Effectiveness of the Mindfulness-Based Diabetes Self- and Family Management Support Program among Adults with Uncontrolled Diabetes: A Randomized Controlled Trial

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Nittaya Sukchaisong
Panan Pichayapinyo
Sunee Lagampan
Laura R. Saslow
James E. Aikens


          Adults with type 2 diabetes need to master illness self-management to meaningfully sustain behavior change and mindfulness practice may facilitate this process. This study investigated the effectiveness of the Mindfulness-Based Diabetes Self- and Family Management Support Program to improve glycated hemoglobin among Thai adults with uncontrolled diabetes. This program was developed from a literature review, and in-depth interviews with 15 participants who had poorly controlled diabetes and their family members. The Information-Motivation-Behavioral Skills Model and mindfulness approach was used as a framework to develop study intervention. We conducted a randomized controlled trial from September 2018 to March 2019. Eighty adults with uncontrolled type 2 diabetes were randomized to 12 weeks of either the control group who received only usual care (n = 40) or the experimental group (n = 40) who received an intervention in addition to usual care. Glycated hemoglobin, fasting blood glucose, mindful-eating, self-efficacy, dietary consumption, physical activity, and medication adherence were assessed at baseline, week 12 and week 16. Data were analyzed using descriptive statistics, ANCOVA, Repeated Measures ANOVA, and Independent t-test.

           The findings showed that participants receiving the intervention improved more between baseline and both weeks 12 and 16 in fasting blood glucose and HbA1c, appropriate dietary consumption, amount of physical activity, medication adherence, mindful eating, and self-efficacy than those in the control group. Nurses can be trained to implement this intervention program in adults with uncontrolled diabetes. However, more studies with a larger number of community participants are recommended with the application of advanced technology such as mobile health.

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Nittaya Sukchaisong, Panan Pichayapinyo, Sunee Lagampan, Laura R. Saslow, James E. Aikens. Effectiveness of the Mindfulness-Based Diabetes Self- and Family Management Support Program among Adults with Uncontrolled Diabetes: A Randomized Controlled Trial. PRIJNR [Internet]. 2022 May 27 [cited 2022 Nov. 27];26(3):517-32. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/258075
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American Diabetes Association. Standards of medication care in diabetes—2018 abridged for primary care providers. Clin Diabetes. 2018;36:14–37. doi: https://doi.org/10.2337/cd17-0119.

Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5:e000354. doi:10.1136/bmjdrc- 2016-000354.

Boniol M, Dragomir M, Autier P, Boyle P. Physical activity and change in fasting glucose and HbA1c: a quantitative metaanalysis of randomized trials. Acta Diabetol. 2017;54: 983–91.doi: https://doi.org/10.1007/s00592-017-1037-3

Cradock KA, ÓLaighin G, Finucane FM, Gainforth HL, Quinlan LR, Ginis KAM. Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2017; 14:18. doi: https://doi.org/10.1186/


Huo R, Du T, Xu Y, Xu W, Chen X, Sun K, et al. Effects of mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individual: a meta-analysis. Eur J Clin Nutr. 2015;69:1200 – 8. doi: https://doi.org/10.1038/ejcn.2014.243

Pan B, Ge L, Xun YQ, Chen Y, Gao C, Han X, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act. 2018;15:72. doi: https://doi.org/10. 1186/s12966-018-0703-3

Liu Y, Ye W, Chen Q, Zhang Y, Kuo CH, Korivi M. Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16:140. doi: https://doi.org/10. 3390/ijerph16010140

Bekele BB, Negash S, Bogale B, Tesfaye M, Getachew D, Weldekidan F, et al. Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: systematic review and meta-analysis of randomized controlled trials. Diabetes

Metab Syndr. 2021;15: 177 – 85. doi: https://doi.org/ 10.1016/j.dsx.2020.12

Lamptey R, Robben MP, Amoakoh‐Coleman M, Boateng D, Grobbee DE, Davies MJ, et al. Structured diabetes self‐management education and glycaemic control in low‐and middle‐income countries: a systematic review. Diabet Med. 2022;00:e14812. doi: https://doi.org/10. 1111/dme.14812

Lavelle D, Zeitoun J, Stern M, Butkiewicz E, Wegner E, Reinisch C. Diabetes self-management education in the home. Cureus. 2016; 8:e710. doi: 10.7759/cureus.710.

