Mindfulness-Based Intervention for Adolescents With Type 1 Diabetes: A Case Series.

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Published in final edited form as: Clin Pract Pediatr Psychol. 2025 Jun 1;13(2):189–198. doi: 10.1177/21694826251319328 Mindfulness-Based Intervention for Adolescents With Type 1 Diabetes: A Case Series Francesca Lupini 1, 2 , Hailey Moore 1 , Molly Basch 3, 4 , Jack Vagadori 1 , Frances Cooke 1, 5 , Katherine Patterson Kelly 6, 4 , Randi Streisand 1, 4 , Lauren Shomaker 7, 8, 9 , Mesgana Dagnachew 1 , Daniel K Cooper 2 , Eleanor R Mackey 1, 4 Author information Article notes Copyright and License information 1 Division of Psychology, Children’s National Hospital, Washington, DC, USA 2 Department of Psychology, University of South Carolina, Columbia, SC, USA 3 Division of Adolescent & Young Adult Medicine Children’s National Hospital, Washington, DC, USA 4 Department of Psychology, The George Washington University School of Medicine, Washington, DC, USA 5 Department of Psychology, The Catholic University of America, Washington, DC, USA 6 Department of Nursing Science, Professional Practice, & Quality, Children’s National Hospital, Washington, DC, USA 7 Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO, USA 8 Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children’s Hospital Colorado, Aurora, CO, USA 9 Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA ✉ Corresponding Author: Francesca Lupini, Department of Psychology, University of South Carolina, 1512 Pendleton St, Columbia, SC 29208, USA. flupini@email.sc.edu Issue date 2025 Jun. Article reuse guidelines: sagepub.com/journals-permissions PMC Copyright notice PMCID: PMC12456681  NIHMSID: NIHMS2070709  PMID: 40994697 The publisher's version of this article is available at Clin Pract Pediatr Psychol Abstract Objective: Adolescents with type 1 diabetes (T1D) have risk for elevated negative affect, and mindfulness-based interventions (MBI) may be effective interventions. The aim of this case series was to (1) highlight individual changes in negative affect (depression, anxiety, and stress), mindfulness, and diabetes outcomes (diabetes distress, diabetes self-management, and HbA1c) after participating in an MBI and (2) highlight the utility of MBI in historically marginalized populations. Methods: Cases were chosen from a sample of adolescents with T1D and elevated negative affect who took part in a pilot randomized controlled trial of an MBI. Individuals were selected due to adherence to study protocol, similar baseline scores on target outcomes, and demographic similarities that indicate historical marginalization. The participants were two 12–14-year-old girls with T1D, one identifying as Black/African American, “Jayla,” and one identifying as biracial Latinx/Hispanic, “Valerie” who participated in a 6–7 session virtual group MBI. Participants completed surveys at baseline, post-intervention, and three months post-intervention. Results: Jayla and Valerie demonstrated improvements in multiple domains including depression, anxiety, stress, mindfulness, diabetes distress, and diabetes self-management. We observed small improvements in HbA1c and disordered eating in Valerie, but not in Jayla. Conclusions: This case series demonstrates the potential utility of MBI in adolescents with T1D and negative affect, particularly those experiencing increased burden of SDOH. Keywords: type 1 diabetes, mindfulness, negative affect, historically marginalized populations Introduction Type 1 diabetes (T1D) is a common chronic illness among children, impacting approximately 200,000 youth in the United States each year ( Mayer-Davis et al., 2017 ). T1D is characterized by a daily management regimen consisting of insulin administration (either via manual injections or managing an insulin pump), regular blood glucose monitoring using a blood glucose monitor or continuous glucose monitor (CGM), and constant oversight of food intake and exercise. Self-management and glycemic control typically worsen during adolescence ( Rausch et al., 2012 ), which increases risk for future adverse health outcomes including retinopathy, cardiovascular diseases, and neuropathy ( Lind et al., 2019 ). Adolescents with T1D are at an increased risk for negative affect (i.e., depression and anxiety), with elevated symptoms present in 40% of adolescents with T1D ( Buchberger et al., 2016 ). Elevated negative affect is related to worse T1D outcomes including less self-management and elevated glycemic levels (HbA1c ≥ 7%; American Diabetes Association Professional Practice Committee, 2021 ; Buchberger et al., 2016 ). One mechanism