Mindfulness Program Fails to Engage Adolescents With Diabetes Distress

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A new report highlights the potential of mindfulness training to help manage the stress of living with type 1 diabetes (T1D), but it also illuminates some of the challenges of implementing the approach to help adolescent patients.

The study was published in JMIR Formative Research.

Teenagers diagnosed with T1D often feel burdened by worry and frustration associated with the disease, noted the study authors. Collectively, these challenges are known as “diabetes distress.” Such concerns can have clinical—not just emotional—effects, the authors noted. Adolescents with greater diabetes distress tend to have a lower quality of life and suboptimal glycemic outcomes, they added.

“Heightened diabetes distress may affect T1D outcomes both indirectly, through decreased engagement in disease self-management behaviors, and directly, through the effects of physiological arousal, hormone secretion, and insulin resistance on blood glucose levels and the microvascular system,” they said.

One potential method of alleviating diabetes distress is mindfulness-based stress reduction (MBSR), a mind-body health intervention designed to help patients manage the stress associated with their chronic condition. The techniques have already shown promise in adults, the study authors said, and newer research suggests they might also be helpful for young adults.

“For example, among emerging adults with T1D and suboptimal glycemic levels, an MBSR intervention was found to improve psychosocial outcomes but not glycemic outcomes and was highly acceptable,” they wrote. “Further, an additional study within the T1D context found that a brief self-compassion intervention, which is a core component of MBSR, was acceptable and feasible among adolescents with disordered eating and improved mindfulness and coping.”

However, given that mindfulness training itself takes considerable time, and that patients with diabetes distress might already be experiencing a significant time crunch, the investigators wanted to know whether a self-led scalable version of MBSR might be a meaningful tool for adolescents.

The investigators recruited 25 patients with T1D who aged 14 to 18 years. Fifteen of the participants were given a 10-week self-guided MBSR workbook program, either in e-book or paper format. The remaining 10 patients were asked to wait 10 weeks before starting the program, to serve as a control group. Follow-up assessments were conducted at 10 and 20 weeks.

The results indicate that patients found the program neither feasible nor acceptable, at least in that format. The authors noted that there was a high rate of patients who withdrew or were lost to follow-up. Two patients withdrew after intake, citing stress and schedule concerns; 2 were lost to follow-up during the program; 7 were lost to follow-up at 10 weeks, and 6 were lost to follow-up at 20 weeks.

“Adolescents reported barriers to completing the weekly material, such as that they forgot or that the material was not sufficiently related to their diabetes management,” the authors said. “Adolescents indicated that a shorter digital mindfulness–based intervention focused on diabetes-specific behaviors may be more helpful.”

The authors said they also came away with several potential improvements to the intervention’s content that might make it more acceptable to patients. For one, they said it could be beneficial to decrease the amount of context and more clearly indicate the connections between MBSR and daily disease management.

“Some participants indicated that the original modules and instructions were difficult to understand,” they wrote. “Therefore, it may be beneficial to focus the program on a few basic mindfulness skills that are connected to diabetes management to help build an insightful mindfulness repertoire that is meaningful to daily diabetes management.”

The authors concluded that additional research—including with more diverse patient populations—is needed to better understand the best ways to apply mindfulness training to young patients with diabetes distress.

Reference

Humiston T, Cummings C, Suss S, Cohen LB, Hazlett-Stevens H, Hughes Lansing A. Acceptability of a self-led mindfulness-based intervention for teens with type 1 diabetes: pilot randomized controlled trial. JMIR Form Res. Published online January 30, 2024. doi:10.2196/45659