User:Saltrabook/empty-page 5

Prediabetes Remission

ABSTRACT
Seafarers and fishermen have an increased risk for diabetes and hypertension as part of the metabolic syndrome including overweight and obesity. Pre-diabetes increases the risk of developing type 2 diabetes, heart disease, and stroke. In Spain, 22% of those with overweight and 41% of those with obesity have diabetes. The fishermen have 2 times higher risk for diabetes compared to the seafarers. Thankfully, you can reverse the damage of pre-diabetes and we can help you. In view of the good research results from the coaching prevention non-maritime areas e.g.: we are challenged to try-out using similar methods including Coaching with the partner maritime medical clinics as an extension of the ongoing prevalence study of diabetes type 2. The study population will be seafarers with newly diagnosed pre-diabetes and overweight in the maritime medical clinics. The purpose is to educate and support the seafarers by their own efforts based on selected study materials specific developed for seafarers and supported by coaches to normalise elevated blood sugars and blood pressure and weight, to provide good health for them. We take the advantage that the seafarers have health examinations anyway biannually and that training materials specifically for seafarers have been developed in the latest years, that reduce the costs, facilitates the study, reduces the number of non responders and increase the quality of the project by including coaches, with knowledge on the seafarers work, health and life and prevention on diabetes type 2. To try out for a start, one or more will give coaching for free over 16 weeks to an invited seafarer and report the experiences to adapt the project to bigger study populations

(Edition & language changes need be done from the original English version)

INTRODUCTION
The program combines the biannual, mandatory clinical fit-for-duty health examinations for seafarers and fishermen in a Public Health perspective with biannual screening for Diabetes Type 2 and Hypertension and a pilot intervention project using Coaching support to the seafarers and fishermen who wants to join the trial and learn more about how they can prevent diabetes themselves.

Seafarers, have a great inequity in health at work with a higher risk of overweight, metabolic syndrome, diabetes type 2 and hypertension and a need for accurate early diagnosis and prevention While the objective one hundred years ago for the fit-for-duty medical examinations was mainly related to the safety for the seafarers and the ships, now the ILO guidelines inspire to include protocols related to the general health of seafarers beyond the fit-for-duty protocol. The focus on early diagnosis of Type 2 diabetes and hypertension seems to be a good choice for intervention based on the evidence that pre-hypertension and pre-diabetes mellitus Type 2 can be reversed by non-pharmacological and pharmacological measures, which is the background for our proposed trial.

OBJECTIVES
The Diabetes Health Coaching study trial is designed to evaluate the effect of a 4 months diabetes health coaching intervention in seafarers with new diagnosed pre-diabetes mellitus (T2DM) on glycated haemoglobin (A1C) on the start and at the end and weekly self administrated glycometer, self-care behaviours. The purpose of this pilot study is to evaluate how the Coaching system functions.

METHODS
The eligibility criteria are: a) adults > 18 years of age; b) a diagnosis of T2DM pre-diabetes: A1C of 5,7%-6,4% (39-47 mmol/L) fasting blood glucose 100-125 mg/dl, c) All levels of Body Mass Index included, d) Ability to read, write and understand English or Spanish; e) Have telephone/internet access at home and on the ships and e) do not take diabetes medicine. In 2024 xx patients in each of the participating maritime medical clinics, completing the elegibility criteria are asked to participate and randomised into the trial. Over one month or so, each clinic, selects xx matched pairs for age, gender, and ship type (fishing/merchant ship) and randomize them for the intervention and the control group. In this way the baseline characteristics of the participants are equally distributed across the intervention and control group and the information is given to the research group. When the seafarer accepts to participate, the data from the "prevalence study" form the basis for the intervention study, where the seafarer collects data every week on the recorded variables, that forms the basis for evaluating the effect of the trial and reporting the results internationally (evidence or data driven coching).

Excel files for registration of data . Each participant get "their own" Excel file deposited in the Coach's personal Google Drive, editable with the rights as Editors for the Seafarer to report the week by week data (automatic data saving) that is available for the Coach for comments in mails and collected for analysis for all 16 weeks at the end. "Start meetings" are held with the Coach and the participants in the Intervention group to be informed on the procedures of the trial one by one. The control group are informed that we want to observe what happens with them in 4 months without any specific intervention. Both the intervention group and the control group are asked to contact the same clinic or another clinic after 4 months to register A1C, weight and the other variables (Excel scheme ). The Diabetes Health Coaching study for Pre-diabetes (T2DM) will examine the effects of the intervention on clinical outcomes, self-care behaviours (maybe more physical activity) and errors in the program to be corrected. To try out for a start, one or more coaches will start to give coaching for free over 16 weeks with only one or more seafarers with no control group and report the experiences to adapt the project to bigger controlled study populations. A fasting glycemia that is, without calorie intake for at least 8 hours. A "1-2 hours after meal" glycemia equal to or greater than 200 mg/dl two hours after eating. A random glycemia = not knowing when you get the latest meal equal to or greater than 200 mg/dL in a patient with symptoms

(1) Start and end meetings at the clinic, first meeting is the obligatory medical heath examination.