through which negative affect may contribute to adverse T1D outcomes is stress-related behaviors, such as disordered eating behavior (DEB), or unhealthy eating and weight-control behaviors. DEB is of particular interest due to the centrality of food in T1D management ( Colton et al., 2009 ; Young et al., 2013 ). Adolescents with T1D, and particularly those with elevated negative affect ( Rose et al., 2020 ), are at an increased risk for DEB, including diabetes-specific DEB, such as insulin withholding for weight loss ( Peterson et al., 2015 ; Toni et al., 2017 ; Young et al., 2013 ). Given the potentially modifiable nature of negative affect and its association with DEB, reduced self-management, and elevated glycemic levels ( Buchberger et al., 2016 ), this risk factor may be of particular interest for intervention. Diabetes distress, which refers to a negative emotional reaction related to diabetes, is also an important factor related to depression, elevated glycemic levels, and reduced self-management among adolescents ( Hagger et al., 2016 ; Hong et al., 2021 ). It is also important to consider the impact of marginalization on T1D and psychosocial outcomes. Marginalization refers to the process of being pushed to a social position with inequitable access to resources, often referred to as social determinants of health (SDOH), which have adverse ramifications on health ( Baah et al., 2018 ). Those who have been historically marginalized, including those from racially/ethnically minoritized and socioeconomically disadvantaged backgrounds, have a greater exposure to SDOH that negatively affect health outcomes (e.g., poverty and discrimination). Indeed, research demonstrates that youth from historically marginalized backgrounds are more likely to experience adverse T1D outcomes. For instance, youth who live in neighborhoods with fewer resources, or higher racial residential segregation, are at a higher risk for elevated glycemic levels, less likely to use diabetes technologies known to reduce glycemic levels (i.e., insulin pump or CGM), and more likely to experience diabetes-related complications ( Crain et al., 2023 ; Ellis et al., 2023 ; Low et al., 2015 ). Similar outcomes are evident for youth with T1D from racially/ethnically minoritized backgrounds compared to non-Hispanic White youth with T1D ( Kanbour et al., 2022 ; Lipman et al., 2020 ; Miller et al., 2020 ). Given the recent rise in rates of T1D among racially/ethnically minoritized youth ( Divers et al., 2020 ), it is imperative that T1D research includes diverse samples and considers marginalization ( Rose et al., 2018 ). Mindfulness-based intervention (MBI), which targets the propensity to pay attention intentionally and non-judgmentally to the present moment ( Kabat-Zinn, 2005 ), may be uniquely situated to address the combined impact of negative affect and stress-related behaviors in adolescents with T1D. MBI has previously demonstrated reductions in negative affect among youth without a chronic illness ( Chi et al., 2018 ; Dunning et al., 2019 ) and decreases in emotional distress among youth with chronic illnesses, including chronic pain and weight-related disease ( Ahola Kohut et al., 2017 ; Chadi et al., 2016 ; Lin et al., 2019 ). Previous research examining MBI in adults and young adults with type 2 diabetes has demonstrated decreases in negative affect ( Armani Kian et al., 2018 ; Friis et al., 2016 ; Tovote et al., 2015 ; van Son et al., 2014 ). A study of adolescents with T1D found that higher trait mindfulness was associated with improved glycemic control and adherence, and lower diabetes distress ( Abujaradeh et al., 2021 ). Moreover, a pilot intervention study found that 16–20-year-olds with T1D who participated in MBI demonstrated reduced stress compared to those in a cognitive-behavioral or a diabetes support group, although diabetes-related improvements were not found ( Ellis et al., 2019 ). Given the disproportionate exposure to chronic stress in individuals with diabetes from historically marginalized backgrounds ( Butler et al., 2022 ), interventions directly addressing stress, such as MBI in psychosocial health and diabetes management, are warranted. A small body of research has demonstrated that MBI may be acceptable among racially/ethnically diverse youth ( Bluth et al., 2016 ; Eva & Thayer, 2017 ; Fung et al., 2019 ). For instance, a previous study examining a school-based MBI conducted among ethnically minoritized youth from low-income backgrounds demonstrated efficacy in reducing perceived stress and internalizing problems and improving emotion regulation ( Fung et al., 2019 ). However, a