uu.seUppsala University Publications
Change search
Refine search result
1 - 42 of 42
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the 'Create feeds' function.
  • 1. Backlund, L.B.
    et al.
    Algvere, P.V.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Early detection of diabetic retinopathy by mobile retinal photography service working in partnership with primary health care teams1998In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 15, no S3, p. S32-S37Article in journal (Refereed)
    Abstract [en]

    Community-wide fundus photography was organized for early detection of diabetic retinopathy (DR) by mobile teams. High-quality three-field Kodachrome fundus photography, performed according to the London Protocol through dilated pupils was offered free of charge to primary care; images were taken in the community and assessed centrally. Data are presented from the first 80 primary health care centres (PHCCs) participating, serving 990 000 (about 60 %) of inhabitants in Stockholm County. Beginning in 1990, 6863 diabetes patients were invited by PHCCs; 5490 (80 %) attended. We reached 77 % of persons with known diabetes; only 37 % had had their eyes examined during the preceding 2 years. For 97 % of patients, images were assessable. DR was present in 34 % of patients (non-proliferative DR not requiring further assessment 29 %, non-proliferative DR requiring further assessment 1.1 %, proliferative DR 0.5 % and macular involvement 3.6 %). Re-examination after 2 years was offered to 64 %; follow-up photography after 1 year to 24 %. Fluorescein angiography and/or photocoagulation treatment was performed in 3.6 %. This method of early diagnosis is feasible, acceptable, and reached twice as many patients as did the usual referral-based system of care. We now plan to extend this service to cover the whole county.

  • 2. Bäcklund, L.B.
    et al.
    Algvere, P.V.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    New Blindness in Diabetes Reduced by More Than One-Third in Stockholm County1997In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 14, no 9, p. 732-740Article in journal (Refereed)
    Abstract [en]

    To monitor changes over time in the incidence of blindness among people with diabetes, referrals (mentioning diabetes) to all vision rehabilitation centres in Stockholm County (1995 population 1 725 756) during 1981-1995 were registered. A mass mailing to people with diabetes in 1989 urged them to have their eyes examined. Mobile fundus photography teams initiated early diagnosis of diabetic retinopathy in primary health care in 1990. Referrals with diabetes and blindness, defined (WHO, ICD 10) as best-corrected visual acuity (VA) of the better eye less than 3/60 (0.05), occurred for 172 persons (7.6% of those referred with diabetes). During 1981-1985, 93 were referred (95% confidence interval 75 to 114); 1986-1990, 51 (38 to 67); 1991-1995, 28 (19 to 41). Five-year average annual incidence rate of referrals with blindness was reduced by 47% from 1.2 to 0.63 to 0.33 per 100,000 population. Mean yearly reduction during 1981-1995 was 11% (8 to 15%), 11.5% (8 to 15%) if blindness was defined as in the UK (VA 3/60 or less), and 7% (4 to 9%) for legal blindness (VA 6/60 or less); test for trend p < 0.001 (Poisson regression analysis). This is the first report of reduction in a geographical region of a proxy measure for new blindness in diabetes by one-third or more, attaining one of the main targets of the St Vincent Declaration.

  • 3.
    Cederholm, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Eeg-Olofsson, Katarina
    Eliasson, Björn
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Gudbjörnsdottir, Soffia
    A new model for 5-year risk of cardiovascular disease in Type 1 diabetes: from the Swedish National Diabetes Register (NDR)2011In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 28, no 10, p. 1213-1220Article in journal (Refereed)
    Abstract [en]

    Aims: We assessed the association between risk factors and cardiovascular disease in an observational study of patients with Type 1 diabetes from the Swedish National Diabetes Register.

    Methods: A derivation sample of 3661 patients, aged 30-65 years, 6.1% with previous cardiovascular disease, baseline 2002, and 197 cardiovascular disease events when followed for 5 years until 2007. A separate validation data set of 4484 patients, baseline 2003, 201 cardiovascular disease events when followed for 4 years.

    Results: Adjusted hazard ratios at Cox regression for fatal/non-fatal cardiovascular disease were: diabetes duration 2.76 (2.21-3.44); onset age 1.47 (1.21-1.78); log ratio total cholesterol:HDL cholesterol 1.26 (1.09-1.45); log HbA(1c) 1.19 (1.03-1.38); log systolic blood pressure 1.17 (1.01-1.34) (1 SD increase in continuous variables); smoker 1.76 (1.27-2.46); macroalbuminuria (> 200 mu g/min) 1.52 (1.10-2.10); previous cardiovascular disease 3.51 (2.54-4.84). All eight variables were used to elaborate a risk equation for 5-year cardiovascular disease risk. Regarding calibration in the derivation data set, ratio predicted 5-year risk (mean 5.4 +/- 7.9%) to observed event rate was 1.0. Discrimination was sufficient, with C-statistic 0.83, sensitivity and specificity 72 and 77%, respectively, for the top quartile of predicted risk. Similarly, calibration and discrimination were adequate in the validation data set: ratio of predicted 4-year risk/observed rate 0.94, C-statistic 0.80, sensitivity and specificity 62 and 77%, respectively, for the top quartile.

    Conclusions: This 5-year cardiovascular disease risk model from a large observational study of patients with Type 1 diabetes in routine care showed adequate calibration and discrimination and can be useful for clinical practice. It should also be tested in patients with Type 1 diabetes from other countries.

  • 4. Dotevall, A
    et al.
    Hasdai, D
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Battler, A
    Rosengren, A
    Diabetes mellitus: clinical presentation and outcome in men and women with acute coronary syndromes. Data from the Euro Heart Survey ACS2005In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 22, no 11, p. 1542-1550Article in journal (Refereed)
    Abstract [en]

    AIMS: To study clinical presentation, in-hospital course and short-term prognosis in men and women with diabetes mellitus and acute coronary syndromes (ACS).

    METHODS: Men (n = 6488, 21.2% with diabetes) and 2809 women (28.7% with diabetes) < or = 80 years old, with a discharge diagnosis of ACS were prospectively enrolled in the Euro Heart Survey of ACS.

    RESULTS: Women with diabetes were more likely to present with ST elevation than non-diabetic women, a difference that became more marked after adjustment for differences in smoking, hypertension, obesity, medication and prior disease [adjusted odds ratio (OR) 1.46 (1.20, 1.78)], whereas there was little difference between diabetic and non-diabetic men [adjusted OR 0.99 (0.86, 1.14)]. In addition, women with diabetes were more likely to develop Q-wave myocardial infarction (MI) than non-diabetic women [adjusted OR 1.61 (1.30, 1.99)], while there was no difference between men with and without diabetes [adjusted OR 0.99 (0.85, 1.15)]. There were significant interactions between sex, diabetes and presenting with ST-elevation ACS (P < 0.001), and Q-wave MI (P < 0.001), respectively. Of the women with diabetes, 7.4% died in hospital, compared with 3.6% of non-diabetic women [adjusted OR 2.13 (1.39, 3.26)], whereas corresponding mortality rates in men with and without diabetes were 4.1% and 3.3%, respectively [OR 1.13 (0.76, 1.67)] (P for diabetes-sex interaction 0.021).

    CONCLUSION: In women with ACS, diabetes is associated with higher risk of presenting with ST-elevation ACS, developing Q-wave MI, and of in-hospital mortality, whereas in men with ACS diabetes is not significantly associated with increased risk of either. These findings suggest a differential effect of diabetes on the pathophysiology of ACS based on the patient's sex.

  • 5. Eliasson, B.
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Nilsson, P.
    Gudbjörnsdóttir, S.
    The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996-20032005In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 22, no 10, p. 1420-6Article in journal (Refereed)
    Abstract [en]

    Guidelines for the treatment of risk factors in diabetes care have been updated recently, due to indisputable results from clinical end-point trials. This study evaluates risk factor control compared with current national and international targets during the period 1996–2003 in Type 2 diabetes (DM2). Patients were registered in primary-care and hospital outpatient clinics using computer software, or via the Internet. The clinical characteristics of the patients, treatment, HbA1c, and risk factors were reported after screening by local methods. The numbers of cases of DM2 reported were 17547 in 1996 and 57119 in 2003. The mean HbA1c decreased from 7.8 to 7.2%, while blood pressure decreased from 150/82 to 143/78 mmHg during the same period. Longitudinal analysis of results was performed in 5356 patients repeatedly reported, showing slightly lower effects. The new European treatment targets of HbA1c≤ 6.1%, blood pressure < 130/80 mmHg and total cholesterol < 4.5 mmol/l were attained by 16, 13 and 28% of the patients in 2003, respectively. The prevalence of the metabolic syndrome in 2003 was 77%. Aspirin was prescribed in 36% of cases. Lipid-lowering, anti-hypertensive drugs, and treatment with oral hypoglycaemic agents in combination with insulin were increasingly employed during the period studied. Risk factor control in DM2 reported to the National Diabetes Register (NDR) is slowly improving, although multiple risk factors and the metabolic syndrome are found in most patients. The majority of subjects do not achieve current target levels for HbA1c, blood pressure and blood lipids. Thus, giving up smoking and increased use of aspirin are called for, as well as more aggressive treatment of hyperglycaemia, elevated blood pressure and blood lipid levels, in accordance with updated international guidelines.