Wooley DS, Kinner TJ. Comparing perceived self-management practices of adult type 2 diabetic patients after completion of a structured ADA certified diabetes self-management education program with unstructured individualized nurse practitioner led diabetes self-management education. Appl Nurs Res. 2016;32:171–6. doi: http://dx.doi.org/10.1016/j.apnr.2016.07.012

Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99:926–43. doi: http://dx.doi.org/10.1016/j.pec.2015.11.003

Azami G, Soh KL, Sazlina SG. Salmiah MS, Aazami S. Behavioral interventions to improve self-management in Iranian adults with type 2 diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord. 2018;17:365–80. doi: https://doi.org/10.1007/s40200-018-0376-0

Ministry of Public Health. Situation on NCDs prevention and control in Thailand. Nonthaburi: Department of Disease Control; 2018. Available from: http://thaincd.com/document/file/download/paper-manual/NCDUNIATF61.pdf (in Thai)

Lakerveld J, Palmeira AL, van Duinkerken E, Whitelock V, Peyrot M, Nouwen A. Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications. Diabet Med. 2020;37:464–72. doi:https://doi.org/10.1111/dme.14228

Fisher WA, Fisher JD, Harman J. The informationmotivation-behavioraI skills model: a general social psychological approach to understanding and promoting health behavior. In: Suls J, Wallston KA, Editors. Social psychological foundations of health and illness . Blackwell Publishing; 2003. pp. 82-106. doi: https://doi.org/10.1002/9780470753552.ch4

Nelson LA, Wallston KA, Kripalani S, LeStourgeon LM, Williamson SE, Mayberry LS. Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model. Diabetes Res Clin Pract. 2018;142:374–84. doi:10.1016/j.diabres.2018.05.046.

Bakır E, Çavuşoğlu H, Mengen E. Effects of the information–motivation–behavioral skills model on metabolic control of adolescents with type 1 diabetes in Turkey: randomized controlled study. J Pediatr Nurs. 2021;58:e19-27. doi:https://doi.org/10.1016/j.pedn.2020.11.019

Mayberry LS, Osborn CY. Empirical validation of the information–motivation–behavioral skills model of diabetes medication adherence: a framework for intervention. Diabetes Care. 2014;37:1246–53. doi: https://doi.org/ 10.2337/dc13-1828

Rhamkisson S, Pillay BJ, Sibanda W. Social support and coping in adults with type 2 diabetes. J Am Prima Fam Med. 2017;9:1405. doi: 10.4102/phcfm.v9i1.1405.

Ferrari M, Speight J, Beath A, Browne JL, Mosely K. The information-motivation-behavioral skills model explains physical activity levels for adults with type 2 diabetes across all weight classes. Psychol Health Med. 2021;26:381–94.DOI: 10.1080/13548506.2020.1749292.

Nelson LA, Wallston KA, Kiparani S, Lestourgean LM, Williumsom SE, Meberly LS. Assessing barriers to diabetes medication adherence using the information motivation behavioral skills model. Diabetes Res Clin Pract. 2018;142:374–84. doi: https://doi.org/10.1016/j.diabres.