lack of diversity-focused research on mindfulness remains ( DeLuca et al., 2018 ). Research examining the utility of mindfulness for youth with T1D, particularly those from historically marginalized backgrounds, is needed. As such, the present case series describes the experiences of two adolescents from historically marginalized backgrounds who participated in a pilot feasibility and acceptability randomized controlled trial (RCT) of an MBI adapted for youth with T1D and elevated negative affect ( Basch et al., 2024 ; Lupini et al., 2024 ). Overall, we found that MBI was feasible and acceptable for the full sample. The current study uses a case series format for a more in-depth examination and patient-centered approach to contextualize aggregate study findings, to (1) highlight individual changes in negative affect (depression, anxiety, stress, and DEB), mindfulness, and diabetes outcomes (diabetes distress, diabetes self-management, and HbA1c) after participating in an MBI and (2) highlight MBI’s utility in historically marginalized communities. While reporting on overall feasibility is useful for understanding group-level effects, case examples can provide added nuance. Methods Study Overview Case examples were chosen from a sample of participants in a pilot RCT ( Basch et al., 2024 ). All study procedures were approved by the hospital’s Institutional Review Board. Inclusion criteria were as follows: (1) age 12–17 years, (2) diagnosed with T1D for ≥1 year, (3) elevated depression or anxiety symptoms (T-score of ≥55 on PROMIS-D or PROMIS-A subscales), and (4) ability to speak and understand English as programs were conducted in English. Participants were not excluded if their parents spoke Spanish. The youth and their guardians provided additional consent/assent to be included in this deidentified case series. Case Reports Details have been modified to maintain anonymity. “Jayla” and “Valerie” were chosen as participants for the current report based on adherence to study protocol, including 100% attendance, and similarity on demographic factors, particularly those relating to marginalization (i.e., race/ethnicity, parent education, household income, and household structure). It is important to note that despite similarities on specific demographic variables, their lived experiences of these factors are unique and do not reflect a universal experience. The outcome variables were not examined until after participants were chosen, to mitigate sampling bias. During the orientation session, Jayla and Valerie did not express a preference for either condition. Jayla and Valerie are both tweens between 12 and 14 years old, living with T1D, with single-parent households, household incomes below the living wage, and parents with less than a college degree. As reported by their parent, Jayla is a non-Hispanic/Latinx Black/African American female, and Valerie is a biracial Hispanic/Latinx female. At baseline, Jayla had T-scores of 59 on self-report measures of anxiety and depression (PROMIS-A and PROMIS-D), a T-score of 57 on a measure of diabetes distress, and an HbA1c of 9.5% (see Outcome Measures section for more details on measurements). Valerie had a T-score of 60 on the PROMIS-A and 62 on the PROMIS-D, a T-score of 66 on diabetes distress, and an HbA1c of 9.9%. Procedure All procedures occurred virtually through a children’s hospital in the Mid-Atlantic region of the US. The intervention and control groups were both conducted over HIPAA-compliant Zoom. Assessments were conducted entirely virtually, with surveys collected through REDCap ( Harris et al., 2009 ), an online database, and qualitative interviews conducted over HIPAA-compliant Zoom. Consent/assent was obtained virtually prior to involvement in assessments and groups. Baseline surveys were distributed prior to randomization. Following baseline assessments, Jayla and Valerie both participated in the 6- or 7-week BREATHE-T1D program, respectively. Following the program, Jayla and Valerie repeated surveys and completed qualitative interviews. Final surveys were completed 3 months after group ended. BREATHE-T1D BREATHE-T1D is an adapted version of Learning to BREATHE (L2B; Broderick & Metz, 2009 ), a manualized MBI designed as a universal socio-emotional learning curriculum for adolescents. We tailored the MBI utilizing qualitative feedback from adolescents with T1D. Details regarding the tailoring process are reported elsewhere ( Lupini et al., 2024 ). The adaptation process resulted in two versions of BREATHE-T1D, with either 6- or 7-week curriculum. The 7-week curriculum contained the same content as the 6-week