One of the new treatment methods or care perspectives for addressing type 1 diabetes, particularly given the potential consequences of inadequate or incorrect management of the condition, is mindfulness. While it is unclear whether mindfulness can improve self-management for every issue under the diabetes umbrella, some evidence suggests that the technique can help people more effectively manage their condition.
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is also characterized by the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells.
When the body does not have enough insulin to use the glucose that is in the bloodstream for fuel, it begins breaking down fat reserves for energy. However, the breakdown of fat creates acidic by-products called ketones, which accumulate in the blood. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis.
Type 1 diabetes often develops in children, although it can occur at any age. Symptoms include unusual thirst, a need to urinate frequently, unexplained weight loss, blurry vision, and a feeling of being tired constantly. Such symptoms tend to be acute.
Diabetes is diagnosed in one of three ways – a fasting plasma glucose test, an oral glucose tolerance test, or a random plasma glucose test – all of which involve drawing blood to measure the amount of glucose in it.
Type 1 diabetes requires insulin treatment for survival. Treatment may also include taking other drugs to prevent kidney damage or to treat diabetes-related conditions such as high blood pressure.
Mindfulness is the practice of being completely aware of your internal and external environment and being fully present in the moment. By focusing on your body and the signals it is sending, you become more aware of your own needs. Dr. Andrew Keen, a psychologist from the University of Aberdeen, Scotland, has been carrying out research to explore whether mindfulness can help people manage their diabetes. He says, “There are a couple of ways that mindfulness may be able to help people with diabetes effectively manage their condition. First, mindfulness may be able to directly help people self-manage. Perhaps, for example, as people become more mindful, they are naturally more in touch with their health needs from moment to moment (increased awareness), and the decluttering effects on cognitions (thoughts) results in better decisions (more clarity around judgments). Second, it may be that mindfulness can be used to overcome significant barriers that impede effective self-management. We know that both anxiety and depression are common among people with diabetes and are associated with higher levels of blood glucose. The hope here would be that self-management naturally improves as psychological well-being increases as a result of mindfulness.”
Randomized controlled trials conducted in Germany and the Netherlands have obtained promising results indicating that mindfulness appeared to help people with diabetes reduce the psychological distress associated with managing their chronic illness. In Germany, the trial used an eight-week mindfulness-based stress reduction program, which combines meditation, mindfulness and yoga to promote healing and was adapted to include practices that helped participants deal with difficult thoughts and emotions commonly experienced by people managing diabetes. The Netherlands research used mindfulness-based cognitive therapy, which was derived from a combination of mindfulness-based stress reduction and mindfulness-based cognitive therapy. Neither study reported improved glycemic control in the participants. “However,” cautions Keen, “most of the participants were adults with type 2 diabetes and were well controlled before they completed the mindfulness training. So we don’t have much evidence about whether mindfulness can help people with type 1 diabetes or help people with relatively poorly controlled diabetes.”
The University of Aberdeen recently launched a pilot study in partnership with the universities of Glasgow and Stirling to determine whether, and to what extent, mindfulness-based cognitive therapy can lower blood glucose levels and reduce anxiety and depression. “There is reasonable evidence that mindfulness training decreases anxiety and depression in people with medical conditions like diabetes,” he says. “On the other hand, what little evidence exists seems to suggest that this alone will not result in better self-management in chronic diseases such as diabetes. My best guess is that we need interventions that both improve emotional well-being and explicitly target self-management behaviors if we want to see improved health outcomes.” Whether mindfulness will increase treatment effectiveness and improve self-management is still an open question, but Keen is optimistic: “I’m inclined to think tailored mindfulness courses may be more useful to people with type 1 diabetes if we are focused on short- and medium-term health outcomes, but to all if we are concerned with emotional well-being.”
Researchers continue to develop new treatments to assist the almost 620 million people worldwide with various forms of diabetes. The Diabetes UK Professional Conference kept attendees abreast of current developments in the field. The sessions were invaluable for increasing awareness regarding troubling trends in the diabetes community or developing new methods or technologies to help people with diabetes manage and monitor their condition. The insights provided predict a future with greater public awareness of the risk of unhealthy lifestyles, a higher standard of care that can be provided by practitioners and a higher quality of life for people with diabetes.
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