Effect of a mindfulness programme for long-term care residents with type 2 diabetes: A cluster randomised controlled trial measuring outcomes of glycaemic control, relocation stress and depression

Mindfulness-based interventions for adults with type 2 diabetes mellitus: A systematic review and meta-analysis

Background

Type 2 diabetes mellitus (T2DM) can lead to macro- and microvascular complications. Mindfulness-based interventions (MBIs) may improve metabolic and psychological health in individuals with T2DM. We aimed to assess the efficacy of MBIs for management of T2DM.

Methods

We searched five databases and two trial registries using a comprehensive search strategy developed by a multidisciplinary team including an information scientist. We included randomised controlled trials (RCTs) investigating MBIs for important clinical outcomes including psychological outcomes, quality of life, glycaemic control and cardiovascular risk factors in adults with T2DM. Where possible, random effects meta-analyses were conducted. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess certainty of the evidence.

Results

We included 31 RCTs (2337 participants: 1107 intervention, 1230 control). We found very low certainty evidence that MBIs may reduce stress (standardized mean difference (SMD) -1.01, confidence interval (CI) -1.91 to -0.20, 8 trials, n = 528), depression (SMD -1.26, CI -2.08 to -0.43; 7 trials, n = 570) and anxiety (SMD -0.67, CI -1.27 to -0.08; 4 studies, n = 255) at end of treatment compared to waitlist control/usual care. MBIs may have a small effect on HbA1c and systolic/diastolic blood pressure at end of treatment compared to waitlist control/usual care (HbA1c mean difference (MD) -0.44, 95 % CI -0.71 to -0.17, 9 trials, n = 734; low certainty evidence). There was very low certainty evidence that MBIs + lifestyle may have no effect on HbA1c or body weight compared to lifestyle alone.

Conclusion

MBIs may have clinical benefits (particularly psychological) for adults with T2DM, but lack of certainty in the evidence precludes clinical recommendations.

Protocol registration

Cochrane Database of Systematic Reviews, DOI: 10.1002/14651858.CD014881.

Comparative efficacy of various mind-body exercise types on cardiometabolic health in patients with type 2 diabetes: a network meta-analysis of randomized controlled trials

OBJECTIVE

This study aims to compare the efficacy of different mind-body exercises (MBEs) on cardiometabolic risk factors in patients with type 2 diabetes mellitus (T2DM) using a network meta-analysis of randomized controlled trials (RCTs).

METHODS

This study followed PRISMA guidelines and was registered in PROSPERO (CRD42025630741). A systematic search of PubMed, Cochrane Library, Web of Science, and Embase was conducted up to December 15, 2024, using MeSH terms related to mind-body therapies and cardiometabolic risk in type 2 diabetes. Randomized controlled trials (RCTs) evaluating mind-body exercises (MBEs) on glucose metabolism, body composition, cardiovascular physiology, and lipid metabolism were included. Data extraction and risk of bias assessment (RoB 2 tool) were performed independently by two reviewers. Network meta-analysis was conducted using R (gemtc package) and Stata 17.0, with effect sizes reported as mean difference (MD) or standardized mean difference (SMD). Evidence quality was assessed using CINeMA.

RESULTS

This network meta-analysis compared the effects of various mind-body exercise interventions on ten cardiometabolic risk factors. Meditative Exercise (ME) was most effective in reducing fasting plasma glucose (SUCRA = 97.9%, SMD = -7.23, 95% CI: -8.27 to -6.20), while Mindfulness Intervention Training (MIT) showed the greatest benefit for glycated hemoglobin (SUCRA = 92.2%, MD = -0.78, 95% CI: -1.12 to -0.44) and blood pressure reduction (SBP: SUCRA = 86.1%, MD = -13.00, 95% CI: -17.22 to -8.78; DBP: SUCRA = 99.8%, MD = -6.00, 95% CI: -7.64 to -4.36), significantly outperforming conventional exercise. Yoga with Meditation (YWM) was most effective in lowering body mass index (SUCRA = 99.4%, MD = -2.90, 95% CI: -4.05 to -1.75). CINeMA assessments rated most comparisons as very low certainty due to within-study bias and between-study heterogeneity. Nevertheless, consistency was supported by node-splitting analysis, and no significant publication bias was detected, indicating robust and reliable findings.

CONCLUSION

Compared with conventional exercise intervention, MBE exerts unique and superior effects on various cardiometabolic risk factors in T2DM, underscoring their potential as effective and integrative interventions for personalized diabetes management. Clinicians should consider incorporating MBEs, such as MIT, ME, and YWM, into treatment plans based on individual patient needs, particularly for glycemic control, weight management, and cardiovascular health. Further research is warranted to explore the long-term benefits and optimal implementation strategies, especially given the heterogeneity in intervention protocols and the relatively short duration of the included trials.

