Progressive muscle relaxation for reducing diabetes distress in adults with type 2 diabetes mellitus: A quasi-experimental study in primary care

https://doi.org/10.52235/lp.v7i4.907

Authors

  • La Rakhmat Wabula Study Program of Bachelor and Professional in Nursing, STIKes Maluku Husada, Maluku, Indonesia
  • Febby Djuwita H Aipassa Study Program of Bachelor and Professional in Nursing, STIKes Maluku Husada, Maluku, Indonesia
  • Salama Sely Study Program of Bachelor and Professional in Nursing, STIKes Maluku Husada, Maluku, Indonesia
  • Artiya Mumina Ahmad Study Program of Bachelor and Professional in Nursing, STIKes Maluku Husada, Maluku, Indonesia

Keywords:

diabetes distress, type 2 diabetes mellitus, progressive muscle relaxation, primary care

Abstract

Background: Diabetes distress is a common psychological burden among adults with type 2 diabetes mellitus and may interfere with self-management in primary care. Although Progressive Muscle Relaxation has been widely used as a simple non-pharmacological relaxation technique, evidence regarding its effect on diabetes-specific distress in primary care settings remains limited.

Objective: This study aimed to evaluate the effect of Progressive Muscle Relaxation on diabetes distress among adults with type 2 diabetes mellitus receiving care in a primary care setting.

Methods: A controlled quasi-experimental study with a pretest-posttest control group design was conducted among 46 adults with type 2 diabetes mellitus at Tulehu Public Health Center, Central Maluku Regency, Indonesia. Participants were recruited using purposive sampling based on predefined eligibility criteria and allocated to intervention and control groups. Eligible participants were adults with T2DM who were able to communicate effectively and perform Progressive Muscle Relaxation. The intervention group received PMR for 14 days, while the control group received usual care. Diabetes distress was assessed before and after the intervention using the Diabetes Distress Scale. Data were analyzed using paired-sample t-tests and independent-samples t-tests.

Results: The mean diabetes distress score in the intervention group decreased from 3.439 at baseline to 1.913 after the intervention, with a mean reduction of 1.526 points. This reduction was statistically significant (p<0.001). The control group showed no significant change in diabetes distress scores (p=0.714). Between-group analysis showed that the reduction in diabetes distress was significantly greater in the intervention group than in the control group (p<0.001), with a large effect size (Cohen’s d=0.85).

Conclusion: Progressive Muscle Relaxation was associated with a significant reduction in diabetes distress among adults with type 2 diabetes mellitus in a primary care setting. This intervention may be integrated into nursing-led diabetes care as a feasible non-pharmacological strategy to support psychological well-being.

Downloads

Download data is not yet available.

References

Abbas, Q., Latif, S., Habib, H. A., Shahzad, S., Sarwar, U., & Shahzadi, M. (2023). Cognitive behavior therapy for diabetes distress , depression , health anxiety , quality of life and treatment adherence among patients with type ‑ II diabetes mellitus : a randomized control trial. BMC Psychiatry, 1–14. https://doi.org/10.1186/s12888-023-04546-w

Abbas, S., Ikram, S., Irfan, H., & Moazzam, A. (2026). Metabolism Diabetes distress : What a clinician needs to know – A South Asian perspective. Best Practice & Research Clinical Endocrinology & Metabolism, xxxx, 102116. https://doi.org/10.1016/j.beem.2026.102116

Alanazi, S. M., Alasad, S. M., Mohammed, M., Alqabi, A., Mohammed, M., Alqabi, A., & Mohammed, A. (2024). Diabetes Mellitus : Pathophysiology , Insulin Resistance , Nutritional Care , and Nursing Implications. Journal of International Crisis and Risk Communication Research, 7.

