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Mindfulness takes diabetic patients off autopilot.

EXPERT ANALYSIS FROM THE ADA ADVANCED POSTGRADUATE COURSE

SAN FRANCISCO -- Cultivating mindfulness in patients with diabetes is a useful self-help strategy to combat depression and foster healthy habits.

"How can you effectively manage yourself if you're not aware of your self?" Dr. Laura Young said at the annual advanced postgraduate course held by the American Diabetes Association.

One in four patients living with diabetes will develop depression in their lifetime, with 80% relapsing within 5 years of their depression going into remission, she said. Comorbid diabetes and depression increase mortality 2.5-fold, as well as raising the risk of all diabetes complications.

Mindfulness-based interventions teach individuals to be in the present moment, without judgment or emotional reactivity. The benefits are thought to be improved clarity, awareness, and acceptance.

Mindfulness also helps to weaken old, unhelpful, and automatic thinking habits that can potentially prevent positive action. This is critical for patients with diabetes, particularly those with type 1, who tend to go into autopilot when managing their disease, said Dr. Young, with the University of North Carolina in Durham.

"So many of our patients just get into a pattern of 'It's just what I've always done,' " she said. "Mindfulness can help patients take a step back, evaluate those habits, and decide which are helping and which are not so great, and potentially change those habits."

Dr. Young recalled a recent patient who each evening had a bedtime snack that was sometimes healthful, but more often, not. The patient could offer no concrete reason for this snacking habit and admitted that 75% of the time he wasn't even hungry.

"It hadn't even occurred to him that it was something he shouldn't be doing because it was something he'd always done," she said.

Mindfulness-based interventions have been studied for decades and have some of the best, most robust evidence behind them among self-help strategies, Dr. Young observed. In the Heidelberger Diabetes and Stress Study, patients with type 2 diabetes randomized to a mindfulness-based intervention had lower levels of depression, psychosocial distress, and improved health status over 5 years of follow-up compared with treatment-as-usual controls (Diabetes Care 2012;35:945-7).

A study found a mindful-eating intervention was as effective as a diabetes education self-management "Smart Choices" intervention in significantly improving depressive symptoms, cognitive control, and disinhibition of control regarding eating habits in adults aged 35-65 years with type 2 diabetes not on insulin therapy. Weight control at 3 months was also similar with either group-based intervention (Health Educ. Behav. 2014 April;41:145-54)

Mindfulness interventions have been readily adopted in some areas, often combined with yoga or cognitive-behavioral therapy, but these could be a hard sell for those who envision sitting cross-legged on yoga mats in the lotus position.

"I have a lot of patients from rural North Carolina, and they aren't going to buy into that," Dr. Young said.

For these patients, her university offers a 2.5-hour class in which patients sit in a circle on chairs while being guided through mindfulness exercises. An ongoing study at the university is comparing this approach with a health education control group on physiological and psychological outcomes in patients with type 2 diabetes and high levels of diabetes-related distress, she said.

A show of hands at the meeting revealed that about a third of the audience is already using mindfulness training in their patients with diabetes. Dr. Young said that the meeting host city of San Francisco had 386 therapists who use a combination of cognitive-behavioral therapy and mindfulness, whereas 40 therapists are available in Mississippi, as are a handful in rural North Carolina. "So your patients can do this," she added.

Dr. Young reported research support from various pharmaceutical firms and the National Institutes of Health.

pwendling@frontlinemedcom.com
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Title Annotation:ENDOCRINOLOGY
Author:Wendling, Patrice
Publication:Internal Medicine News
Date:Apr 1, 2014
Words:625
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