Effect of mindfulness-based intervention in patients with diabetes: a meta-analytic review

BACKGROUND/OBJECTIVE

Traditional management strategies for diabetes primarily focus on behavioural risk factors and pharmacological therapies. Furthermore, mindfulness-based interventions (MBIs) aim to assist patients in recognising and accepting sensations, emotions and cognitions without automatic reactivity. This approach can potentially enhance glycaemic control and mental health in diabetic patients. This systematic review and meta-analysis aim to assess the effects of MBIs among individuals diagnosed with diabetes.

METHODS

A systematic literature search and meta-analysis were conducted following international quality standards utilised by the Cochrane Collaboration. Randomised controlled trials were included. The population of interest was defined as any patient diagnosed with diabetes; MBIs were defined as the intervention. Pubmed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Lilacs were accessed. A grey literature search was performed using OpenGrey and ClinicalTrials tools. Outcomes included changes in glycosylated haemoglobin percentage (%HbA1c), depression, and stress scores. The risk of bias was assessed using the RoB 2 tool, and publication bias was evaluated through Egger's test. The results were presented with forest plots. The mean difference (MD) for the %HbA1c and the standardised MD for the measurement scale scores were used as effect measures.

RESULTS

The initial search retrieved 442 scientific articles, 11 randomised clinical trials were finally selected for the systematic review, which included 987 participants (487 in the intervention groups), and seven articles were included in the meta-analysis. The meta-analysis showed that MBIs had effects at follow-up (between 12 and 20 weeks) in reducing %HbA1c levels (MD = -0.5, CI 95% [-0.67, -0.34]) and depression SMD = -0.84, CI 95% [-1.11, -0.56]).

CONCLUSIONS

It is proposed that mindfulness significantly enhances mental health and glycaemic control in patients with diabetes. Further research is warranted to confirm these effects and gain a deeper understanding of the contribution of MBIs in comprehensive diabetes treatment.

Effectiveness of Nurse-Led Psychological Interventions on Diabetes Distress, Depression, and Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

PURPOSE

To explore the effect of nurse-led psychological interventions on diabetes distress, depression, and glycemic control in individuals with type 2 diabetes mellitus (T2DM).

METHOD

Seven databases were systematically searched. Outcome measures were diabetes distress, depression, and hemoglobin A1c (HbA1c) level. RoB 2.0 was used for risk of bias assessment. Data were synthesized using Review Manager 5.4 software.

RESULTS

Fourteen studies were included from 2,837 articles. Five studies pooled in the meta-analysis demonstrated reduction in diabetes distress (standard mean difference = -0.36, 95% confidence interval [-0.49, -0.24], p < 0.001), favoring nurse-led psychological interventions over controls. Effects of the interventions on depression and HbA1c level were inconsistent across studies.

CONCLUSION

Nurse-led psychological interventions demonstrated the effect of reducing diabetes distress and some promising benefits for depression and glycemic control. Integrating nurse-led psychological interventions into usual care will be beneficial for individuals with T2DM in the future. [Journal of Psychosocial Nursing and Mental Health Services, 63(3), 11-18.].

Improving nursing care protocols for diabetic patients through a systematic review and meta-analysis of recent years

BACKGROUND

Diabetes mellitus has become one of the major pandemics of the 21st century. In this scenario, nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus. Nursing interventions are crucial for managing the disease and preventing complications.

AIM

To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.

METHODS

This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables, such as glycated haemoglobin and fasting plasma glucose.

RESULTS

After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables, a descriptive analysis of the studies with the most significant changes was conducted. Based on this, an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient's technological skills.

CONCLUSION

The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.

Improving the Transition of Older Adults into Residential Aged Care: A Scoping Review

OBJECTIVES

The transition into residential aged care (RAC) is often associated with loss, grief, isolation and loneliness. This scoping review aimed to identify quantitative research which focused on reducing the negative effects associated with transition, thereby improving the transition experience.

METHODS

A scoping review, which concentrated on quantitative research, was conducted. MEDLINE, CINAHL andPSYCHINFO databases were searched using the initial search terms "olderadults", "residential aged care" and "transition".

RESULTS

From the 457 original citations identified, four met the inclusion criteria. The interventions used a range of professionals and clinicians, diverse content, and a mixture of outcomes. The content of the more successful studies were underpinned by mental wellness themes and helped to reduce depressive symptoms among new residents.

