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  • 1.
    Agardh, Carl-David
    et al.
    Lund University, Lund, Sweden.
    Ahrén, Bo
    Lund University, Lund, Sweden.
    Hanås, Ragnar
    Jansson, Stefan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Uppsala University, Uppsala, Sweden.
    Smith, Ulf
    Gothenburg University, Gothenburg, Sweden.
    Toft, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Östenson, Claes-Göran
    Karolinska Institutet, Stockholm, Sweden.
    Varning för okritisk användning av överviktskirurgi vid typ 2-diabetes2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 25, p. 1208-1209Article in journal (Refereed)
    Abstract [sv]

    Överviktskirurgi diskuteras nu som ett behandlingsalternativ även för patienter med typ 2-diabetes där BMI inte överstiger nuvarande indikationsgräns 35 kg/m2. Artikelförfattarna vill varna för en sådan utveckling i avvaktan på kritisk värdering av denna typ av kirurgi.

  • 2.
    Cos, X.
    et al.
    Sant Marti de Provenҫals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain.
    Seidu, S.
    Diabetes research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, United Kingdom.
    Brunton, S.
    Primary Care Metabolic Group, Los Angeles, California, USA.
    Harris, S. B.
    Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Mata-Cases, M.
    La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
    Neijens, A. M. J.
    Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy. Deventer, The Netherlands.
    Topsever, P.
    Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey.
    Khunti, K.
    Diabetes research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, United Kingdom.
    Impact on guidelines: the general practitioner point of view2020In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 166, article id 108091Article in journal (Refereed)
    Abstract [en]

    Primary care physicians are uniquely placed to offer holistic, patient-centred care to patients with T2DM. While the recent FDA-mandated cardiovascular outcome trials offer a wealth of data to inform treatment discussions, they have also contributed to increasing complexity in treatment decisions, and in the guidelines that seek to assist in making these decisions. To assist physicians in avoiding treatment inertia, Primary Care Diabetes Europe has formulated a position statement that summarises our current understanding of the available T2DM treatment options in various patient populations. New data from recent outcomes trials is contextualised and summarised for the primary care physician. This consensus paper also proposes a unique and simple tool to stratify patients into 'very high' and 'high' cardiovascular risk categories and outlines treatment recommendations for patients with atherosclerotic cardiovascular disease, heart failure and chronic kidney disease. Special consideration is given to elderly/frail patients and those with obesity. A visual patient assessment tool is provided, and a comprehensive set of prescribing tips is presented for all available classes of glucose-lowering therapies. This position statement will complement the already available, often specialist-focused, T2DM treatment guidelines and provide greater direction in how the wealth of outcome trial data can be applied to everyday practice.

