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Participants completed a baseline diabetes knowledge test and received accelerometers at the first visit. At the second visit, they were randomly assigned to a cartoon distribution group or a lecture attendance group. Six months later, knowledge tests and accelerometer data were collected at home by mail, with 30 children completing follow-up. Both groups improved within-group, while between-group changes were not 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disease knowledge and physical activity among Japanese children: a preliminary randomized controlled trial  \nYasuhiro Suzuki1–3 , Daichi Sugawara4 , Mika Oki5, 6 , Hirofumi Takahashi7 , Takaaki Matsuda8, 9 , Hiroaki Suzuki10 , Hitoshi Shimano2, 11–13 , Yasushi Hada14 , and Kenji Suzuki6  \n1Institute of Systems, Information and Engineering, University of Tsukuba, Tsukuba, Japan  \n2Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Tsukuba, Japan  \n3Biomedical Science and Engineering Research Center, Hakodate Medical Association Nursing and Rehabilitation Academy, Hakodate, Japan  \n4Institute of Human Sciences, University of Tsukuba, Tsukuba, Japan  \n5International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan  \n6Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan  \n7Nutrition Department, University of Tsukuba Hospital, Tsukuba, Japan  \n8Tsukuba Clinical Research and Development Organization (T-CReDO), University of Tsukuba, Tsukuba, Japan  \n9Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Tsukuba, Japan  \n10Department of Food and Health Sciences, Institute of Human Life Sciences, Jissen Women’s University, Tokyo, Japan  \n11Japan Agency for Medical Research and Development-Core Research for Evolutional Science and Technology (AMED-CREST), Tokyo, Japan  \n12Life Science Center of Tsukuba Advanced Research Alliance (TARA), University of Tsukuba, Tsukuba, Japan  \n13International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan  \n14Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan  \nHighlights  \n● Cartoon based educational intervention is as effective as lecture-based educational intervention.  \n● Diabetes education via cartoons and educational lectures increase physical activity.  \n● Cartoons aimed at disease awareness are associated with psychological stress.  \nReceived: July 6, 2025 Accepted: October 6, 2025 Advanced Epub: October 16, 2025  \nCorresponding Author: Yasuhiro Suzuki, Ph.D., RPT, Institute of Systems, Information and Engineering, University of  \nTsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan [E-mail: minaminagasaki2007@yahoo.co.jp](E-mail: minaminagasaki2007@yahoo.co.jp)  \nThis is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial No Derivatives (by-nc-nd) License \u003C[http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)> .  \nCopyright© 2026 by The Japanese Society for Pediatric Endocrinology  \nClin Pediatr Endocrinol 75  \nAbstract. We examined whether cartoon-based diabetes education could enhance diabetes knowledge and physical activity among children. During the first visit, participants completed a diabetes knowledge test; accelerometers, which were worn, were distributed. During the second visit, participants were randomly assigned to the cartoon distribution or lecture attendance group. At 6 mo post-intervention, the children received the diabetes knowledge test and accelerometers via mail, completed them at home, and returned them. Thirty children participated, with a 100% follow-up rate. Changes in diabetes knowledge test scores or physical activity levels showed no significant between-group differences; however, both groups exhibited significant within-group improvements. In the diabetes knowledge test, the cartoon distribution and lecture attendance groups improved by 11 (19 [17, 22] to 30 [23, 35], p = 0 .003) and 10 (17 [14, 23] to 28 [26, 32], p = 0 .007) points, respectively. Physical activity significantly increased, with the cartoon distribution and lecture attendance groups gaining 1,427 ± 2,980 (6190 ± 2529 to 7617 ± 3315, p = 0.0","cbCaicgC1Yl38iv7","https://ap.wps.com/l/cbCaicgC1Yl38iv7","pdf",1300584,"English","# Abstract\n# Introduction\n## Background on pediatric diabetes\n## Need for accurate knowledge and self-management\n# Methods","[{\"question\":\"What was the main purpose of this trial?\",\"answer\":\"To determine whether diabetes-themed cartoon-based education improves children’s diabetes knowledge and physical activity.\"},{\"question\":\"How were participants assigned to groups?\",\"answer\":\"At the second visit, participants were randomly assigned to receive diabetes-themed cartoons or to attend lectures.\"},{\"question\":\"Did cartoons outperform lectures in improving outcomes?\",\"answer\":\"No. Changes between the cartoon and lecture groups showed no significant differences, although both groups had significant within-group improvements.\"}]","Effects of a Diabetes-Themed Cartoon-Based Education on Disease Knowledge and Physical Activity Among Japanese Children - a Preliminary Randomized Controlled Trial | PDF",1790737761,28]