CONCLUSIONS

Our review provides a summary of interventions aimed at improving the transition experience for older adults moving into RAC and highlights gaps in the literature. This review is limited by the paucity of quantitative research in this area. Further research is required to address the negative psychosocial effects associated with transition into RAC.

CLINICAL IMPLICATIONS

Assessing which of the transition phases an individual is in can help individualize interventions to reduce negative symptoms relating to transition.

Sex-based factors influencing perceived relocation stress and glycemic control among older adults with diabetes

This study investigated sex differences perceived relocation stress and glycemic control among older adults with type 2 diabetes in long-term care facilities. A cross-sectional correlation design was used to recruit 120 residents during their first year after moving into the facilities in southern Taiwan. The results showed that almost two-thirds of the participants (64.2%) were women. The mean age was 79.62 (SD = 1.71). Older women with diabetes were reported to have significantly lower levels of education and poor glycemic control but higher levels of perceived relocation stress than men; however, functional independence was significantly higher in men. Although perceived relocation stress significantly predicted HbA1c levels in both women and men, length of stay was also significant in predicting HbA1c levels in women. These findings indicate the need for effective physical and psychological measures to improve glycemic control during the first year of stay in long-term care facilities.

Meditation for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy.

OBJECTIVES

To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence.

MAIN RESULTS

We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates.

AUTHORS' CONCLUSIONS

Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.

American Diabetes Association Professional Practice Committee, ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Factors associated with adaptation level in the older adult residential care facilities: a path analysis

Background

It has become very common for older adults to relocate to residential care facilities. Yet whether older adults adapt to life in a long-term care residential facility through perception, reflection, and conscious behavioral choices is a challenging social issue. Previous research has shown that adaptation is influenced by physical, mental, psychological, social systems, and other debris factors. However, existing knowledge is often based on unidirectional relationships between these factors and adaptation. Few studies have formally examined bivariate relationships between these factors, and the influence of adaptation between these factors internally remains unclear. Therefore, there is a need to examine the structural causality of adaptation in residential care facilities influenced by a combination of physical, emotional, social and psychological factors, life satisfaction, and social support.

Methods

The present cross-sectional study recruited older adults from three residential care facilities in Henan province, China, through convenience sampling. The Chinese Nursing Home Adjustment Scale (NHAS), Geriatric Depression Scale-15 (GDS-15) and Social Support Scale (SSRS), Satisfaction with Life Scale (SWLS), and Barthel Index were employed to measure the older adult' adjustment level, depression level, social support, satisfaction with life, and self-care ability of the BMC, respectively. The relationships between depression, social support, self-care, satisfaction with life, and adaptation were analyzed and a structural equation model was developed.

Results

A total of 210 participants completed the questionnaire. The model demonstrated an acceptable fit of the data. The results showed that the difference between life satisfaction and depression on the level of adaptation was 60 and 23%, respectively. Social support and life satisfaction had a positive direct effect on the level of adaptation, both showing a positive correlation with the level of adaptation. Depression, on the other hand, have a direct effect on the level of adaptation and showed a negative correlation with the level of adaptation. Self-care ability indirectly influenced adaptation mediated by social support.

Conclusion

Social support has a positive impact on both life satisfaction and depression, which in turn promotes adaptation. As a major source of social support, family members and nursing home staff in residential care facilities can enhance social support for older people through improved interaction, which can have a meaningful and positive impact on levels of adjustment. The model demonstrates the strengthening and weakening of social support, self-care, life satisfaction, and depression levels, which can help inform the development of relevant care health strategies for older people to promote levels of adjustment and improve quality of life.

The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses

Background: Previous research has demonstrated the effectiveness of mindfulness interventions in improving glycemic control. By enhancing attention control, emotion regulation, and self-awareness, mindfulness shows promise in managing the lifestyle factors associated with cardiovascular disease risk. However, the impact of mindfulness on glycemic control in people with diabetes remains unclear. This overview aims to summarize the current evidence of the impact of mindfulness interventions on glycemic control in people with diabetes and propose suggestions for future research. Methods: The author searched electronic databases (PubMed/MEDLINE, Embase, and Cochrane Library) to identify relevant systematic reviews and meta-analyses. The current evidence regarding the effects of mindfulness on glycemic control in people with diabetes was summarized. Results: This review evaluated a total of five systematic reviews and meta-analyses of randomized controlled trials (RCTs). Mindfulness interventions show potential for improving glycemic control as measured by hemoglobin A1c (HbA1c) levels, as well as reducing stress, depression, and anxiety in people with diabetes. Four out of five systematic reviews and meta-analyses reported a significant reduction in HbA1c levels by approximately 0.3%. However, the available studies lacked adequate description of key characteristics of study subjects, such as body mass index, medication, and disease conditions, which are essential for assessing the impact of mindfulness on glycemic control. Moreover, there was significant heterogeneity in the intervention methods employed across the included RCTs. Conclusions: Mindfulness interventions are effective in improving glycemic control in people with type 2 diabetes. However, the overall quality of the reviewed studies raises uncertainty regarding the effectiveness of mindfulness as a treatment for people with diabetes. Further research is necessary to elucidate the biological effects of mindfulness on physiological, neurological, and endocrinological functions in humans.