curriculum, with the first session split into two to provide more opportunities for group connection building, as requested by participant feedback. BREATHE-T1D maintains the core principles of L2B, including the weekly themes that correspond to the letters in the acronym BREATHE: (1) Body, body awareness; (2) Reflections, mindfulness of thoughts; (3) Emotions, mindfulness of feelings; (4) Attention, using mindfulness of body, thoughts, and feelings to cope with stress; (5) Tenderness, reducing unhealthy mental habits; (6) Habits, integrating mindfulness into daily life, with the final E representing the overall goal of the program, Empowerment. BREATHE-T1D is a group program delivered virtually over HIPAA-compliant Zoom at an afterschool time according to participants’ schedules and includes interactive activities to further understanding of mindfulness, as well as mindfulness practices, such as a body scan, mindfulness of thoughts, and mindful movement. BREATHE-T1D was modified to incorporate examples related to living with T1D, which were woven into activities, mindfulness practices, and discussion probes. Participants were assigned home practices between sessions, including 5–10-min formal practices and informal practices to integrate into daily life. Participants received a practice workbook, yoga mat, throw blanket, and audio recordings of mindfulness practices. The program was cofacilitated by a doctoral-level psychologist and a master’s level research coordinator, who completed a 2-day training on L2B and weekly supervision by a child psychologist certified in L2B training and facilitation. Measures Attendance and Acceptability Group attendance was tracked weekly. After each session, participants completed an 8-question survey assessing acceptability. Questions included Likert scale ratings ranging from 1 ( not at all ) to 5 ( extremely ) of how enjoyable and helpful the session was, how supportive the group facilitators and members were, whether mood and stress changed from before to after the session, and questions regarding home practice. There was also an open-ended question for additional feedback. After completing the full course of the group programs, adolescents participated in 30-to-60-min qualitative interviews to further assess acceptability and obtain feedback to inform iterative changes between cohorts. Interview transcripts were coded holistically by research staff to inform adaptations. For the purposes of this case series, Jayla’s and Valerie’s interview transcripts were reviewed by two coders for themes regarding their perceptions of the utility of participating in the MBI, utilizing Microsoft Office tools, rather than specific qualitative software (e.g., Atlas and Dedoose). Outcome Measures All outcome measures were assessed at baseline, post-, and 3 months post-intervention. Depression. The PROMIS-D subscale short form is an 8-item self-report measure of depression/negative affect ( Irwin et al., 2010 ). Adolescents rate how often each item applied to them over the past week on a five-point Likert scale ( never to almost always ), with higher scores indicating greater frequency. A T-score of ≥55 is considered clinically elevated. Anxiety. The PROMIS-A subscale short form is an 8-item self-report measure of anxiety ( Irwin et al., 2010 ). Adolescents are asked to rate how often each item applied to them over the past week, on a five-point Likert scale ( never to almost always ), with higher scores indicating greater frequency. A T-score of ≥55 is considered clinically elevated. Stress. The Patient-Reported Outcomes Measurement Information System Stress (PROMIS-S) subscale short form is an 8-item measure of psychological stress ( Bevans et al., 2018 ). Adolescents rate how often each item applied to them over the past week on a five-point Likert scale ( never to almost always ), with higher scores indicating greater frequency. A T-score of ≥55 is considered clinically elevated. DEB. The Diabetes Eating Problems Survey Revised (DEPS-R) is a measure of DEB in individuals with diabetes, consisting of 16 items ( Markowitz et al., 2010 ). Adolescents rate how often they engage in each behavior on a six-point Likert scale ( never to always ), with higher scores indicating greater severity of DEB and a clinical cutoff of >20. Mindfulness. The Mindfulness Attention Awareness (MAAS) is a 15-item measure of trait mindfulness ( Brown & Ryan, 2003 ). Adolescents are asked to rate how frequently they experience each item, on a six-point Likert scale ( almost always to almost never ). Scores are averaged with higher scores indicating higher levels of trait mindfulness. Diabetes