  • 3.
    de Brun, Maryam
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Region Västmanland-Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Sweden.
    Johansson, Naimi
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Simmons, David
    Örebro University, School of Medical Sciences. Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology and Public Health, University College London, UK .
    Berntorp, Kerstin
    Genomics, Diabetes and Endocrinology Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Jansson, Stefan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Wennerholm, Ulla-Britt
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Wikström, Anna-Karin
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Strevens, Helena
    Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Ahlsson, Fredrik
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Sengpiel, Verena
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Storck-Lindholm, Elisabeth
    Department of Obstetrics and Gynecology Södersjukhuset, Karolinska Institute, Sweden.
    Persson, Martina
    Department of Clinical Science and Education Karolinska Institute, Department of Medicine, Clinical Epidemiology Karolinska Institutet and Sachsska Childrens´ and Youth Hospital Stockholm, Sweden.
    Petersson, Kerstin
    Department of Obstetrics and Gynecology Södersjukhuset, Umeå University, Sweden.
    Ursing, Carina
    Södersjukhuset, Stockholm.
    Ryen, Linda
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Backman, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Healthcare cost consequences of changing diagnostic criteria for gestational diabetes mellitus (CDC4G) in Sweden: Alongside a stepped wedge cluster randomised trialManuscript (preprint) (Other academic)
  • 4.
    de Brun, Maryam
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Magnusson, Anders
    Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology and Public Health, University College London, UK .
    Patil, Snehal
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Simmons, David
    Örebro University, School of Medical Sciences. Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Berntorp, Kerstin
    Genomics, Diabetes and Endocrinology Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Wennerholm, Ulla-Britt
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Wikström, Anna-Karin
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Strevens, Helena
    Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Ahlsson, Fredrik
    Department of Women’s and Children’s Health, Uppsala University. Akademiska sjukhuset, Uppsala.
    Sengpiel, Verena
    Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden.
    Schwarcz, Erik
    Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Storck-Lindholm, Elisabeth
    Department of Obstetrics and Gynecology Södersjukhuset, Karolinska Institute, Sweden.
    Persson, Martina
    Department of Clinical Science and Education Karolinska Institute, Department of Medicine, Clinical Epidemiology Karolinska Institutet and Sachsska Childrens´ and Youth Hospital Stockholm, Sweden.
    Petersson, Kerstin
    Department of Obstetrics and Gynecology Södersjukhuset, Umeå University, Sweden.
    Ryen, Linda
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Ursing, Carina
    Södersjukhuset, Stockholm.
    Hildén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Backman, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: a stepped wedge cluster randomised trialManuscript (preprint) (Other academic)
  • 5.
    Eriksson, J.
    et al.
    Uppsala University, Medical Sciences, Uppsala, Sweden.
    Bennet, L.
    Lund University, Clinical Sciences, Lund, Sweden.
    Eliasson, B.
    Gothenburg University, Medicine, Gothenburg, Sweden.
    Leksell, J.
    Uppsala University, Medical Sciences, Uppsala, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Kristofi, R.
    Uppsala University, Medical Sciences, Uppsala, Sweden.
    Lundqvist, M.
    Uppsala University, Medical Sciences, Uppsala, Sweden.
    Östlund, O.
    Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.
    Sundström, J.
    Uppsala University, Medical Sciences, Uppsala, Sweden.
    Metformin or SGLT2 inhibitor as 1st line treatment of type 2 diabetes? Design and interim results of the SMARTEST trial2023In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 197, no Supl. 1, article id IDF2022-0Article in journal (Other academic)
    Abstract [en]

    Background: Metformin is generally recommended as 1 st line medication in T2D. However, there is no compelling evidence of its superiority in preventing diabetes complications. SGLT2 inhibitors prevent cardiovascular mortality, heart failure and renal impairment in T2D patients at high cardiovascular risk.

    Aim: To assess whether an SGLT2 inhibitor is superior to metformin in preventing organ complications and premature death in early-stage T2D.

    Method: The SMARTEST study (SGLT2 inhibitor or Metformin As standaRd Treatment of Early Stage Type 2 diabetes) is a registry-based trial in primary care. Participants are included via on-site or video visits at 31 centers across Sweden; T2D <4 yr; drugnaïve (currently 31%) or montherapy; no cardiorenal diseases. Randomizaton 1:1, open label metformin (individualized dose) or dapagliflozin 10 mg/day. Diet, exercise and other medications are stipulated according to national guidelines. Patients are followed 2–6 yrs.

    Endpoints are collected using NDR and the national Patient Registry. The study will close when 844 primary endpoint events have occurred, giving 90% power to detect a HR of 0.8 for dapagliflozin vs metformin. Primary composite endpoint: time to death, myocardial infarction, stroke, heart failure or appearance/progression of microvascular complications (retinopathy, nephropathy, diabetic foot lesions). Other endpoints include: need for insulin therapy; blood pressure, BMI, HbA1c, PROM and health economy.

    Results: From late 2019 until May 2022 1100 patients are included. 38% are females, mean age is 60 years and HbA1c 46.5 mmol/mol (6.4%). So far, the primary endpoint event rate is 11/100 patient years (PY), whereas 7/100 PY was estimated from previous data. Nephropathy and foot-at-risk had high rates (6 and 3/100 PY) but MACE was rare (1/100 PY). The recruitment target is 2700 participants, expected by end 2023.

