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Background: ADHD is highly comorbid with Delayed Sleep Phase Syndrome (DSPS). Both are associated with obesity and diabetes, which can be caused by long-term dysregulations of appetite and glucose metabolism. This study explores hormones involved in these processes and the effects of chronotherapeutic interventions in a small sample of adults with ADHD and DSPS. Methods: Exploratory, secondary analysis of data from the PhASE study, a three-armed randomized clinical trial, are presented, including 37 adults (18-53 years) with ADHD and DSPS receiving three weeks of 0.5 mg/day (1) placebo, (2) melatonin, or (3) melatonin plus 30 minutes of bright light therapy (BLT). Leptin (appetite-suppressing), ghrelin (appetite-stimulating), insulin, insulin-like growth factor-1 (IGF-1), and glucose were measured from blood collected at 08:00 hours. Salivary cortisol was collected during the first 30 minutes after awakening and self-reported appetite was assessed. Results: Baseline leptin and IGF-1 levels were higher than reference ranges, and ghrelin and cortisol levels were lower, while insulin and glucose were normal. Melatonin treatment decreased leptin and insulin. Other outcomes remained unchanged and melatonin + BLT had no effects. Conclusion: Due to the small sample size and exploratory nature of the study, results should be interpreted with caution. Overall, these results show no strong indications for dysregulation of appetite and glucose metabolism to suggest high risk of obesity and diabetes in this small sample of adults with ADHD and DSPS. However, baseline appetite was suppressed, likely because measurements took place in the early morning which could be considered the biological night for this study population. Melatonin treatment seemed to cause subtle changes in appetite-regulating hormones suggesting increased appetite. Chronotherapeutic treatment may affect appetite-regulating hormones by advancing the biological rhythm and/or altering eating behaviors, but this remains to be investigated in larger samples using detailed food diaries.

Objective: To gain retina physicians' and diabetic retinopathy (DR) patients' perspectives on needs and opportunities in DR education, and then develop and pilot test an educational video. Design: This study utilised qualitative interview data for video creation, and interview and survey data for assessment. Setting: This study was conducted in a single large academic medical centre. Method: We conducted semi-structured interviews with attending retina physicians and DR patients (Cohort A) which were coded for themes about needs in DR patient education. Using these interviews, we designed and piloted a 6-minute user-centred animated video among a second patient cohort (Cohort B), who completed post-intervention interviews. Results: Four physicians and 14 DR patients participated in the study. Themes from Cohort A included accessible information, early management, lifestyle factors and emotional context. Physician themes included effective communication, visual information delivery and individual-level diabetes management. Cohort B commented on the subsequently created video's improved accessibility, engagement and supplementation of their existing DR knowledge. Conclusion: Physicians and patients showed an interest in video education and identified unique educational needs. We used these insights to create a video that demonstrated positive patient uptake. Close attention to retina physicians' and DR patients' perspectives can offer a valuable approach in developing materials to increase patients' health knowledge. Within the context studied, videos may be more accessible and engaging than the use of traditional print-based education materials.

Limited research on diabetes education and support implementation in Appalachia, which is a critical knowledge gap considering barriers to care, and high prevalence rates. The aim was to understand what each facility is providing regarding diabetes education and services within West Virginia. This study reports cognitive interview qualitative findings from a multi-methods study. Individuals were recruited through an online search to identify clinics, organizations, and hospital staff that provided diabetes education in the state of West Virginia. Eligible participants were individuals who facilitated and managed diabetes education and support in counties of West Virginia. The interviews followed an 11-item interview guide, approved, and reviewed by a practicing Registered Dietitian and Certified Diabetes Care Education Specialist in West Virginia. All qualitative data from the interviews were hand-coded using grounded theory, by two researchers. 15 participating organizations from the state of West Virginia were included and described three phenomena: Diabetes Education Implementation (differences in: evaluation measures, modality, delivery format, topical areas); Barriers to Care (staffing, lack of training, evaluation, loss of research partnerships and funding); and Facilitators to Care (community-based involvement, interdisciplinary collaboration, capacity building (trainings). There are concerns with program drift and "risky" adaptations such as inconsistent evaluative measures, lack of training for program facilitators, variety of delivery formats, and content material. Findings recommend more alignment in program delivery to better implementation. Further studies should assess patient experiences with implemented diabetes education programs in West Virginia to further support the current research findings.

Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for the pregnant individual and their baby. Screening approaches for GDM have undergone several iterations, introducing variability in practice among healthcare providers. As such, our study aimed to explore the views of antenatal providers regarding their practices of, and counseling experiences on the topic of, GDM screening in Ontario. We conducted a qualitative, grounded theory study. The study population included antenatal providers (midwives, family physicians, and obstetricians) practicing in Hamilton, Ottawa, or Sudbury, Ontario. Semi-structured telephone interviews were conducted and transcribed verbatim. Transcripts were analyzed using inductive coding upon which codes, categories, and themes were developed to generate a theory grounded in the data. Twenty-two participants were interviewed. Using the social-ecological theory, we created a model outlining four contextual levels that shaped the experiences of GDM counseling and screening: Intrapersonal factors included beliefs, knowledge, and skills; interpersonal factors characterized the patient-provider interactions; organizational strengths and challenges shaped collaboration and health services infrastructure; and finally, guidelines and policies were identified as systemic barriers to health care access and delivery. A focus on patient-centered care was a guiding principle for all care providers and permeated all four levels of the model. Patient-centered care and close attention to barriers and facilitators across intrapersonal, interpersonal, organizational, and policy domains can minimize the impact of variations in GDM screening guidelines. Among care providers, there is a desire for additional skill development related to GDM counseling, and for national consensus on optimal screening guidelines.

