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Abnormal insulin metabolism and decreased levels of mindfulness in type 2 diabetes mellitus

Diabetology & Metabolic Syndrome volume 17, Article number: 32 (2025) Cite this article

Abstract

Objective

Disorders of insulin metabolism are strongly associated with a variety of psychological problems. The aim of this study was to investigate the differences in mindfulness levels among type 2 diabetes mellitus (T2DM) patients categorized based on their insulin resistance and β-cell function.

Methods

A total of 157 T2DM patients were included in this study and divided into four groups according to their levels of insulin resistance and β-cell function. The Five Facet Mindfulness Questionnaire (FFMQ) was employed to assess the mindfulness levels of the patients. Linear regression models were utilized to investigate the relationships between various T2DM categories and mindfulness levels and dimensions. Furthermore, subgroup analyses of key variables were conducted, and mediation analysis was performed to evaluate the sources of differences.

Results

Significant differences were observed among the four groups in terms of total mindfulness scores and in the dimensions of “Describing,” “Non-judging of Inner Experience,” and “Acting with Awareness” (P < 0.05). Compared to the control group (low HOMA-IR/high HOMA-β), the high HOMA-IR/low HOMA-β group exhibited markedly lower scores in “Non-judging of Inner Experience” (P = 0.02) and “Acting with Awareness” (P < 0.001). The low HOMA-IR/low HOMA-β group demonstrated weaker performance in “Non-judging of Inner Experience” (P = 0.005) and “Describing” (P = 0.002).

Conclusion

Significant differences in mindfulness levels were found to exist among T2DM patients with varying degrees of insulin resistance and β-cell function. Early-stage diabetes patients, particularly those with lower β-cell function or higher insulin resistance levels, may require additional psychological intervention support to enhance their mindfulness and overall well-being.

Introduction

Diabetes has emerged as a global public health issue, with the estimated number of people affected worldwide reaching 529 million in 2021 and projected to surge to 1.31 billion by 2050 [1]. As a highly prevalent chronic disease, diabetes not only affects patients’ physical health but also imposes a significant psychological burden. Multiple factors collectively contribute to patients’ physical and mental distress, including physical symptoms caused by poor blood glucose control, long-term self-management requirements (such as timely medication, blood glucose monitoring, dietary restrictions, etc.), and high healthcare costs [2]. Research indicates that among adult patients with T2DM, the prevalence of comorbid depressive and anxiety symptoms is as high as 10% and 16%, respectively [3]. This deterioration in psychological state not only significantly reduces patients’ treatment adherence but also increases the mortality risk in severe cases [4]. Therefore, in addition to focusing on physical symptoms and blood glucose control, appropriate psychological assessment is equally crucial in the management of diabetes patients.

Mindfulness, as a psychological concept, reflects the process of an individual’s conscious engagement in present experiences [5]. It is typically closely associated with an individual’s awareness, attention, and acceptance of things [6]. A substantial body of research evidence demonstrates that cultivating mindfulness can significantly improve people’s physical and mental health [5, 7]. Over the past three decades, the concept of mindfulness has gradually gained popularity and has been widely applied in various fields, including healthcare, corporate management, military training, and education. In the field of diabetes research, patients’ mindfulness levels have consistently been a focus of scholarly attention. Multiple studies have found that enhancing individual mindfulness levels helps T2DM patients better control blood glucose and improve insulin resistance [8, 9]. As research into mindfulness continues, it is becoming clear that it may mitigate the development of insulin resistance by helping individuals to cope and adapt to stress more effectively, while increasing awareness of healthy behaviours (e.g. improving sleep quality and avoiding emotional eating) [10, 11]. These mechanisms may explain why higher levels of positive thinking can significantly improve insulin resistance. Moreover, populations with higher baseline mindfulness levels exhibit significantly lower rates of anxiety and depression and markedly improved quality of life [12, 13]. Therefore, assessing the mindfulness levels of T2DM patients not only contributes to the precise monitoring of diabetes but also enhances patients’ life satisfaction, reduces the occurrence of complications, and lowers long-term mortality rates.

