Improved Glycemic Control through Robot-Assisted Remote Interview for Outpatients with Type 2 Diabetes: A Pilot Study.

Background and Objectives: Our research group developed a robot-assisted diabetes self-management monitoring system to support Certified Diabetes Care and Education Specialists (CDCESs) in tracking the health status of patients with type 2 diabetes (T2D). This study aimed to evaluate the impact of this system on glycemic control and to identify suitable candidates for its use. Materials and Methods: After obtaining written informed consent from all participants with T2D, the CDCESs conducted remote interviews with the patients using RoBoHoN. All participants completed a questionnaire immediately after the experiment. HbA1c was assessed at the time of the interview and two months later, and glycemic control status was categorized as either "Adequate" or "Inadequate" based on the target HbA1c levels outlined in the guidelines for adult and elderly patients with type 2 diabetes by the Japan Diabetes Society. Patients who changed their medication regimens within the two months following the interview were excluded from the study. Results: The clinical characteristics of the 28 eligible patients were as follows: 67.9 ± 14.8 years old, 23 men (69%), body mass index (24.7 ± 4.9 kg/m2), and HbA1c levels 7.16 ± 1.11% at interview and two months later. Glycemic control status (GCS) was Adequate (A) to Inadequate (I): 1 case; I to A: 7 cases; A to A good: 14 cases; I to I: 6 cases (p-value = 0.02862 by Chi-square test). Multiple regression analyses showed that Q1 (Did RoBoHoN speak clearly?) and Q7 (Was RoBoHoN's response natural?) significantly contributed to GCS, indicating that the naturalness of the responses did not impair the robot-assisted interviews. The results suggest that to improve the system in the future, it is more beneficial to focus on the content of the conversation rather than pursuing superficial naturalness in the responses. Conclusions: This study demonstrated the efficacy of a robot-assisted diabetes management system that can contribute to improved glycemic control.

Effectiveness of management protocol for insulin balls in diabetics: a scoping review.

Aim: In order to achieve good glycemic control, the prevention and management of insulin balls is important for diabetic patients during insulin therapy. However, insulin balls still occur within the clinical setting. This review evaluated the effectiveness of programs designed to manage insulin balls. Methods: A scoping review was conducted based on the Japanese and English literature available from a systematic literature search conducted from January 1964 to March 2022. Three databases were searched: PubMed, CINAHL, and Ichushi-Web. Results: A total of 33 articles met the inclusion criteria, which consisted of 3 for prevention management of insulin balls and 30 for management after the occurrence of insulin balls. Findings for prevention management suggested that the insulin injection technique education (avoidance of repeated injections to the same site) and providing knowledge (about insulin balls) prevented the appearance of insulin balls. As for post-occurrence management, insulin injection technique education (avoidance of injections to the insulin ball, avoidance of repeated injections to the same site, and switching the injection site) improved blood glucose control. Hypoglycemia was observed in all studies that included an assessment of hypoglycemia. None of the studies evaluated long-term effects of either preventive or post-occurrence management. Conclusions: Providing insulin injection technique education is an effective management protocol for insulin balls. Moreover, education about hypoglycemia is important for patients with insulin balls. Further studies to investigate the long-term effects in the management of insulin balls are needed.

Oral microbiome changes associated with the menstrual cycle in healthy young adult females.

The relationship between the menstrual cycle and the oral microbiome has not been clarified. The purpose of this study was to assess potential changes in the oral microbiome of healthy young adults using 16S rRNA-based sequencing. Eleven females (aged 23-36 years) with stable menstrual cycles and without any oral problems were recruited. Saliva samples were collected before brushing every morning during the menstrual period. Based on basal body temperatures, menstrual cycles were divided into four phases, namely the menstrual, follicular, early luteal, and late luteal phases. Our results showed that the follicular phase had a significantly higher abundance ratio of the Streptococcus genus than the early and late luteal phases, whereas the abundance ratios of the Prevotella 7 and Prevotella 6 genera were significantly lower in the follicular phase than those in the early and late luteal phases and that in the early luteal phase, respectively. Alpha diversity by the Simpson index was significantly lower in the follicular phase than that in the early luteal phase, and beta diversity showed significant differences among the four phases. Using the relative abundance data and copy numbers of the 16S rRNA genes in the samples, the bacterial amounts in the four phases were compared, and we observed that the follicular phase had significantly lower amounts of the Prevotella 7 and Prevotella 6 genera than the menstrual and early luteal phase, respectively. These results indicate reciprocal changes with the Streptococcus genus and Prevotella genera, particularly in the follicular phase. In the present study, we showed that the oral microbiome profiles are affected by the menstrual cycles of healthy young adult females.

[Introduction of a joint academic project between the Japan Academy of Nursing Science and the Japanese Pharmacological Society: a scoping review on assessment and preventive care of insulin balls].

