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Level 1 and Level 2 Interventions in the Mediation of Diabetes

Diabetes is a chronic debilitating medical condition that affects an estimated 30.3 million individuals in the United States, of which 30.2 million are adults aged 18 years or older representing 12.2% of all U.S. adults.1 Diabetes is associated with significant morbidity and mortality. It is the leading cause of end-stage renal disease and amputation of the lower extremity in the general population and the leading cause of new cases of blindness in individuals aged 20–74 years. 2 In addition, diabetes is the sixth leading cause of death in the U.S., moving up a notch from seventh place in 2015.3 Furthermore, diabetes imposes significant financial burden on individuals with the disease. The annual medical cost associated with diabetes is 327 billion dollars, including direct and indirect medical costs and lost productivity.4

This paper evaluates the effectiveness of Level 1 (Spirit) and Level 2 (Mind) interventions as defined in the Model for Consciousness Based Medicine (CBM).

Level 1 interventions in CBM encompass involvement at the spirit level and include grace, prayer, meditation, mindfulness practice, spiritual guidance and spiritual engagement at a community level.5 Spirituality is an increasingly important aspect of healthcare, and health professionals are beginning to recognize that addressing patients’ spiritual needs is an essential part of patient-centered care.6 Spirituality and a sense of meaning in suffering bring people with chronic health conditions to the process of transformation, help them know their strengths through finding inner self and achieve wellbeing.7,8

In 2009, N Parsian and Trisha Dunning conducted a study aimed to explore how young adults with diabetes define spirituality, and the relationship between spirituality and coping in young adults with diabetes. [Parsian, Dunning] The study consisted of 100 young adults aged 18 to 30. The study defined spirituality as a process of finding meaning in suffering and being able to transcend the suffering through connections with the inner self, other people and the universe, which ultimately helps people cope with the situation, in this case diabetes, and achieve a sense of inner peace and wellbeing. [Parsian, Dunning]

I want to include the diagram which was used to guide the study in defining the conceptual framework. Figure 1 eloquently shows the relationship of Spirit through self-actualization, relationships, connectedness with the universe, finding meaning in suffering, spiritual practice, self-awareness and spiritual beliefs leading to the transformation of inner peace and facilitating the process of then being emotionally ready to enter Level 2 interventions.

Figure 1. [Parsian, Dunning]

In the process, the following seven themes emerged as important interventions related to Spirit:

• Being in touch with the inner self

• Having a sense of purpose and meaning in life

• Connecting with other people, nature and a higher being

• Having a belief system

• Positive attitude

• Having a sense of inner peace and balance

• Connecting spirituality with religion

The findings suggest that healthcare professionals need to consider the role of spirituality in diabetes self-management and to address spirituality in diabetes care plans and consultations. [Parsian, Dunning] There were significant relationships among aspects of coping and spirituality, which one can conclude greatly helped in improving their overall perception of their disease through the first steps of coping and acceptance.

Level 2 interventions in CBM encompass involvement at the level of the Mind and include Individual and group psychotherapy, psychoeducation, training in skillful communication and social engagement. [Fauver]

Research of the past 25 years has improved our understanding of how common emotional problems are among patients with diabetes, and how profoundly emotional problems affect diabetes outcomes.9 Psychological disorders, such as depression, are a problem for people with diabetes, in addition to less serious issues of frustration and being overwhelmed by the demands of the disease. Rubin adds that a key to effectively treating diabetes-related distress is found in enhancing the patients coping skills. [Rubin, pg 174] Interventions included therapy groups, self-help groups and support groups where benefits such as greater emotional well-being, enhanced coping skills, better regimen adherence and improved glycemic control. [Rubin, pg 174]

In a study published in 2015 by Jeff C. Huffman et al, boosting positive affect, optimism, and psychological well-being lead to better health behavior adherence in the treatment of Diabetes. For people with diabetes, it can be challenging to stick to a healthy diet, be physically active, and follow a medication plan. Research suggests that experiencing positive thoughts and feelings (like feeling hopeful, satisfied, or proud) can help people to stick to healthy behaviors.9

There is sufficient evidence to show that Level 1 and Level 2 interventions in the Consciousness Based Medicine Model improve an individuals ability to experience a more positive healing outcome. Exploring Spirit based activities such as attending church, meditating, praying, utilizing modalities like Therapeutic Touch, or simply practicing self-actualization can help achieve wellbeing and peaceful acceptance of the disease. Next, by engaging in a Mind based intervention like group education or psychotherapy, feelings of optimism and acceptance are enhanced, allowing the individual with diabetes to maintain behaviors that will benefit their overall health.

REFERENCES

  1. National Diabetes Statistics Report, 2017. Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

  2. Leonard E. Egede, MD, MS, Xiaobou Ye, MD, MS, Deyi Zheng, MB, PHD and Marc D. Silverstein, MD. The Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals With Diabetes Diabetes Care 2002 Feb; 25(2): 324-329. https://doi.org/10.2337/diacare.25.2.324 or http://care.diabetesjournals.org/content/25/2/324.full

  3. The top 10 leading causes of death in the United States https://www.medicalnewstoday.com/articles/282929.php

  4. The Cost of Diabetes. American Diabetes Association. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

  5. Randy Fauver, PhD. The Seven Layers of Health. 2011. chrome-extension://gbkeegbaiigmenfmjfclcdgdpimamgkj/views/app.html

  6. N Parsian RN, MSN, PhD, T Dunning AM, RN, MED, PhD, FRCNA. Spirituality and coping in young adults with diabetes: a cross‐sectional study. First published: 14 December 2009. https://doi.org/10.1002/edn.144 or https://onlinelibrary.wiley.com/doi/full/10.1002/edn.144

  7. McSherry W, Cash, K. The language of spirituality: an emerging taxonomy. Int J Nurs Stud 2004; 41: 151–161.

  8. Pesut B. Spirituality and spiritual care in nursing fundamentals textbooks. J Nurs Educ 2008; 47: 167–173.

  9. Jeff C. Huffman, Christina M. DuBois, Rachel A. Millstein, Christopher M. Celano, and Deborah Wexler. Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development. Journal of Diabetes Research. Volume 2015, Article ID 428349, 18 pages. http://dx.doi.org/10.1155/2015/428349.

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