Insulin resistance and β-cell function decline have been identified as two major pathophysiological characteristics of patients with T2DM [14, 15]. Research suggests that there is an association between abnormal insulin metabolism and a wide range of psychosocial problems, such as anxiety, depression and suicidal behaviour [16]. The use of antidepressants may improve insulin sensitivity through multiple pathways. Moreover, abnormal insulin metabolism is closely associated with a variety of diseases including cardiovascular, neurological and obesity. In terms of obesity, a meta-analysis incorporating nine microbiome datasets revealed that insulin resistance might play a crucial role in the onset and progression of obesity [17]. T2DM patients with comorbid obesity are more likely to experience psychological distress, such as low self-esteem and anxiety, due to concerns about their physical appearance, which may contribute to a reduction in mindfulness levels.

Despite the widespread recognition of mindfulness as a significant indicator for assessing patients’ psychological states, research investigating mindfulness levels in T2DM patients categorized based on varying degrees of insulin resistance and β-cell function remains relatively limited. In the diabetic population, the assessment of insulin resistance and β-cell secretory function is indispensable, and combined analyses allow a more precise assessment of the metabolic status of the organism. Consequently, this study aims to explore the differences in mindfulness levels among various subgroups of T2DM patients by conducting a comprehensive analysis of their insulin resistance levels and β-cell function. This approach enables a preliminary assessment through laboratory test results without necessitating the direct evaluation of patients’ mindfulness levels using scales. Low insulin resistance and high beta-cell function usually reflect a more stable state of insulin metabolism, and we hypothesised that this group had higher levels of positive thoughts than the other groups. By elucidating the characteristics of patients with low mindfulness levels, this study provides a crucial foundation for the development of targeted psychological interventions, thereby contributing to further enhancements in the psychological well-being and physical management efficacy of T2DM patients.

Materials and methods

Study subjects

This is a cross-sectional study designed to investigate the relationship between HOMA-IR and HOMA-β subgroups and the mindfulness levels in patients with T2DM. In this study, 161 T2DM patients who were hospitalized in the endocrinology department of a tertiary comprehensive hospital in Jiangsu Province from March 2023 to August 2024 were selected. The inclusion criteria were: (1) meeting the diagnostic criteria for T2DM in the “Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition)” [18]; (2) age 18 or above. The exclusion criteria included: (1) acute complications of diabetes (such as hyperosmolar nonketotic coma, hypoglycemic coma, ketoacidosis) and severe infections; (2) other serious acute or chronic diseases of organs and systems; (3) infectious diseases such as hepatitis and tuberculosis, and malignant tumors; (4) severe mental illness, visual or hearing impairment; and (5) Pre-diabetes, type 1 diabetes, gestational diabetes and other types of diabetes. This study adhered to the principles of the Helsinki Declaration (1989) and was approved by the hospital’s ethics committee. Informed consent was obtained from all subjects.

Survey tools

General information questionnaire

1. General Information Collection.

Within 48 h of admission, general demographic information and anthropometric indicators of the subjects were collected, including age, gender, education level (primary school and below, middle school, university and above), duration of diabetes (< 1 year, 1–5 years, 5–10 years, > 10 years), smoking history, drinking history, and body mass index (BMI).

2. Laboratory Examinations.

In this study, fasting blood specimens were taken from all admitted patients after fasting for at least 8 h to ensure accuracy and consistency of blood biochemical parameters. The laboratory measurements collected in this study included fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and serum C-peptide. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and β-cell function (HOMA-β) were calculated using the following formulas based on participants’ fasting blood glucose and fasting C-peptide levels [19]:

HOMA-IR = 1.5 + FBG * C-Peptide / 2800.

HOMA-β = (0.27 * C-Peptide) / (FBG − 3.5) + 50.

The study population was divided into four categories based on the median values of HOMA-IR and HOMA-β as cutoff points: low HOMA-IR/high HOMA-β, high HOMA-IR/high HOMA-β, high HOMA-IR/low HOMA-β, and low HOMA-IR/low HOMA-β [20]. Of these, the low HOMA-IR/high HOMA-βgroup was defined as the control group due to its higher insulin sensitivity and relatively preserved β-cell function, reflecting a closer-to-normal metabolic state and thus serving as a baseline for comparison. All study subjects were randomised during hospitalisation according to the criteria of nativity.