  • 6.
    Engström, Sevek
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Gahnberg, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Effectiveness of screening for diabetes mellitus in dental health care2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 2, p. 239-245Article in journal (Refereed)
    Abstract [en]

    Aims:  The aim of the present study was to test the effectiveness of opportunistic blood glucose screening in a cooperational framework between dental and primary health care.

    Methods:  Altogether, 1568 subjects, age 20-75 years, with no previous history of diabetes, who came for a regular dental examination, had their non-fasting blood glucose measured with a portable blood glucose meter. Subjects with a concentration of ≥ 6.7 mmol/l (121 mg dl(-1) ) were referred to their primary healthcare centre for follow-up. The outcome, a diagnosis of diabetes mellitus, was obtained from primary healthcare centre and hospital patient records, during 3 years after screening.

     Results:  Of the 155 (9.9%) subjects who screened positive, 139 (89.7%) came to their primary healthcare centre within the 3-year follow-up period and nine (5.8%) were diagnosed as having diabetes mellitus according to the World Health Organization criteria. Of the 1413 subjects who screened negative, 1137 (80.5%) came to the primary healthcare centre and eight (0.6%) were found to have diabetes mellitus. Screening sensitivity was 52.9%, specificity 90.6% and positive predictive value 5.8%. The number of subjects needed to screen to find one case of diabetes was 196. Delineating the study population to those 40- to 75-year-olds with a BMI ≥ 25 kg/m(2) , and 30-to 75-year-olds with a BMI ≥ 30 kg/m(2) , the numbers needed to screen was reduced to 96.

    Conclusions:  Cooperation between dental and primary care for high blood glucose screening and follow-up appears to be a feasible method for early diagnosis of diabetes.

  • 7.
    Espes, Daniel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lau, Joey
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Carlsson, Per-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Increased levels of irisin in people with long-standing Type1 diabetes2015In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, no 9, p. 1172-1176Article in journal (Refereed)
    Abstract [en]

    BackgroundIrisin stimulates browning of white adipose tissue and improves metabolic control in mice. Betatrophin, another recently described hormone, improves metabolic control in mice by inducing -cell proliferation. Invitro, irisin stimulates the expression of betatrophin in rat adipocytes. There is a great interest in developing drugs that target or use these hormones for the treatment of obesity and diabetes. We have previously reported on increased levels of betatrophin in people with Type1 diabetes, but the levels of irisin are currently unknown. AimTo characterize the levels of irisin in Type1 diabetes and investigate a potential correlation with betatrophin. MethodsIrisin and betatrophin were measured by enzyme-linked immunosorbant assay (ELISA) in 45 individuals with Type1 diabetes and in 25 healthy controls. ResultsIrisin levels were increased in people with Type1 diabetes, and especially in women. Negative correlations between irisin levels and age at onset of Type1 diabetes and plasma triacylglycerol levels were observed. Interestingly, in women with Type1 diabetes a negative correlation between irisin and insulin doses was also observed. When computing correlations for all study participants, a positive correlation between irisin and total betatrophin was observed, but not between irisin and full-length betatrophin. ConclusionWe report on increased circulating levels of irisin in people with Type1 diabetes, especially in women. For women with Type1 diabetes, the levels of irisin correlated with lower insulin requirements. Further studies are clearly needed to determine the role of irisin in Type1 diabetes.

  • 8. Fadl, H. E.
    et al.
    Ostlund, I. K. M.
    Magnuson, A. F. K.
    Hanson, Ulf S. B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 20032010In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 27, no 4, p. 436-441Article in journal (Refereed)
    Abstract [en]

    P>Aims To determine maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden during 1991-2003, and to compare the outcomes in the two time periods. Methods This is a population-based cohort study using the Swedish Medical Birth Register data for the period 1991-2003. There were 1 260 297 women with singleton pregnancies registered during this time, of whom 10 525 were diagnosed with GDM, based on a 75 g oral glucose tolerance test. The main diagnostic criteria were fasting capillary whole blood glucose >= 6.1 mmol/l and 2 h blood glucose >= 9.0 mmol/l. Results Maternal characteristics differed significantly between the GDM and non-GDM group. Adjusted odds ratios (OR) were as follows: for pre-eclampsia, 1.81 (95% confidence interval (CI) 1.64-2.00); for shoulder dystocia, 2.74 (2.04-3.68); and for Caesarean section, 1.46 (1.38-1.54). No difference was seen in perinatal mortality, stillbirth rates, Apgar scores, fetal distress or transient tachypnoea. There was a markedly higher risk of large for gestational age, OR 3.43 (3.21-3.67), and Erb's palsy, OR 2.56 (1.96-3.32), in the GDM group, and statistically significant differences in prematurity < 37 weeks, birth weight > 4.5 kg, and major malformation, OR 1.19-1.71. No statistically significant improvement in outcomes was seen between the two study periods. Conclusions Women with GDM have higher risks of pre-eclampsia, shoulder dystocia and Caesarean section. Their infants are often large for gestational age and have higher risks of prematurity, Erb's palsy and major malformations. These outcomes did not improve over time.

  • 9. Fall, T.
    et al.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    The role of obesity-related genetic loci in insulin sensitivity2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 7, p. E62-E66Article in journal (Refereed)
    Abstract [en]

    Aims Despite rapid advancements and many new diabetes susceptibility loci found in the past few years, few genetic variants associated with insulin sensitivity have been described, potentially attributable to the lack of larger cohorts examined with gold standard methods for insulin sensitivity assessment. There is a strong link between obesity and insulin sensitivity, and we hypothesized that known obesity susceptibility loci may act via effects on insulin sensitivity. Methods A cohort of 71-year-old men without diabetes (Uppsala Longitudinal Study of Adult Men) underwent a euglycaemichyperinsulinaemic clamp and genotyping for genetic variants representing 32 loci recently reported to be associated with BMI (n = 926). The effect of these loci on the insulin sensitivity index (M/I ratio) was examined using linear regression. An in silico replication was performed in publically available data for the three top single-nucleotide polymorphisms from the Meta-Analyses of Glucose and Insulin-related traits Consortium analyses of homeostasis model assessment of insulin resistance (n = 37 037). Results Three loci (SH2B1, MTCH2 and NEGR1) were associated with decreased insulin sensitivity at a nominal significance (P = 0.05) after adjustment for BMI, but did not hold for multiple comparison correction. SH2B1 rs7359397 was also associated with homeostasis model assessment of insulin resistance in the Meta-Analyses of Glucose and Insulin-related traits Consortium data set (P = 3.9 x 10(3)). Conclusions Our study supports earlier reports of SH2B1 to be of importance in insulin sensitivity and, in addition, suggests potential roles of NEGR1 and MTCH2.

  • 10. Fawwaz, S.
    et al.
    Nikamo, P.
    Törn, C.
    Landin-Olsson, M.
    Lernmark, A.
    Alarcón-Riquelme, Marta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Kockum, I.
    No evidence of association of the PDCD1 gene with Type 1 diabetes2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 12, p. 1473-1477Article in journal (Refereed)
    Abstract [en]

    Aims: To test the association between the immunoreceptor PD-1 (PDCD1) gene and Type 1 diabetes mellitus (T1DM). This gene has been reported to be associated with other autoimmune diseases such as systemic lupus erythematosus (SLE) as well as T1DM. Methods: Genotyping of single nucleotide polymorphisms (SNPs) in the PDCD1 gene was performed using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP), pyrosequencing and TaqMan in two separate cohorts of Swedish patients and control subjects: a family study consisting of 184 multiplex and eight simplex families and a case-control study consisting of 586 patients and 836 control subjects. Three SNPs were genotyped: PD-1 7146, PD-1 7785 and PD-1 8738. Results: We did not detect any association or linkage between SNPs in PDCD1 and T1DM. We further performed a meta-analysis for association of PD-1 7146, PD-1 7785 and PD-1 8738 to T1DM. We detected heterogeneity in association with weak evidence for overall association. Conclusions: We conclude that PDCD1 is unlikely to be a major susceptibility gene for T1DM.

  • 11. Fhärm, E
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Eliasson, B
    Gudbjörnsdottir, S
    Rolandsson, O
    Time trends in absolute and modifiable coronary heart disease risk in patients with Type 2 diabetes in the Swedish National Diabetes Register (NDR) 2003-20082012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 2, p. 198-206Article in journal (Refereed)
    Abstract [en]

    Aims: 

    The aim was to evaluate treatment goal achievements early in the course of Type 2 diabetes, and their effect on 10-year risk of coronary heart disease in patients receiving usual care.

    Methods: 

    Assessment of risk factor control 3 years after diagnosis in patients with Type 2 diabetes with no previous coronary heart disease included from the Swedish National Diabetes Register; a total of 19 382 patients (mean age 58 years) in cross-sectional surveys from 2003 to 2008, and a subgroup of 4293 patients followed individually from year of diagnosis to follow-up after a mean 2.6 years. Estimation of absolute 10-year risk of coronary heart disease using the UK Prospective Diabetes Study risk engine, and modifiable 10-year risk defined as percentage excess risk above patients with 'normal' risk factor values.

