{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:55:12Z","timestamp":1790848512788,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/Introduction<\/jats:title>\n                    <jats:p>Diabetes self\u2010management education and support (DSMES) is essential for long\u2010term diabetes care; however, its psychological impact in routine outpatient practice remains unclear. This study evaluated the clinical and psychological effects of DSMES using the Diabetes Card System, a visually structured educational tool developed in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This retrospective observational study included 141 patients with type 2 diabetes who received DSMES using the Diabetes Card System at a single outpatient clinic between April 2022 and July 2025. Changes in Problem Areas in Diabetes (PAID) scores and glycated hemoglobin (HbA1c) over 6\u2009months were analyzed. Multivariable linear regression analyses were performed to identify factors associated with changes in PAID (\u0394PAID) and HbA1c (\u0394HbA1c). Additional analyses were conducted according to treatment modification status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total PAID scores and HbA1c levels significantly improved over 6\u2009months. Baseline PAID score was the only factor associated with \u0394PAID. \u0394HbA1c was associated with baseline HbA1c, duration of diabetes, and age, but not with baseline PAID. Greater \u0394PAID was observed in patients with higher baseline PAID scores irrespective of HbA1c levels. Treatment intensification was associated with greater reductions in HbA1c, whereas PAID improvement did not differ according to treatment modification status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DSMES using the Diabetes Card System was associated with reductions in diabetes\u2010related distress and improvements in glycemic control in routine outpatient care. Psychological improvement appeared independent of patient background factors, whereas glycemic improvement was associated with disease\u2010related indicators. The Diabetes Card System may represent a practical DSMES tool in routine outpatient practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdi.70404","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:22:41Z","timestamp":1785320561000},"page":"1847-1855","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and psychological effects of the\n                    <scp>JADEC<\/scp>\n                    Diabetes Card System assessed using the Problem Areas in Diabetes (\n                    <scp>PAID<\/scp>\n                    ): A\u00a0retrospective observational study"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7520-4142","authenticated-orcid":false,"given":"Yu","family":"Kouchi","sequence":"first","affiliation":[{"name":"Kouchi Clinic  Shinjo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-016-1168-2"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/ds17-0067"},{"key":"e_1_2_9_4_1","unstructured":"JADEC.Diabetes Education Card System Program. Available from:https:\/\/www.nittokyo.or.jp\/modules\/doctor\/index.php?content_id=29Update March 31 2025; Accessed December 31 2025."},{"key":"e_1_2_9_5_1","first-page":"505","article-title":"Diabetes care system in a diabetes specialty clinic","volume":"14","author":"Osonoi T","year":"2016","journal-title":"Diabetes Pract Master"},{"key":"e_1_2_9_6_1","first-page":"280","article-title":"Individualized patient education using the diabetes education card system","volume":"15","author":"Osonoi T","year":"2017","journal-title":"Diabetes Pract Master"},{"key":"e_1_2_9_7_1","first-page":"36","article-title":"Effects of introducing a diabetes educational card system in an acute care hospital ward","volume":"64","author":"Otsuji M","year":"2021","journal-title":"J Japan Diabetes Soc"},{"key":"e_1_2_9_8_1","first-page":"105","article-title":"Changes in diabetes distress of inpatients by educational support method using diabetes education card system: Comparison of before and after educational support","volume":"26","author":"Goya H","year":"2022","journal-title":"J Jpn Acad Diabetes Educ Nurs"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.18.6.754"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-009-1559-5"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-1552"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12245"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci20-0023"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2018.00302"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-9923"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0036361"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.2196\/35079"},{"key":"e_1_2_9_18_1","first-page":"90","article-title":"The effectiveness of providing audiovisual\u2010based diabetes self management education (DSME) interventions on diabetes self\u2010care knowledge and skills","volume":"11","author":"Sari NMCC","year":"2022","journal-title":"Jurnal Kesehatan"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-023-02180-2"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-55901-0"},{"key":"e_1_2_9_21_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-056304","article-title":"How to identify clinically significant diabetes distress using the problem areas in diabetes (PAID) scale in adults with diabetes treated in primary or secondary care? 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