# Maritime Health Research and Education-NET/DM2/International Coordination

THUR 2 DEC 2021 EC, OJ, LC WhatsApp conversation
SAT 21 NOVEMBER 2021 EC, OJ WhatsApp conversation
* Agree collaboration with EC Colombia
* Zoom meeting Saturday 27 Nov at 1PM
* Wikiversity page ready https://es.wikiversity.org/wiki/Diabetes2

#### SAT 6 NOVEMBER 2021 ZOOM VC, DL, LC, ID, OJ

* Article planning
* A1C data from BCN and TGn ongoing. Ask for data from other countries.

#### THU 28 OCTOBER 2021 TGn : LC, OJ

* ca 100 cases registred, will continue

#### FRI 22 OCTOBER 2021 RungstK FG, OJ

* Article 1-2: FG co-author

#### FRI 29 OCTOBER 2021 BCN: HE, OJ

* Ca. 100 cases registred, will continue to collect, despite littel time
* Excel Form is sent

#### THU 28 OCTOBER 2021 TGn : LC, OJ

* ca 100 cases registred, will continue

#### FRI 22 OCTOBER 2021 RungstK FG, OJ

* Article 1-2: FG co-author

#### WED 20 OCTOBER 2021 Aarh JHA, OJ

* Group interested in PhD in T2DM in TRANSPORT is established Herning

#### THURSDAY 14 OCTOBER 2021 at SDCC with ALS, GSA, OJ

* Article 1 "Primary Care Diabetes" background for national and international executive order to use Hb1Ac and not urine sugar stix
* Article 2 Prevalence data from different countries as supplemental background for executive order, looking for a younger researcher.
* Ph.D. study Occupational Medical University Clinic was proposed ask JHA
* Danish-international guidelines for routine medical health exams in seafarers and fishermen be amended by executive order
* Meeting with SST / Ministry to be planned to propose an executive order
* Monitor T2DM Prevalence Transport workers with Central registration of data
TUESDAY 12 OCTOBER 2021 LC,OJ Tarragona Casa Del mar
Agenda: Data collection
The excel with 77 recorded seafarers 17% T2DM.

#### MONDAY 11 OCTOBER 2021 with HE, OJ Barcelona Casa Del mar

Agenda: Data collection
The excel with 82 recorded seafarers 24% T2DM. We agreed that they will include all ages also > 50 and those who are without risk or visible risk.
So everyone will be included from now on. The data still useful. .