    Results: 

    Treatment goals for HbA(1c) , blood pressure, total and LDL cholesterol were achieved in 78.4, 65.5, 55.6% and 61.0%, respectively, in the cross-sectional survey in 2008, following a trend of generally improved control. In the individually followed patients in the subgroup, mean absolute 10-year coronary heart disease risk increased from 13.7% (men/women 16.9/9.5%) to 14.2 (men/women 17.6/9.6%) (P < 0.001) from year of diagnosis to follow-up after 2.6 years, while mean modifiable risk decreased from 37.7% (men/women 28.6/49.9%) to 19.1% (13.2/26.9%) (P < 0.001 in all).

    Conclusions:

    A high achievement of treatment goals and a low mean modifiable 10-year coronary heart disease risk was found at the 3-year follow-up, both in the cross-sectional survey in 2008 and in patients individually followed since diagnosis. This indicates the feasibility and significance of early multifactorial risk factor treatment.

  • 12.
    Gao, H.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Hägg, Sara
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Sjögren, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lambert, P. C.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    van Dam, R. M.
    Serum selenium in relation to measures of glucose metabolism and incidence of Type 2 diabetes in an older Swedish population2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 7, p. 787-793Article in journal (Refereed)
    Abstract [en]

    Aims The relation between selenium status and risk of Type2 diabetes is controversial. We aimed to evaluate associations of serum selenium, a marker of dietary selenium, with measures of glucose metabolism and risk of diabetes. Methods We used data from a population-based, longitudinal cohort of 1925 Swedish men who were 50years old and did not have diabetes at baseline in the 1970s. At baseline, an intravenous glucose tolerance test was performed and, at a follow-up examination after 20years, an oral glucose tolerance test and a hyperinsulinaemic euglycaemic clamp for the assessment of insulin sensitivity were conducted. Results At baseline, the mean (standard deviation) selenium concentration was 75.6 (14.3) g/l. During 20years of follow-up, 88 incident cases of diabetes occurred in 1024 participants with follow-up data. Baseline serum selenium levels were not associated with risk of diabetes (odds ratio1.06; 95%CI 0.83-1.38). Higher selenium levels were associated with lower early insulin response (standardized -0.08; 95%CI -0.14 to -0.03) at baseline after adjusting for potential confounders, but not with any other measures of -cell function or insulin sensitivity at baseline or follow-up. The association with early insulin response was non-significant after taking multiple testing into account. Conclusions Our results do not support a role of dietary selenium in the development of disturbances in glucose metabolism or diabetes in older individuals.

  • 13. Garmo, A.
    et al.
    Hornsten, A.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Diabetes Nursing Research.
    "The pump was a saviour for me.": 'Patients' experiences of insulin pump therapy2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 6, p. 717-723Article in journal (Refereed)
    Abstract [en]

    Background and aim The present study formed part of a larger study examining the potential long-term effects of glycaemic control and treatment satisfaction in people with Type1 diabetes mellitus who changed from multiple daily insulin injections to insulin pump therapy. Individuals (n=46) who made the transition between May 1999 and February 2004 participated. The aim of the study was to describe experiences of the impact of insulin pump therapy in adults with Type1 diabetes mellitus after >5years' use of an insulin pump. Method During spring 2009, 16 of the individuals were interviewed through a narrative approach on the effects of insulin pump therapy on daily life. The interviews were analysed using content analysis. Results The overarching theme revealed that insulin pump therapy was experienced as both a shackle and a lifeline. Six sub-themes emerged: subjected vs. empowered; dependent vs. autonomous; vulnerable vs. strengthened; routinized vs. flexible; burdened vs. relieved; and stigmatized vs. normalized. Conclusions Users of insulin pump therapy have different views about and experience of having used the technical equipment over years. Both positive and negative views emerged. However, it is difficult to identify any general trends that cover all views and can predict which individuals will be able to manage pump therapy in the best way. Even so, the sub-themes and theme that emerged could be used by physicians and diabetes specialist nurses when counselling and planning educational programmes aimed at supporting self-management among people with insulin pump treatment.

  • 14.
    Garpenstrand, H
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Ekblom, J
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Bäcklund, L.B.
    Oreland, L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Elevated plasma semicarbazide-sensitive amineoxidase (SSAO) activity in type 2 diabetes melitus complicated by retinopathy1999In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 16, no 6, p. 514-521Article in journal (Refereed)
    Abstract [en]

    Aims To measure plasma semicarbazide-sensitive amine oxidase (SSAO) activities and detect retinopathy in Type 2 diabetes mellitus (DM).

    Methods Cross-sectional, population-based study of 65 diabetes patients (61 diagnosed from the age of 30 years) with or without retinopathy as determined by fundus photography in primary care. HbA1c was analysed by ion exchange chromatography on a Mono S for HbA1c column. SSAO activities were assayed radiometrically and formaldehyde-albumin adducts by ELISA in plasma samples from patients and 136 healthy controls.

    Results Subjects with diabetes had higher plasma SSAO activity, measured as nmol benzylamine.ml plasma-1.h-1(mean 20.6), than controls (mean 14.3), P < 0.0001; 95% confidence interval (CI) for difference 4.9–7.7. SSAO activity was higher in patients with retinopathy (mean 23.2) than in those without (mean 18.9), P = 0.012; 95% CI for difference 1.0–7.5, and related to the HbA1c value. No statistically significant relationship between diabetes duration and SSAO activity was found. With HbA1c values and insulin treatment entered into a multiple logistic regression model, SSAO activity no longer predicted retinopathy, P increasing from 0.025 to 0.17. SSAO activity and the presence of any retinopathy were unrelated to titres of antibodies against formaldehyde-treated human serum albumin.

    Conclusions SSAO activity, earlier found to be elevated in Type 1 DM, is also elevated in Type 2 DM. The SSAO family of enzymes may be involved in the development of diabetic retinopathy, possibly by catalysing the formation of toxic metabolites. A potent and specific inhibitor of human SSAO might help prevent retinopathy in Type 1 and Type 2 DM.

  • 15. Gudbjörnsdottir, S
    et al.
    Eeg-Olofsson, K
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Eliasson, B
    Nilsson, P. M.
    Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)2009In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 26, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    AIMS: Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. METHODS: This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). RESULTS: In patients with CHD 1-2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA(1c) < 7%, 47%/54% (P < 0.01); blood pressure < or = 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) > or = 25 kg/m(2)], 86%/85%; obesity (BMI > or = 30 kg/m(2)), 41%/42%; smokers in age group < 65 years, 16-23%/18-19%; as well as waist circumference > or = 102 cm (men) or > or = 88 cm (women), 68% in 2005. CONCLUSIONS: Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients.

  • 16.
    Hilden, K.
    et al.
    Univ Orebro, Sch Hlth & Med Sci, Dept Obstet & Gynaecol, Orebro, Sweden..
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Univ Orebro, Sch Hlth & Med Sci, Dept Obstet & Gynaecol, Orebro, Sweden.
    Persson, M.
    Karolinska Inst, Dept Clin Epidemiol, Stockholm, Sweden..
    Fadl, H.
    Univ Orebro, Sch Hlth & Med Sci, Dept Obstet & Gynaecol, Orebro, Sweden..
    Overweight and obesity: a remaining problem in women treated for severe gestational diabetes2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 8, p. 1045-1051Article in journal (Refereed)
    Abstract [en]

    Aim: To analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes.

    Methods: This was a population-based cohort study including all singleton pregnancies in Sweden without pre-existing diabetes in the period 1998-2012. Only mothers with an early-pregnancy BMI of >= 18.5 kg/m(2) were included. Logistic regression analysis was used to determine odds ratios with 95% CIs for maternal outcomes and fetal growth. Analyses were stratified by maternal gestational diabetes/non-gestational diabetes to investigate the impact of overweight/obesity in each group.

    Results: Of 1 249 908 singleton births, 13 057 were diagnosed with gestational diabetes (1.0%). Overweight/obesity had the same impact on the risks of caesarean section and fetal macrosomia in pregnancies with and without gestational diabetes, but the impact of maternal BMI on the risk of preeclampsia was less pronounced in women with gestational diabetes. Normal-weight women with gestational diabetes had an increased risk of caesarean section [odds ratio 1.26 (95% CI 1.16-1.37)], preeclampsia [odds ratio 2.03 (95% CI 1.71-2.41)] and large-for-gestational-age infants [odds ratio 2.25 (95% CI 2.06-2.46)]. Risks were similar in the overweight group without gestational diabetes, caesarean section [odds ratio 1.34 (1.33-1.36)], preeclampsia odds ratio [1.76 (95% CI 1.72-1.81)], large-for-gestational-age [odds ratio 1.76 (95% CI 1.74-1.79)].

    Conclusions: Maternal overweight and obesity is associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Obese women with gestational diabetes are defined as a high-risk group. Normal-weight women with gestational diabetes have similar risks of adverse outcomes to overweight women without gestational diabetes.