Five facet mindfulness questionnaire (FFMQ)

The FFMQ was employed to assess the participants’ mindfulness levels [21]. This scale evaluates five components of mindfulness: (1) Observing (8 items); (2) Describing (8 items); (3) Acting with awareness (8 items); (4) Non-judging of inner experience (8 items); and (5) Non-reactivity to inner experience (7 items). The FFMQ utilizes a 5-point Likert scale for scoring, with responses ranging from 1 (never or very rarely true) to 5 (very often or always true). The total score is calculated by summing the individual item scores, with higher scores indicating greater levels of mindfulness. In this study, the Cronbach’s α values for the five subscales were 0.81, 0.80, 0.85, 0.77, and 0.60, respectively, demonstrating adequate internal consistency.

Statistical methods

Statistical analyses were performed using R version 4.3, with all tests two-sided and the significance level set at P < 0.05. The normality of continuous data was assessed using the Kolmogorov-Smirnov test, while homogeneity of variance was evaluated using Levene’s test. Normally distributed data were reported as mean ± standard deviation (x̄ ± s), whereas non-normally distributed data were presented as median (interquartile range) [M(Q1, Q3)]. Categorical data were expressed as frequency (percentage) [n(%)].

For continuous data meeting parametric assumptions, one-way ANOVA was employed for pairwise comparisons between groups. In cases where parametric assumptions were not met, the Kruskal-Wallis rank-sum test was utilized. Comparisons of categorical data were conducted using the χ² test or Fisher’s exact test, as appropriate. Linear regression models were used to investigate the differences in overall mindfulness scores and dimension scores among the four categories of T2DM populations. The fit of the model was evaluated in terms of the reported coefficient of determination (R²) and the adjusted R² to measure the ability of the model to explain the variables. Also, the overall significance of the model was assessed using the F-test and the assumptions of normality, independence and homoskedasticity of the regression residuals were checked to validate the suitability of the model. Subgroup analyses of major covariates were performed to examine the impact of insulin resistance and β-cell function on mindfulness levels in different subgroups. Furthermore, causal mediation analysis was conducted to identify the sources of the observed differences.

Results

General characteristics of T2DM subgroups

Initially, this study included 161 T2DM patients. After excluding 4 patients with missing serum C-peptide data, 157 eligible T2DM patients were finally included, comprising 100 males and 57 females. Based on median HOMA-IR and HOMA-β as cut-off values (HOMA-IR = 1.51; HOMA-β = 50.08), the patients were categorized into four groups: low HOMA-IR/low HOMA-β group with 47 cases (30%), high HOMA-IR/low HOMA-β group with 31 cases (20%), low HOMA-IR/high HOMA-β group with 49 cases (31%), and high HOMA-IR/high HOMA-β group with 30 cases (19%). Statistically significant differences were observed among the four groups in terms of age, education level, duration of diabetes, BMI, total mindfulness score, and three dimensions: describing, acting with awareness, and non-judging of inner experience (P < 0.05). Table 1 presents the detailed results.

Table 1 Demographic characteristics of the baseline population
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Association between subgroups of T2DM patients and total mindfulness score

As the total mindfulness and five dimensions were found to be approximately normally distributed overall, linear regression models were employed in this study to investigate the differences in total mindfulness levels among different categories of T2DM patients. Three regression models were established: Model 1 did not account for covariates, Model 2 adjusted for age and gender, and Model 3 adjusted for education level, duration of diabetes, drinking history, and smoking history based on Model 2. In terms of variable inclusion, the present study included in the model as many important variables related to the level of positive thoughts as possible. However, BMI was not included mainly because of its possible strong correlation with HOMA-IR and HOMA-β. The inclusion of BMI may lead to the problem of multicollinearity, thus affecting the stability and explanatory power of the model. Based on this, we chose to exclude BMI from the model. Using the reference group with low HOMA-IR and high HOMA-β, the study yielded the following findings: (1) In the absence of covariate adjustment, the other three groups exhibited significant negative correlations with total mindfulness (P < 0.05), with the high HOMA-IR/low HOMA-β group demonstrating the most substantial decrease in total mindfulness (β: -11.12, 95%CI: -17.01 to -5.23). (2) After full adjustment for covariates, the strength of association between the three groups and total mindfulness diminished. Table 2 presents the detailed results.