Distress. The Problem Areas in Diabetes-Teen (PAID-T) is a 14-item measure of diabetes distress in adolescents with T1D ( Shapiro et al., 2018 ). Adolescents are asked how much each diabetes-related problem applied to them in the past month, on a six-point Likert scale ( not a problem to serious problem ), with higher scores indicating greater severity and a cut-point of >44 considered clinically elevated. Diabetes Self-Management. The Self-Care Inventory-Child (SCI-C) is a 14-item self-assessment of perceived adherence to diabetes care regimen ( La Greca et al., 1995 ). Adolescents rate how well they followed their diabetes care regimen in the past two weeks, on a five-point Likert scale ( never do it to always do this recommendation without fail ). Higher average scores indicate greater perceived adherence, with no formal clinical cutoff. HbA1c. Glycemic control as measured by HbA1c was extracted from the medical record at the participant’s clinic visit closest to baseline (within 3 months prior to baseline) and at the visit 3–6 months following the last study assessment. Results Attendance and Acceptability Measures Both Jayla and Valerie attended all of their group program sessions. Jayla reported 100% acceptability as assessed by reporting “mostly” or “extremely” on all post-session survey questions regarding enjoyability and helpfulness of sessions. Valerie completed acceptability measures after 6 out of 7 group sessions. She reported sessions as “mostly” or “extremely” enjoyable and helpful 33% of the time while another 50% of the time, Valerie indicated that sessions were “somewhat” enjoyable and helpful. Jayla reported her mood was “better” or “much better” after 4 out of 6 group sessions, and her stress was “better” or “much better” after 5 out of 6 group sessions, while Valerie reported that her mood was “better” after 4 out of 6 group sessions and her stress was “better” after 5 out of 6 group sessions. Qualitative Findings Jayla’s and Valerie’s qualitative interviews following the program yielded similar patterns of feedback. Most saliently, both endorsed that the program made them feel calmer and less stressed. For instance, Valerie said, “I forgot all the things that I was holding that would make me stressed.” Similarly, Jayla reported that, “At first I didn’t really think it was going to affect me, but during the session I began to feel more stress free and more calm.” They both cited the mindfulness practices taught during sessions, particularly small stickers as reminders for mindful breathing and meditations, as helpful during stressful moments and will continue to use these practices. For instance, Jayla shared, “Anytime I get stressed out about my diabetes, I will just remember what I learned, do my breathing, and listen to some of the [meditation] audios. That would probably make it better.” Furthermore, both Jayla and Valerie shared the value of the group format to feel not alone in their experiences with T1D. For instance, Valerie said, “It kind of made me feel happy because I would always think that I was alone and that there was no one like me in the world, but I was wrong because I had finally met some kids that were like me.” Jayla Survey Outcomes Depression. Jayla showed an improvement in depression symptoms, such that by immediate post-intervention follow-up she no longer was above the clinical cutoff for elevated depression, and she remained non-elevated at 3-month follow-up (see Figure 1 ). Figure 1. Open in a new tab Mood outcomes. Anxiety. Jayla showed an improvement in anxiety symptoms, such that by post-intervention follow-up her anxiety score had dropped below the clinical cutoff for elevated anxiety, and her symptoms had further decreased at 3-month follow-up (see Figure 1 ). Stress. Jayla showed a similar pattern of improvement in stress, with her stress score dropping below the clinical cutoff for elevated stress at immediate post-intervention follow-up and further reduction at 3-month follow-up (see Figure 1 ). DEB. At baseline, Jayla scored in a non-elevated range for DEB. Following intervention participation, Jayla’s DEB remained non-elevated (see Figure 1 ). Mindfulness. Jayla showed an improvement in trait mindfulness (3.47, 4.8, and 5 on 1–5 scale at baseline, post-intervention follow-up, and 3-month follow-up, respectively). Diabetes Outcomes Diabetes Distress. Jayla showed a short-term improvement in diabetes distress, such that at the immediate post-intervention follow-up, she no longer endorsed elevated distress, but by 3-month follow-up, her diabetes distress returned to an elevated range according to clinical cutoffs (see Figure 2 ). Figure 2. Open in a new tab Diabetes outcomes. Diabetes Self-Management. For diabetes self-management, Jayla showed a small improvement from baseline through 3-month follow-up (see Figure 2 ). HbA1C. Jayla did not show improvements on HbA1c values and remained above the recommended HbA1c (see Figure 2 ). Valerie Survey Outcomes Depression. Similar to Jayla, Valerie also showed an improvement in depression symptoms, such that by post-intervention follow-up she no longer was above the clinical cutoff for elevated depression and remained non-elevated at 3-month follow-up (see Figure 1 ). Anxiety. Valerie also showed an improvement in anxiety symptoms, such that by immediate follow-up her anxiety score had dropped below the clinical cutoff for anxiety and further decreased at 3-month follow-up (see Figure 1 ). Stress. Valerie demonstrated a similar pattern of improvement in stress, with her stress score dropping below the clinical cutoff for elevated stress at immediate follow-up and a further reduction at 3-month follow-up (see Figure 1 ). DEB. Valerie endorsed elevated DEB at baseline and at immediate follow-up, but her DEB score fell below the clinical cutoff by the 3-month follow-up see ( Figure 1 ). Mindfulness. Valerie showed a marginal improvement in trait mindfulness (3.08, 2.57, and 3.5 on 1–5 scale, respectively, at each timepoint). Diabetes Outcomes Diabetes Distress. Valerie demonstrated an improvement in diabetes distress, such that at immediate post-intervention follow-up, she endorsed lower, yet still elevated distress, but by the 3-month follow-up, her diabetes distress dropped below the clinical cutoff (see Figure 2 ). Diabetes Self-Management. For diabetes self-management, Valerie demonstrated a small improvement from baseline through the 3-month follow-up (see Figure 2 ). HbA1c. Valerie showed a small improvement in HbA1c from baseline through 3-month follow-up but remained above the recommended HbA1c (see Figure 2 ). Discussion Overall, this case series illustrates the potential utility of MBI in adolescents with T1D and elevated negative affect, particularly in those from historically marginalized backgrounds. Jayla and Valerie were both tweens, living with T1D, with minoritized racial/ethnic identities, in single-parent households with incomes below the living wage, and parents with an education below a college degree. They both demonstrated several improvements following their participation in the MBI group, including clinically meaningful decreases in depression, anxiety, stress, and diabetes distress, and increases in mindfulness and diabetes self-management. Valerie also demonstrated additional improvements in HbA1c and DEB, the latter of which reduced below the clinical cutoff following participation. Taken together, these results highlight the experiences of two case examples for which participation in MBI demonstrated clinically meaningful improvements in several mood and stress outcomes. While we cannot make claims of efficacy with two case examples, this report suggests that MBI may have potential utility to address mood and stress in youth with T1D, including those from historically marginalized backgrounds. BREATHE-T1D is an MBI tailored to include explicit references to stressful T1D experiences, to provide mindfulness-based coping strategies and reduce negative affect generally and specific to T1D. BREATHE-T1D did not include medical recommendations related to T1D management but aimed to teach adolescents strategies to mitigate stress in T1D-related situations. As such, the improvements in both Jayla’s and Valerie’s mood and stress were anticipated. For Jayla, there was no concomitant improvement in glycemic control during the three months that HbA1c was tracked, but Valerie did demonstrate some improvement in glycemic control. Although a case report, Jayla’s pattern aligns with a previous MBI pilot trial in emerging adults ages 16–20 years old with T1D, which found improvements in stress but not glycemic control following MBI ( Ellis et al., 2019 ). Yet, unlike this previous work, both case examples demonstrated reductions in diabetes distress and a slight improvement in self-management. One possibility is that the current MBI, with T1D specific adaptations based upon stakeholder input, offers enhanced therapeutic value, as opposed to general MBI without tailoring. This explanation would be consistent with multiple theoretical frameworks for intervention tailoring (e.g., ORBIT; Czajkowski et al., 2015 ), which postulate that tailoring interventions for specific populations is critical, rather than taking a one size fits all