36 ALTERN ATIVE TH ERAPIES, sep/o c t 2007, VOL. 13, N O. 5
Mindfulness-based Stress Reduction and Diabetes
MINDFULNESS-BASED STRESS REDUCTION IS
ASSOCIATED WITH IMPROVED GLYCEMIC CONTROL
IN TYPE 2 DIABETES MELLITUS: A PILOT STUDY
Steven Rosenzweig, MD; Diane K. Reibel, PhD; Jeffrey M. Greeson, PhD; Joel S. Edman, DSc; Samar A. Jasser, MD;
Kathy D. McMearty, BA; Barry J. Goldstein, MD, PhD
this risk.7-9 Although stress-reduction interventions may improve
glycemic control among people with diabetes, data are limited
and results are confl icting.5,10-14
Mindfulness-Based Stress Reduction (MBSR) is an 8-week
group intervention shown to reduce stress-related symptoms
in various patient populations, but the program is yet untested
in diabetic cohorts.15,16 The core of MBSR involves training in
mindfulness meditation, a practice of self-regulating attention
that lowers reactivity to stress triggers.17 Aims of the current
pilot study were to estimate changes in glycemic control,
weight, blood pressure, and stress-related psychological symp-
toms in patients with type 2 diabetes participating in a stan-
dard MBSR program.
RESEARCH AND DESIGN MODELS
This prospective observational study included adults aged
30 to 75 years treated with oral hypoglycemic agents but not
with insulin. Additional inclusion criteria were glycosylated
hemoglobin (HA1c) >6.5% and <8.5%; fasting blood glucose
<275 mg/dL upon screening and again at baseline; no change in
medication, diet, or exercise <12 weeks prior to intervention;
absence of severe psychopathology (eg, psychotic disorder or
substance use disorder); and no current meditation practice. To
avoid confounding effects of changes in medication, diet, or exer-
cise, participants were excluded from analyses if they reported
such changes during the intervention.
Subjects participated in a standard MBSR intervention for
heterogeneous patient populations at an academic health center.
Steven Rosenzweig, MD, is an associate professor in the
Department of Emergency Medicine, Jefferson Medical
College, Thomas Jefferson University, Philadelphia, Pa.
Diane K. Reibel, PhD, is the Director of Professional
Education, Mindfulness-Based Stress Reduction Program,
Jefferson Myrna Brind Center of Integrative Medicine,
Thomas Jefferson University. Jeffrey M. Greeson, PhD, is a
post-doctoral research fellow at the Duke Center for
Integrative Medicine, Duke University Medical Center,
Durham, NC. Joel S. Edman, DSc, is the Director of
Integrative Nutrition, Jefferson Myrna Brind Center of
Integrative Medicine, Thomas Jefferson University and
Hospital. Samar A. Jasser, MD, is an assistant instructor in
the Department of Psychiatry, University of Pennsylvania
School of Medicine, Philadelphia, Pa. At the time this
research was conducted, Kathy D. McMearty, BA, was a
research assistant in the Jefferson Myrna Brind Center of
Integrative Medicine, Thomas Jefferson University. Barry J.
Goldstein, MD, PhD, is Director of the Division of
Endocrinology, Diabetes and Metabolic Diseases at Jefferson
Medical College, Thomas Jefferson University.
sychological distress is linked with impaired glycemic
control in diabetics and increased risk of diabetes
mellitus.1-6 Physiological responses to stress, includ-
ing increased glucose production, glucose mobiliza-
tion, and insulin resistance, could partially mediate
Context • Psychological distress is linked with impaired glyce-
mic control among diabetics.
Objective • Estimate changes in glycemic control, weight,
blood pressure, and stress-related psychological symptoms in
patients with type 2 diabetes participating in a standard
Mindfulness Based Stress Reduction (MBSR) program.
Design • Prospective, observational study.
Setting • Academic health center.
Patients • Adult patients with type 2 diabetes mellitus.
Interventions • Participation in MBSR program for heterogeneous
patient population. Diet and exercise regimens held constant.
Main Outcome Measures • Glycosylated hemoglobin A1c
(HA1c), blood pressure, body weight, and Symptom Checklist
90-Revised (anxiety, depression, somatization, and general
psychological distress scores).
Results • Eleven of 14 patients completed the intervention. At
1 month follow-up, HA1c was reduced by 0.48% (P=.03), and
mean arterial pressure was reduced by 6 mmHg (P=.009). Body
weight did not change. A decrease in measures of depression,
anxiety, and general psychological distress was observed.
(Altern Ther Health Med. 2007;13(5):36-38.)
o r ig in al r esear c h
ALTERN ATIVE TH ERAPIES, sep/o c t 2007, VOL. 13, N O. 5 37
Mindfulness-based Stress Reduction and Diabetes
was found at 1 month follow-up, representing a large magnitude
effect size (P=.03, d=0.88). A downward trend in mean arterial
pressure was also seen at 8 weeks (P=.07, d=0.27), reaching sta-
tistical signifi cance at 1 month follow-up (P=.009, d=0.48). There
was no change in mean body weight during the study period.