    Conclusion: Final results are expected in 2025 and can challenge or, equally important, reinforce the current metformin paradigm in early T2D. Event rates are higher than previously recognized for nephropathy and diabetic foot problems but lower for MACE.

  • 6.
    Fadl, Helena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Patil, Snehal
    Örebro University, School of Medical Sciences. Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Wikström, Anna-Karin
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Sengpiel, Verena
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Berntorp, Kerstin
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Ryen, Linda
    Örebro University, School of Health Sciences. Örebro University Hospital. Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Ahlsson, Fredrik
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Lindholm, Elisabeth S.
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Strevens, Helena
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Wennerholm, Ulla-Britt
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Persson, Martina
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    de Brun, Maryam
    Örebro University, School of Medical Sciences. Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    SIMMONS, DAVID
    Örebro, Sweden; Uppsala, Sweden; Gothenburg, Sweden; Lund, Sweden; Kullavik, Sweden; Stockholm, Sweden; Västerås, Sweden; Campbelltown, Australia.
    Association of GDM Risk Factors with Glucose at Diagnosis and Treatment in Sweden2022In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 71, no Supplement_1, article id 1039-PArticle in journal (Refereed)
  • 7.
    Fadl, Helena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynaecology.
    Saeedi, Maryam
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, University Hospital Örebro, Örebro, Sweden.
    Patil, Snehal
    Örebro University, School of Medical Sciences.
    Simmons, David
    Örebro University, School of Medical Sciences. Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Schwarcz, Erik
    Department of Internal Medicine, Schoolof medical health and sciences, Örebro University Hospital, Örebro, Sweden.
    Berntorp, Kerstin
    Department of Endocrinology, Skåne University Hospital, Clinical Research Center Malmö, Lund University, Lund, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Persson, Martina
    Department of Paediatrics, Sachsska Children’s and Youth hospital and Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Storck-Lindholm, Elisabeth
    Department of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, Sweden.
    Sengpiel, Verena
    Department of Obstetricsand Gynaecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wennerholm, Ulla-Britt
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ahlsson, Fredrik
    Department of Women’s and Children’s health, Uppsala University, Uppsala, Sweden.
    Wikström, Anna-Karin
    Women’s and Children’s Health, Uppsala university, Uppsala, Sweden.
    Strevens, Helena
    Department of Obstetrics and Gynaecology, Skåne University Hospital, Clinical Research Center Lund, Lund University, Lund, Sweden.
    Petersson, Kerstin
    Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
    Ryen, Linda
    Örebro University, School of Health Sciences. Center for Health Care Science.
    Hildén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology.
    Ursing, Carina
    Department of Endocrinology, Södersjukhuset, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden: a stepped wedge cluster randomised controlled trial2023Conference paper (Other academic)
  • 8.
    Fadl, Helena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynaecology.
    Saeedi, Maryam
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, University Hospital Örebro, Örebro, Sweden.
    Schwarcz, Erik
    Department of Internal Medicine, Schoolof medical health and sciences, Örebro University Hospital, Örebro, Sweden.
    Berntorp, Kerstin
    Department of Endocrinology, Skåne University Hospital, Clinical Research Center Malmö, Lund University, Lund, Sweden.
    Sengpiel, Verena
    Department of Obstetricsand Gynaecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Storck-Lindholm, Elisabeth
    Department of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, Sweden.
    Strevens, Helena
    Department of Obstetrics and Gynaecology, Skåne University Hospital, Clinical Research Center Lund, Lund University, Lund, Sweden.
    Wikström, Anna-Karin
    Women’s and Children’s Health, Uppsala university, Uppsala, Sweden.
    Brismar-Wendel, Sophia
    Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Persson, Martina
    Department of Paediatrics, Sachsska Children’s and Youth hospital and Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Ahlsson, Fredrik
    Department of Women’s and Children’s health, Uppsala University, Uppsala, Sweden.
    Ursing, Carina
    Department of Endocrinology, Södersjukhuset, Stockholm, Sweden.
    Ryen, Linda
    Örebro University, School of Health Sciences. Center for Health Care Science.
    Petersson, Kerstin
    Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
    Wennerholm, Ulla-Britt
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hildén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology.
    Simmons, David
    Örebro University, School of Medical Sciences. Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Changing diagnostic criteria for gestational diabetes in Sweden: a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 398Article in journal (Refereed)
    Abstract [en]

    Background: The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden () is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches.