Table 2 Linear regression models of subgroups of T2DM patients with total mindfulness scores
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Association of T2DM subgroups with five dimensions of mindfulness

The association between different subgroups of T2DM patients and the five dimensions of mindfulness (describing, observing, non-judging of inner experience, non-reactivity to inner experience, and acting with awareness) was further explored. The results, as shown in Table 3, revealed the following: (1) The low HOMA-IR/low HOMA-β group exhibited statistically significant associations in the dimensions of describing and acting with awareness compared to the low HOMA-IR/high HOMA-β group (reference group), although the strength of the association was attenuated after full adjustment for covariates. (2) Lower levels in the non-judging of inner experience dimension were observed in the high HOMA-IR/low HOMA-β and high HOMA-IR/high HOMA-β groups compared to the control group, with this association being strengthened after adjusting for relevant covariates. (3) A statistically significant difference was found between the high HOMA-IR/low HOMA-β group and the reference group in the dimension of acting with awareness.

Table 3 Linear regression models of T2DM subgroups with five dimensions of mindfulness
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Differences in mindfulness levels among four groups of T2DM populations

Subgroup analyses were performed for major influencing factors, including age, gender, duration of diabetes, and education level. The results indicated the following: (1) Age: A larger decrease in mindfulness levels was observed in the population over 60 years old in the three groups compared to the control group. The inter-group difference in the dimension of acting with awareness was most significant between the high HOMA-IR/low HOMA-β group and the control group in the elderly population. Lower levels of non-judging of inner experience were found in the young and middle-aged group (20–50 years old). (2) Gender: When stratified by gender, significant differences in total mindfulness levels, non-judging of inner experience, acting with awareness, and non-reactivity to inner experience were observed in the male subgroup. However, no significant differences were detected in these dimensions within the female subgroup. (3) Duration of diabetes: Lower levels of total mindfulness, non-judging of inner experience, acting with awareness, and non-reactivity to inner experience were found in the population with a disease duration within one year. (4) Education level: Statistically significant variations in overall mindfulness level, acting with awareness, describing, and non-judging of inner experience were observed among the four groups in the population with middle school education level (Fig. 1).

Fig. 1
figure 1

Subgroup analysis of total mindfulness and five-dimensional scores in four T2DM groups. Note: group1, high HOMA-IR/high HOMA-β; group2, high HOMA-IR /low HOMA-β; group3, low HOMA-IR/low HOMA-β

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Mediation analysis

Significant differences were observed in FBG and HbA1c levels among different categories of T2DM patients (P < 0.001). The association between FBG and total mindfulness, non-judging of inner experience, and acting with awareness dimensions was found to be statistically significant through statistical analysis. Mediation analysis was conducted to investigate the potential mechanisms underlying the mindfulness differences among the four groups of T2DM patients. However, no significant mediation effects were identified (p > 0.05) (Fig. 2).

Fig. 2
figure 2

Mediation analysis mediated by fasting blood glucose

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Disscussion

This study conducted an in-depth exploration of the differences in mindfulness levels among T2DM patients with varying degrees of insulin resistance and β-cell function, offering a novel perspective on the psychological health management of diabetes patients. The findings highlighted the intricate relationship between T2DM subtypes and mindfulness levels while emphasizing the importance of addressing mental health in diabetes management.

Compared to the control group, the other three groups of T2DM patients exhibited lower total mindfulness levels, with the most significant decrease observed in the high HOMA-IR/low HOMA-β group. This finding suggests that the interplay between insulin resistance and β-cell function may influence patients’ psychological well-being. Patients in the control group generally demonstrate good islet function and relatively stable blood glucose metabolism. In contrast, patients in the high HOMA-IR/low HOMA-β group may encounter more metabolic disorders and β-cell function depletion issues, which can subsequently impact their attention concentration, emotion regulation, and self-awareness [14, 22]. These results align with the findings of A.C. et al. in their study of osteoarthritis patients, where describing, acting with awareness, and non-judging of inner experience were identified as crucial factors in mental health [23].