The proportion of infants in the United States who are breastfed at 1 year remains well below the Healthy People 2030 target. The health implications of suboptimal breastfeeding durations are significant, including increased risk of childhood leukemia and maternal Type 2 diabetes. Prenatal breastfeeding education provides an opportunity to improve breastfeeding self-efficacy among pregnant individuals and to establish their coping skills in case future breastfeeding problems arise. Although prenatal breastfeeding education is known to improve breastfeeding self-efficacy, characteristics of prenatal breastfeeding education interventions that are successful at increasing breastfeeding duration have not been well defined. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Health Action Process Approach, we conducted a systematic review of the literature examining the impact of prenatal breastfeeding education interventions on breastfeeding duration measured at least 12 weeks postpartum. Twenty-one studies were identified. Prenatal breastfeeding education was most likely to increase breastfeeding duration when education interventions integrated psychological components (Health Action Process Approach coping planning) or were paired with in-person postpartum breastfeeding support. Additional research is needed to examine the role of psychological components in breastfeeding education interventions in diverse populations and to determine the specific psychological intervention components with the greatest impact on breastfeeding duration.

Aggressive and violent behaviour is a challenging psychiatric emergency to manage, especially among vulnerable categories such as patients with Intellectual Developmental Disorder. Although there is some evidence that clozapine may be useful as an anti-violence compound, its use is limited by common metabolic complications. An adult patient presented with obesity, type II diabetes mellitus, compulsive food intake, severe Intellectual Developmental Disorder, and a treatment-resistant aggressive behaviour. Clozapine was administered resulting in reduced aggressive behaviour. Unexpectedly, a reduction in the food craving as well as a sustained improvement in both anthropometric parameters and glycemic control were observed during the clozapine treatment. Our case report, describes these findings for the first time, highlighting the need for more clinical research to investigate both the efficacy of clozapine in the Intellectual Developmental Disorder populations and its long-term effects with special regard to the metabolic outcomes in this type of patients.

Background: Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease contribute significantly to societal and individual impact globally. High-quality management of these long-term health conditions is important to prevent deterioration of health, although potentially more complex for patients with intellectual disabilities in residential care. Disease management in this context particularly benefits from complete and accurate recording of disease management. Without complete records, long-term health conditions are more difficult to track due to the level of uncertainty regarding which clinical examinations have and have not been performed. This study therefore aims to examine the recording routines of quality indicators for disease monitoring for chronically ill patients with intellectual disabilities in Dutch residential care. Methods: This retrospective study utilised medical record data from a large Dutch long-term care provider. We assessed the occurrence of cardiovascular disease (ICPC-2 codes K74, K75, K76, K89 and K90), type 2 diabetes mellitus (T90, T90.02) and/or COPD (R91, R95). For adults with intellectual disabilities and long-term condition, we analysed data entries in an 18-month period (between July 2020 and December 2021). Observed consultation rates were calculated and presented in median with interquartile range and contrasted against the baseline number of consultations in primary care. Information on recorded quality indicators was presented in frequencies and percentages. Findings: Of the three long-term conditions investigated, the most common was type 2 diabetes mellitus (8.6%; n = 287), followed by cardiovascular disease (5.8%; n = 195) and COPD (3.0%; n = 101). Of those who received management for their long-term condition from their contracted GP, patients with type 2 diabetes mellitus, cardiovascular disease, or COPD had fewer consultations in 2021 than the Dutch baseline. Discussion of lifestyle was often not recorded. Disease monitoring quality indicators were recorded more often but at a lower frequency than expected. Conclusions: Because of the infrequent recording of quality indicators, recording of management of long-term conditions for patients with intellectual disabilities in long-term care appears suboptimal. Although this may not directly harm individual patients, it may jeopardise the quality of management of long-term conditions, as suboptimal recording limits opportunities for evaluation and improvement. Within a broader trend towards data-driven work methods in healthcare, recording of quality indicators requires attention from practice, research and policy.

Autistic adults experience stark health disparities and difficulties accessing health care. Their realities of managing complex health conditions are unknown. Our research explored the experience of Autistic adults self-managing diabetes. Interviews with Autistic adults with diabetes and their support people were thematically analysed to identify three key themes. The Autistic experience influenced diabetes self-management, including autism-unique challenges and strengths. Participants prioritised avoiding Autistic burnout over diabetes self-management; mitigating the psychosocial pressures of neurotypical systems took precedence. Health professionals often separated autism and diabetes subsequently overlooking key factors impacting diabetes self-management. To better meet the needs of Autistic adults, diabetes care and health management more broadly should be considered within the context of autism, including supports for self-management during Autistic burnout.

It can be tough to talk about disabilities. However, when we avoid talking about it, we ignore a huge piece of someone's personal identity. This identity is complex, multifaceted, and requires a unique set of needs. It is important that students with disabilities are heard. When living with a disability, society can often have lower expectations of what we can do in comparison to our non-disabled counterparts. In this article, the author describes a few of the stories and assumptions people with disabilities experience every day on college campuses due to their unique characteristics. In telling these stories, the author demonstrates how students with disabilities are constantly trying to prove that they are more than just their disability.

Diabetes mellitus is a challenging chronic health condition at the forefront of attention of the healthcare system. Important estimates quantifying how diabetes prevalence varies by age are available for the general population, but these estimates are poorly characterized among autistic adults. Improved diabetes prevalence and likelihood estimates are needed to understand the impact of diabetes on this population. We analyzed IBM MarketScan health claims data from 2019 to 2020 to estimate diabetes prevalence among privately insured autistic (N = 54,500) and non-autistic adults (N = 109,000) and estimate autistic adults' likelihood of diabetes relative to non-autistic adults at 5-year age intervals (e.g. 18-22 to 23-27) when controlling for demographic factors. Diabetes prevalence was 5.15% for autistic adults and 3.07% for non-autistic adults. Autistic adults had a higher likelihood of diabetes than non-autistic adults at most 5-year age intervals, with the greatest difference at ages 23-37 (odds ratio = 2.67; 95% confidence interval = 2.33-3.06). Our findings suggest that autistic adults may be more likely than non-autistic adults to experience diabetes. Thus, development of diabetes support services and programs that accommodate autistic adults' individualized needs are important for future study to promote optimal diabetes outcomes for this population.

The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour [greater than or equal to] 7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores ([beta] = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.