Kasar KS, Asiret GD, Yilmaz CK, Canlar Ş. The effect of modelbased telephone counseling on HbA1c and self-management for individuals with type 2 diabetes: a randomized controlled trial. Prim Care Diabetes. 2022;16:41-8. doi: https://doi.org/10.1016/j.pcd.2021.09.005

Alhaik S, Anshasi HA, Alkhawaldeh J, Sho KL, Naji AM. An assessment of self-care knowledge among patients with diabetes mellitus. Diabetes Metab Syndr. 2019;13:390–4.doi: https://doi.org/10.1016/j.dsx.2018.10.010

Ghisi GLM, Althman C, Kodinis R, Foster E, Tahsinul A, Sandison N, et al. Effectiveness of an education intervention associated with an exercise program in improving diseaserelated knowledge and health behaviours among diabetes patients. Patient Educ Couns. 2020;103:1790–7. doi:https://doi.org/10.1016/j.pec.2020.04.007

Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischi AH, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clin Diabetes. 2016;34:70–80. doi: https://doi.org/10.2337/diaclin.34.2.70

Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes Outcomes for adults. Ann N Y Acad Sci. 2015;1353:89–112. doi: https://doi.org/10.1111/nyas.12844

Tabashi HK, Madarshahian FNMK, Hassanabadi M, Mahmoudirad G. Impact of family support improvement bahaviors on anti diabetic medication adherence and cogition in type 2 diabetic patients. J Diabetes Metab Disord. 2014;13:1–6. doi: https://doi.org/10.1186/s40200-014-0113-2

Mason AE, Epel ES, Kristeller J, Moran PJ, Dallman M, Lustig RH, et al. Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. J Behav Med. 2016;39:201–13. doi:


Kabat ZJ. Mindfulness‐based interventions in context: past, present, and future. Clin Psychol (New York). 2003;10: 144–56. doi: https://doi.org/10.1093/clipsy.bpg016

Lattimore P. Mindfulness-based emotional eating awareness training: taking the emotional out of eating. Eating Weight Disord. 2020;25:649–57. doi: https://doi.org/10.1007/s40519-019-00667-y

Stanszus LS, Frank P, Geiger SMJA. Healthy eating and sustainable nutrition through mindfulness? Mixed method results of a controlled intervention study. Appetite. 2019;141:104325. doi: 10.1016/j.appet.2019.104325.

Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009; 109:1439–44. doi:10.1016/j.jada.2009.05.006.

Ritter PL, Lorig K, Laurent DD. Characteristics of the Spanish- and English-Language self-efficacy to manage diabetes scales. Diabetes Educ. 2016;42:167–77. doi:10.1177/0145721716628648.

Pichayapinyo P, Saslow LR, Aikens JE, Marinec N, Sillabutra J, Rattanapongsai P, et al. Feasibility study of automated interactive voice response telephone calls with community health nurse follow-up to improve glycaemic control in patients with type 2 diabetes. Int J Nurs Pract. 2019; e12781. doi: https://doi.org/10.1111/ijn.12781

Kiernan M, Schoffman DE, Lee K, Brown SD, Fair JM, Perri MG, et al. The Stanford Leisure-Time Activity Categorical Item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women. Int J Obes. 2013;37:1597–602. doi:https://doi.org/10.1038/ijo.2013.36

Kim MT, Hill MN, Bone LR, Levine DM. Development and testing of the Hill‐Bone Compliance to High Blood Pressure Therapy Scale. Prog Cardiovasc Nurs. 2000;15:90–6. doi: https://doi.org/10.1111/j.1751-7117.2000.tb00211.x

Furukawa T, Nishida Y, Hara M, Shimanoe C, Koga K, Iwasaka C, et al. Effect of the interaction between physical activity and estimated macronutrient intake on HbA1c:population-based cross-sectional and longitudinal studies. BMJ Open Diabetes Res Care. 2022;10:e002479.

doi: 10.1136/bmjdrc-2021-002479.

Meunier S, Coulombe S, Beaulieu MD, Côté J, Lespérance F, Chiasson JL, et al. Longitudinal testing of the Information- Motivation-Behavioral Skills model of self-care among adults with type 2 diabetes. Patient Educ Couns. 2016;99:1830–6. doi: https://doi.org/10.1016/j.pec.2016.06.011

Brown SA, García AA, Brown A, Becker BJ, Conn VS, Ramírez G, et al. Biobehavioral determinants of glycemic control in type 2 diabetes: a systematic review and metaanalysis. Patient Educ Couns. 2016;99:1558-67. doi:https://doi.org/10.1016/j.pec.2016.03.020

Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1997.