Turtle Therapy on HbA1c and Self-Efficacy Levels With Type 2 Diabetes

The Effect of Turtle Therapy on HbA1c and Self-Efficacy Levels in Diabetes Medication Use in Individuals With Type 2 Diabetes: A Double-Blind Randomized Controlled Study

This study examined the effect of live and video turtle therapy on hemoglobin A1c tests and self-efficacy levels in adults with Type 2 Diabetes Mellitus for the first time using pre-test and post-test methods.

Study Overview

• Status: Completed
• Conditions: Type 2 Diabetes Mellitus; Pet-Human Bonding
• Intervention / Treatment: Behavioral: Live Turtle Therapy (Pet therapy); Behavioral: Video Turtle Therapy (Pet therapy)

Detailed Description

In the international literature reviewed, only two studies reported that pet therapy reduced hemoglobin A1c tests and increased self-efficacy in adolescents with Type 1 Diabetes Mellitus. One study examined the use of live fish (repeated care behaviors during pet care, such as feeding twice a day and cleaning the aquarium). In the other study, adolescents who owned different types of pets (dogs, cats, birds, fish, reptiles, amphibians, rodents, etc.) were included in the study. In this context, our study will be the first study conducted in individuals with Type 2 Diabetes Mellitus using live and video turtle therapy at the national and international level. With the theoretical clarification of the methodological steps, this study, which has methodological characteristics, is unique in that it compares live animal (turtle) and video animal (turtle video) therapy in individuals with Type 2 Diabetes Mellitus, making it a pet therapy study conducted both nationally and internationally in both turtles and individuals with Type 2 Diabetes Mellitus. Within the scope of all this information, this study examined the effect of live and video turtle therapy on hemoglobin A1c and self-efficacy levels in adults with Type 2 Diabetes Mellitus.

• Study Type: Interventional
• Enrollment (Actual): 51
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Gümüşhane, Turkey (Türkiye), 29600
    • Gumushane University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Being 18 years of age or older,
• Agreement to participate in the study,
• Being literate,
• Being able to communicate verbally,
• No vision, hearing, or speech impairments,
• Agreeing to adopt and care for a turtle (turtle group),
• Ownership of a smartphone, tablet, or computer (video turtle group),
• Having been diagnosed with T2DM and having been receiving DM treatment for at least 6 months,
• HbA1c >7%.

Exclusion Criteria:

• Refusal to participate in the study,
• Not having T2DM,
• Having received DM treatment for less than 6 months,
• Having a psychiatric disorder diagnosed by a psychiatrist.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Live Turtle Group; Before starting the study, a nurse who was unaware of the study details (to prevent bias) administered the "Structured Patient Information Form" and "Diabetes Medication Self-Efficacy Scale", and the "hemoglobin A1c " value measured immediately before the study began was recorded. At the end of the three-month pet therapy period, the same nurse administered the "Diabetes Medication Self-Efficacy Scale" test, and the physician recorded the "hemoglobin A1c" value result as requested. During this process, patients continued their routine Type 2 Diyabetus Mellitus treatment.	Behavioral: Live Turtle Therapy (Pet therapy); The individuals were asked to take on the responsibility of caring for the turtles. The patients in this group were given one turtle and the necessary materials (aquarium, food, aquarium sand, etc.) for 12 weeks. Within this scope, patients fed the turtles twice a day, once in the morning (08:00) and once in the evening (20:00), and changed the water in the aquarium every two days with water that had been kept at room temperature beforehand. In addition, they were asked to spend 20 minutes a day with the turtle. During the twelve-week (3-month) period in which the individuals took responsibility for turtle care, the "Turtle Monitoring Form" was administered by the executor to evaluate the time spent with the turtle and the implementation of practices related to how they performed turtle care.
Experimental: Video Turtle Group; Before starting the study, a nurse who was unaware of the study details (to prevent bias) administered the "Structured Patient Information Form" and "Diabetes Medication Self-Efficacy Scale", and the "hemoglobin A1c" value result measured immediately before the study began was recorded.In addition, at the end of the three-month pet therapy period, the same nurse administered the "Diabetes Medication Self-Efficacy Scale" and the physician recorded the "hemoglobin A1c" value result requested. During this process, patients continued their routine Type 2 Diyabetus Mellitus treatment.	Behavioral: Video Turtle Therapy (Pet therapy); In addition, the consultant faculty member provided approximately 15 minutes of face-to-face information to patients regarding watching the turtle videos. Patients in this group were asked to watch documentaries featuring turtle videos for at least 20 minutes a day for twelve weeks. The "Turtle Viewing Form" was administered by the researcher to determine how many minutes per day the individuals watched the turtle videos.
No Intervention: Control Group; A nurse who was unaware of the study details prior to its commencement (to prevent bias) administered the "Structured Patient Information Form" and "Diabetes Medication Self-Efficacy Scale", and the "hemoglobin A1c" value result obtained immediately before the study began was recorded. No intervention was performed on these patients. Patients only continued their routine Type 2 Diyabetus Mellitus treatments. In addition, "Diabetes Medication Self-Efficacy Scale" was administered to patients at the end of the three-month period, and the "hemoglobin A1c" value requested by the physician was recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hemoglobin A1c	Hemoglobin A1c is a clinically useful index of average blood glucose levels over the past 120 days (average red blood cell lifespan). It most accurately reflects glycemic control over the past 2-3 months. Hemoglobin A1c was measured twice, before and after the study.	12 week
Diabetes Medication Self-Efficacy Scale	Diabetes Medication Self-Efficacy Scale was developed by Sleath and colleagues (2016) to assess self-efficacy in overcoming barriers to diabetes medication use. Its Turkish validity and reliability were established by Kavuran & Türkoğlu (2022) using a 19-item, 3-point Likert-type scale. The scale consists of three subscales: "Requirement" (items 1-4), "Busyness" (items 5-9), and "Worry" (items 10-19). The scale scores range from 19 (low self-efficacy) to 57 (high self-efficacy). Diabetes Medication Self-Efficacy Scale was measured twice, before and after the study.	12 week

Collaborators and Investigators

• Sponsor: Karadeniz Technical University
• Collaborators: Gümüşhane Universıty

Study record dates

Study Major Dates

• Study Start (Actual): July 18, 2024
• Primary Completion (Actual): August 1, 2024
• Study Completion (Actual): November 1, 2024

Study Registration Dates

• First Submitted: December 9, 2025
• First Submitted That Met QC Criteria: December 20, 2025
• First Posted (Actual): December 23, 2025

Study Record Updates

• Last Update Posted (Actual): December 23, 2025
• Last Update Submitted That Met QC Criteria: December 20, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Self-efficacy; Type 2 Diabetes Mellitus; Pet Therapy; Hemoglobin A1c Test; Turtle Therapy
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Diabetes Mellitus; Behavior; Nutritional and Metabolic Diseases; Human-Animal Interaction; Diabetes Mellitus, Type 2; Human-Animal Bond; Therapeutics; Physical Therapy Modalities; Patient Care; Health Services; Health Care Facilities Workforce and Services; Psychotherapy; Behavioral Disciplines and Activities; Rehabilitation; Aftercare; Continuity of Patient Care; Animal Assisted Therapy
• Other Study ID Numbers: RCS04072024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: I'll decide later

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No