Effects of Mind-Body Training as a Mental Health Therapy in Adults with Diabetes Mellitus Type II: A Systematic Review

The increase in the prevalence and disease burden of diabetes has highlighted the need to strengthen a comprehensive care system that includes mental health treatment. A systematic review was carried out to analyze the effectiveness of mind-body training as a therapy for the mental health management of adult patients with type 2 diabetes mellitus (T2DM) following the PRISMA 2020 guidelines. Pubmed, Scopus and Web of Science databases were consulted between November and December 2022. Eight articles were selected according to the inclusion and exclusion criteria. Only randomized controlled trials were included. The interventions focused on mindfulness and yoga with variable durations of between 8 weeks and 6 months. Four of the included studies observed statistically significant changes (p < 0.05) in anxiety. Six articles determined that mind-body training was effective for treating depression. Finally, five articles found favorable effects on stress, while one did not observe changes at 8 weeks of intervention or after 1 year of follow-up. The evidence supports the use of mind-body training to reduce stress, depression, and anxiety levels in the adult population with T2DM, which makes this type of training a valuable intervention to be included in an integral approach to diabetic pathology.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Effects of meditation on physiological and metabolic parameters in patients with type 2 diabetes mellitus "MindDM": study protocol for a randomized controlled trial

BACKGROUND

Sri Lanka is faced with the challenge of managing a large population with diabetes mellitus by 2030. Psychological stress plays a major role in disease outcome by exerting physiological, psychological and social effects on individuals with chronic disorders. Meditation-based interventions have positive effects on the management of stress and diabetes, which are mediated via modulation of neuro-humoral mechanisms and autonomic functions, among others. Mechanisms of bio-physiological effects of meditation are considered to be through reduction of stress hormones, improvement of insulin resistance and improvement of autonomic dysfunction.

METHODS

This study will be conducted as an open-label, randomized controlled clinical trial in the Faculty of Medicine, University of Colombo. The aim is to investigate the effects of meditation on glycaemic control and possible mechanisms of how meditation affects glycaemic control in patients with type 2 diabetes. The study was approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo (ERC/2019/094). Patients who are attending the professorial unit medical clinic with type 2 diabetes (172 in total) will be recruited based on inclusion-exclusion criteria. Patients who have never meditated or rarely meditated (less than once every three months) will be randomized using block randomization to meditation and waitlisted arms (1:1 allocation ratio). The meditation arm will undergo a mindfulness meditation program (selected after studying several meditation methods) conducted by a qualified instructor weekly for a period of 12 weeks in addition to usual care, while the waitlisted arm will only receive usual care. Daily meditation practices will be recorded in a diary. The primary outcome measure is HbA1c. Secondary outcome measures are fasting blood sugar, fructosamine, insulin resistance (calculated using fasting serum insulin), 24-h urinary cortisol, body mass index, cardiac autonomic reflex testing (Ewing's battery of tests) and orocecal transit time using hydrogen breath analysis. All these will be done prior to commencement of the intervention and after 3 months in both arms. Data will be analysed using SPSS V-23.

DISCUSSION

This study aims to identify the effect of mindfulness meditation on glycaemic control and the possible mechanisms (neuro humoral and autonomic functions) by which beneficial effects are mediated.

TRIAL REGISTRATION

Registered under Sri Lanka Clinical Trial Registry: SLCTR/2021/015 The Universal Trial Number (UTN) U1111-1266-8640.