Background: We now have sufficient evidence demonstrating inequalities in specific avoidable causes of death for adults with intellectual disability compared to their peers without intellectual disability. Apart from COVID-19, the largest differentials that disadvantage people with intellectual disability are in relation to pneumonia, aspiration pneumonia, epilepsy, cerebrovascular disease, ischaemic heart disease, deep vein thrombosis, diabetes and sepsis. The aim of this systematic review is to report on strategies at the individual, population or policy levels aimed at preventing these conditions that are applicable to adults with intellectual disability and that have been based on or recommended by research. Methods: Systematic review of PUBMED, EMBASE, CINAHL, PsychInfo, Social Care Online, International Bibliography of the Social Sciences (IBSS), Web of Science, Scopus, Overton, the Cochrane Library and Google Scholar databases was carried out. Searches were completed on 30 June 2023. Quantitative, qualitative and mixed-methods research; systematic, scoping or evidence-based reviews; and audit and reports of mortality reviews were included. Publications included in the review were about preventing the eight potentially avoidable causes of death. Findings: Ninety-four papers were included in the review (9 in relation to pneumonia; 11 for aspiration pneumonia; 18 for sudden unexpected death in epilepsy; 7 for cerebrovascular disease; 8 for ischaemic heart disease; 4 for deep vein thrombosis; 31 for diabetes; 6 for sepsis). The eight most frequently occurring potentially avoidable causes of death in people with intellectual disability are very different medical conditions, but they shared striking similarities in how they could be prevented. The literature overwhelmingly implicated the need to make lifestyle changes to address obesity, lack of exercise and poor nutrition, and to have regular medical reviews. In addition, 'whole-population' approaches are required that look beyond the individual to the social determinants of health. Conclusions: We found little peer-reviewed evidence specifically about preventing these conditions in people with intellectual disability. However, most of the literature about preventative strategies pertaining to the general population was applicable to people with intellectual disability, albeit that some 'reasonable adjustments' would be required.

Views of obesity as a consequence of "lack of willpower" or other behavioral choices, rather than a complex array of biological and other factors, are quite common among undergraduate students. Many undergraduates in prenursing or biology programs have little exposure to the physiology and pathophysiology of obesity, including learning about leptin and other hormones involved in appetite control. I developed materials for teaching about the pathophysiology of obesity in two different pathophysiology courses: one designed as a survey of pathophysiology topics for prenursing majors, and the other designed as an in-depth exploration of the molecular and cellular basis of selected diseases for upper-division biology majors. In the molecular basis of disease course, obesity is covered as part of a unit organized around metabolic syndrome. The discussion includes molecular and cellular mechanisms that link obesity to several other diseases, including type 2 diabetes and atherosclerosis. This article briefly describes the approaches I have taken for teaching obesity to two different undergraduate student populations and lists several resources that may be useful tools for teaching about obesity.

Diabetes mellitus and obesity are major public health issues that significantly impact the health care system. The next generation of health care providers will need a deep understanding of the pathophysiology of these diseases if we are to prevent, treat, and eventually cure these diseases and ease the burden on patients and the health care system. Physiology core concepts are a set of core principles, or "big ideas," identified by physiology educators that are thought to promote long-term retention, create a deeper understanding, and help with formation of critical thinking skills. Here we describe our scaffolded teaching approach in an upper year undergraduate pathophysiology course to educate students about these two diseases and discuss how learning about the basis of these highly integrative diseases from the biochemical to whole body level is a meaningful tool in the physiology educator toolbox to reinforce physiology core concepts. This teaching strategy is designed to engage students in the scientific process and hone their problem-solving skills such that they are hopefully equipped to treat and eventually cure these diseases as they move forward in their careers.

Adults with Intellectual and Developmental Disabilities (IDD) are aging with chronic health issues. However, little is known about the racial disparities in chronic health conditions among adults with IDD. Do racial and ethnic minority adults with IDD experience elevated risk of chronic health conditions like in the general population? How do factors such as health risk behavior, health status, and residential status impact their risk of chronic health conditions? To answer these questions, the current study examines the racial differences in the prevalence of three chronic conditions: diabetes, hypertension, and asthma, using baseline data from the Longitudinal Health and Intellectual Disability Study. Our sample includes 2,173 adults with IDD. We conducted a multivariable logistic regression to examine racial disparity in prevalence controlling for factors such as demographics, IDD diagnosis, health status, and health risk behaviors. Consistent with established evidence of racial disparities in the general population, being Black was significantly associated with an elevated risk of all three chronic conditions than Whites, even after controlling for a host of demographic, health risk and environmental factors that typically influence health. Our findings contribute to the sparse literature on the intersection of race, ethnicity and disability among racial and ethnic minority adults with IDD and how it relates to health. It also provides important policy and practice implications regarding the urgency of developing culturally appropriate health promotion interventions for racial minority adults with IDD.

The high level of consumption of processed foods has an effect on human health. The consumption of doughnuts, pastries, fried chicken, French fried potatoes, snack chips, and imitation cheese is high among teenagers. These foods are generally rich in fats, although the focus has often been on the quantity rather than the quality of these fats. These products often contain saturated and trans fatty acids, which have adverse effects on triglycerides and cholesterol levels and raise lipoprotein(a) levels in plasma. These modifications are associated with the risk of developing certain health conditions, such as heart disease, stroke, type 2 diabetes, and obesity. It is important to note that not all fats have this negative effect on health. Dietary fats are an essential part that cannot be substituted for a healthy diet. A diet rich in healthy fats, such as monounsaturated and polyunsaturated fats, has an important benefit in human health. For this reason, it is crucial to read, identify, and interpret food labels in processed food to identify the presence of saturated or trans fats and choose healthier alternatives. Therefore, in this workshop, students in the first year of baccalaureate extracted oils and fats from a range of processed foods, quantifying and characterizing their nature by analyzing their fatty acid composition by gas chromatography. Subsequently, students compared their results according to the information given on the food package label and the literature. Finally, the students gave a talk on the work done in the laboratory and the knowledge gained from the students in lower grades, third and fourth years of high school, to raise awareness among these students.

