A blended mindfulness-based stress reduction program to improve diabetes self-management among people with type 2 diabetes mellitus: a mediation effect analysis

The mechanisms through which the blended mindfulness-based stress reduction (MBSR) program improves diabetes self-management among individuals with Type 2 diabetes mellitus (T2DM) remain unclear. This study aims to evaluate the effectiveness of blended MBSR on perceived stress, anxiety, and depressive symptoms, while also exploring the potential mechanisms underlying its effects on improving diabetes self-management. One hundred individuals with T2DM were recruited and randomly assigned to two groups (50 participants each) from March 2020 to July 2020. A randomized clinical trial, combined with generalized estimating equations for repeated measures, was employed to assess the intervention effects of the blended MBSR on perceived stress, anxiety, and depressive symptoms compared to standard care. Mediation analyses using Model 4 in SPSS PROCESS were conducted to evaluate the contributions of the blended MBSR to diabetes self-management. Participants in the blended MBSR group showed a significant reduction in perceived stress, anxiety, and depressive symptoms compared to the control group over 12 weeks. Bootstrap mediation analyses indicated that changes in perceived stress and anxiety fully mediated the effect of the blended MBSR on diabetes self-efficacy. In contrast, depressive symptoms were not associated with diabetes self-efficacy and therefore did not qualify as mediators. Additionally, diabetes distress was found to be an insignificant mediator. Furthermore, changes in diabetes self-efficacy served as a partial mediator of the positive effects of the blended MBSR on diabetes self-management. The blended MBSR program effectively reduced perceived stress, anxiety, and depressive symptoms in individuals with T2DM. The intervention's impact on perceived stress and anxiety contributed to an increase in diabetes self-efficacy, subsequently enhancing diabetes self-management. Interventions that aim to reduce perceived stress and anxiety, while also increasing diabetes self-efficacy, are recommended to develop diabetes self-management strategies with clearly defined mechanistic pathways.