  • 17.
    Jansson, S P O
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, D K G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Effects of fasting blood glucose levels and blood pressure and treatment of diabetes and hypertension on the incidence of cardiovascular disease: a study of 740 patients with incident Type 2 diabetes with up to 30 years' follow-up.2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 9, p. 1055-63Article in journal (Refereed)
    Abstract [en]

    AIMS: To analyse the effects of hyperglycaemia and hypertension and treatment of diabetes and hypertension on cardiovascular disease incidence in patients with Type 2 diabetes with up to 30 years of follow-up.

    METHODS: A total of 740 patients with incident Type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual data on mean fasting blood glucose, systolic, diastolic and mean arterial blood pressure, and type of diabetes and hypertension treatment were obtained from patient records, and information on cardiovascular disease, myocardial infarction and stroke events was obtained from national registers.

    RESULTS: During the follow-up period, cumulative cardiovascular disease incidence increased significantly with male sex (hazard ratio 1.48, 95% CI 1.21-1.82), number of previous cardiovascular disease events (hazard ratio 1.13, 95% CI 1.08-1.18), age, per year (HR 1.05, 95% CI 1.04-1.07), mean fasting blood glucose, per mmol/l (hazard ratio 1.05, 95% CI 1.00-1.10) BMI (hazard ratio 1.04, 95% CI 1.01-1.06), mean arterial blood pressure, per mmHg (hazard ratio 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (hazard ratio 0.58, 95% CI 0.38-0.90) and sulfonylurea (hazard ratio 0.73, 95% CI 0.55-0.97). Cumulative myocardial infarction incidence increased significantly with male sex, number of previous myocardial infarction events, mean fasting blood glucose level, BMI, age and mean arterial blood pressure, and decreased with metformin treatment. Cumulative stroke incidence increased with number of previous stroke events, age and mean arterial blood pressure.

    CONCLUSIONS: The cumulative incidence of cardiovascular disease and myocardial infarction increased with number of previous events and presence of hyperglycaemia and hypertension and decreased with pharmacological treatment of diabetes. A higher number of previous stroke events increased the cumulative incidence of stroke but no protective effect of pharmacological treatment was observed.

  • 18.
    Jansson, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, Dan KG
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Effects of fasting blood glucose, diabetes treatment, blood pressure, and anti-hypertension treatment on cardiovascular disease incidence: a 30-year follow-up study of 740 incident patients with type 2 diabetes2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Article in journal (Refereed)
    Abstract [en]

    Aims To analyse the effects of hyperglycaemia and blood pressure, diabetes and anti-hypertension treatment on total and various types of cardiovascular disease incidence in patients with Type 2 diabetes followed for 30years. Methods A total of 740 incident patients with Type 2 diabetes were registered at the Laxa Primary Health Care Centre, Sweden between 1972 and 2001. Information on systolic, diastolic, and mean arterial blood pressure, mean fasting blood glucose, type of diabetes and anti-hypertension treatment was obtained from the patient records, and information on cardiovascular disease, myocardial infarction and stroke events from National Registers. Results During the follow-up period the cumulative incidence of cardiovascular disease increased significantly with male sex (HR 1.52, 95% CI 1.251.85), age (HR 1.05, 95% CI 1.041.07), year of diabetes onset (HR 1.03, 95% CI 1.011.05), BMI, (HR 1.04, 95% CI 1.021.07), mean arterial blood pressure (HR 1.04, 95% CI 1.021.05) and number of previous cardiovascular disease events (HR 1.15, 95% CI 1.101.21), and decreased significantly with sulfonylurea treatment (HR 0.64, 95% CI 0.490.84), insulin (HR 0.57, 95% CI 0.330.98) and calcium channel blocker treatment (HR, 0.69, 95% CI 0.480.99). Cumulative incidence of myocardial infarction increased significantly with male sex, age, BMI, mean arterial blood pressure, number of previous myocardial infarction events and diuretic treatment, and decreased with metformin treatment. Cumulative incidence of stroke increased with age, year of diabetes onset, mean arterial blood pressure, and previous number of stroke events. Conclusions Cumulative cardiovascular disease, myocardial infarction and incidence of stroke increased with number of previous events and presence of hypertension and decreased with pharmacological anti-diabetic treatment and, to a lesser extent, with anti-hypertension treatment.

  • 19.
    Jansson, Stefan P O
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, D K G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Mortality and cardiovascular disease outcomes among 740 patients with new-onset Type 2 diabetes detected by screening or clinically diagnosed in general practice.2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 3, p. 324-331Article in journal (Refereed)
    Abstract [en]

    AIM: Screening for Type 2 diabetes among people at high risk is recommended by many organizations. The aim of this study was to analyse all-cause mortality and cardiovascular disease (CVD) outcomes in patients with Type 2 diabetes detected by screening or diagnosed clinically.

    METHODS: A diabetes register was established at the primary healthcare centre in Laxå, Sweden beginning in 1972. The register was based on data from clinical records with information on medical treatment and laboratory data, as well as all-cause mortality, CVD, myocardial infarction and stroke events from national registers until 31 December 2013. A total of 740 patients with new-onset Type 2 diabetes were registered between 1972 and 2001. In addition, an opportunistic diabetes-screening programme involving people aged 35-79 years started in 1983 and was repeated onwards in 5-year cycles.

    RESULTS: Baseline characteristics showed a significantly higher CVD risk, mainly depending on more prevalent CVD events in the screened compared with the clinically detected group (propensity score 0.59 vs. 0.46, P < 0.0001). After mean follow-up periods of 12.9 and 13.6 years for screening detected vs. clinically detected patients, respectively, hazard ratios were as follows: all-cause mortality, 0.99 (P = 0.89); CVD, 1.17 (P = 0.10); myocardial infarction, 1.08 (P = 0.49); and stroke, 1.03 (P = 0.83).

    CONCLUSIONS: No reduction in total mortality or CVD outcomes was found in patients with Type 2 diabetes that was detected by screening compared with those diagnosed clinically.

  • 20.
    Jansson, Stefan P.O.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Andersson, Dan K.G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Effects of fasting blood glucose, diabetes treatment, blood pressure, and hypertension treatment on cardiovascular disease incidence: A 30-year follow-up study of 740 incident patients with type 2 diabetesIn: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Article in journal (Refereed)
    Abstract [en]

    Aims: To analyse the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment on total and various types of cardiovascular disease (CVD) incidence in patients with type 2 diabetes followed for 30 years.

    Methods: 740 incident patients with type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual information on systolic, diastolic, and mean arterial blood pressure (MABP), mean fasting blood glucose (FBG), type of diabetes and hypertension treatment was obtained from the patient records, and information on CVD, myocardial infarction (MI), and stroke events from National Registers.

    Results: During the follow-up period cumulative CVD incidence increased significantly with male sex (HR 1.48, 95% CI 1.21-1.82), number of previous CVD events (HR 1.13, 95% CI 1.08-1.18) age (HR 1.05, 95% CI 1.04-1.07), mean FBG (HR 1.05, 96% CI 1.00-1.10) BMI, (HR 1.04, 95% CI 1.01-1.06), MABP (HR 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (HR 0.58, 95% CI 0.38-0.90) and sulfonylurea (HR 0.73, 95% CI 0.55-0.97). Cumulative MI incidence increased significantly with male sex, number of previous MI events, mean FBG, BMI, age, and MABP, and decreased with metformin treatment. Cumulative stroke incidence increased with previous number of stroke events, age, and MABP.

    Conclusions: Cumulative CVD and MI incidence increased with number of previous events and presence of hypertension and hyperglycaemia and decreased with pharmacological diabetic treatment. For stroke, previous number of events increased the incidence but no pharmacological protective effect was seen.

  • 21. Jensen, R.
    et al.
    Gilliam, L.
    Törn, C.
    Landin-Olsson, M.
    Palmer, J.
    Åkesson, K.
    Kockum, I.
    Lernmark, B.
    Karlsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lynch, K. F.
    Breslow, N.
    Lernmark, Åke
    Sundkvist, G.
    Islet cell autoantibody levels after the diagnosis of young adult diabetic patients2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 11, p. 1221-1228Article in journal (Refereed)
    Abstract [en]

    Aims The aim was to determine the course of islet cell antibodies [glutamate decarboxylase (GADA), tyrosine phosphatase-like islet antigen 2 (IA-2A) and islet cell (ICA)] after the diagnosis of the diabetic patient.

    Methods The Diabetes Incidence Study in Sweden (DISS) attempted to prospectively enrol all newly diagnosed diabetic patients aged 15–34 years during 1992 and 1993. C-peptide and autoantibody levels were determined from venous blood samples at diagnosis and again at yearly intervals for 6 years.

    Results After the first year, the odds of remaining GADA positive decreased by 9% per year [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.85–0.96] while the mean GADA index remained unchanged ( = 0.8, P = 0.37). There was no change in the percentage of subjects testing IA-2A positive after the first year ( = 0.1, P = 0.75). However, the mean index decreased 0.04 per year (95% CI: 0.03–0.05)—a 7.9% decline (95% CI: 5.4–10.4%). The odds of a subject testing positive for ICA decreased by 24% per year (OR = 0.76, 95% CI = 0.70–0.82). The mean ICA levels decreased 0.75 per year (95% CI: 0.66–0.84)—a 16.4% decline (95% CI: 14.1–18.6%). The rate of change in titres for all three autoantibodies was independent of gender, human leucocyte antigen genotype and C-peptide status.