    Methods: This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January-December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included.

    Discussion: The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.

  • 9.
    Galavazi, Marije
    et al.
    Örebro University, School of Medical Sciences.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Long-term effects of low energy diet combined with CBT-based group treatment of patients with obesity on weight, quality of life and eating behaviour: a 2-year intervention study2018Conference paper (Other academic)
  • 10. Göranzon, Carl
    et al.
    Lidskog, Marie
    Örebro University, School of Medical Sciences.
    Freire, Fernando
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Peer learning: Medical students learn from and with each other in placement training at the primary health center2019Conference paper (Other academic)
    Abstract [en]

    Background: Peer learning is an emerging educational concept in health education in Sweden and in other countries. Students, as peers, learn from and with each other. Studies show that students develop increased self-confidence, increased independence and confidence in their skill to solve problems and improve the ability for clinical reasoning. The aim of this pilot study was to further develop forms for clinical training which stimulate student active learning and to make the best use of available supervisor resources.

    Summary of Work: During 2018, a peer learning activity was tested for medical students during their clinical training at a primary health center. Before the placement, students were informed of the peer learning project. Two students worked together. Before the meeting, the supervisor introduced the students to the tasks to be performed. The students prepared the reception together. At the patient meeting, one student took the active part and the other observed. The students took turns so that they were the active part in every two patient meetings. Feedback with supervisor and between students took place continuously after the visits and at the end of the day. The project was evaluated by a questionnaire to students and supervisors, and a student diary.

    Summary of Results: Ten students agreed that they were completely instructed for the task, two agreed partly. Ten supervisors felt they gave instructions completely, five agreed partly and one didn’t answer. On a scale of 1 to 5, students agreed on average 4.3 or more for questions regarding preparation, constructive feedback, facilitated learning and time for reflection and feedback. Supervisors agreed on average 4.1 or more for the same questions with focus on student learning.

    Discussion and Conclusions: Although this is a pilot study, the results show that arranging a peer reception, both from student and supervisor perspective, has a positive effect. Diary writing in combination with peer reception contributes to the students gaining a deeper insight into their learning process and skills development. Larger studies are needed to confirm this. Take-home Messages: A peer reception can create a deeper understanding of the learning process and its guidance.

  • 11.
    Hellgren, Mikko
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden.
    Wennberg, Patrik
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Hedin, Katarina
    Futurum, Jönköping, Region Jönköping County, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nilsson, Staffan
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Nilsson, Gunnar
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Wändell, Per
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
    Bengtsson Boström, Kristina
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Hypertension management in primary health care: a survey in eight regions of Sweden2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 3, p. 343-350Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore hypertension management in primary healthcare (PHC).

    Design: Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021.

    Setting: Seventy-six PHCCs in eight regions of Sweden.

    Main outcome measures: Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up.

    Results: The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300-11300) patients.

    Conclusions: The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.

    KEY POINTS: Hypertension is mainly handled in primary healthcare (PHC), and this study shows important dissimilarities in organization and clinical management. Several variants in techniques and measurements of blood pressure were found between PHC centres. Lifestyle, clinical and laboratory assessments decreased at follow-ups compared to at diagnosis, specifically for lipids, microalbuminuria and electrocardiograms. Nearly half of the PHC centres reported that they had dedicated hypertension teams.

