Examining the Effect of a Novel Stress Reduction Intervention on the Control of Prediabetes: A Feasibility Study

For nursing students

Study summary

Prediabetes affects millions of adults and is a major risk factor for both type 2 diabetes (T2D) and cardiovascular disease. Researchers have long known that chronic stress is linked to prediabetes, but most prevention programs focus on diet and exercise rather than on stress itself. This study, published in the Canadian Journal of Nursing Research, asked a different question: could directly treating chronic psychological stress help people at high risk for prediabetes manage that risk?

The research team, led by Maha Albdour at Wayne State University in Detroit and including Canadian nursing researcher Maher El-Masri, tested a therapy called Emotional Awareness and Expression Treatment, or EAET. EAET was originally developed by co-author Mark Lumley for conditions like fibromyalgia and chronic pain, and it works by helping people recognize, process, and healthily express difficult emotions, especially ones tied to stress, conflict, and unresolved trauma. The idea behind adapting EAET for prediabetes is that unprocessed emotional stress can drive the very behaviors, poor eating, inactivity, and physiological changes, that push someone from prediabetes toward full diabetes.

This was a feasibility study, meaning the main goal was to find out whether the intervention could realistically be delivered and tolerated, not to prove definitively that it works. The design was a prospective, within-subjects, repeated-measures study without a comparison group, so every participant received the same intervention and served as their own baseline. Forty adults were screened for prediabetes, and sixteen were found eligible. According to the study's public trial registration, eligibility generally required an A1C in the prediabetes range, a body mass index of 25 or higher, and no existing diagnosis of type 2 diabetes. Participants were divided into three small groups and each group received four weekly virtual sessions of EAET delivered over telehealth.

The researchers measured outcomes at three points: baseline, three months, and six months. Two lab-based markers were tracked: glycated hemoglobin, or A1C, which reflects average blood sugar over roughly three months, and C-peptide, a marker of how much insulin the body is producing. Participants also completed self-report measures of perceived stress, eating habits, and physical activity.

Twelve of the sixteen participants completed all four sessions and stayed engaged throughout, a completion rate the authors treat as evidence the program is feasible to deliver. Over the study period, perceived stress and unhealthy eating habits both decreased significantly. Exercise frequency and duration increased significantly as well. C-peptide concentration, the insulin marker, also increased significantly, which the authors interpret as a sign of improving insulin secretion capacity. A1C did drop by six months, but that change was not statistically significant, meaning the study cannot say for certain that EAET changed long-term blood sugar control within this small sample and short follow-up window.

The authors conclude that EAET is feasible to deliver virtually to people with prediabetes and shows promising early signals for reducing stress and several behavioral risk factors for T2D. They frame this as an early step: if EAET can be refined and tested in a larger, controlled trial, it could become a new tool for preventing the progression from prediabetes to diabetes, potentially reducing the substantial health and cost burden that T2D places on individuals and health systems.

For nursing students, this study is a useful example of feasibility research, the stage where clinicians and researchers ask "can we do this, and does it look promising?" before investing in a large randomized controlled trial. It also illustrates how mental and emotional health are increasingly understood as directly connected to metabolic health, not just as separate concerns. Because the sample was small, uncontrolled, and drawn from one university community, students should be cautious about generalizing these results to other populations, and should watch for whether this research team publishes a larger follow-up trial testing EAET against a control condition.

For educators

Teaching and appraisal notes

This feasibility study by Albdour, El-Masri, Jaber, Burghardt, Jenuwine, and Lumley, published in the Canadian Journal of Nursing Research, adapts Emotional Awareness and Expression Treatment (EAET), an approach previously validated for chronic pain conditions such as fibromyalgia, to a metabolic prevention context: adults at high risk for prediabetes. The rationale is grounded in the well-documented but under-treated link between chronic psychological stress and the behavioral and physiological pathways (poor diet, inactivity, dysregulated cortisol and insulin dynamics) that drive progression from prediabetes to type 2 diabetes (T2D).

Methodologically, this is a single-arm, prospective, within-subjects, repeated-measures feasibility study, explicitly uncontrolled. Forty individuals were screened; sixteen met eligibility (per the study's public trial registration: A1C 5.7 to 6.4 percent, BMI 25 or higher, no T2D diagnosis) and were divided into three groups receiving four weekly virtual EAET sessions. Outcomes were assessed at baseline, three months, and six months, combining objective biomarkers, A1C and C-peptide, with self-reported perceived stress, eating habits, and physical activity. This is an appropriate design for an initial feasibility question but cannot establish causal efficacy; instructors should use it to model the distinction between feasibility and efficacy trials for students learning the intervention research pipeline.

Twelve of sixteen participants (75%) completed all sessions, which the authors present as evidence of acceptable engagement and feasibility for a virtual, group-based emotional-processing intervention in this population. Statistically significant improvements were reported in perceived stress, unhealthy eating habits, exercise frequency, and exercise duration. C-peptide, a surrogate for insulin secretion, increased significantly, which the authors interpret as a favorable metabolic signal. A1C decreased over six months but the change was not statistically significant, an important nuance for critical appraisal: the study's headline metabolic marker did not reach significance, even though several downstream behavioral and secondary biomarker outcomes did.

For seminar discussion, this is a strong case study in appraising small-sample feasibility research. Key appraisal points include the very small final sample (n=12 completers), the absence of a control or comparison group (making it impossible to rule out regression to the mean, natural fluctuation, or nonspecific attention effects), the short four-week intervention period relative to a six-month follow-up, and the single-institution recruitment base, which limits generalizability beyond a university-affiliated population. Instructors might also prompt students to consider measurement validity: self-reported diet and activity are subject to social-desirability and recall bias, particularly in a study explicitly targeting stress and behavior change.

Clinically and pedagogically, the study is valuable for illustrating the integration of psychological and metabolic health in nursing practice, an area increasingly emphasized in chronic disease prevention curricula. It also offers a concrete example of adapting an existing evidence-based psychotherapy (EAET) to a new population and outcome domain, a common and useful translational research strategy. Faculty teaching research methods or chronic disease prevention could use this article to discuss when and how a promising feasibility study should lead to a larger randomized controlled trial before informing practice guidelines, and to reinforce that "promising" and "proven" are not synonymous in the appraisal of emerging interventions.