Arunraj, M., Vijay, V., Kumpatla, S., & Viswanathan, V. (2025). The effect of progressive muscle relaxation therapy on diabetes distress & anxiety among people with type 2 diabetes. Indian J Med Res, January, 72–80. https://doi.org/10.25259/IJMR

Çapacı, S., & As, G. D. (2022). European Journal of Integrative Medicine Effect of progressive muscle relaxation on caregiver satisfaction , caregiver burden and depression levels of the caregivers of older patients : A randomized control trial. European Journal of Integrative Medicine, 50(February), 1–8. https://doi.org/10.1016/j.eujim.2022.102114

Cardon, A., Andersen, T. H., Akerkar, A., Due-christensen, M., Honoré, O. B., Rasmussen, A., Rossing, P., & Cleal, B. (2026). Psychological and emotional aspects in people with diabetic foot disease : a systematic scoping review. Cardon et Al. BMC Psychology, 14(789).

Care, D., & Suppl, S. S. (2025a). 1 . Improving Care and Promoting Health in Populations : Standards of Care in Diabetes — 2025. Diabetes, 48(January), 14–26.

Care, D., & Suppl, S. S. (2025b). Introduction and Methodology : Standards of Care in Diabetes — 2025. Diabetes Care, 48(January), 1–5.

Conrad, A., & Roth, W. T. (2007). Muscle relaxation therapy for anxiety disorders : It works but how ? Journal of Anxiety Disorder, 21, 243–264. https://doi.org/10.1016/j.janxdis.2006.08.001

Dennick, K., Sturt, J., & Speight, J. (2017). Journal of Diabetes and Its Complications What is diabetes distress and how can we measure it ? A narrative review and conceptual model. Journal of Diabetes and Its Complications, 31(5), 898–911. https://doi.org/10.1016/j.jdiacomp.2016.12.018

Feleke, M. G., & Ashager, K. (2025). Prevalence and associated factors of diabetes- related distress among type 2 diabetic patients in Africa : a systematic review and meta-analysis. BMC Public Health, 25(3994).

Giuseppe, M. Di. (2021). Assessing the Prevalence of Diabetes Distress and Determining Its Psychosocial Predictors Among Saudi Adults With Type 2 Diabetes : A Cross-Sectional Study. Frontiers in Psychology, 12(December), 1–12. https://doi.org/10.3389/fpsyg.2021.759454

Hannan, M. A., Rahman, M. M., Alam, M. S., Amin, M. N., Kabir, M. R., & Chanda, P. K. (2022). Prevalence and predictors of diabetes distress among adults with type 2 diabetes mellitus : a facility-based cross-sectional study of Bangladesh. BMC Endocrine Disorders, 3(22), 1–9.

Hedstr, M., Josefsson, C., & Ulrika, P. (2026). Primary Care Diabetes Diabetes distress and associated factors among adults with type 2 diabetes in Sweden – a cross-sectional study. Primary Care Diabetes Journal, 20(January), 357–364. https://doi.org/10.1016/j.pcd.2026.04.009

Ibrahim, A., El, A., & Mohamed, H. S. (2023). Diabetes Distress and Self-Care Activities Among Patients With Diabetes Type II : A Correlation Study. SAGE Open Nursing, 9(1–9). https://doi.org/10.1177/23779608231189944

IDF. (2025). Diabetes Atlas. International Diabetes Federation.

Kunhi, A. A., Arlappa, N., & Jaleel, A. (2026). Diabetes self-care , psychological distress , and quality of life among people with type 2 diabetes in low-income urban communities : An exploratory mixed-methods study in Hyderabad , India. Archives of Gerontology and Geriatrics Plus, 3(2), 100262. https://doi.org/10.1016/j.aggp.2026.100262

Kurian, J., Mohanthy, S., & Mavathur, R. (2022). Journal of Bodywork & Movement Therapies Mechanism of action of yoga on prevention and management of type 2 diabetes mellitus : Narrative review. Journal of Bodywork & Movement Therapies, 29, 134–139. https://doi.org/10.1016/j.jbmt.2021.10.003

Kwon, C., Won, J., & Lee, B. (2026). Complementary Therapies in Medicine The health effects of diaphragmatic breathing : A systematic review. Complementary Therapies in Medicine, 96(December 2025), 103317. https://doi.org/10.1016/j.ctim.2025.103317

Mathiesen, A. S., & Egerod, I. (2019). Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus : a systematic review and meta-analysis. Dovepress, 19–33.