  • 12.
    Husdal, Rebecka
    et al.
    Centre for Clinical Research Västmanland, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research Västmanland, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
    Leksell, Janeth
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Eliasson, Bjorn
    Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Jansson, Stefan
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jerden, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Stålhammar, Jan
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Steen, Lars
    Drug and Therapeutics Committee, Södermanland County Council, Eskilstuna, Sweden.
    Wallman, Thorne
    Centre for Clinical Research Södermanland, Uppsala University, Eskilstuna, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Adolfsson, Eva Thors
    Centre for Clinical Research Västmanland, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Primary Health Care Västmanland, Västmanland County Hospital, Västerås, Sweden.
    Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 20132017In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    Aims: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.

    Methods: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.

    Results: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.

    Conclusions: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM. (C) 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  • 13.
    Husdal, Rebecka
    et al.
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
    Leksell, Janeth
    Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
    Eliasson, Björn
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Jerden, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Stålhammar, Jan
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Steen, Lars
    Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden.
    Wallmang, Thorne
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Svensson, Ann-Marie
    National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
    Adolfsson, Eva Thors
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
    Resources and organisation in primary health care are associated with HbA(1c) level: A nationwide study of 230 958 people with Type 2 diabetes mellitus2018In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 1, p. 23-33Article in journal (Refereed)
    Abstract [en]

    Aims: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbAic level in people with Type 2 diabetes mellitus (T2DM).

    Methods: People with T2DM attending 846 PHCCs (n =230 958) were included in this crosssectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.

    Results: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbAi, level were mean credits of diabetes specific education among registered nurses (RNs) (-0.02 mmol/mol for each additional credit; P < 0.001) and length of regular visits to RNs (-0.19 mmol/mol for each additional 15 min; P < 0.001). Organisational features associated with HbAie level were having a diabetes team (-0.18 mmol/mol; P <0.01) and providing group education (-0.20 mmol/mol; P < 0.01).

    Conclusions: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA(1c), level in people with T2DM.

  • 14.
    Husdal, Rebecka
    et al.
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
    Thors Adolfsson, Eva
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
    Leksell, Janeth
    Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Eliasson, Björn
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Jerdén, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Stålhammar, Jan
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Steen, Lars
    Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden.
    Wallman, Thorne
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Svensson, Ann-Marie
    National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
    Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey2019In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe and analyse the associations between primary health care centres' (PHCCs') quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).

    METHODS: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.

    RESULTS: Of the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53-69mmol/mol), and 12.1% uncontrolled (≥70mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs' results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p<0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p<0.05).

    CONCLUSIONS: This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs' QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

  • 15.
    Husdal, Rebecka
    et al.
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
    Thors Adolfsson, Eva
    Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
    Leksell, Janeth
    Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Eliasson, Björn
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Jerdén, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Stålhammar, Jan
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Steen, Lars
    Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden.
    Wallman, Thorne
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Svensson, Ann-Marie
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
    Rosenblad, Andreas
    Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; Department of Statistics, Stockholm University, Stockholm, Sweden.
    Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study2020In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 167, article id 108352Article in journal (Refereed)
    Abstract [en]

    AIMS: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM).

    METHODS: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied.

    RESULTS: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895-0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM.

    CONCLUSIONS: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM.

  • 16.
    Högberg, Cecilia
    et al.
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden.
    Cronberg, Olof
    Department of Clinical Sciences, Lund University, Lund, Malmö; Department of R & D, Region Kronoberg, Växjö, Sweden.
    Thulesius, Hans
    Department of Clinical Sciences, Lund University, Lund, Malmö; Department of R & D, Region Kronoberg, Växjö, Sweden; Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Lilja, Mikael
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Gunnarsson, Ulf
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Use of faecal immunochemical tests common in patients with suspected colorectal cancer but unrelated to travel distance to secondary care: a population-based study from Swedish primary care2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence is increasing for the use of faecal immunochemical tests (FITs) for occult blood as diagnostic tools when colorectal cancer can be suspected. FITs have been used for this purpose in Swedish primary care since around 2005 despite absence of supporting guidelines. To our knowledge, the extent of this use has not been studied.

