Clinical and psychological effects of the JADEC Diabetes Card System assessed using the Problem Areas in Diabetes (PAID): A retrospective observational study

Abstract

Aims/Introduction

Diabetes self-management education and support (DSMES) is essential for long-term 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.

Materials and Methods

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 months were analyzed. Multivariable linear regression analyses were performed to identify factors associated with changes in PAID (ΔPAID) and HbA1c (ΔHbA1c). Additional analyses were conducted according to treatment modification status.

Results

Total PAID scores and HbA1c levels significantly improved over 6 months. Baseline PAID score was the only factor associated with ΔPAID. ΔHbA1c was associated with baseline HbA1c, duration of diabetes, and age, but not with baseline PAID. Greater ΔPAID 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.

Conclusions

DSMES using the Diabetes Card System was associated with reductions in diabetes-related 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-related indicators. The Diabetes Card System may represent a practical DSMES tool in routine outpatient practice.