Further analysis based on different dimensions revealed several interesting and important connections. The results suggest that unique characteristics are exhibited by different T2DM subgroups across various dimensions of mindfulness. Significant decreases in the “describing” and “acting with awareness” dimensions were shown by the low HOMA-IR/low HOMA-β group, possibly reflecting the impact of insufficient insulin secretion on cognitive function. For instance, one participant from this group reported in the questionnaire: “I often find myself absent-minded when doing things and find it difficult to describe my current feelings.” The occurrence of various neuropsychiatric diseases has been associated with decreased expression of brain-derived insulin and insulin receptors, as demonstrated by previous studies [24, 25]. In the Alzheimer’s disease model induced by amyloid-β1–42 (Aβ1–42), the downregulation of hippocampal insulin (Ins2) expression is achieved through the activation of glycogen synthase kinase-3β (GSK-3β), suggesting that mindfulness levels may be affected by GSK-3β [24]. Furthermore, various factors, such as diet, exercise, aging, and genetic susceptibility, are related to insulin sensitivity. Metabolic disorders, accompanied by chronic inflammation and increased oxidative stress, are often experienced by bodies with insulin resistance, which may negatively impact brain function [26, 27].

Weakening in the “non-judging of inner experience” dimension was shown by the high HOMA-β group, suggesting a link between high insulin levels and self-critical tendencies. A decrease in conscious activities was also shown by the high HOMA-IR/low HOMA-β group, possibly reflecting the combined consequences of insulin resistance and insufficient secretion. A strong relationship between HOMA-IR and higher psychological distress (depression, anger) has been demonstrated by early research [28]. The balance of certain neurotransmitters in the body may be affected by abnormal insulin levels and energy-regulating hormone, thereby influencing attention, emotion regulation, and self-cognition [29]. As an excitatory neurotransmitter in the CNS, glutamate has the function of regulating endocrine cells in the islets. Decreased glutamate/glutamine concentrations in the subcortical cortex may be related to severe depression in T2DM patients, as found by studies [30]. This suggests that one of the mechanisms for the occurrence of neuropsychiatric dysfunction in DM may be abnormal activity of the glutamatergic system.

It is noteworthy that in this study, the high HOMA-IR/high HOMA-β group exhibited significantly higher weight compared to other groups, with 82% of patients falling within the overweight range. This finding aligns with previous studies, which have demonstrated that insulin resistance frequently induces various metabolic disorders, including weight gain and obesity [26]. Obesity serves as a crucial mediating factor contributing to psychological diseases in diabetic populations. It is closely associated with chronic inflammation of adipose tissue (AT), and the activation of inflammatory cells and overexpression of inflammatory factors in adipose tissue ultimately disrupt tissue homeostasis [31, 32]. Consequently, obesity may be one of the sources of variations in mindfulness levels among T2DM populations with differing degrees of insulin resistance and islet β-cell function. Kara et al. discovered in their study that obese PCOS patients exhibited lower mindfulness levels compared to non-obese PCOS patients (p = 0.02). Obesity is not only linked to the biological mechanism of chronic inflammation and hypothalamic-pituitary-adrenal axis dysfunction but may also exacerbate psychological distress through weight stigma and discrimination [33,34,35]. Prolonged chronic stress may lead to emotional disorders in this population, impairment of self-confidence, and inability to implement effective self-management, thereby resulting in a decrease in individual mindfulness levels.

Subgroup analysis of the participating population revealed that the decrease in mindfulness levels was more pronounced in elderly, male, and T2DM patients with medium education, consistent with previous studies [36]. This phenomenon may reflect the differences in mental states of different populations. It has been shown that signaling molecules secreted by intestinal flora can influence insulin signaling, hormone levels, neurotransmitters, and expression of inflammatory factors through the flora-gut-brain axis, thus regulating the mental state of individuals [37, 38]. Furthermore, patients with shorter and medium disease durations exhibited significant differences in mindfulness levels compared to the control group, potentially reflecting the dynamic changes in patients’ psychological states throughout the disease development process. DeCota et al. reported similar findings, observing that emotional distress such as sadness, anxiety, and anger in type 1 diabetes populations peaked at initial diagnosis, followed by a gradual decline and subsequent increase [39]. This dynamic change in mental state may reflect the patient’s cognitive and acceptance process of the disease, which falls under the category of mindfulness. The study did not identify a significant mediating effect of FBG between T2DM subgroups and mindfulness, suggesting that the relationship between T2DM subgroups and mindfulness may be influenced by complex physiological and psychological factors. This study investigated the relationship between differences in insulin metabolism and positive thinking levels in patients with T2DM and made preliminary recommendations for the assessment of mindfulness in patients. Firstly, it emphasizes the need for personalized psychological intervention strategies based on the mindfulness dimension characteristics of different T2DM subgroup patients. For instance, mindfulness-based cognitive behavioral therapy can be implemented for patients with weaker “describing” and “acting with awareness”, while acceptance-based psychological therapy techniques (such as acceptance and commitment therapy) can be attempted for patients with weaker “non-judging of inner experience”. Secondly, the research results highlight the necessity of focusing on patients’ mental health in the early stages of T2DM, particularly for high-risk groups (such as the high HOMA-IR/low HOMA-β group). Moreover, diabetes management should emphasize multi-dimensional management, encompassing not only blood glucose control but also psychological health interventions such as mindfulness training, stress management, and emotion regulation. This study unveils the potential connection between insulin metabolism and mental health, providing new research directions for future exploration of the biological mechanisms of mental health in diabetic patients.