Symptoms of depression, anxiety, and general psychological
distress decreased by 43%, 37%, and 35%, respectively, upon com-
pletion of the intervention (depression: P=.03, d=0.86; anxiety:
P=.33, d=0.43; general severity index: P=.07, d=0.60). No change
in somatization was detected. Follow-up means at 12 weeks were
not signifi cantly different compared to post-intervention means.
Results of this pilot study support the hypothesis that
MBSR training is associated with improved glycemic regulation
in type 2 diabetes. Changes in lifestyle do not account for the
observed reduction in HA1c. There were no reported changes in
medication, diet, or exercise that could account for improved
glycemic control. Mean body weight did not change, making
unreported signifi cant changes in diet or exercise unlikely.
An alternative explanation recognizes the counter-regulatory
effects of the physiological response to stress. Stress-mediated pro-
duction of cortisol, norepinephrine, beta endorphin, glucagon,
and growth hormone increases blood glucose and insulin resis-
tance. Mindfulness training appears to interrupt or down-regulate
an individual’s psychological reactivity to stress triggers, which
may in turn mitigate physiological stress response and thereby
improve glycemic regulation. In this pilot, reduction in mean arte-
rial pressure may be another physiological marker of stress
Trends in psychological symptom reduction further support
a stress-reduction hypothesis. Psychometric data were generally
consistent with those reported for heterogeneous subjects partic-
ipating in MBSR20; statistical significance may not have been
reached due to the small sample size.
Limitations of the present study include absence of a control
group and a small cohort size. These promising fi ndings warrant
further investigation of MBSR with a randomized clinical trial.
This research was supported by the Diabetes Action Research and Education Foundation,
MBSR consists of 8 weekly 150-minute sessions plus a 7-hour
weekend session. The program follows the curriculum devel-
oped at the University of Massachusetts Stress Reduction
Program by Dr Jon Kabat-Zinn.17 A range of mindfulness medi-
tation techniques are taught: body scan, awareness of breath-
ing, mindful walking, mindful eating, and mindful
communication. In all of these practices, the participant trains
to pay full attention to present-moment experience, choosing to
respond skillfully rather than react automatically to external
events, thoughts, emotions, or sensations as they arise. Each
participant receives 2 practice compact discs to support a home
practice requirement of at least 20 to 30 minutes of formal med-
itation per day, 6 days per week.
Outcome measures were taken at 3 time points: baseline
(week preceding MBSR), program completion (week 8), and
1-month follow-up (week 12). Variables included HA1c, a mea-
sure of average blood sugar over the prior 12 weeks; blood pres-
sure; weight; and selected subscales from the Symptom Checklist
90-Revised (depression, anxiety, somatization, general severity
index18). Data on compliance with home meditation practice were
collected weekly during the intervention. Paired t-tests (2-tailed,
α=.05) were used to compare baseline, post-intervention, and
follow-up means on dependent variables. Cohen’s d was used to
estimate the magnitude of treatment effect sizes at post-interven-
tion and follow-up relative to baseline status.19 Data are reported
as mean ± SD unless otherwise indicated.
Fourteen patients enrolled (5 men, 9 women). Mean age
was 59.2 ± 2.57 years. Ten subjects were Caucasian; 4 were
African American. Average time since diagnosis was 7.36 ± 1.63
years. Eleven subjects completed the intervention: 1 subject
dropped out of the MBSR program, 1 subject was excluded
because medication was decreased during the study period, and
1 subject was excluded because medication was increased during
the study period. Compliance with home meditation practice
was excellent, with subjects reporting a mean of 6.5 (±0.9) ses-
sions per week for 24 (±2.5) minutes per session. No changes in
diet or exercise regimen were reported during the investigation.
As shown in the Table, a downward trend in HA1c was
observed after 8 weeks at completion of intervention (P=.14,
d=0.46). A statistically signifi cant reduction in HA1c of 0.48%
TABLE Treatment-related Changes in Glycemic Control, Weight, and Blood Pressure*
Baseline (Week 0) Post-intervention (Week 8) Follow-up (Week 12)
Glycemic control (HA1c %) 7.50 ± 0.517.23 ± 0.67 .14.467.02† ± 0.58.03.88
Weight (lbs) 236 ± 48 238 ± 50
97‡ ± 10
.20.04 240 ± 46
94† ± 13
Mean arterial pressure (mmHg)100 ± 12
*Data are reported as mean ± SD. †P<.05 for paired, 2-tailed t-test with pre-intervention mean. ‡P<.10 for paired, 2-tailed t-test with pre-intervention mean.
§Interpretative ranges: 0.20=small, 0.50=medium, 0.80=large.19
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