Naja, T., Kohandany, M., Oskouei, F. H., & Malek, M. (2017). The effect of progressive muscle relaxation on glycated hemoglobin and health-related quality of life in patients with type 2 diabetes mellitus. Applied Nursing Research, 33, 142–148. https://doi.org/10.1016/j.apnr.2016.11.008

Özyiğit, G., & Sukut, Ö. (2025). Progressive muscle relaxation to reduce anxiety before electroconvulsive therapy ( ECT ). Özyiğit and Sukut BMC Nursing, 24(1217).

Rasmussen, B., Mekonnen, A., Geller, G., Holton, S., Orellana, L., Nankervis, A., Houlihan, C., Hendrieckx, C., Steele, C., Mcnamara, C., Read, M., & Wynter, K. (2025). Sexual & Reproductive Healthcare Psychosocial well-being and diabetes distress in the transition to motherhood among women with type 1 or type 2 diabetes. Sexual & Reproductive Healthcare, 43(July 2024), 101048. https://doi.org/10.1016/j.srhc.2024.101048

Setyowati, R., Haroen, H., Yosep, I., Agustina, H. R., Setyowati, R., Haroen, H., & Yosep, I. (2025). A Scoping Review of Psychoeducational Interventions for Managing Type 2 Diabetes Mellitus in Asian Countries A Scoping Review of Psychoeducational Interventions for Managing Type 2 Diabetes Mellitus in Asian Countries. Journal of Multidisciplinary Healthcare ISSN:, 2390. https://doi.org/10.2147/JMDH.S568155

Sorrell, S. (2025). Digital technologies for the assessment , diagnosis , and treatment of diabetes distress : A review of current evidence. Health Sciences Review, 15(April), 100227. https://doi.org/10.1016/j.hsr.2025.100227

Weerasinghe, S. A., Wang, G., Izadikhah, Z., Goh, Y., Ireland, M. J., Wang, G., & Izadikhah, Z. (2025). Psychosocial interventions for diabetes distress in culturally diverse populations : a systematic scoping review. BMJ Open, 15(e102630). https://doi.org/10.1136/bmjopen-2025-102630

Weng, Y., Xu, X., Ruan, M., Zhu, L., Zhu, J., & Jin, X. (2026). Effects of diabetes distress on glycemic level and health-related quality of life among patients with type 2 diabetes mellitus : A cross-sectional study. Journal of Psychosomatic Research, 205(February), 112612. https://doi.org/10.1016/j.jpsychores.2026.112612

Yao, T., Sun, J., Jiang, Q., Wang, H., Zhang, J., Zhang, F., Cao, H., Li, D., Yan, J., & Yang, J. (2025). The mediating role of expectations regarding aging between diabetes distress and self-management behaviors in older adults with type 2 diabetes mellitus. Geriatric Nursing, 63, 362–369. https://doi.org/10.1016/j.gerinurse.2025.03.033

Zhang, F., Zhao, J., Zhang, Y., Tian, Z., Li, J., Lü, Q., Wang, W., Hong, T., Shan, Z., Yan, L., Peng, Y., & Tong, N. (2026). Clinical guidelines on physical activity and exercise therapy for Chinese adults with type 2 diabetes : A clinical practice guideline from the Chinese Society of Endocrinology. Journal of Sport and Health Science, 15, 101124. https://doi.org/10.1016/j.jshs.2026.101124

Zu, W., Li, F., Ma, X., Zhang, S., Nie, W., & Wang, L. (2024). Journal of Contextual Behavioral Science Exploring the interconnectedness of depression , anxiety , diabetes distress , and related psychosocial factors in adults with type 2 diabetes : A network analysis. Journal of Contextual Behavioral Science, 34(October), 100843. https://doi.org/10.1016/j.jcbs.2024.100843

Downloads

Published

2026-10-05

How to Cite

Wabula, L. R., Aipassa, F. D. H., Sely, S., & Ahmad, A. M. (2026). Progressive muscle relaxation for reducing diabetes distress in adults with type 2 diabetes mellitus: A quasi-experimental study in primary care. Lentera Perawat, 7(4), 857–866. https://doi.org/10.52235/lp.v7i4.907

Similar Articles

<< < 4 5 6 7 8 9 10 11 12 13 > >> 

You may also start an advanced similarity search for this article.