The "International Maritime research based Diabetes2/HTN Coaching Program" (IMDCP) is designed to teach and support seafarers on how to prevent the development of manifest type 2 diabetes and normalise their blood pressure and personal weight. The program targets individuals with (HbA1c) A1c = 39-47 mmol/L (5,7%-6,4%) who are currently not taking medication for diabetes. For the diagnosis of diabetes, these values ​​are considered as in Table 1.

Laboratory tests

The start lab analysis includes A1c, total cholesterol, LDL, HDL and TG as part of the routine medical exams-to be reported in the Excel data scheme. The same lab tests should be repeated after 16 weeks training to evaluate the effects. There will be no extra costs for the maritime clinics as they are normally allowed to take extra laboratory tests when this is relevant for the seafarer's future health. For the study is also relevant to have lab. tests after 1 one and two years. The latter is part of the routine biannual medical examination.

Goal setting during a weight loss

The primary goal is to normalise weight, blood sugar and blood pressure by setting gradually more physical sub-goals that can be a good way to motivation The seafarers write down their goals step by step in the Excel scheme and compare week by week the obtained results.

Requirements to be a coach for Maritime Diabetes Prevention Coaching

The requirements to be a coach: as a minimum to have a good knowledge on how to prevent diabetes type 2 to help the seafarers to prevent diabetes, hypertension and overweight. The coaches need to have knowledge on the seafarers work, health and life conditions on board. Certification to be an approved coach and support from the relevant maritime organisations to be developed to create credibility to the quality of the service. Training programs on how to be a good coach in general is offered from specialists in the area

As a starting point, it is only the maritime doctors and practice doctors who, via their legal authorization, have the legal responsibility and not the coaches. Soefartsgerne and other authorized healthcare professionals can perform the same type of coaching as patient care under the same rights and duties as all healthcare professionals. Doctors and other health personnel can waive their authorization and carry out diabetes type 2 coaching without stepping over the maritime doctors' professional domain and without being responsible for patients. In order to cover the expected need for diabetes type 2 coaching, master coaching courses must probably be established in the long term for seamen, cooks, staff from the shipping companies and other relevant groups of people. Among the requirements will be that they themselves have completed a good diabetes type 2 coaching course.

Among the 16 weeks, there are multiple choice tasks that must be passed to get the certificate. We will be calling for short multiple choice tasks among WhatsApp groups.

The coaching methods

A mixture of personal telephone-based health coaching and digital data driven coaching method will be used. The digital data driven health coaching method is reported to give similar benefits to in-person or telephone-based health coaching. We argue that, by using this method we have the potential to treat large numbers of individuals in diverse geographic locations, digital coaching offers a promising solution to the rapid increase in diabetes prevalence.

The Educational materials

Globally there is an abundance of materials to educate the population on prevention of overweight, diabetes and hypertension. There are lots of educational materials for seafarers, unfortunately these materials haven't been tested for their usefulness e.g. the ISWAN produced materials, which is also the intention to do and over time replace some of the materials by other and better materials.

DISCUSSION
Our 16 week pre-diabetes coaching program is designed to inspire and support seafarers how to prevent the further development from pre-diabetes to manifest type 2 diabetes. This program targets individuals with an A1c between 5.7% and 6.4% who are currently not taking medication for diabetes.The new "International Maritime Diabetes and Hypertension Coaching Program" (IMDCP) offers individual patient-centered support, delivered with personal contact to the Coaches.

Health coaching focuses on increasing patients' skills and confidence to manage their own condition and set achievable goals - engaging patients to make informed decisions. Our one year pre-diabetes coaching program is designed to teach members how to prevent the development of type 2 diabetes from pre-diabetes. This program targets seafarers with an A1c between 5.7% and 6.4% who are currently not taking medication for diabetes. The program is done in close collaboration between the Maritime Medical Doctors, the Seafarers and the Coaches. By personal meetings and online support the objective is to activate internal strengths and external resources to make sustainable and healthy lifestyle behavior changes. Health coaches use a personal-centered approach wherein the seafarers decide their goals, engage in active learning processes, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a health coach. Health coaches work to educate and motivate the seafarers on making changes in their lives by placing an emphasis on Nutrition and Exercise in weekly, progressive goals. Along with weekly calls from their dedicated coach and access to online tracking tools, participants receive weekly emails to support them in their lifestyle change. (See the scheme for the 16 weeks training below). Most of the seafarers enrolled have just passed their obligatory health examination and are ready or already at sea.