## "Brief Report" for "Primary Care Diabetes" version 1 Dec with the contributions from AELS, and GSA (MEJ on the way )

Co-authors write small reviews of the proposed topics in the list 25-100 words review/per topic with 0-3 references. The article is maximum 1000 words and 20 references.
Title Early diagnosis using Hb1Ac test for T2DM in the obligatory medical examinations for fishers and transport-workers
Authors OCJ, AF, MEJ, GSA, ALS, FG, LC, VC, DL, ID, DEP-III
Abstract
Transport workers like seafarers, truck-, bus-, train- and taxi drivers and fishers have a known great inequity in health at work including high risk of developing type 2 diabetes. Their routine mandatory medical examinations use urine glucose for diabetes check with up to 50% false negatives which should be replaced by HbA1c blood tests.
Manuscript
1.The prevalence of type 2 diabetes (T2DM) is globally increasing and especially increasing with social inequity in health in relation to work and living conditions.Transport workers like seafarers, truck-, bus-, train-and taxi drivers and fishers have a known great inequity in health at work. They have annual or biannual mandatory medical examinations including screening for diabetes with urine glucose strip test according to the international guidelines for medical examinations. While the medical certificates historically have been issued with the aim to secure the workers´ fitness to stay safe and healthy on long distance travels at sea and on the roads, far away from hospitals, we suggest the obligatory medical examinations to address both fitness-check and health promotion by using the valid HbA1c blood test for diabetes screening instead urine glucose strip test. There are several good reasons as explained in the following:
2. Urinary glucose has been widely used as a screening tool for diabetes being non-invasive, cheap and easy to perform. However, due to a low sensitivity it cannot be recommended as a screening test: In a cross-sectional random sample the urine glucose test strip was 14% sensitive and 12% in another study respectively . Continued employing a screening method with such a low sensitivity will cause a false sense of safety among users, and might lead to a delayed diagnosis of DM.
3. Since 2011, Glycosylated Hemoglobin (HbA1c) has been used to diagnose diabetes in most countries and replaced blood glucose performed in the fasting state or 2 hours after and oral glucose tolerance test. HbA1c 1s recommended by the WHO and the American Diabetes Association for diabetes screening in healthy populations
5. National/international Diabetes plans, workplace Diabetes screening and prevention. With almost half of all cases of T2D undiagnosed, and 541 million at high risk of developing T2D, screening for diabetes in high-risk populations, may be a cost-effective approach to prevent T2D and promote early intervention. Work places with a high-risk profile could be a suitable venue for diabetes screening. Few studies have investigated the effect of workplace screening on detection rates, however a number of studies have shown beneficial effect of DPP and other lifestyle intervention programs when applied in a workplace setting.
6. Social Determinants T2DM at the workplace A number of psychosocial factors that are likely to be prevalent in transport workers have also been associated with development of T2D. These include job insecurity, work stress, long working hours, workplace related bullying and violence and a high degree of manual work. Following diagnosis, psychosocial factors may also play a role and work environment related factors has been shown to affect self-management in persons with already developed diabetes.
7. According to the European guidelines for prevention of non-communicable diseases (NCDs) the key challenge for the future is ensuring that NCDs can be monitored and evaluated by building up capacity in information systems so that the health outcomes of such interventions can be adequately measured.There is no specific policy for early diagnosis for T2DM for the most vulnerable groups of workers neither in the European guidelines nor in the WHO Global Action Plan for the Prevention and Control of Non-Communicable diseases. 9. Economic gains by prevention and early diagnosis of T2DM. According to a Canadian modelling study, costs for each QALY gained for conventional screening with a frequency of once every 3 years were $2,281 compared to no screening $2,890. Thus, there are financial benefits when IFG screening occurs every 3 years for those without pre-diabetes and every year for those with pre-diabetes. Another cost-effectiveness analysis found that screening for T2DM is more cost-effective when initiated between the ages of 30 and 45 years (<$11,000 per QALY gained) compared to other screening strategies.
10. QALYs gained by early diagnosis and prevention. In 2021, using nationally representative data and a validated microsimulation model, voluntary sugar reformulation policy was estimated to generate significant health gains and cost savings in USA. Over a lifetime, the policy could gain 6.67 million QALYs . In a recent systematic review, nine studies assessed the cost-effectiveness of the early detection of T2DM. They found that incremental cost-effectiveness ratios of early detection programs for cardiovascular diseases and T2DM were below a threshold of US $42,900 (equivalent to £30,000) per QALY gained.
11. Workplace multifaceted health risk prevention. Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of T2DM when supportive environments are established by the shareholders with the needed conditions for good health practices for diabetics and all others with risk for chronic metabolic diseases: time and allowance for sufficient work breaks, restroom visits, access to low calories healthy meals in social company, and access to perform physical activities There is a significant underreporting of T2DM, and the true prevalence is not known. Systematic monitoring of the prevalence of HbA1c and to centralise the data are needed for prevention planning. National/International central registration of T2DM prevalence in workers, as example the National Diabetes Registers, fails to include data in relation to the workplaces. Such a register for the most vulnerable groups of workers could be of great help for the prevention planning.
12. Conclusions and Recommendations. There is substantial scientific evidence for upgrading the obligatory routine medical examinations for various jobs including fishermen, seafarers and other transport workers with valid HbA1c blood test instead of urine glucose strip test for screening and early diagnosis of T2DM. Increased focus on T2DM may act as a lever for prevention of other NCD metabolic diseases and a cost-effective health promotion part is added to the routine fitness checks with benefit for the workers and employers. International policies for diabetes screening among transport workers and other vulnerable groups at the workplaces ought to be updated.
13. Final revision and corrections ALS/FG
14 Submission for publication and correspondence OJ
Acknowledgements
References
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* ↑ Internationale Arbeitsorganisation, and International Maritime Organization, eds. Guidelines on the Medical Examinations of Seafarers. Geneva: ILO, 2013
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* ↑ Mickael Hiligsmann, Caroline E Wyers, Susanne Mayer, Silvia M Evers, Dirk Ruwaard. A systematic review of economic evaluations of screening programmes for cardiometabolic diseases European Journal of Public Health, Volume 27, Issue 4, August 2017, Pages 621–631, https://doi.org/10.1093/eurpub/ckw237
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* ↑ Lin JS, O’Connor E, Evans CV, Senger CA, Rowland MG, et al. (2014)Behavioral counseling to promote a healthy lifestyle in persons with cardiovascular risk factors: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 161: 568-578
* ↑ Mata-Cases, Manel; Mauricio, Dídac; Real, Jordi; Bolíbar, Bonaventura; Franch-Nadal, Josep (2016-11-01). "Is diabetes mellitus correctly registered and classified in primary care? A population-based study in Catalonia, Spain". Endocrinología y Nutrición (English Edition) 63 (9): 440–448. doi:10.1016/j.endoen.2016.10.005. ISSN 2173-5093. https://www.Elsevier.es/en-Revista-endocrinologia-nutricion-english-edition--412-articulo-is-diabetes-mellitus-correctly-registered-S2173509316300952.
* ↑ Carstensen, Bendix, Jette Kolding Kristensen, Peder Ottosen, and Knut Borch-Johnsen. “The Danish National Diabetes Register: Trends in Incidence, Prevalence and Mortality.” Diabetologia 51, no. 12 (2008): 2187–96.