    OBJECTIVE: To investigate the use of FITs as diagnostic tools, and if the use was related to patient age, sex and travel time from primary care to diagnostic facilities in secondary care.

    DESIGN: Population-based retrospective study using data from electronic health records.

    SETTING AND SUBJECTS: Patients ≥18 years that provided FITs in primary care in five Swedish health care regions during 2015. Driving times from their primary care centres to secondary care were calculated.

    MAIN OUTCOME MEASURES: The proportion of patients that provided FITs was calculated for each region, different age intervals and grouped driving times.

    RESULTS: 18,913 patients provided FITs. The proportion of listed patients in the five regions that provided FITs increased with age: 0.86-1.2% for ages <65 years, 3.6-4.1% for ages 65-79 years and 3.8-6.1% for ages ≥80 years. Differences between the regions were small. There was no overall correlation between the proportion of patients that provided FITs and driving time to secondary care.

    CONCLUSION: FITs were used extensively in Swedish primary care with a higher use in older age groups. There was no tendency towards a higher use of FITs at primary care centres with longer driving times to secondary care.Key PointsEvidence is increasing for the use of faecal immunochemical tests (FITs) as diagnostic tools when colorectal cancer can be suspected. We investigated the use of FITs in Sweden.FITs were used extensively in primary care especially in older age groups.There were small differences in the use of FITs between five studied health care regions.There was no tendency towards a higher use of FITs at primary care centres with longer driving times to diagnostic facilities in secondary care.

  • 17.
    Högberg, Cecilia
    et al.
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden.
    Gunnarsson, Ulf
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå Sweden.
    Cronberg, Olof
    Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of R & D, Region Kronoberg, Växjö, Sweden.
    Thulesius, Hans
    Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of R & D, Region Kronoberg, Växjö, Sweden; Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Lilja, Mikael
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study2020In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 35, no 11, p. 2035-2040Article in journal (Refereed)
    Abstract [en]

    Background: Rectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC.

    Methods: Results of all FITs requested in primary care for symptomatic patients in the orebro region during 2015 were retrieved. Data on each patient's history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden.

    Results: A total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1-13.4) and negative predictive value 99.7% (95% CI 99.2-100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6-10.9) and 100% (95% CI 99.6-100).

    Conclusion: The diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

  • 18.
    Högberg, Cecilia
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå.
    Gunnarsson, Ulf
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Thulesius, Hans
    Department of Clinical Sciences, Lund University, Malmö; professor of primary care, Department of Medicine and Optometry, Linnaeus University, Kalmar.
    Cronberg, Olof
    Department of Clinical Sciences, Lund University, Malmö.
    Lilja, Mikael
    Department of Public Health and Clinical Medicine, Umeå University, Umeå.
    Diagnosing colorectal cancer in primary care: cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts2020In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 70, no 701, p. e843-e851Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Colorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC.

    AIM: To evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC.

    DESIGN AND SETTING: A population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions.

    METHOD: Patients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated.

    RESULTS: In total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%-100%; specificities 65.7%-79.5%; positive predictive values 4.7%-8.1%; and negative predictive values 99.5%-100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9-100%. Adding thrombocytosis did not further increase the diagnostic performance.

    CONCLUSION: Qualitative FITs requested in primary care seem to be useful as rule-in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.

  • 19. Högberg, Cecilia
    et al.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Thulesius, Hans
    Cronberg, Olof
    Gunnarsson, Ulf
    Lilja, Mikael
    The usefulness of Faecal Immunochemical Tests alone and combined with blood counts in the diagnosis of colorectal cancer in primary care in Sweden2019Conference paper (Other academic)
  • 20.
    Imhagen, Annika
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    A lifelong struggle for a lighter tomorrow: A qualitative study on experiences of obesity in primary healthcare patients2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 5-6, p. 834-846Article in journal (Refereed)
    Abstract [en]

    AIM: To describe experiences of living with obesity before the start of a group-based lifestyle intervention.