    Conclusions GADA levels remained high while ICA levels declined. In contrast to a previous study, we found that the proportion of IA-2A subjects remaining positive did not decrease after the first year, while the average index decreased slightly.

  • 22.
    Johansson, H.-E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Öhrvall, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Haenni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Edén Engström, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Gastric bypass alters the dynamics and metabolic effects of insulin and proinsulin secretion2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 11, p. 1213-1220Article in journal (Refereed)
    Abstract [en]

    Aims Hyperproinsulinaemia is associated with obesity and is a risk factor for Type 2 diabetes. We explored the dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in subjects who had undergone gastric bypass (GBP) surgery compared with morbidly obese (MO) subjects and normal weight control subjects (NW). Methods Subjects free from diabetes were recruited: 10 previously MO subjects [body mass index (BMI) ± SD, 34.8 ± 6.2 kg/m2] who had undergone GBP surgery, 10 MO subjects (BMI 44 ± 3.1 kg/m2) and 12 NW control subjects (BMI 23.2 ± 2.4 kg/m2). After an overnight fast, a standard meal (2400 kJ) was ingested and glucose, proinsulin, insulin free fatty acids and triglycerides were determined up to 180 min. Results Fasting proinsulin was similar in the GBP group and NW control subjects, but threefold increased in MO subjects (P < 0.05). Postprandial AUC for glucose was similar in the three groups and AUC for proinsulin was high in MO, intermediate in the GBP group and lowest in NW control subjects (P for trend = 0.020). Postprandial proinsulin at 60 min was similar in the GBP group and MO subjects and twofold higher than in NW control subjects. Postprandial proinsulin at 180 min was normal in the GBP group, but fivefold increased in MO subjects (P = 0.008). Insulin increased rapidly at 30 min in the GBP group and was normal at 90 min, whereas insulin was still increased at 90-180 min in the MO subjects (P < 0.001). Conclusions MO subjects, free from diabetes, have elevated proinsulin concentrations in the fasting as well as the postprandial phase. After GBP surgery markedly lower fasting and postprandial proinsulin concentrations were observed, although BMI was higher compared with NW control subjects.

  • 23. Jonsson, PM
    et al.
    Nystrom, L
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sterky, G
    Wall, S
    Ostman, J
    Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis1996In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 13, p. 1056-1063Article in journal (Refereed)
    Abstract [en]

    All incident cases of diabetes mellitus in the age group 15 to 34 years have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease onset, we selected the cases registered in 1983 and two controls per case from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns during a 3-month period were collected via a mailed questionnaire, returned by 317 (72%) patients with diabetes and 586 (68%) controls. Seventy-four percent of the cases and 19% of the controls reported at least one visit to a hospital outpatient clinic, including accident and emergency departments. The odds ratio for one visit was 14 (95% CI 9.6-20), for two visits 11 (95% CI 7.0-18), and for three or more visits 8.9 (95% CI 5.6-14). Even when specialized diabetes clinics were excluded from the analysis, the cases had higher odds for visits to internal medicine clinics, to ophthalmology clinics, and to gynaecology clinics, but not for visits to surgical clinics or to accident and emergency departments. Of non-hospital outpatient services, only visits to nurse practitioners were reported by a higher percentage of diabetic responders. Twenty-seven percent of patients with diabetes, as compared to 9% of the controls, had visited both hospital and non-hospital outpatient offices. Females were overrepresented among diabetic high-consumers. The results indicate that most young to middle-aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerable overlap exists between hospital and non-hospital outpatient services. Further research is needed into the determinants of utilization patterns in diabetes, such as gender.

  • 24.
    Karacagil, Sadettin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Almgren, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bowald, S.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Comparative analysis of patency, limb salvage and survival in diabetic and non-diabetic patients undergoing infrainguinal bypass surgery1995In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 12, no 6, p. 537-541Article in journal (Refereed)
    Abstract [en]

    In 92 diabetic and 175 non-diabetic patients undergoing 336 femoropopliteal or femorodistal bypass procedures, 1- and 3-year cumulative life-table patency, limb salvage, and survival rates were comparatively analysed. The peroperative mortality rate was significantly higher in diabetic patients (5% compared to 1.4%, p < 0.001). The cumulative graft patency rates were 61% at 12 months and 46% at 36 months in diabetic patients compared to 64 and 52% in non-diabetic patients. Significantly better patency rates were observed in limbs with good runoff compared to limbs with poor runoff in both groups. The limb salvage rates at 3 years were 70% in diabetic patients and 62% in non-diabetic patients. The survival rate at 3 years was significantly lower in diabetic patients, 62% compared to 86% in non-diabetic patients. Diabetic patients with poor runoff demonstrated a significantly lower survival rate after 36 months compared to diabetic patients with good runoff (48% and 74%, respectively). The results of this study demonstrate that the early and intermediate patency and limb salvage rates are similar in diabetic and non-diabetic patients. On the other hand the survival rate in diabetic patients, especially in those with poor distal runoff, is significantly lower than non-diabetic patients.

  • 25. Kelly, P. J.
    et al.
    Clarke, P. M.
    Hayes, A. J.
    Gerdtham, U. -G
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nilsson, P.
    Eliasson, B.
    Gudbjornsdottir, S.
    Predicting mortality in people with Type 2 diabetes mellitus after major complications: a study using Swedish National Diabetes Register data2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 8, p. 954-962Article in journal (Refereed)
    Abstract [en]

    Aim To predict mortality risk and life expectancy for patients with Type 2 diabetes after a major diabetes-related complication. Methods The study sample, taken from the Swedish National Diabetes Register, consisted of 20 836 people with Type 2 diabetes who had their first major complication (myocardial infarction, stroke, heart failure, amputation or renal failure) between January 2001 and December 2007. A Gompertz proportional hazards model was derived which determined significant risk factors associated with mortality and was used to estimate life expectancies. Results Risk of death changed over time according to type of complication, with myocardial infarction initally having the highest initial risk of death, but after the first month, the risk was higher for heart failure, renal failure and amputation. Other factors that increased the risk of death were male gender (hazard ratio 1.06, 95% CI 1.02-1.12), longer duration of diabetes (hazard ratio 1.07 per 10 years, 95% CI 1.04-1.10), smoking (hazard ratio 1.51, 95% CI 1.40-1.63) and macroalbuminuria (hazard ratio 1.14, 95% CI 1.06-1.22). Low BMI, low systolic blood pressure and low estimated GFR also increased mortality risk. Life expectancy was highest after a stroke, myocardial infarction or heart failure, lower after amputation and lowest after renal failure. Smoking and poor renal function were the risk factors which had the largest impact on reducing life expectancy. Conclusions Risk of death and life expectancy differs substantially among the major complications of diabetes, and factors significantly increasing risk included smoking, low estimated GFR and albuminuria.

  • 26. Lindmark, S
    et al.
    Wiklund, U
    Bjerle, P
    Eriksson, Jan W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Does the autonomic nervous system play a role in the development of insulin resistance? A study on heart rate variability in first-degree relatives of Type 2 diabetes patients and control subjects.2003In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 20, no 5, p. 399-405Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate dysregulation of the autonomic nervous system as a potential mechanism for early insulin resistance in the development of Type 2 diabetes.

    METHODS: Thirteen healthy individuals with first-degree relatives with Type 2 diabetes (R) were compared with 14 control subjects without family history of diabetes (C), matched for age, body mass index and sex. An oral glucose tolerance test and a hyperinsulinaemic euglycaemic clamp were performed. Analysis of heart rate variability during rest, controlled breathing, an orthostatic manoeuvre and a standardized physical stress (cold pressor test (CPT)), were used to evaluate the activity of the autonomic nervous system.

    RESULTS: Fasting blood glucose, HbA1c and serum insulin were similar in the R and C groups. The M-value, reflecting insulin sensitivity, did not differ significantly between the groups. Total spectral power and high-frequency power were lower in R during controlled breathing (P = 0.05 and P = 0.07, respectively), otherwise there were no significant differences between R and C in heart rate variability. However, low-frequency (LF)/high-frequency (HF) spectral power ratio during CPT, reflecting sympathetic/parasympathetic balance, was negatively associated with insulin sensitivity (r = -0.53, P = 0.006). When all subjects were divided into two groups by the mean M-value, the low M-value group displayed an overall higher LF/HF ratio (P = 0.04). HF power was lower in the low M-value group during controlled breathing and CPT (P = 0.01 and P = 0.03, respectively).

    CONCLUSION: An altered balance of the parasympathetic and sympathetic nervous activity, mainly explained by an attenuated parasympathetic activity, might contribute to the development of insulin resistance and Type 2 diabetes.

