The investigators will conduct a pilot randomized controlled trial (RCT) of
Mindfulness-Based Diabetes Education (MBDE) versus standard Diabetes Self-Management
Education (DSME) in adults with type 2 diabetes and moderate-severe diabetes distress who
receive their care from safety-net healthcare systems. The goal of this pilot RCT will be
to assess the acceptability and feasibility of MBDE; acceptability will be assessed
through qualitative follow-up interviews with participants and feasibility will be
assessed through process measures. The investigators will recruit up to approximately 96
participants, 48 from each site to account for potential loss to follow up of up to 20%,
for the study with total study duration of 6 months. Participants will be randomized 1:1
to each study arm. This study will also serve as a pilot test for the procedures of the
RCT and of measures to be used in participant assessments.
The study will be conducted at two safety-net clinics that provide care for residents of
Jefferson County using a sliding scale program based on income level - Cooper Green Mercy
Health Services Authority (CGMHSA) and Alabama Regional Medicine Services (ARMS). CGMHSA,
an affiliate of University of Alabama at Birmingham (UAB) Health System, is Jefferson
County's public safety-net health care facility. CGMHSA provides care primarily to the
indigent county residents, geographically spanning most of the Birmingham metropolitan
area. Ambulatory care services are provided to patients who have type 2 diabetes through
Cooper Green's Primary Care Clinic and multi-disciplinary Diabetes Clinic. ARMS is a
Community Health Center serving the greater Birmingham area since 1983. ARMS provides
ambulatory care for adults, including primary care, diabetes self-management education
classes, and behavioral health services. ARMS offers services to patients, with or
without insurance, on a sliding scale fee program based on income.
Trained study staff overseen by the study PI will recruit participants from CGMHSA and
ARMS through three methods. Opt-out letters will be mailed to patients seen at CGMHSA or
ARMS in the preceding three years with a diagnosis of type 2 diabetes; study staff will
then call potential participants to provide more information about the study and to gauge
their interest in participating. The investigators will obtain a HIPAA waiver to access
potential participant information from the medical record in order to generate a
recruitment list. The investigators will also conduct in-person recruitment of
participants at CGMHSA and ARMS, as well as direct referral of potential participants by
providers or patients. Trained study personnel will obtain screening consent from
potential participants prior to screening for eligibility based on inclusion and
exclusion criteria, which will include assessment of diabetes distress and hemoglobin A1c
(A1C) through point-of-care (POC) finger-stick sample. Study staff will then obtain
informed consent from eligible participants at the time of enrollment.
Both MDBE and standard DSME study arms will be delivered in-person, in a group setting
with 10-14 participants per group. MBDE will be delivered in 8 weekly group sessions
followed by 2 bimonthly individual, booster sessions conducted by phone for a total
duration of 6 months. MBDE will be delivered by an interventionist with a background in
nursing and training as an MBSR instructor, who will receive additional training in MBDE
with an emphasis on content drawn from DSME. Standard DSME will be delivered by a
certified diabetes educator in eight weekly sessions of 2 hours duration. Sessions will
cover seven core content areas - healthy eating, physical activity, medication usage,
self-monitoring, preventing and treating acute and chronic complications, healthy coping,
and problem solving.
Total study duration will be six months; a trained study staff will complete assessments
of participants in both study arms at baseline, 2 months, and 6 months. Participants in
both study arms will complete assessments that will be conducted by trained study
personnel, including interviewer-administered questionnaire, biometric assessment
(height, weight, blood pressure), and POC A1C testing from a finger-stick sample at 3
time points - baseline, 2 months, and 6 months. Participants in the MBDE arm will be
asked to participate in a focus group (estimated length 1 hour) at the 2 month time
point. Participants will receive an incentive for their participation for each study
assessment and for participation in a focus group.