    BACKGROUND: Obesity is a chronic disease that affects a person's physical and psychological health. Increased knowledge of experiences of living with obesity is required.

    DESIGN: A qualitative study with a descriptive design.

    METHODS: Semi-structured individual interviews with 17 participants living with obesity (Body Mass Index 32-49) were conducted between October and November 2019. The interviews were analysed using qualitative content analysis. The COREQ checklist was followed.

    RESULTS: The analysis resulted in one main theme: Struggling for a lighter tomorrow and three subthemes: Suffering, Resilience and Need for support in making changes. For the majority of the participants, living with obesity was a lifelong struggle involving suffering on different levels. Yet despite this, the participants had not given up and hoped for a better life. They showed a degree of resilience and motivation, and a perceived ability to achieve lifestyle changes. However, there was a pronounced need for support to help them achieve this.

    CONCLUSION: Living with obesity is complex and carries a risk of medical complications as well as psychosocial suffering. Healthy lifestyle habits to achieve better health and to lose weight should be encouraged, taking patient resources into account. Patients also need help in handling weight stigmatisation, and both healthcare professionals and society must engage with this.

    RELEVANCE TO CLINICAL PRACTICE: Obesity is a chronic disease, and patients need ongoing support. Therefore, care for patients with obesity in primary health care must be further developed. Patient resources and strengths have to be acknowledged and encouraged in the process of helping them adopt healthy lifestyle habits. The findings of this study can contribute to ending weight stigmatisation by increasing the knowledge of living with obesity.

  • 21.
    Imhagen, Annika
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Ohlsson-Nevo, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Stenberg, Erik
    Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden; School of Medical Sciences, Örebro University, SE-701 82, Örebro, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Levels of Physical Activity, Enjoyment, Self-Efficacy for Exercise, and Social Support Before and After Metabolic and Bariatric Surgery: a Longitudinal Prospective Observational Study2023In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 33, no 12, p. 3899-3906Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Physical activity (PA) after metabolic and bariatric surgery (MBS) can influence weight loss, health status, and quality of life. Known mediators to participate in PA are enjoyment, self-efficacy, and social support. Little is known about PA behavior in MBS individuals. The aim of this study was to explore levels of PA and the PA mediators enjoyment, self-efficacy, and social support before and after MBS and to investigate changes over time.

    METHODS: Adults scheduled to undergo MBS were recruited from a Swedish university hospital. Accelerometer-measured and self-reported PA, body weight, and PA mediators were collected at baseline and at 12 to 18 months post-surgery.

    RESULTS: Among 90 individuals included, 50 completed the follow-up assessment and had valid accelerometer data. Sedentary time (minutes/day) was unchanged, but sedentary time as percentage of wear time decreased significantly from 67.2% to 64.5% (p<0.05). Time spent in light PA and total PA increased significantly from 259.3 to 288.7 min/day (p < 0.05) and from 270.5 to 303.5 min/day (p < 0.01), respectively. Step counts increased significantly from 6013 to 7460 steps/day (p < 0.01). There was a significant increase in self-reported PA, enjoyment, self-efficacy for exercise, and positive social support from family. The increase in PA mediators did not lead to a significant change in time spent in moderate to vigorous PA.

    CONCLUSION: The increase in PA-mediators was not associated with an increase in moderate to vigorous PA, but the strengthened PA mediators suggest potential for an increase in moderate to vigorous PA in patients undergoing MBS.

  • 22.
    Jansson, S. P. O.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Orebro Univ, Sch Med Sci, Orebro, Sweden..
    Ramstrand, S.
    Örebro University, School of Health Sciences.
    Carlberg, M.
    School of Medical Science, Örebro University, Örebro, Sweden.
    Johannesson, G. A.
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Hiyoshi, A.
    Örebro University, School of Medical Sciences. Orebro Univ, Sch Med Sci, Orebro, Sweden..
    Jarl, G.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Exploring potential risk factors for lower limb amputation in people with diabetes: an observational cohort study of 66,565 individuals with diabetes in Sweden2023In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 66, no Suppl. 1, p. S114-S115, article id 216Article in journal (Other academic)
    Abstract [en]

    Background and aims: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how demographic and socioeconomic, medical and life-style risk factors may be associated with LLA in people with newly diagnosed diabetes.

