Maritime Health Research and Education-NET/DM2/Diabetes 2 Spanish Group

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Background:
The prevalence of diabetes2 is globally increasing and especially increasing with social inequality in health in relation to work and living conditions. There is a significant underreporting, so the true prevalence is not known. Urine dipsticks are of insufficient 35%-50% sensitivity to be used as a screening tool in an asymptomatic population. As part of the MAHRE-Net research program, seafarers and fishermen are seen as workers with different levels of inequality of health and justify this research project. The Steering Committee in "Pillars of the Sea" prompt MAHRE-Net to start using Hb1Ac and fasting glucose for early diagnosis of diabetes. The intention is to utilize the one- or two-year mandatory health examinations in seafarers and fishermen to do testing for Diabetes 2 with Hb1Ac strategically selected samples of employees in these occupations in different countries. The program starts in Spain with a descriptive study of the target group's prevalence of Diabetes2 from the 16th of June to 31th of December 2021 in Tarragona and Barcelona. Later the intervention will be proposed inspired by what is already done in the countries. The study is done in collaboration with the DASAM Danish Society of Occupational and Environmental Medicine, DSMM Danish Society of Maritime Medicine, SEMM, and SFMM. The Danish part is also directed at the train- and bus drivers who also have obligated biannual health examinations.

Purpose
To measure the Hb1Ac prevalence in the target groups in this first step of the program. Early diagnosis and prevention of diabetes type 2 among employees in some jobs with mandatory health examinations. To use the mandatory health examinations to include valid tests for diabetes type 2, i.a. with a blood test to measure Hb1Ac. To use valid methods for diagnosis, prevention, and follow-up of the effect of interventions. The prevention includes i.a. arranging the organization of the work routines, and the workplaces so that employees with Diabetes type 2 can continue their employment with due consideration keeping their Diabetes type 2 in well-treated status.

Goals
Systematization of the results of the mandatory health examinations for different job groups, And to make a central record of data from these health data from ther surveys for research.

Study design
Cross-sectional study using data collected in the maritime health clinics

Time frame for data collection
The data collection starts in Aug 2021 and stops when 400 participants in each country are included.

Inclusion criteria
All the selected groups of transport workers, seafarers and fishermen, age ≥21 years with at least 3 years of paid work in coming to health examinations are included.

Demographics
Age, gender, seafarer, fisherman, nationality, position on board, work area on board

Laboratory data
HbA1c, height, weight.

Diagnostics
Question to all: have you ever been diagnosed with diabetes (yes, no, don't know)? One test, HbA1c is sufficient to diagnose diabetes. A positive diagnosis can be made if the HbA1c level is ≥6.5% A case of positive diagnosis should be confirmed with a repeat HbA1c test and/or plasma glucose One test, HbA1c is sufficient to diagnose diabetes. A positive diagnosis can be made if the HbA1c level is ≥6.5% A case of positive diagnosis should be confirmed with a repeat HbA1c test and/or plasma glucose American Diabetes Association Danish Endocrinological Society

Data collection
Data from the medical- and laboratory records are entered directly in Word/Excel Form En-Diabetes Prevalence Study Form.docx

Prevention
Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:
 * 1) Achieve and maintain healthy body weight
 * 2) Physically active – doing at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control
 * 3) Eat a healthy diet, avoiding sugar and saturated fats; and
 * 4) Avoid tobacco use – smoking increases the risk of diabetes and cardiovascular disease One test, HbA1c is sufficient to diagnose diabetes. A positive diagnosis can be made if the HbA1c level is ≥6.5% A case of positive diagnosis should be confirmed with a repeat HbA1c test and/or plasma glucose American Diabetes Association Danish Endocrinological Society

Intervention in collaboration with the shareholders
The shareholders in the respective job groups are included to help to establish the needed specific conditions available for keeping good health practices for employees with Diabetes 2 in the different job types. This in order to have good opportunities during the working day to have time and allowance for relevant work breaks, restroom visits, access to healthy meals in a good social company, and possibilities for adequate physical activities. These conditions are different for each job group and the analysis of these conditions and suggestions on how it can be made optimal is part of the project. Installations for the adequate structural change in the workplaces, time for meal breaks and restroom visits, cooks are hired to make healthy lunches, fitness room, and other relevant installations.

Ethics for protection of personal data
Confidentiality in the handling of personal data is in accordance with the rules of the national data protection agencies and the General Data Protection Regulation (GDPR) and is prepared with. No personally sensitive information is included in the data set given to the researchers, so approval from the Ethics Committee is not necessary. All questionnaires ask for informed consent as the first question.

Danish version []