Improvements in self-care among patients with diabetes in a remote island in Japan: a pilot study

Objective: The traits of the inhabitants of rural areas could affect clinical improvements. In the rural areas of Japan, a feeling of competitiveness often exists between the members of a community; this competitiveness could prompt patients to exert efforts in improving their health. This study aimed to assess the effects of competitiveness on the clinical outcomes of patients with diabetes. Patients and Methods: Between December 2014 and December 2015, a pilot study was conducted among patients with diabetes to assess the effects of an intervention on improvements in self-care, quality of life (QOL), and hemoglobin A1c (HbA1c) values. The intervention included showing each participant a histogram of the HbA1c levels of all patients visiting a clinic in the remote island as well as the location of their own HbA1c level on the histogram. Once every 4 months, the patient's HbA1c level was assessed by conducting a blood test, and the self-care agency questionnaire 30 (SCAQ30) was administered by a community health nurse. After 12 months, changes in HbA1c values, SCAQ30 score, and MOS 36-item short-form health survey score were evaluated. Results: Sixty-four participants (mean age: 63.6 years; male-to-female ratio: 35:29) were included in the final analysis (follow-up rate: 71.1%). In participants with HbA1c values ≥ 8% and < 8% at baseline, the HbA1c value decreased by 1.39 (p < 0.001) and 0.12 (p = 0.137), respectively, and the mean SCAQ30 score increased by 14.94 and 6.39 points (p < 0.001), respectively. Furthermore, in participants with an HbA1c value ≥ 8%, the mean mental component summary score increased by 5.64 points (p = 0.019), and the mean role/social component summary score decreased by 6.04 points (p = 0.022). Conclusion: The continuous stimulation of competitiveness may help improve the health conditions of patients with diabetes. Moreover, collaboration between rural clinics and community health nurses may also be important.