NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
Front Endocrinol (Lausanne). 2020 Oct 6;11:570777. doi: 10.3389/fendo.2020.570777. eCollection 2020.
Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia.
We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer.
Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; = 0.034).
pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted.
Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.
2 型糖尿病（T2DM）是一个重大的健康问题，给个人和医疗系统带来了巨大的负担。人们越来越感兴趣地将共同医疗预约（SMAs）用于 T2DM 的管理。我们假设在 SMA 中加入正念可能是有益的。本研究旨在评估在澳大利亚的初级保健中，T2DM 患者使用正念的 SMA 的可行性和可接受性。
我们在澳大利亚西悉尼的初级保健中进行了一项单盲随机对照可行性研究，以评估 SMA 治疗 T2DM 的可行性和可接受性。年龄在 21 岁及以上、HbA1c＞6.5%或过去 3 个月内空腹血糖＞7.00mmol/L 的 T2DM 患者有资格参加。T2DM 患者参加了六个 2 小时的程序化 SMA（pSMA），每两周举行一次。pSMA 包括结构化教育计划和正念部分。对照组接受他们的医疗保健提供者的常规护理。我们使用 ActiGraph 加速度计收集了关于可接受性以及糖化血红蛋白和连续血糖监测、血脂、人体测量指标、血压、自我报告的心理结果、生活质量、饮食和身体活动的定量和定性数据。
在 2 个月的时间里，我们招募了 18 名参与者（10 名女性，8 名男性），平均年龄为 58 岁（标准差为 9.8）。我们的保留率为 94.4%。所有参加干预组的参与者都至少完成了四个 pSMA。参与者报告说，参加 pSMA 是一次积极的经历，使他们能够接受自己的诊断，并使他们有能力做出改变，这导致了有益的效果，包括体重减轻和更好的血糖控制。四个参加 pSMA 的参与者发现正念部分有帮助，而两个参与者则没有。所有七位参与定性评估的参与者都报告说他们的心理健康状况得到了改善，并认为小组设置很有帮助。在 12 周时，两组之间的总胆固醇水平（干预组 3.86mmol/L，对照组 4.15mmol/L； = 0.025）以及 PROMIS-29 测量的疼痛强度水平（2.11 vs. 2.38； = 0.034）有显著差异。
pSMA 对 T2DM 患者是可行和可接受的，可能会导致临床改善。需要进行后续的、充分的、随机对照试验。
澳大利亚和新西兰临床试验注册处，标识符 ACTRN12619000892112。