  • 27. Lofvenborg, J. E.
    et al.
    Andersson, T.
    Carlsson, Per-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Dorkhan, M.
    Groop, L.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Rasouli, B.
    Storm, P.
    Tuomi, T.
    Carlsson, S.
    Coffee consumption and the risk of latent autoimmune diabetes in adults-results from a Swedish case-control study2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 7, p. 799-805Article in journal (Refereed)
    Abstract [en]

    Aims Coffee consumption is associated with a reduced risk of Type2 diabetes. Our aim was to investigate if coffee intake may also reduce the risk of latent autoimmune diabetes in adults, an autoimmune form of diabetes with features of Type2 diabetes. Methods We used data from a population-based case-control study with incident cases of adult onset (35years) diabetes, including 245 cases of latent autoimmune diabetes in adults (glutamic acid decarboxylase antibody positive), 759 cases of Type2 diabetes (glutamic acid decarboxylase antibody negative), together with 990 control subjects without diabetes, randomly selected from the population. Using questionnaire information on coffee consumption, we estimated the odds ratio of latent autoimmune diabetes in adults and Type2 diabetes adjusted for age, sex, BMI, smoking, physical activity, alcohol, education and family history of diabetes. Results Coffee intake was inversely associated with Type2 diabetes (odds ratio0.92, 95%CI 0.87-0.98 per cup/day). With regard to latent autoimmune diabetes in adults, the general trend was weak (odds ratio1.04, 95%CI 0.96-1.13), but stratification by degree of autoimmunity (median glutamic acid decarboxylase antibody levels) suggested that coffee intake may be associated with an increased risk of high glutamic acid decarboxylase antibody latent autoimmune diabetes in adults (odds ratio1.11, 95%CI 1.00-1.23 per cup/day). Furthermore, for every additional cup of coffee consumed per day, there was a 15.2% (P=0.0268) increase in glutamic acid decarboxylase antibody levels. Conclusions Our findings confirm that coffee consumption is associated with a reduced risk of Type2 diabetes. Interestingly, the findings suggest that coffee may be associated with development of autoimmunity and possibly an increased risk of more Type1-like latent autoimmune diabetes in adults.

  • 28. Nathanson, D.
    et al.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Andrén, Bertel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Ingelsson, E.
    Holst, J. J.
    Nyström, T.
    Plasma levels of glucagon like peptide-1 associate with diastolic function in elderly men2011In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 28, no 3, p. 301-305Article in journal (Refereed)
    Abstract [en]

    Aims: Congestive heart failure is a major cause of morbidity and mortality in diabetes. Besides the glycaemic effects of glucagon-like peptide 1 (GLP-1) mimetics, their effects on the heart are of interest. Methods We aimed to investigate longitudinal relationships between plasma levels of fasting GLP-1 (fGLP-1), 60-min oral glucose tolerance test-stimulated GLP-1 levels (60GLP-1), and the dynamic GLP-1 response after oral glucose tolerance test (Delta GLP-1 = 60GLP-1 - fGLP-1) and incidence of hospitalized congestive heart failure, during a follow-up time of a maximum of 9.8 years in 71-year-old men. We also investigated, cross-sectionally, the association between GLP-1 and left ventricular function as estimated by echocardiography. Results During the follow-up period, 16 of 290 participants with normal glucose tolerance experienced a congestive heart failure event (rate 0.7/100 person-years at risk), as did eight of 136 participants (rate 0.8/100 person-years at risk) with impaired glucose tolerance and nine of 72 participants (rate 1.7/100 person-years at risk) with Type 2 diabetes mellitus. Although GLP-1 concentrations did not predict congestive heart failure (fGLP-1: HR 0.98, 95% CI 0.4-2.4; 60GLP-1: HR 1.1, 95% CI 0.4-2.6; Delta GLP-1: HR 0.9, 95% CI 0.3-2.3), there was an association between left ventricular diastolic function (E/A ratio) and fGLP-1 (r = 0.19, P = 0.001), 60GLP-1 (r = 0.20, P < 0.001) and Delta GLP-1 (r = 0.18, P = 0.004). There was a lack of differences in plasma levels of GLP-1 between the groups with Type 2 diabetes and normal glucose tolerance. Conclusions There were no longitudinal associations between GLP-1 levels and incidence of hospitalization for congestive heart failure. However, without any causality proven, GLP-1 levels did correlate, cross-sectionally, with left ventricular diastolic function in this cohort, suggesting that pathways including GLP-1 might be involved in the regulation of cardiac diastolic function.

  • 29. Ostgren, C. J.
    et al.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Svennblad, Bodil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lohm, L.
    Nilsson, P. M.
    Johansson, G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Associations of HbA1c and educational level with risk of cardiovascular events in 32871 drug-treated patients with Type2 diabetes: a cohort study in primary care2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 5, p. E170-E177Article in journal (Refereed)
    Abstract [en]

    Aims To explore the association of HbA1c and educational level with risk of cardiovascular events and mortality in patients with Type2 diabetes. Methods A cohort of 32871 patients with Type2 diabetes aged 35years and older identified by extracting data from electronic patient records for all patients who had a diagnosis of Type2 diabetes and had glucose-lowering agents prescribed between 1999 and 2009 at 84 primary care centres in Sweden. Associations of mean HbA1c levels and educational level with risks of cardiovascular events and all-cause mortality were analysed. Results The associations of HbA1c with risk of all-cause and cardiovascular mortality were J-shaped, with the lowest risk observed for cardiovascular mortality at an HbA1c level of 51mmol/mol (6.8%) for subjects on oral agents and 56mmol/mol (7.3%) in insulin-treated patients. The lowest risk observed for all-cause mortality was at an HbA1c level of 51mmol/mol (6.8%) for subjects on oral agents and 56mmol/mol (7.3%) in insulin-treated patients. There was an increased risk for cardiovascular death [hazard ratio1.6 (1.22.1), P=0.0008] at the lowest HbA1c decile for subjects in the low education category. For subjects with higher education there was no evident J curve for cardiovascular death [hazard ratio1.2 (0.81.6), P=0.3873]. Conclusions Our results lend support to the recent American Diabetes Association/ European Association for the Study of Diabetes position statement that emphasizes the importance of additional factors, including the propensity for hypoglycaemia, which should influence HbA1c targets and treatment choices for individual patients. 

  • 30.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lagali, N.
    Linkoping Univ, Dept Clin & Expt Med, Sect Ophthalmol, Linkoping, Sweden..
    Dahlin, L. B.
    Hand Surg Lund Univ, Dept Translat Med, Malmo, Sweden.;Skane Univ Hosp, Dept Hand Surg, Malmo, Sweden..
    Rolandsson, O.
    Umea Univ, Dept Publ Hlth & Clin Med, Sect Family Med, Umea, Sweden..
    Association between HbA1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 12, p. 1756-1764Article in journal (Refereed)
    Abstract [en]

    Aims: To explore the association between HbA(1c) and sural nerve function in a group of people with normal glucose tolerance, impaired glucose tolerance or Type 2 diabetes.

    Methods: We conducted a 10-year follow-up study in 87 out of an original 119 participants. At study commencement (2004), 64 men and 55 women (mean age 61.1 years) with normal glucose tolerance (n=39), impaired glucose tolerance (n=29), or Type 2 diabetes (n=51) were enrolled. At the 2014 follow-up (men, n=46, women, n=41; mean age 71.1 years), 36, nine and 42 participants in the normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes categories, respectively, were re-tested. Biometric data and blood samples were collected, with an electrophysiological examination performed on both occasions.

    Results: At follow-up, we measured the amplitude of the sural nerve in 74 of the 87 participants. The mean amplitude had decreased from 10.9 V (2004) to 7.0 mu V (2014; P<0.001). A 1% increase in HbA(1c) was associated with a similar to 1% average decrease in the amplitude of the sural nerve, irrespective of group classification. Crude and adjusted estimates ranged from -0.84 (95% CI -1.32, -0.37) to -1.25 (95% CI -2.31, -0.18). Although the mean conduction velocity of those measured at both occasions (n=73) decreased from 47.6 m/s to 45.8 m/s (P=0.009), any association with HbA(1c) level was weak. Results were robust with regard to potential confounders and missing data.

    Conclusions: Our data suggest an association between sural nerve amplitude and HbA(1c) at all levels of HbA(1c). Decreased amplitude was more pronounced than was diminished conduction velocity, supporting the notion that axonal degeneration is an earlier and more prominent effect of hyperglycaemia than demyelination.