Future controlled trial by including a control group

No control group are included in this first trial on how the coaching works in everyday life. If it works good a new trial will be done with a control group. Both the intervention group and the control group are asked to contact the same clinic or another clinic after 4 months and again after one year to register A1C, weight and the other variables.

Guidelines on the training of ships’ cooks

The ships' cooks should be prepared to support the crew members with overwight and pre-diabetes. However, the ILO guidelines on training ships' cooks from 2014 don't mention how the ship's cooks could help pre-diabetes seafarers with diet that could also help the non-diabetics. Now with more focus on pre-diabetes, chapters on dietary advice should be added in the next version of the Guidelines. Could be done by referring to some of the materials included here. The ship's cooks would also benefit from training like the seafarers to be prepared to offer "dietary food suppply".

VIDEO PRESENTATION
Millions in the populations have pre-diabetes and most of them don’t even know it. An individual is pre-diabetic when their blood sugar levels are higher than normal, but aren’t high enough to be diagnosed with type 2 diabetes. Pre-diabetes increases the risk of developing type 2 diabetes, heart disease, and stroke. In Spain, 22% of the fishermen and seafarers with overweight and 41% of those with obesity have pre-diabetes or diabetes. The fishermen have x2 times the risk for diabetes compared to the seafarers. Thankfully, you can reverse the damage of pre-diabetes and we can help you. We have a supporting program with Zoom meetings every 3 weeks and weekly mail contacts starting with your health examination in the maritime medical clinics. Our 16 week pre-diabetes coaching program is designed to inspire and support seafarers how to prevent the further development from pre-diabetes to manifest type 2 diabetes. This program targets individuals with an A1c between 39-47 mmol/L (5,7%-6,4%) and who are currently not taking medication for diabetes. For a start only a few seafarers are carried through the 16 weeks program by the coach.

Later a video will be prepared to be used for announcement

TO SEAFARERS
Dear seafarers,

With great respect for your important and hard work you do as a seafarer to bring all types of goods around in the world, you will need to stay healthy. Now, you have been diagnosed with pre-diabetes(T2D) you should know that this is not a serious disease, that can be prevented to be a more serious disease by changes of your food and physical exercise pattern. Pre-diabetes increases the risk of developing type 2 diabetes, heart disease, and stroke. Our 16 week pre-diabetes coaching program is designed to support you to change your daily food habbits and physical activities and get rid of diabetes and overweight. If you accept the invitation given by your maritime medical doctor, you will get in contact with a support person, a "coach" with further information.

MARITIME DOCTORS
Dear Maritime Doctors,

As you know an increasing part of seafarers have overweight and pre-diabetes that can be changed to normal by early diagnose and early changing the type and pattern of the food and drink and physical activity. This is very difficult for the seafarers to do alone. Our program supports them in learning about pre-diabetes and how they can normalise pre-diabetes, hypertension and overweight by changing their pattern of physical activity and food and drink patterns. As a maritime medical doctor you will not use much extra time and probably no extra costs for laboratory you are allowed to take, but your collaboration is very important. If you want to participate in the project, you are kindly asked to identify just one seafarer for a start from your actual medical examinations with newly diagnosed pre-diabetes and ask him/her to participate. The interested seafarer is put in contact to our coaches, that will help them to normalise the pre-diabetes and probably also loose some kg weight over a 16 weeks course.

Thank you for your attention

Contact person: ______________________, WhatsApp______________

The International Maritime Diabetes-2 Coaching Group (MDCG)

Project Title Project Summary Statement of Problem (scientific justification) Justification and Use of Results (final objectives, applicability) Theoretical Framework (argumentation, possible answers, hypothesis) Research Objectives (general and specific) Methodology Type of Study and General Design Operational Definitions (operationalization) Universe of Study, Sample Selection and Size, Unit of Analysis and Observation: Selection and Exclusion Criteria Proposed intervention (if applicable) Data-Collection Procedures, Instruments Used, and Methods for Data Quality Control Procedures to Ensure Ethical Considerations in Research Involving Human Subjects Plan for Analysis of Results Methods and Models of Data Analysis according to Types of Variables Programs to be Used for Data Analysis Bibliographic References Timetable Budget Annexes (data-collection instruments, elaboration on methods and procedures to be used, and more)

16 WEEK COURSE
LINK ->