Influence of Self-Practice Oriented Teaching plus Psychological Intervention on Blood Glucose Level and Psychological State in Patients with Type 2 Diabetes Mellitus on Insulin Therapy

Background. The study aimed to examine the effect of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological status of type 2 diabetic patients on first insulin therapy. Methods. A total of 80 patients with type 2 diabetes admitted from April 2020 to November 2020 were assessed for eligibility and included. They were then assigned to a control group and an observation group via the random number table method, with 40 cases in each group. In addition to insulin injection treatment in both groups prior to intervention, the control group received health education and psychological intervention, whereas the observation group adopted a self-practice oriented teaching strategy plus psychological intervention. Insulin injections, nursing satisfaction, blood glucose level, and disease awareness were compared between the two groups. The Exercise of Self-Care Agency (ESCA) scale was used to assess the patients’ self-care ability, the Generic Quality of Life Inventory-74 (GQOLI-74) scale was used to assess their quality of life, and the emotional state of patients was evaluated by the Hospital Anxiety and Depression (HAD) scale. Results. Patients in the observation group outperformed the control group in terms of insulin injection after intervention ( $P<0.05$ ). Significantly higher nursing satisfaction and ESCA scores were observed after intervention ( $P<0.05$ ). Self-practice oriented teaching plus psychological intervention resulted in remarkably lower postintervention glycemic indexes ( $P<0.001$ ). Markedly higher disease knowledge scores and GQOLI-74 scores were witnessed in the observation group in contrast to those of the control group ( $P<0.001$ ). The observation group patients showed lower HAD scores than those of the control group ( $P<0.001$ ). Conclusion. Self-practice oriented teaching plus psychological intervention could effectively alleviate the negative emotions of type 2 diabetic patients on first insulin therapy, stabilize glycemic indexes, and improve quality of life, demonstrating good potential for clinical promotion.

Development and validation of a Perceived Relocation Stress Scale for older individuals transferred to long-term care facilities in Taiwan

BACKGROUND

The aim of the current study was to develop and validate a Perceived Relocation Stress Scale.

METHODS

A cross-sectional research design was used. A total of 175 older adults residing in long-term care facilities in Southern Taiwan for at least 1 y were recruited. An exploratory factor analysis was performed to examine item convergent and discriminant validity. Concurrent validity was checked using the Depression Anxiety and Stress scale. The reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients.

RESULTS

The face and content validity of the scale were verified by adequately measuring the scale items. Factor analysis consisted of four components (challenge/chance, positive appraisal, threat, loss), with a total variance of 67.35%. The content validity was determined by an expert panel to systematically examine the relevance of all items. The results of item convergent and discriminant validity supported the constructs of the scale. The alpha coefficient for the overall scale was .958, indicating good internal consistency reliability.

CONCLUSIONS

The Perceived Relocation Stress Scale is a reliable and valid measurement to assess the stress perceived by older individuals being transferred to a long-term care facility.

Utilization of Mind–Body Intervention for Integrative Health Care of COVID-19 Patients and Survivors

Recent findings suggest a correlation between COVID-19 and diabetes, although the underlying causes are still little understood. COVID-19 infection tends to induce severe symptoms in patients with underlying diabetes, increasing their mortality rate. Moreover, COVID-19 itself appears to be a diabetogenic factor. In addition, mental health conditions, such as depression due to lockdown and anxiety about infection, were found to affect glycemic control and immunity, highlighting the importance of mental health care during the pandemic. Mind–Body Intervention (MBI), which includes meditation, yoga, and qigong, has emerged as a tool for mental health management due to its effects on stress reduction and the promotion of mental and physical well-being. Here, we review the latest randomized controlled trials to determine the effects of MBI on glycemic control and the immune system and discuss the underlying mechanisms by which MBI facilitates the virtuous cycle of stress management, glycemic control, and immune modulation. Furthermore, we examine the actual utilization of MBI during the COVID-19 pandemic era through recent studies. With proper online education, non-pharmacological MBI may be more widely used as an important tool for self-health care that complements the usual treatment of COVID-19 patients and survivors.

Adapting Mindfulness-Based Interventions for Residents of Long-Term Care Facilities

Mindfulness-based interventions (MBIs) have received increased clinical attention in recent years. While some MBI research has focused on healthy older adults, research with more emotionally and physically vulnerable populations, such as residents of long-term care facilities (LTCFs), is lacking. The current paper presents quantitative and qualitative results from a pilot study of an individual MBI designed for residents of LTCFs. Participants included 8 residents from two skilled nursing facilities in the southeastern United States. Data were collected between October 2016 through June 2017. A modified MBI is proposed with specific adaptations for LTCF residents. Recommended adaptations for LTCFs include a shift from a group to an individual format, individual weekly instructor–participant meetings, removal of the yoga and full-day silent retreat and shortening the duration of the formal practices. The current study found that these adaptations result in an individual MBI that is accessible to most LTCF residents while still providing the associated benefits of traditional group MBIs.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review

INTRODUCTION

Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies.

METHODS

We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936).

RESULTS

Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1).

CONCLUSIONS

MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.