  • 31.
    Rasouli, B.
    et al.
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, Stockholm, Sweden..
    Andersson, T.
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Carlsson, P-O
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Grill, V.
    Norwegian Univ Sci & Technol, NTNU Inst Canc Res & Mol Med, Trondheim, Norway.;Univ Trondheim Hosp, Dept Endocrinol, Trondheim, Norway..
    Groop, L.
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden..
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Midthjell, K.
    Norwegian Univ Sci & Technol, Dept Community Med & Gen Practice, HUNT Res Ctr, Levanger, Norway..
    Storm, P.
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden..
    Tuomi, T.
    Univ Helsinki, Cent Hosp, Dept Med, Helsinki, Finland.;Univ Helsinki, Res Program Diabet & Obes, Helsinki, Finland..
    Carlsson, S.
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, Stockholm, Sweden..
    Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA)2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 4, p. 514-521Article in journal (Refereed)
    Abstract [en]

    AimsIt has been suggested that moist snuff (snus), a smokeless tobacco product that is high in nicotine and widespread in Scandinavia, increases the risk of Type 2 diabetes. Previous studies are however few, contradictory and, with regard to autoimmune diabetes, lacking. Our aim was to study the association between snus use and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA). MethodAnalyses were based on incident cases (Type 2 diabetes, n = 724; LADA, n = 200) and population-based controls (n = 699) from a Swedish case-control study. Additional analyses were performed on cross-sectional data from the Norwegian HUNT study (n = 21 473) with 829 prevalent cases of Type 2 diabetes. Odds ratios (OR) were estimated adjusted for age, BMI family history of diabetes and smoking. Only men were included. ResultsNo association between snus use and Type 2 diabetes or LADA was seen in the Swedish data. For Type 2 diabetes, the OR for > 10 box-years was 1.00 [95% confidence interval (CI), 0.47 to 2.11] and for LADA 1.01 (95% CI, 0.45 to 2.29). Similarly, in HUNT, the OR for Type 2 diabetes in ever-users was estimated at 0.91 (95% CI, 0.75 to 1.10) and in heavy users at 0.92 (95% CI, 0.46 to 1.83). ConclusionThe risk of Type 2 diabetes and LADA is unrelated to the use of snus, despite its high nicotine content. This opens the possibility of the increased risk of Type 2 diabetes seen in smokers may not be attributed to nicotine, but to other substances in tobacco smoke.

  • 32.
    Rasouli, B.
    et al.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Andersson, T.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Carlsson, P-O
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden..
    Hjort, R.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Lofvenborg, J. E.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Groop, L.
    Lund Univ, Dept Clin Sci Malmo, Clin Res Ctr, Malmo, Sweden.;Univ Helsinki, Finnish Inst Mol Med, Helsinki, Finland..
    Tuomi, T.
    Univ Helsinki, Helsinki Univ Hosp, Abdominal Ctr, Res Program Diabet & Obes,Div Endocrinol, Helsinki, Finland.;Folkhalsan Res Ctr, Helsinki, Finland..
    Carlsson, S.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Serious life events and the risk of latent autoimmune diabetes in adults (LADA) and Type 2 diabetes2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 9, p. 1259-1263Article in journal (Refereed)
    Abstract [en]

    AimIt has been suggested that experiencing serious life events may promote Type1 diabetes in children. Studies in adults are lacking, as are studies on the interaction of life events with genetic factors. We aimed to investigate life events and the risk of latent autoimmune diabetes in adults (LADA) and Type 2 diabetes while taking into account HLA genotype. MethodsAnalysis was based on 425 incident cases of LADA, 1417 incident cases of Type 2 diabetes and 1702 population-based controls recruited in Sweden between 2010 and 2016. Self-reported information on life events including conflicts, divorce, illness/accidents, death and financial problems experienced during the 5years preceding diagnosis/index year was used. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated by logistic regression and adjusted for age, sex, BMI, family history of diabetes, smoking, physical activity and education. ResultsOverall there was no association between experience of any life event and either LADA (OR 0.86, 95% CI 0.68-1.08) or Type2 diabetes (OR 1.00, 95% CI 0.83-1.21). The results were similar for individual events as well as in separate analysis of men and women. Similar results were seen in more autoimmune LADA (glutamic acid decarboxylase antibodies >median) [OR (any life event) 0.88, 95% CI 0.64-1.21] and in LADA carriers of the high-risk HLADR4-DQ8 genotype (OR 0.89, 95% CI 0.61-1.29). ConclusionsOur findings indicate that experience of a serious life event, including the death of a family member, divorce or financial problems, is not associated with an increased risk of LADA, overall or in genetically susceptible individuals.

  • 33. Ringborg, A.
    et al.
    Lindgren, P.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Yin, D. D.
    Schön, S.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Prevalence and incidence of Type 2 diabetes and its complications 1996-2003: estimates from a Swedish population-based study2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 10, p. 1178-1186Article in journal (Refereed)
    Abstract [en]

    AIMS

    To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003.

    METHODS

    Retrospective population-based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30-39, 40-49, 50-59, 60-69, 70-79 and > or = 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause-of-death registers.

    RESULTS

    Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged > or = 30 years, the age- and sex-adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47-1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age- and sex-adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94-0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation.

    CONCLUSIONS

    Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes-related complications, notably cardiovascular disease, continued to impose a substantial burden.

  • 34.
    Schölin, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Nyström, L.
    Arnqvist, H.
    Bolinder, J.
    Björk, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Proinsulin/C-peptide ratio, glucagon and remission in new-onset Type 1 diabetes mellitus in young adults2011In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 28, no 2, p. 156-161Article in journal (Refereed)
    Abstract [en]

    Aims: After initiation of treatment in Type 1 diabetes, a period with lower insulin requirement often follows, reflecting increased insulin sensitivity and improved insulin secretion. We explored if efficiency of proinsulin processing is associated with the remission phenomenon. Methods Seventy-eight patients with new-onset Type 1 diabetes were followed prospectively for 3 years. Daily insulin dosage, HbA(1c), plasma glucose, proinsulin, C-peptide, glucagon concentrations and islet antibodies were determined at diagnosis and after 3, 6, 9, 12, 18, 24, 30 and 36 months. We studied remission, defined as an insulin dose < 0.3 U kg-1 24 h-1 and HbA(1c) within the normal range, in relation to the above-mentioned variables. Results A rise and subsequent decline in plasma proinsulin and C-peptide concentrations was observed. Forty-five per cent of the patients experienced remission at one or more times, characterized by higher proinsulin and C-peptide levels, and lower proinsulin/C-peptide ratios, indicating more efficient proinsulin processing, compared with those not in remission. Non-remission also tended to be associated with higher glucagon values. Patients entering remission were more often men, had higher BMI at diagnosis, but did not differ at baseline with respect to islet antibody titres compared with patients with no remission. Conclusions Remissions after diagnosis of Type 1 diabetes were associated with lower proinsulin/C-peptide ratios, suggesting more efficient proinsulin processing, and tended to have lower glucagon release than non-remissions. This indicates that, in remission, the residual islets maintain a secretion of insulin and glucagon of benefit for control of hepatic glucose production.

  • 35.
    Schölin, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Törn, C
    Nyström, L
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Arnqvist, H
    Blohme, G
    Bolinder, J
    Eriksson, Jan W
    Department of Medicine, Umeå Hospital.
    Kockum, I
    Landin-Olsson, M
    Östman, J
    Karlsson, F Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Sundkvist, G
    Björk, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Normal weight promotes remission and low number of islet antibodies prolong the duration of remission in Type 1 diabetes2004In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 21, no 5, p. 447-455Article in journal (Other academic)
    Abstract [en]

    Aim 

    To identify clinical, immunological and biochemical factors that predict remission, and its duration in a large cohort of young adults with Type 1 diabetes mellitus (DM).

    Methods 

    In Sweden, 362 patients (15–34 years), classified as Type 1 DM were included in a prospective, nation-wide population-based study. All patients were followed at local hospitals for examination of HbA1c and insulin dosage over a median period after diagnosis of 5 years. Duration of remission, defined as an insulin maintenance dose ≤ 0.3 U/kg/24 h and HbA1c within the normal range, was analysed in relation to characteristics at diagnosis.

    Results 

    Remissions were seen in 43% of the patients with a median duration of 8 months (range 1–73). Sixteen per cent had a remission with a duration > 12 months. Among patients with antibodies (ab+), bivariate analysis suggested that adult age, absence of low BMI, high plasma C-peptide concentrations, lack of ketonuria or ketoacidosis at diagnosis and low insulin dose at discharge from hospital were associated with a high possibility of achieving remission. Multiple regression showed that normal weight (BMI of 20–24.9 kg/m2) was the only factor that remained significant for the possibility of entering remission. In survival analysis among ab+ remitters, a low number of islet antibodies, one or two instead of three or four, were associated with a long duration of remissions.

    Conclusion 

    In islet antibody-positive Type 1 DM, normal body weight was the strongest factor for entering remission, whilst a low number of islet antibodies was of importance for the duration.

  • 36. Sparring, V.
    et al.
    Nystrom, L.
    Ostman, J.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Burstrom, K.
    Jonsson, P. M.
    Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 6, p. 784-791Article in journal (Refereed)
    Abstract [en]

    Aims To describe healthcare utilization patterns in young and middle-aged patients with diabetes 1 year and 8 years after diagnosis and to compare with the general population at two time points, 16 years apart.

    Methods Four cohorts with disease duration of 1 year or 8 years were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the 15- to 34-year age group. Control subjects were selected from the population register matched by age, sex and county of residence. A postal questionnaire was sent to the 1983 and 1992 cohorts in 1991 and 1993, and to the 1999 and 2008 cohorts in 2007 and 2009. Nine hundred and thirteen patients with diabetes and 1679 control subjects responded.

    Results One year after diagnosis, 49% of patients with diabetes in the 1992 cohort compared with 4.2% in the 2008 cohort reported visits to departments of internal medicine and endocrinology. A similar pattern was seen 8 years after diagnosis. The use of day care was 45 times higher among patients with diabetes compared with control subjects. Utilization of outpatient hospital care was higher among patients with diabetes compared with control subjects, even when excluding visits to diabetes clinics.

