approaches may reduce distress and HbA 1c levels and promote self care in people with type 2 diabetes. Further controlled trials are recommended to examine the clinical effectiveness of such programmes for people with type 2 diabetes of diverse clinical, cultural and socio‐demographic backgrounds.