The present study has the following limitations. Firstly, the study population was limited to inpatients of a single medical institution, and the lack of multicentre data may limit the external validity of the findings. Second, the low explanatory power of the linear regression model suggests that the level of trait positivity may be influenced by a combination of more complex factors. In addition to the insulin metabolism indexes that were the focus of this study, variables such as environmental factors, psychological status, and social support may all play an important role. However, these potential confounders were not included in the analyses of the present study, which may have a substantial impact on the interpretation of the findings.

Future research can be carried out in the following aspects: (1) expanding the study scale, conducting a multi-centre, large-sample prospective cohort study, including both inpatients and outpatients, so as to enhance the representativeness and generalizability of the results; (2) adopting a longitudinal study design, tracking the dynamic changes in the level of trait positivity, and exploring its temporal and sequential associations with glycaemic control and progression of complications; (3) constructing a construct a better theoretical framework to systematically examine the moderating effects of physiological indicators (e.g. inflammatory factors, stress hormones), psychological characteristics (e.g. coping styles, personality traits) and environmental factors (e.g. family support, accessibility to healthcare) on trait positive thinking, and to elucidate the potential mechanisms of their effects; (4) developing targeted mindfulness intervention programmes based on the findings of the study, evaluating the effectiveness and efficacy of the intervention programmes in clinical practice through randomized controlled trials and providing an evidence-based basis for the comprehensive management of diabetic patients.

Conclusions

The results of this study suggest a causal association between insulin resistance and βcell function levels and mindfulness levels in patients with T2DM. Different T2DM subgroups, categorized by insulin resistance and β-cell function levels, exhibit unique mindfulness characteristics. These findings provide a new perspective on T2DM management, highlighting the importance of incorporating psychological assessment, particularly mindfulness evaluation, into T2DM care. Personalized psychological intervention strategies, such as targeted therapies for specific mindfulness dimensions, may improve the overall health of T2DM patients. However, larger-scale, multi-center studies are needed to further validate these findings and explore potential physiological mechanisms.

Data availability

No datasets were generated or analysed during the current study.

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Funding

This work was supported by The Second Affiliated Hospital of Xuzhou Medical University of China (XYFC2020005).

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Authors and Affiliations

  1. Department of Endocrinology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Xue Zhang, Rui Huang, Jiaxin Li, Mingyue Yang, Daowen Zhang, Cancan Liu & Kuanlu Fan

Authors
  1. Xue Zhang
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  2. Rui Huang
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  3. Jiaxin Li
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  4. Mingyue Yang
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  5. Daowen Zhang
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  6. Cancan Liu
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  7. Kuanlu Fan
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Contributions

Conceptualization: XZ, DWZ, KLF; Formal analysis: XZ, RH; Methodology: XZ, JXL, CCL, KLF; Resources and data curation: XZ, JXL, MYY; Visualization: XZ, RH; Supervision and funding acquisition: DWZ, CCL, KLF; Writing—preparing the first draft: XZ, RH; Writing—review & editing: XZ, CCL, DWZ, KLF.

Corresponding author

Correspondence to Kuanlu Fan.

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Ethics approval and consent to participate

The present study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of The Second Affiliated Hospital of Xuzhou Medical University (Approval Number: [2023] 010107). Informed consent was obtained from all participants prior to their inclusion in the study.

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The authors declare no competing interests.

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Zhang, X., Huang, R., Li, J. et al. Abnormal insulin metabolism and decreased levels of mindfulness in type 2 diabetes mellitus. Diabetol Metab Syndr 17, 32 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13098-025-01594-y

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13098-025-01594-y

Keywords

Diabetology & Metabolic Syndrome

ISSN: 1758-5996

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