approach. The aim of the present study was to examine individual changes in key outcomes to highlight the utility of MBI in historically marginalized populations. When working with participants from marginalized backgrounds, it is crucial to create interventions that are feasible and acceptable. Given the 100% session attendance and positive qualitative feedback, it appears that this virtual MBI was feasible and acceptable for these two participants. Although SDOH were not discussed throughout the intervention content, the virtual delivery of this group intervention made the group more accessible, as this eliminated physical barriers of additional time for travel and the expenses of transportation. Additionally, considering that youth from historically marginalized backgrounds are more likely to experience adverse T1D outcomes ( Crain et al., 2023 ; Low et al., 2015 ), and the associations between T1D outcomes and negative affect ( Buchberger et al., 2016 ), accessible interventions that effectively target negative affect, like MBI, may be of particular interest. As such, this case series highlights the unique utility of MBI in adolescents with T1D from historically marginalized backgrounds, demonstrated by Jayla’s and Valerie’s improvements in multiple targets related to mood and diabetes outcomes. It is possible that virtual, group MBI may be a more cost effective and suitable avenue for historically marginalized participants with limited access to traditional therapy. As with any study, it is important to recognize the limitations of the present study. Given the case series format of the present study, we cannot draw conclusions regarding efficacy of MBI based on the present information. This report is not intended to make claims of efficacy. Furthermore, variables representing marginalization were limited to sociodemographic information provided by parent report and do not capture the full nuanced experiences of marginalization or adolescent perspective. For instance, we did not collect information regarding food insecurity, housing insecurity, or health literacy in this study. Furthermore, potential mediating or moderating variables, such as resilience or social support, were not examined. Lastly, although we observed clinically meaningful changes in these two cases as defined by moving from above clinical cutoffs to below, it is possible that some changes were due to confounding variables (e.g., time). Lastly, for some key outcomes (e.g., depression, anxiety, and stress), Jayla and Valerie were only mildly elevated, which may limit generalizability. However, it is possible that MBI may be particularly useful for youth who experience mildly elevated negative affect. In addition, Jayla and Valerie both had a 100% attendance rate, which may also limit generalizability for lower doses of the intervention. Of note, the attendance rate in the overall pilot was also high (96%; Basch et al., 2024 ); in a real-world setting, this attendance rate may be less likely and, as such, may limit the implications of the present work. Conclusions This case series uses two case examples to demonstrate the value of an adapted MBI with adolescents with T1D, particularly those from historically marginalized backgrounds, for improvements in mood and diabetes outcomes. Jayla and Valerie reported improvements in nearly all behavioral outcomes of interest following participation and qualitatively endorsed that participation resulted in stress reduction. Further research is warranted to investigate the unique utility of MBI for youth from historically marginalized communities and potential mechanisms. Implications for Impact Statement. This study presents case examples of adolescents with T1D from historically marginalized backgrounds who participated in a mindfulness-based intervention. Both participants improved in depression, anxiety, stress, diabetes distress, and diabetes self-management. Mindfulness may be a useful intervention in this population. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: National Center for Complementary and Integrative Health (R34AT011035-01A1) awarded to the last author. Footnotes Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Trial Registration ClinicalTrials.gov Identifier: NCT05268393 . Related presentations: Basch, M., Lupini, F., Vagadori, J., Ho, S., Gutierrez-Colina, A., Kelly, K.P., Streisand, R., Shomaker, L., and Mackey, E. (2024, April) Mindfulness-based group intervention for adolescents with Type 1 diabetes (T1D): Initial findings from a pilot and feasibility randomized controlled trial. 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