Diabetes is a significant population health threat. Evidence-based interventions, such as the Centers for Disease Control and Prevention's National Diabetes Prevention Program and diabetes self-management education and support programs, can help prevent, delay, or manage the disease. However, participation is suboptimal, especially among populations who are at an increased risk of developing diabetes. Evaluations of programs reaching populations who are medically underserved or people with lower incomes can help elucidate how best to tailor evidence-based interventions, but it is also important for evaluations to account for cultural and contextual factors. Culturally responsive evaluation (CRE) is a framework for centering an evaluation in the culture of the programs being evaluated. We integrated CRE with implementation and outcome constructs from the Adapted Consolidated Framework for Implementation Research (CFIR) to ensure that the evaluation produced useful evidence for putting evidence-based diabetes interventions to use in real-world settings, reaching populations who are at an increased risk of developing diabetes. The paper provides an overview of how we integrated CRE and CFIR approaches to conduct mixed-methods evaluations of evidence-based diabetes interventions.

Objectives: This study evaluated the effects of reading different versions of a fotonovela about diabetes in resource-poor settings in South Africa. Design: An experimental study was conducted with 411 participants, comparing a fotonovela with a younger protagonist, a similar fotonovela version with an older protagonist and a no message control condition. Differences between the two fotonovela versions were analysed for two age groups of readers (25-49 years, and 50 years and older). Setting: Community centres in vulnerable communities in the South African provinces of the Western Cape, the Northern Cape and Gauteng. Method: In the experimental conditions, participants completed a questionnaire after reading one of the fotonovela versions. Participants in the control condition answered similar questions without having read a fotonovela. Results: Both fotonovela versions resulted in more diabetes knowledge than the control condition. Limited positive effects were found for attitudes and behavioural intentions. In the younger participant group, age similarity between the protagonist and readers resulted in knowledge gain, while in the older participant group, no such effect was found. In both age groups, no age similarity effects were found for attitudes or behavioural intentions. Conclusion: This study confirms that fotonovelas can be an effective means of health communication. Furthermore, for a narrative on a health topic for which age is relevant, it can be beneficial to choose a young protagonist. For readers from the same age group, the impact of the story on knowledge acquisition may then be greatest, while for older readers, the age of the protagonist does not seem to influence the knowledge effects of the story.

Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient-practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in post-program telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.

African Americans (AAs) are disproportionately burdened with diabetes and prediabetes. Predominately AA churches may be optimal settings for reaching AAs at greatest diabetes risk, along with related morbidities and mortalities. The current study used the RE-AIM framework to qualitatively examine the feasibility, acceptability, and satisfaction with the Project Faith Influencing Transformation (FIT) intervention, a diabetes risk reduction intervention in AA churches. Participants were (N = 21) church and community members who also participated in the larger Project FIT intervention and were primarily female, with an average age of 60 years (SD = 11.1). Participants completed a brief survey and focus group discussion. Participants discussed intervention effectiveness in changing health behaviors and outcomes, with high rates of adoption, acceptability, and satisfaction across churches that conducted the intervention. Participants also discussed outreach to members of the broader community, the role of the pastor, and challenges to intervention implementation and maintenance-tailored strategies to improve intervention effectiveness are discussed. Given the significant diabetes disparities that exist for AAs, it is imperative to continue to investigate best practices for reaching communities served by churches with sustainable, relevant health programming. This study has the potential to inform more effective, tailored diabetes prevention interventions for high-risk AAs in faith-based settings.

Type 2 diabetes is a complex disease with several modifiable lifestyle factors. The Extension 'Live well, Eat well, be Active with Diabetes' curriculum provides four 90-minute sessions teaching individuals to live well, eat well, and be active with diabetes. Fourteen Extension educators implemented and evaluated the curriculum with 107 participants. Participants reported the program helped them feel better able to take care of their health. We observed significant differences in participants' retrospective pre and post 'Live well,' 'Eat well' and 'be Active' total scores. Extension has a unique opportunity to educate individuals so they may better manage their diabetes.

In this study, we apply theories about self-efficacy, empowerment and motivation to account for the phenomena that people with diabetes Mellitus type 1 express as being influential for people with diabetes' behaviour regarding self-regulation. They must make significant changes to their lifestyle, to keep the disease stabilized. The changes can be cumbersome and hard to implement why people with diabetes receive training in self-regulation. For many people it can be challenging to comply with the recommendations. We conducted field observations and surveys to understand how people with diabetes experience their perceived self-efficacy, and what motivates them to perform blood sugar measurements and physical activities. We found differences in people with diabetes' ability to follow the recommendation based on gender, motivation, and their level of self-efficacy. We also found indications on how a motivational dialog may affect both professionals and people with diabetes. Thus, we suggest that guidance of people with diabetes should be based on an emancipating motivational approach such enabling the possibility of strengthening the people with diabetes' motivation and thereby their self-efficacy. Through these processes, the people with diabetes may become able to achieve a higher level of health literacy such experiencing a better outcome of their self-regulation. With this paper we contribute to the contemporary overall knowledge about the diabetes field, such our investigation focus on people with diabetes ability to act upon information provided by healthcare professionals and how to best approach the issues people with diabetes experience as being essential for their general well-being and everyday lives.

The study aims to analyse the phenomenon in a holistic and comprehensive way according to the perceptions of education workers who experience presenteeism more frequently and reveal the relationship of presenteeism with the sociological, psychological, and theological dynamics of Turkish society. The study was conducted with a phenomenological design, one of the qualitative research methods. The study group consists of five teachers and five school administrators working in Elazig, a province in Türkiye in the 2020-2021 academic year. It was determined that educators can voluntarily decide to work when they are not feeling well due to motivations such as a sense of responsibility, conscience, commitment to work, public service, and religious sensitivity. In addition, some participants stated that due to organisational pressure, economic difficulties, and workload, employees make a forced decision to work when they are not well. Finally, in addition to the negative results of presenteeism, positive results, which are rarely seen in the literature, were also obtained. Therefore, the experience of presenteeism should be evaluated considering its positive and negative effects on organisations and employees. Finally, suggestions were developed to monitor the situation of employees experiencing presenteeism, develop policies regarding this, and prevent them from being forced to work in bad situations they cannot tolerate.

To assess the impact of a school-based health intervention on adolescents' health knowledge, psychosocial assets and health behaviors, including comparisons of implementation mode: remote, hybrid or in-person. The Stanford Youth Diabetes Coaches Program, an 8-week, school-based health promotion and coaching skills program, was offered to adolescents (ages 14--18 years) from four low-income US communities. Mode of program implementation was remote, hybrid or in-person. Participants completed online pre- and postsurveys. Analysis included paired t-tests, linear regression and qualitative coding. From Fall 2020 to Fall 2021, 262 adolescents enrolled and 179 finished the program and completed pre- and postsurveys. Of the 179, 80% were female, with a mean age of 15.9 years; 22% were Asian; 8% were Black or African American; 25% were White; and 40% were Hispanic. About 115 participants were remote, 25 were hybrid and 39 were in-person. Across all participants, significant improvements (P < 0.01) were reported in health knowledge, psychosocial assets (self-esteem, self-efficacy and problem-solving) and health behaviors (physical activity, nutrition and stress reduction). After adjusting for sex and age, these improvements were roughly equivalent across the three modes of delivery. Participation was associated with significant improvements in adolescent health behaviors. Furthermore, remote mode of instruction was just as effective as in-person and hybrid modes.

Common ways to test associations between two repeatedly measured constructs have two primary limitations. Studies often report the average effects and ignore the heterogeneity. Independently interpreted autoregression and cross-lagged coefficients (i.e. local effects) may not match the holistic dynamic patterns (i.e. considering all coefficients simultaneously). Our paper aims to address the limitations by introducing vector plots to visualize holistic person-specific dynamic patterns. We utilized a case example of 14-day daily diary data of diabetes self-efficacy and self-care from 200 emerging adults with type 1 diabetes. A dynamic structural equation model was used to generate person-specific coefficients. Vector plots and eigenvalues were generated to visualize person-specific holistic patterns. We found heterogeneity in both local and holistic dynamic patterns. Most participants (N = 178) had mismatching local and holistic patterns. Our study provided important evidence that failing to capture person-specific holistic dynamic patterns might result in incomplete interpretations of dynamic associations.

Background: Type 1 Diabetes (T1D) requires consistent disease management for blood sugar regulation. A theoretical framework can assist with interpreting behavioral processes needed for disease management. However, limited qualitative studies have explored disease management practices among college students with T1D using a theoretical framework. Purpose: To theoretically explore college students' engagement in T1D self-care behaviors to further understand disease management experiences. Methods: One-on-one interviews with 31 full-time college students attending universities in the Southeastern United States. A thematic analysis was conducted to generate subthemes. Results: Subthemes explained self-care maintenance behaviors performed daily (i.e. carry supplies, administer insulin), self-care monitoring behaviors (e.g. analyzing blood sugar trends), and how self-care behaviors were adjusted when previous behaviors were no longer effective for blood sugar regulation. Discussion: Although participants routinely performed T1D self-care behaviors, additional information is needed on how technology is used for self-care monitoring. Future studies should explore college students' T1D self-care management behaviors to determine strategies that are used to improve their blood sugar. Translation to Health Education Practice: Findings from this study can assist health education specialists and healthcare professionals with creating interventions to support disease management among college students living with T1D.

Objective: To determine differences in glucose control and cardiovascular disease risk factors following three weeks of added soda, 100% fruit juice, or water in apparently healthy, college-aged adults. Participants: Thirty-six adults (18 males; 18 females) between the ages of 18 and 30 years of age. Methods: A 3-arm randomized controlled parallel-arm trial; at baseline and after three weeks consuming the assigned beverage, participants completed glucose control and cardiovascular disease risk factor assessments. Results: There were no significant differences between beverage conditions for glucose control or cardiovascular disease risk factors (ps > 0.05). There were no significant changes in caloric intake or differences in caloric intake between conditions, p = 0.17. p Conclusions: In healthy, young adults, under free-living conditions, short-term consumption of two commercially packaged servings of SBs did not lead to significant glucose control or cardiovascular disease risk factor changes, indicating potential compensation and/or resilience to negative short-term effects.

Background: Saudi Arabia has the second-highest prevalence of diabetes in the Middle East. Therefore, providing patients with high-quality materials is essential to help them understand their illness. The Patient Education Materials Assessment Tool (PEMAT) contrasts and evaluates materials regarding understandability and actionability. Purpose: This study aimed to evaluate materials for type 2 diabetes using a printed version of the PEMAT. Methods: This observational study was conducted in Riyadh from December 2022 to May 2023. Sixty-nine samples were collected from hospitals affiliated with the Ministry of Health and the government sector. Results: Materials evaluated in this study had an excellent understandability score of 78.9% and a low actionability score of 66.6%, with significant differences between the sources. Some of the materials (42%) achieved high quality regarding understandability and actionability. Discussion: Less than half of the materials were considered high quality. Approximately 99% of the materials made their purposes completely evident and logically presented the information, and approximately 97% identified at least one action. However, only 17.4% of the materials provided summaries and tangible tools. Translation to Health Education Practice: Health Educators should consider including summaries and tangible tools when developing patient education materials to make them more understandable and actionable.

Early intervention can reduce disability in children diagnosed with autism spectrum disorder. Screening for autism spectrum disorder in young children identifies those at increased likelihood of diagnosis who may need further support. This study assessed in "utero" exposure to maternal obesity and diabetes and offspring performance on the Quantitative Checklist for Autism in Toddlers, an autism spectrum disorder screening questionnaire administered between 18 and 24 months at well-child visits. This retrospective cohort study included 65,433 singletons born in a single healthcare system. Demographic data, maternal obesity, Type 1/Type 2 and gestational diabetes mellitus information, and Quantitative Checklist for Autism in Toddlers score in children 12-30 months old were extracted from electronic medical records. Negative binomial models were used to estimate incidence rate ratios of associations between maternal obesity and diabetes exposure and continuous offspring Quantitative Checklist for Autism in Toddlers scores. Maternal obesity, Type 1/Type 2 diabetes (incidence rate ratio: 1.13, 1.06-1.21) and gestational diabetes mellitus [less than or equal to] 26 weeks (incidence rate ratio: 1.10, 1.05-1.17) were associated with one-unit increases in Quantitative Checklist for Autism in Toddlers scores. Relationships with obesity and gestational diabetes mellitus [less than or equal to] 26 weeks remained after mutual adjustment and excluding children with autism spectrum disorder diagnoses. No associations were reported for gestational diabetes mellitus > 26 weeks. Maternal obesity and diabetes were associated with higher Quantitative Checklist for Autism in Toddlers scores in children 12-30 months old, suggesting these exposures in pregnancy may be associated with a range of early childhood behavior.

Developing self-care behaviors is a fundamental yet challenging strategy to prevent the complications of diabetes. This three-arm randomized controlled trial aimed to compare the effectiveness of combined mindfulness and self-regulation-based intervention with self-regulation-based intervention on self-care behaviors of Iranian older adults with diabetes in 2021-2022. Three public diabetic clinics were randomly assigned to three study groups and then 45 participants were randomly recruited from every clinic. 24-week educational interventions via WhatsApp included a self-regulation-based intervention (SRIP), a combined mindfulness and self-regulation intervention (CMSRIP), and routine care with training on COVID-19 prevention were performed in two intervention groups and a control group respectively. Data were collected at baseline and four and 16 weeks using a Mindfulness-based questionnaire (MSCS) and a summary of the diabetes self-care activities scale (SDSCA). The SPSS software (V. 22) was used to analyze data through ANOVA test, chi-square tests, one-way ANOVA, Levene's test, and Repeated measures MANCOVA at a significance level of less than 0.05. The total scores of MSCS and SDSCA in four and 16 weeks significantly increased compared to the baseline in both SRIP and CMSRIP groups (P < 0.001), but not in the control group. The mean scores of MSCS and SDSCA at week 4 in CMSRIP group improved significantly more than SRIP group (98.43 ± 5.83 vs. 90.31 ± 12.62 and 70.38 ± 4.18 vs. 62.35 ± 5.53). Combined mindfulness and self-regulation education are significantly effective in promoting self-care skills and improving cognitive processes and can used to improve older adults' self-care behaviors.

Changes in antenatal gut microbiota (GM) have been associated with gestational diabetes and obesity which are influenced by diet and lifestyle. Gamification can be used as an interactive health education tool to convey this concept to the public. Thus, we designed an interactive story titled 'MoM: Microbiome of Maternity' highlighting the importance of diet and lifestyle during pregnancy. Using the 'RPG Maker MV' software, a branching narrative emphasizing flavour texts with a local flair was developed. The choice-based game narrative revolves around daily diet and lifestyle preferences in an engaging story throughout pregnancy. A graphical report is provided at predetermined intervals, highlighting the relevant details on their health and GM. A pilot evaluation was conducted using feedback surveys: Part A evaluated the knowledge on GDM, healthy diet and GM (13 items, score [more than or equal to]8 ([more than or equal to]60%) depicts adequate knowledge) and Part B evaluated the satisfaction on the game design and structure (24 items, score [more than or equal to]38 depicts satisfaction and pleasant experience). We found that the initial knowledge on the introduced health concept were inadequate (Part A score 7.67 ± 2.97). After playing 'MoM', their understanding was improved and were satisfied with the design (Part B score 42.3 ± 6.49). In conclusion, 'MoM' is an effective educational game in promoting health awareness among women.

Rare events meta-analyses of randomized controlled trials (RCTs) are often underpowered because the outcomes are infrequent. Real-world evidence (RWE) from non-randomized studies may provide valuable complementary evidence about the effects of rare events, and there is growing interest in including such evidence in the decision-making process. Several methods for combining RCTs and RWE studies have been proposed, but the comparative performance of these methods is not well understood. We describe a simulation study that aims to evaluate an array of alternative Bayesian methods for including RWE in rare events meta-analysis of RCTs: the naïve data synthesis, the design-adjusted synthesis, the use of RWE as prior information, the three-level hierarchical models, and the bias-corrected meta-analysis model. The percentage bias, root-mean-square-error, mean 95% credible interval width, coverage probability, and power are used to measure performance. The various methods are illustrated using a systematic review to evaluate the risk of diabetic ketoacidosis among patients using sodium/glucose co-transporter 2 inhibitors as compared with active-comparators. Our simulations show that the bias-corrected meta-analysis model is comparable to or better than the other methods in terms of all evaluated performance measures and simulation scenarios. Our results also demonstrate that data solely from RCTs may not be sufficiently reliable for assessing the effects of rare events. In summary, the inclusion of RWE could increase the certainty and comprehensiveness of the body of evidence of rare events from RCTs, and the bias-corrected meta-analysis model may be preferable.

Because FCS agents teach communities about dietary guidelines, it is important that they are aware of the latest nutrition research. This study assessed FCS agents' knowledge of popular fad diets (low-carbohydrate, intermittent fasting, detoxes and cleanses) and their potential adverse effects, and its relationship among location, certifications, years of experience, professional association memberships, and education. Agents in Louisiana, Texas, Arkansas, and Mississippi were emailed a survey. RDN, DTR, and CHES certifications had significant associations (p = 0.03) with knowledge of adverse effects of fad diets. Agents who hold these credentials may have more knowledge about adverse effects of fad diets.

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina's persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.

Gastrointestinal disturbances (GIDs) are relatively common in children diagnosed with autism spectrum disorder (ASD). This study assessed associations between maternal obesity, diabetes, preeclampsia, and asthma and likelihood of ASD with GIDs. This retrospective cohort study included 308,536 mother-child pairs of singletons born between 2001 and 2014 in a single integrated health care system. Social demographics, maternal health conditions during pregnancy, and child's ASD and/or GID diagnosis by age 5 were extracted from electronic medical records. Child's outcome was classified as: no ASD no GIDs; no ASD with GIDs; ASD no GIDs; and ASD with GIDs. Multinomial logistic regression was used to estimate odds ratios of child's outcomes associated with maternal exposures, adjusting for covariates. Compared to children with neither disorder, each maternal condition was associated with higher odds of no ASD with GIDs, ASD no GIDs, and ASD with GIDs. Association was greatest for likelihood of ASD with GIDs (Maternal obesity odds ratio (95% confidence interval): 1.37 (1.22-1.54); Diabetes: 1.50 (1.28-1.76); Preeclampsia: 1.63 (1.36-1.95); Asthma: 1.39 (1.17-1.67); relative to no ASD no GIDs). Associations were robust to mutual adjustment for all maternal exposures. Maternal obesity, diabetes, preeclampsia, and asthma exposure during pregnancy may increase likelihood of both GIDs and ASD with or without co-occurring GIDs in offspring. This association was greatest in children diagnosed with ASD with co-occurring GIDs.

Project Extension for Community Healthcare Outcomes (ECHO) Nevada applied the ECHO virtual hub-and-spoke telementoring model over nine 6-week cohorts (between November 2019 and November 2021) supporting community health workers (CHWs) who advise clients with diabetes or pre-diabetes. This study describes the program implementation, including evaluation data collection efforts. Didactic topics included 'Intro to Healthy Eating and Easy Wins' to 'Grocery Shopping, Cooking Tips, Reading Labels, Meal Plans' and 'Reducing Bias and Being a Good Role Model'. Spoke participants signed up to review cases. Seventy-three of the enrolled participants (n = 100) attended three or more of the six sessions. Spoke participants completed 42 case presentations. The average self-efficacy increased from 2.7 [standard deviation (SD): 1.1] before completing the program to 4.1 (SD: 0.8) after completing the program. Average knowledge scores increased from 71 (SD: 16) before completing the program to 83 (SD: 14) after completing the program. Five group interviews drew actionable feedback that was incorporated into the program. Key elements of the ECHO model were successfully incorporated to support educational goals of a cohort of CHWs in nutritional coaching. Our program evaluation data tracking system shows non-significant but encouraging results regarding self-efficacy improvement and knowledge retention.

This article meta-analyzed 21 studies that tested the effectiveness of animated videos in improving learning in clinical and nonclinical settings compared with standard education. Animation was defined as the use of moving objects that are typically drawn or simulated. Videos ranged from just over 2 min in duration to 16 min in duration in articles published from 2009 through 2020. Mayer's Cognitive Theory of Multimedia Learning provided the theoretical model to frame the current analyses. Findings indicated an overall positive effect (d = 0.35) for use of animation in improving viewers' learning across a variety of health and clinical contexts, including surgery and diabetes. Moderator analyses indicated learning effects were greater in patient samples and samples with a higher proportion of male participants. Study findings were discussed in terms of the theoretical and practical implications for health communication scholars and practitioners.

Growth mixture models (GMMs) are applied to intervention studies with repeated measures to explore heterogeneity in the intervention effect. However, traditional GMMs are known to be difficult to estimate, especially at sample sizes common in single-center interventions. Common strategies to coerce GMMs to converge involve post hoc adjustments to the model, particularly constraining covariance parameters to equality across classes. Methodological studies have shown that although convergence is improved with post hoc adjustments, they embed additional tenuous assumptions into the model that can adversely impact key aspects of the model such as number of classes extracted and the estimated growth trajectories in each class. To facilitate convergence without post hoc adjustments, this paper reviews the recent literature on covariance pattern mixture models, which approach GMMs from a marginal modeling tradition rather than the random effect modeling tradition used by traditional GMMs. We discuss how the marginal modeling tradition can avoid complexities in estimation encountered by GMMs that feature random effects, and we use data from a lifestyle intervention for increasing insulin sensitivity (a risk factor for type 2 diabetes) among 90 Latino adolescents with obesity to demonstrate our point. Specifically, GMMs featuring random effects--even with post hoc adjustments--fail to converge due to estimation errors, whereas covariance pattern mixture models following the marginal model tradition encounter no issues with estimation while maintaining the ability to answer all the research questions. [For the corresponding grantee submission, see ED618691.]

The purpose of this study was to 1) help novice students scaffold problem-solving and engage safely in the deliberate practice of diagnostic reasoning and medical decision-making in real time; 2) assess how accurately students gather and apply data in medical reasoning and treatment during high-fidelity patient simulations (HFPSs); 3) identify students' scientific misconceptions related to the case; 4) promote student metacognitive processing, self-assessment, and self-efficacy; and 5) facilitate the explicit calibration of student confidence in deliberate reasoning with patient outcomes. In a mixed-method design, a metacognitive calibration self-assessing (MCC) survey tool was applied to HFPS (n = 80, 20 teams of 6 medical students) and semistructured interviews were conducted with faculty (n = 5). When scored by faculty with a rubric, the mean student accuracy ranged from 23% to 74%, whereas their self-assessment of confidence ranged from 71% to 86%. This result revealed overconfidence bias in novice students regarding the correctness of their wrong responses. The most common misconception identified was inverting cause and effect: metabolic acidosis was pointed to as the cause of the patient's problems rather than a consequence of untreated diabetes mellitus. The most common treatment error was overtreatment, with unnecessary added medication. Interviews with faculty suggested that the MCC tool improved the team process by slowing students down, requiring them to think through their answers, and that overall the tool improved their critical thinking. This study demonstrated the feasibility of using a metacognitive confidence calibration tool to assist novice students in learning safely to make deliberate diagnostic reasoning and decisions on patient care in real time during complex simulations while observing objectively their levels of psychological confidence against patient outcomes. New & Noteworthy: This study demonstrates the feasibility of a metacognitive confidence calibration tool (MCC) to assess and promote novices in the learning of diagnostic reasoning and treatment decisions on patient care in real time during high-fidelity patient simulations while comparing confidence and accuracy data and identifying students' scientific misconceptions. Results revealed the presence of overconfidence bias, overtreatment, and the misconception of metabolic acidosis as the cause of the patient's problems rather than a consequence of untreated diabetes mellitus.

Objective: The objective of this study was to investigate how a 1-hour education session that highlights American Heart Association/American Diabetes Association's Know Diabetes by Heart (KDBH) messaging changed the knowledge and behavioural intention of participants. Design: Single group, quasi-experimental study evaluating the impact of the KDBH education intervention on participants' knowledge and intentions to engage in risk-lowering behaviours related to the link between diabetes and cardiovascular disease. Setting: A free, 1-hour, synchronously delivered education session was offered through an online platform and facilitated by Cooperative Extension agents. Methods: A pre- and post-Qualtrics survey was used to assess changes in knowledge and intended behaviours. Slides were provided by the American Diabetes Association and tailored for clarification and evaluation purposes. Results: The study included 259 adults with an average age of 54 years (standard deviation [SD] = 16.67) and 72.97% being 46 years or older. When participants were asked if having type 2 diabetes put them at risk for development of hypertension, unhealthy cholesterol levels, heart attack, or stroke, 84.84% answered correctly at baseline. After session completion, the percentage correct increased to 92.2% (p = 0.002). Individual's knowledge of cardiovascular disease as the leading cause of death for people with type 2 diabetes was assessed; 66.80% answered correctly pre-intervention. After completing the KDBH programme, 95.37% answered correctly (p = 0.001). In addition, more than half of those with type 2 diabetes reported intended to adopt several behaviours related to reducing the risk of cardiovascular disease at the completion of the programme. Conclusions: The pilot study indicates successful information transfer in a 1-hour education session focused on chronic disease risks associated with T2DM. Results support the use of synchronous online platforms for diabetes and heart disease information transfer. Future prospective studies measuring sustained knowledge, behaviour adoption and incidence of heart-disease before and after education are needed.

School nutrition programs are integral to academic success. To support the whole child, teachers must appreciate what role nutrition plays in academic success. Studies of food insecurity reveal there are degrees of severity. Although the key determinate of food security is poverty, employment is not necessarily a shield. One can eat and still be malnourished by high starch low nutrient food. In northern communities, severe costs result in food insecurity reaching higher up the income pyramid. Co-occurring measures of poverty, food insecurity, obesity and diabetes within Manitoba's Indigenous communities are high. Schools are ideally positioned as supports within our communities.

The global epidemic of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, is creating unsustainable burdens on health systems worldwide. NCDs are treatable but not curable. They are less amenable to top-down prevention and control than are the infectious diseases now in retreat. NCDs are mostly preventable, but only individuals themselves have the power to prevent and manage the diseases to which the enticements of modernity and rising prosperity have made them so susceptible (e.g., tobacco, fat-salt-carbohydrate laden food products). Rates of nonadherence to healthcare regimens for controlling NCDs are high, despite the predictable long-term ravages of not self-managing an NCD effectively. I use international data on adult functional literacy to show why the cognitive demands of today's NCD self-management (NCD-SM) regimens invite nonadherence, especially among individuals of below-average or declining cognitive capacity. I then describe ways to improve the cognitive accessibility of NCD-SM regimens, where required, so that more patients are better able and motivated to self-manage and less likely to err in life-threatening ways. For the healthcare professions, I list tools they can develop and deploy to increase patients' cognitive access to NCD-SM. Epidemiologists could identify more WHO "best buy" interventions to slow or reverse the world's "slow-motion disaster" of NCDs were they to add two neglected variables when modeling the rising burdens of disease. The neglected two are both cognitive: the distribution of cognitive capacity levels of people in a population and the cognitive complexity of their health environments.

A multi-centre clinical trial involves the implementation of the same clinical protocol at several independent investigational centres. Multi-centre clinical trials may be preferable to single-centre trials, but their implementation and management is more complex. EU-funded collaborative projects involve several participating organizations and countries and their consortia are typically multidisciplinary. Their coordination requires a joint effort from several actors, and an appropriate managerial structure and procedures need to be defined and established. The management of the Framework Programme 7 (FP7) PREVIEW project, whose core consisted of a clinical trial with 8 intervention centres/sites is presented as case study. PREVIEW was coordinated by the University of Copenhagen. The project management was implemented by a combination of decentralised project management, at the department level, jointly by the Project Coordinator (PC) and Project Manager (PM), and centralised, by a dedicated EU Liaison Officer from the Project Management Office (PMO). The Quality Manager role was undertaken by the PC, with support from selected consortium members. The Exploitation Manager role was assumed by the leader of the dissemination and exploitation work package. The Data Manager (DM) at the University of Copenhagen established and maintained a datahub for all data from the clinical trial. The General Assembly and Steering Committee were key decision bodies with regard to taking and implementing decisions. The Scientific Advisory Board (SAB) was formed by reputed external experts providing guidance and advice. The project website was the main channel to reach the general public. A password protected private section was used as internal repository for the project. Regular meetings at all levels were key to ensure good communication and collaboration among the project team. Appropriate attention to data management was given from the start. The privacy of personal data was ensured in accordance with national and EU regulations. The PC was also the Sponsor of the multicentre clinical trial, and the PM served as the overall Clinical Trial Administrator. Each centre was led by a Principal Investigator (PI), running the trial together with the local daily responsible. The tasks and responsibilities for the clinical trial of the Coordinating Centre were shared between Copenhagen and Helsinki centres. The trial was overall led by the Clinical Trial Manager (CTM), who was the PI at the Helsinki centre. The local Independent Ethical Committees approved the protocol prior to the start of the intervention. One member of the SAB acted as Ethical Officer. The trial/study had an overall statistician. The Analyst role was shared among different people from the Copenhagen and Helsinki centres. The DM created and maintained database for the intervention and the Clinical Report Forms by using OpenClinica open source software. The staff in the intervention received training in Good Clinical Practices, the protocol and its procedures. The monitoring tasks were jointly undertaken by the Sponsor and the CTM. The documents from the Trial Master File were saved in the Internal Repository. A set of Standard Operation Procedures was defined. Meetings among all PIs, and within the Instructors' Network were key in the success of the intervention. This case study aims at serving as guidance to coordinating researchers, both during the proposal preparation and project implementation phases, as well as to provide visibility and insight into the multi-faceted role of the project managers and administrators of such projects.

Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; "P"-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.