the effect of a spirituality-based intervention on diabetes distress, spiritual well-being, and quality of life in women with type 2 diabetes: a randomized controlled trial

Background: type 2 diabetes (t2d) disproportionately affects women, increasing diabetes distress and reducing quality of life. spirituality-based interventions may improve coping and resilience. this study evaluated a 12-week spirituality-based intervention’s efficacy in reducing diabetes distress and enhancing spiritual well-being and quality of life in women with t2d, with spiritual well-being as a mediator. objectives: this study evaluated a 12-week spirituality-based intervention versus routine care in reducing diabetes distress and improving spiritual well-being and quality of life in women with t2d. methods: a randomized controlled trial (rct) enrolled 88 women with t2d (aged 18 - 75) in bandar abbas, iran (november 2024 - may 2025), randomized to a 12-week spirituality-based intervention (n = 43; mindfulness, journaling, discussions, psychoeducation) or routine care (n = 45). outcomes [diabetes distress scale (dds-17), spiritual well-being scale (swbs), diabetes quality of life (dqol) measure] were assessed at baseline, post-intervention, and 1-month follow-up. data were analyzed using t-tests, chi-square, and mixed-effects linear regression. results: participants had a mean age of 53.8 years (intervention) and 54.6 years (control), with 70.5% having at least a high school education. the intervention group demonstrated significantly lower dds-17 scores compared to the control group immediately after the intervention (2.0 ± 0.5 vs. 2.6 ± 0.6, p < 0.001, cohen’s d = 1.05) and at the 1-month follow-up (2.1 ± 0.5 vs. 2.7 ± 0.7, p = 0.001, cohen’s d = 0.94). the s0wbs also improved substantially in the intervention group, with higher post-intervention scores (91.5 ± 10.2 vs. 79.0 ± 11.8, p < 0.001, cohen’s d = 1.12) and sustained improvement at follow-up (89.8 ± 10.5 vs. 78.5 ± 11.9, p < 0.001, cohen’s d = 1.00). mediation analysis revealed that swbs accounted for 65% of the intervention’s total effect on reducing diabetes distress, with a statistically significant indirect effect (p < 0.001). the dqol scores showed a non-significant trend toward improvement (70.8 ± 11.7 vs. 67.5 ± 12.5, p = 0.18). conclusions: the 12-week spirituality-based intervention reduced diabetes distress and improved spiritual well-being in women with t2d, with sustained effects at 1-month follow-up. spiritual well-being mediated distress reductions. non-significant quality of life improvements suggest potential benefits, supporting spirituality-based approaches in t2d psychosocial care.