Japanese Academy of Nursing Science (JANS) and the Japanese Pharmacological Society (JPS) have been conducting human interaction at each other's scientific meeting symposia in a home-and-away fashion since 2018. JANS and JPS have been working on a joint scientific project, "Scoping Review: Insulin Balls" since 2021. At the 95th Annual Meeting of the JPS held in 2022, we reported from a nursing perspective on the theme of "Assessment and preventive care of insulin balls from a scoping review". Subcutaneous injection into insulin balls has been reported to cause poor blood glucose control. Therefore, it is important to prevent insulin balls. In this study, we had the research questions, "What methods are available for assessment of the insulin injection site?" and "What is the care to prevent induration and how effective is it?" and conducted a scoping review. Regarding methods of injection site assessment, most of the literature identified the injection site by palpation, visual examination, and ultrasonography. About the preventive care, there were some reports of insulin balls occurring because patients have been injecting insulin at the same site, even though healthcare professionals instructed them to avoid the same site. Some of the literature had specific teaching methods such as hand site rotation and calendar injection method, and they were reported effective. In the future, we plan to proceed with the review including care after the development of insulin balls.

Development of a Family Support Scale for Diet Therapy for Male Workers with type 2 diabetes.

AIM: Dietary self-care for patients with type 2 diabetes can be improved with family support. The purpose of this study was to develop a scale to assess family support for diet therapy for male workers with type 2 diabetes and to examine its reliability and validity. METHODS: In this cross-sectional study, we collected data from 110 Japanese male workers with type 2 diabetes. Data were analyzed using exploratory factor analysis, reliability testing, and validity testing. RESULTS: The resultant Family Support Scale for Diet Therapy for Male Workers (FSS-DMW) with type 2 diabetes consisted of 31 items and a six-factor structure. The six factors explained 72.9% of the variance, and Cronbach's alpha for the total scale was .964. The scale correlated as expected with the Social Support Scale for Chronic Illness and the dietary subscale of the Japanese version of the Summary of Diabetes Self-Care Activities Measure. CONCLUSION: The FSS-DMW is a reliable and valid measure which can be used to assess family support for diet therapy for male workers with type 2 diabetes and has the potential to be used as a clinical instrument for family guidance.

Validation of the relationship consciousness of Japanese Patients with type 2 diabetes scale.

OBJECTIVES: The management of type 2 diabetes mellitus can be improved for individuals by developing relationships with other patients with diabetes. We created the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale to measure the relationship consciousness of type 2 diabetes mellitus patients for other patients based on the Health Belief Model. METHODS: This was a cross-sectional study of Japanese patients with type 2 diabetes mellitus (n = 289). Data were analyzed via exploratory factor analyses, reliability tests, concurrent validity. RESULTS: The final scale obtained for the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale comprised a six-factor structure with 36 items. All 36 items had a Cronbach's α coefficient of 0.893 and explained 59.38% of the total variance. The scale was significantly correlated with a related reciprocity consciousness scale. CONCLUSIONS: The Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale may be an important tool for nurses to assess the relationship consciousness of patients with type 2 diabetes mellitus. In addition, by understanding patients' relationship consciousness for others who share their disease, nurses can begin to recommend ways to establish relationships between patients that suit patients' particular relationship. consciousness levels and to provide better care in their clinical practice.

The Concept of Sleep Ability and its Effect on Diabetes Control in Adults With Type 2 Diabetes.

OBJECTIVES: Few published studies have examined the effects of various components of sleep on the control of type 2 diabetes. This study aimed to construct a concept of sleep ability and examine its effect on diabetes control in adults with type 2 diabetes. METHODS: Participants were 37 outpatients, 41 to 73 years of age, who had type 2 diabetes. Participants monitored their sleep for 14 days using a sleep meter, and they completed questionnaires concerning quality of life (Problem Areas in Diabetes), self-care (Self-Care Agency Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index). Data on glycated hemoglobin levels and body mass index were also collected. Canonical correlation analysis and exploratory selection were used to investigate the relationships between the variables involved in diabetes control and sleep ability. RESULTS: Using canonical correlation analysis and exploratory selection, sleep ability was found to be composed of the Pittsburgh Sleep Quality Index score, objective total sleep time, wake after sleep onset, bedtime standard deviation, wake-up time standard deviation and the absolute value of the difference between subjective and objective sleep efficiency. A significant correlation was found between components of diabetes control (glycated hemoglobin levels, body mass index, quality-of-life evaluation from Problem Areas in Diabetes and self-care evaluation from the Self-Care Agency Questionnaire) and sleep ability (canonical correlation coefficient [RC] =0.755, p=0.006). CONCLUSIONS: The significant elements of sleep ability represented the quality, quantity, maintenance, regularity and recognition of sleep, and each element made a large contribution to diabetes control. We conclude, therefore, that improving sleep ability may lead to good diabetes control.