    Conclusions Excess use of health care among patients with diabetes remained 16 years after the first follow-up. Utilization patterns were stable, except for a major decrease in inpatient care 1 year after diagnosis and an increase in day care 8 years after diagnosis. Observed changes probably reflect successive reforming of diabetes care in Sweden.

  • 37.
    Särnblad, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ingberg, Claes-Mårten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Åman, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Schvarcz, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Body composition in young female adults with Type 1 diabetes mellitus. A prospective case-control study2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 7, p. 728-734Article in journal (Refereed)
    Abstract [en]

    Aims: Overweight is common during late puberty in female patients with Type 1 diabetes. The aim of this study was to examine the change in body composition from late puberty to early adulthood in such female patients in comparison with age-matched control subjects.

    Methods: Eighteen females with Type 1 diabetes and 19 healthy female control subjects were recruited for a case-control study at the age of 16-19 years (baseline). Six years later, 16 of the diabetic females and 17 of the control subjects were re-examined (follow-up). Body composition was assessed by dual energy X-ray absorptiometry.

    Results: Body mass index (BMI) and fat mass index (total fat mass/height(2)) were significantly higher at baseline in the diabetic patients than in the control subjects (26.4 +/- 2.6 vs. 23.9 +/- 3.7 kg/m(2), P < 0.05, and 10.0 +/- 2.4 vs. 8.0 +/- 2.8 kg/m(2), P = 0.04, respectively). At follow-up, these parameters still tended to be higher in the diabetic group (27.8 +/- 4.9 vs. 24.6 +/- 5.7 kg/m(2), P = 0.09, and 11.8 +/- 5.6 vs. 8.7 +/- 4.9 kg/m(2), P = 0.05, respectively). BMI at baseline was strongly correlated to BMI at follow-up in both diabetic patients (r = 0.60; P < 0.05) and control subjects (r = 0.83; P < 0.01).

    Conclusions: Increased fat mass in pubertal girls with Type 1 diabetes seems to persist in young adulthood. This study emphasizes the need for new strategies to prevent the development of overweight during puberty in diabetic girls.

  • 38.
    Söderström, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Samuelsson, U
    Sahlqvist, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Åman, J
    Impaired metabolic control and socio-demographic status in immigrant children at onset of Type 1 diabetes2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 11, p. 1418-1423Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type 1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status.

    METHODS AND DESIGN:

    This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13 415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type 1 diabetes.

    RESULTS:

    The proportion of low capillary pH (< 7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P < 0.001)]. HbA1c was also higher [95 mmol/mol (10.8%) vs. 88 mmol/mol (10.2%), respectively (P < 0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA1c was 0.983 (95% CI 0.976-0.991) and for plasma glucose was 0.953 (95% CI 0.933-0.973).

    CONCLUSION:

    Children born to immigrant parents have lower capillary pH and higher HbA1c at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.

  • 39. Tan, M H
    et al.
    Johns, D
    Strand, J
    Halse, J
    Madsbad, S
    Eriksson, Jan W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Clausen, J
    Konkoy, C S
    Herz, M
    Sustained effects of pioglitazone vs. glibenclamide on insulin sensitivity, glycaemic control, and lipid profiles in patients with Type 2 diabetes.2004In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 21, no 8, p. 859-66Article in journal (Refereed)
    Abstract [en]

    AIMS: This study compared the effects of 52 weeks' treatment with pioglitazone, a thiazolidinedione that reduces insulin resistance, and glibenclamide, on insulin sensitivity, glycaemic control, and lipids in patients with Type 2 diabetes.

    METHODS: Patients with Type 2 diabetes were randomized to receive either pioglitazone (initially 30 mg QD, n = 91) or micronized glibenclamide (initially 1.75 mg QD, n = 109) as monotherapy. Doses were titrated (to 45 mg for pioglitazone and 10.5 mg for glibenclamide) to achieve glycaemic targets during the next 12 weeks: fasting blood glucose of < or = 7 mmol/l and 1-h postprandial blood glucose of < or = 10 mmol/l. Patients were maintained on the titrated dose for 40 weeks.

    RESULTS: Pioglitazone significantly increased insulin sensitivity compared with glibenclamide, as assessed by homeostasis model assessment (17.0% vs. -13.0%; P < 0.001), quantitative insulin sensitivity check index (0.011 vs. -0.007; P < 0.001) and fasting serum insulin (-1.3 pmol/l vs. 23.8 pmol/l; P = 0.007). The glibenclamide group had significantly lower HbA1c than the pioglitazone group after 12 weeks of therapy (7.8% vs. 8.3%, P = 0.015), but significantly higher HbA1c after 52 weeks of therapy (7.8% vs. 7.2%, P = 0.001). Pioglitazone significantly (vs. glibenclamide) increased mean HDL-C (P < 0.001), decreased mean triglycerides (P = 0.019), and decreased mean atherogenic index of plasma (AIP; P = 0.001) and mean total cholesterol/HDL-C (P = 0.004), without significantly elevating mean total cholesterol or mean LDL-C compared with glibenclamide. CONCLUSIONS These data suggest that the effects of pioglitazone are more sustained than those of glibenclamide for improving insulin sensitivity in patients with Type 2 diabetes, and that 52 weeks' treatment with pioglitazone has favourable effects on glycaemic control and lipoprotein profile.

  • 40.
    Viklund, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Örtqvist, Eva
    Wikblad, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Assessment of an empowerment education programme.: A randomized study in teenagers with diabetes2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 5, p. 550-556Article in journal (Refereed)
    Abstract [en]

    Aims: To determine the effects of an empowerment programme on glycaemic control and empowerment, and to study the role of parental involvement. Methods: The wait-list design is a randomized controlled trial lasting for 6 months, after which the control group participate in the same education programme as the intervention group. After 6 months, data from the two groups are analysed together (pre/post). Thirty-two teenagers with Type 1 diabetes (12-17 years) completed an empowerment group education programme, meeting weekly for 6 weeks. They were also offered an extra meeting together with their parents, which resulted in three groups: together with parents, only parents and no parent involvement at all. HbA1c was measured before intervention and after 6, 12, 18 and 24 months, and empowerment before, and 6 and 12 months after. Results: HbA1c and empowerment were similar in the intervention group and the control group 6 months after intervention. In pre/post analysis, HbA1c was significantly higher 6 and 12 months after intervention in teenagers > 14 years (from 8.4% to 9.3%; P < 0.05 to 9.6%; P < 0.01), but returned to baseline 18 months after the programme. In teenagers ≤ 14 years of age, HbA1c did not change during the study. The teenagers felt more ready for changes after the programme than before (3.9 sd = 0.5 to 4.1 sd = 0.5; P < 0.05). In the teenagers in the group that involved their parents, there was a significant decrease in HbA1c 12 and 24 months after intervention, from 8.9% (sd = 1.1) to 7.6% (sd = 1.3; P < 0.05, confidence interval 0.37, 2.26). Conclusion: This empowerment programme for teenagers with diabetes showed no positive glycaemic or empowerment effects. Empowerment programmes for diabetic teenagers in early and middle adolescence should include parental involvement.

  • 41.
    Vég, Anikó
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Variation of patients’ views on Type 2 diabetes management over time2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 4, p. 408-414Article in journal (Refereed)
    Abstract [en]

    Aims The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3–7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time.

    Methods The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A1c (HbA1c).

    Results The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA1c compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected.

    Conclusions From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.

  • 42. Wang, Z H
    et al.
    Kihl-Selstam, E
    Eriksson, Jan W
    The Lundberg Laboratory for Diabetes Research, Sahlgrenska University Hospital, Göteborg, Sweden.
    Ketoacidosis occurs in both Type 1 and Type 2 diabetes: a population-based study from Northern Sweden2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 7, p. 867-870Article in journal (Refereed)
    Abstract [en]

    AIMS:

    To determine the occurrence of diabetic ketoacidosis (DKA) in adult Type 2 and Type 1 diabetic patients in Northern Sweden and to determine whether DKA presents with a different clinical picture in Type 2 compared with Type 1 diabetic subjects.

    METHODS:

    All adult patients from a hospital catchment area in Northern Sweden with diagnosed DKA episodes during 1997-2000 were included in a retrospective study. Medical records and laboratory reports were analysed.

    RESULTS:

    During the years 1997 to 2000, the average annual incidence rate for DKA was 5.9 per 100 000 adult inhabitants. Twenty-five patients developed DKA, eight (32%) had Type 2 diabetes, while 17 (68%) had Type 1 diabetes. Type 2 diabetic patients with DKA were older and had higher levels of C-peptide than Type 1 diabetic patients. On admission because of DKA, a similar degree of hyperglycaemia was present in Type 1 and Type 2 patients. Metabolic acidosis was more severe in Type 1 compared with Type 2 diabetic patients. In 50% of the Type 2 diabetic patients, diabetes was diagnosed at the episode of DKA.

    CONCLUSIONS:

    DKA occurs in Caucasian Type 2 diabetic patients within a Swedish population. Although the frequency of DKA is much higher in Type 1 diabetic patients, Type 2 diabetes may account for as much as one-third of the overall DKA cases.

1 - 42 of 42
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf