The Effectiveness of SKT1–3 Meditative Exercise Therapy on Hemoglobin A1c Control (HbA1c) in Patients With Type 2 Diabetes

Abstract

Introduction and Objective: Diabetes mellitus is a chronic metabolic disorder characterized by abnormalities in the cellular processes that convert blood glucose into energy. This process involves insulin, a hormone produced by the pancreas, which regulates blood sugar levels. When glucose is not adequately utilized by the cells, it results in elevated hemoglobin A1c levels, reflecting sustained hyperglycemia above the normal range. The Samatha–Kammatthana Therapy, known as SKT1–3 meditation therapy, is a breathing–based mindfulness practice designed to slow down baroreflex activity, thereby decreasing the sympathetic nervous system’s autonomic responses. This leads to a reduction in blood pressure, skeletal muscle relaxation, alleviation of muscle tension, and a decrease in blood glucose levels. This research aimed to (1) examine the effects of SKT1–3 meditation therapy on the control of hemoglobin A1c levels within and between the intervention and control groups; (2) compare the effectiveness of blood glucose control between these groups; and (3) investigate the effects of SKT1–3 meditation therapy on stress reduction within and between the groups. The study findings were intended to contribute as an alternative treatment option for patients with type 2 diabetes mellitus.

          Method: A quasi–experimental design with two groups, employing pretest–posttest measures, was utilized for this study. Participants included individuals diagnosed with type 2 diabetes mellitus, with or without comorbid hypertension, who had hemoglobin A1c levels ranging from 7.0 to 10.0 percent. Eligible participants were aged twenty years and older and were not concurrently involved in other research that could affect glycemic control. Research instruments consisted of a detailed SKT1–3 meditation therapy manual tailored for patients with type 2 diabetes mellitus, having a content validity index of 1.00, and a self–assessment stress evaluation tool developed by the Department of Mental Health in 2020. The sample size comprised eighty–four individuals, randomly assigned into an intervention group and a control group. The intervention group practiced SKT1–3 meditation therapy consistently over a three–month period, three days per week–specifically on Monday, Wednesday, and Friday. The regimen was structured so that SKT1 was practiced in the morning upon waking, SKT2 in the evening, and SKT3 before bedtime. The control group received usual nursing care without meditation intervention. Data normality was tested, and statistical analyses comparing hemoglobin A1c and stress levels employed the Wilcoxon Signed Ranks Test, Mann–Whitney U Test, and McNemar Test, with significance set at p < 0.05.

          Results: Following the intervention period, the intervention group demonstrated a statistically significant reduction in hemoglobin A1c levels compared to their baseline measurements (p < 0.05). Moreover, their hemoglobin A1c values were significantly lower than those observed in the control group (p < 0.05). In addition, 30 participants in the intervention group, accounting for 71.43 percent, exhibited improved glycemic control post–intervention, with a mean hemoglobin A1c level of 6.67 percent. Regarding psychological stress, the intervention group showed a significant decrease from baseline levels (p < 0.05), and their stress scores were also significantly lower than those of the control group (p < 0.05). The average stress score for the intervention group post–intervention was 15.43 points, falling within the normal stress range.

          Discussion: The SKT1–3 meditation therapy represented a form of integrative medicine combining conventional medical treatment with complementary therapeutic approaches. The study revealed statistically significant reductions in both hemoglobin A1c levels and stress scores among participants, suggesting that SKT1–3 meditation therapy had potential long–term benefits for metabolic and emotional regulation. The underlying physiological mechanism was likely related to the reduction of psychological stress and modulation of the autonomic nervous system. During meditation practice, the baroreflex mechanism functioned more slowly, the sympathetic nervous system activity was suppressed, while the parasympathetic nervous system activity was enhanced. These physiological changes led to decreased levels of cortisol and catecholamines, which played a crucial role in improving insulin sensitivity and reducing hepatic glucose production. Through this neuroendocrine modulation, regular practice of SKT1–3 meditation therapy restored balance within the psychoneuroendocrine system, resulting in improved regulation of hemoglobin A1c levels over time. Therefore, SKT1–3 meditation therapy could serve as an effective complementary approach to conventional diabetes management and may contribute to holistic care for patients with type 2 diabetes mellitus.

          Conclusion and Recommendation: Regular and consistent practice of SKT1–3 meditation therapy significantly reduced both hemoglobin A1c levels and stress among patients with type 2 diabetes mellitus. Although the observed improvements in average hemoglobin A1c and stress levels might not have resulted solely from meditation practice, other contributing factors such as increased health awareness through participation in the study, improved dietary behavior, and regular physical activity could have played supportive roles. Future studies should therefore explore the integrated implementation of SKT1–3 meditation therapy in primary health care settings and chronic disease clinics as part of a comprehensive diabetes care model. Moreover, this approach could be extended to high–risk populations for diabetes prevention, including individuals with prediabetes, metabolic syndrome, or a family history of diabetes. SKT1–3 meditation therapy thus offered a practical, low–cost, and sustainable intervention that supported self–management, enhanced quality of life, and promoted long–term glycemic control among individuals with type 2 diabetes mellitus.