DESCRIPTION (provided by applicant): Twenty-five percent of military Veterans who receive care through the Veterans Health Administration (VHA) have diabetes, making support for diabetes self-management a priority. However, diabetes-related distress resulting from daily self-care tasks affects up to 40% of people with diabetes, placing them at risk for impaired diabetes self-management, decreased metabolic control, and higher morbidity and mortality. Emerging research suggests that mindfulness, a mind-body therapy studied in a variety of chronic health conditions over the past 30-years, helps to reduce emotional distress and may improve diabetes outcomes. The objectives of this study are to examine the effects of a program of mindfulness training and practice, provided as part of diabetes education, which we call Mind-STRIDE (Mindful Stress Reduction in Diabetes Education), on psycho- behavioral and glycemic outcomes including: 1) mindfulness, 2) diabetes-related distress, 3) diabetes self- efficacy, 4) diabetes self-management, and 5) glycemic control. We will also explore Veterans' satisfaction and experiences with mindfulness training and practice. To achieve these objectives, we will conduct a mixed- methods randomized controlled trial of 126 Veterans randomly assigned to either the experimental condition that receives routine diabetes education plus Mind-STRIDE, or to usual care that receives diabetes education alone. Quantitative outcomes will be measured by subjective questionnaires except for hemoglobin A1c, which will be assessed through standard laboratory methods. Data will be collected at baseline, 12-weeks, and 24- weeks, and will be analyzed by mixed-effects modeling. Qualitative telephone interviews will be conducted at 15-weeks in a subset of participants from the experimental group, and will be analyzed using modified Grounded Theory methods. Quantitative and qualitative findings will be compared and interpreted using Convergent Parallel Design. By examining the acceptance and effects of mind-body interventions like Mind- STRIDE among Veterans who have chronic health conditions such as diabetes, the VA will benefit from new evidence-based, patient-centered approaches that support self-care.

One million Veterans who receive healthcare at VA have diabetes. Self-management of diabetes can cause distress, and this distress can make self-care even more difficult. As a result, some individuals “tune-out” and their diabetes can become uncontrolled. Many people first learn how to self-manage diabetes through diabetes education classes, but these classes do not teach them how to manage stress. Mindfulness, the practice of non-judgmentally paying attention in the present moment, helps many people feel more calm and able to focus on their health. Mindfulness has been studied in over 5000 Veterans with chronic health conditions, but it has not been studied in Veterans who have diabetes. This study proposes to examine the effects of mindfulness training on the stress of having diabetes, diabetes self-care, and diabetes control, and will also explore Veteran experiences with mindfulness training and practice.