    Materials and methods: We conducted a cohort study using Swedish national register-linked data. We identified, through the Swedish national diabetes register, all individuals 18 years or older with an incident diabetes diagnosis and no previous amputation from 2007 to 2016. These individuals were followed from the date of the diagnosis to amputation, emigration, death, or the end of the study in 2017, whichever occurred first. Several national Swedish registers were used to obtain data on incident LLA and potential risk factors, including demographic and socioeconomic, medical and lifestyle variables. Variables with more than 40% missing data were excluded from the analysis. The cohort consisted of 66,569 individuals, where of 133 hadan amputation. Cox proportional hazards models were used to obtain hazard ratio (HR) with 95% confidence interval (CI) for associations between demographic and socioeconomic, medical and lifestyle vari-ables and amputation risk. Both unadjusted and mutually adjusted models were fitted.

    Results: During the median follow-up time of 4 years there were in total 133 LLA. Based on the model mutually adjusting for all variables, higher age, HR 1.08 (95% CI, 1.05 - 1.10) per year, and being divorced compared with being married, HR 1.67 (1.07 - 2.60) showed positive association. Male sex indicated higher risk, HR 1.57 (1.06 - 2.34). Individuals with an increased foot risk at baseline had increased risk for LLA compared to individuals with healthy feet (neuropathy/angiopathy, HR 4.12 (2.84 - 5.98), previous wounds, HR 8.26 (3.29 - 20.74), ongoing severe foot disease, HR 11.24 (4.82 - 26.23). Insulin treatment compared with diet-only treatment showed HR 2.03 (1.10 - 3.74). Hypertension and HbA1c were not statistically significantly associated with LLA risk. People with obesity had a statistically significant lower risk, HR 0.46 (0.29 - 0.75), compared with individuals with normal weight. Smoking was associated with an increased risk compared with no smoking, HR 1.99 (1.28 - 3.09). Finally, low physical activity (<1 time/week) was associated with an increased risk with a HR of 2.05 (1.30 - 3.23) compared with daily physical activity.

    Conclusion: This study found a higher risk for LLA among people with higher age, male sex, who were divorced, who had a higher foot risk group, who were on insulin treatment, lower physical activity levels, and who were smoking. Obesity was associated with lower risk for LLA. Thus, these variables may have important roles in LLA risk among individuals with diabetes.

  • 23.
    Jansson, Stefan
    Uppsala.
    Mortality in a cohort of individuals with and without diabetes mellitus in a Swedish community during 30 years of follow up2008Conference paper (Refereed)
  • 24.
    Jansson, Stefan
    Uppsala.
    Mortality in a cohort of individuals with and without diabetes mellitus in a Swedish community during 30 years of follow up2008Conference paper (Refereed)
  • 25.
    Jansson, Stefan
    Uppsala.
    Mortality in i cohort of individuals with and without diabetes mellitus in a Swedish community during 30 years of follow up2008Conference paper (Other academic)
  • 26. Jansson, Stefan
    et al.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences.
    Förändrad livsstil kan förhindra typ 2-diabetes: interventionsstudier visar goda resultat hos "prediabetiker"2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 49-50, p. 3771-3774Article in journal (Refereed)
  • 27.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Uppsala University, Uppsala, Sweden.
    Diabetes i Laxå under 30 år: hög prevalens, stabil incidens2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 23, p. 1778-1778Article in journal (Other academic)
  • 28.
    Jansson, Stefan P. O.
    Brickebackens vårdcentral, Örebro.
    Diabetes i primär- och kommunvård2020In: Diabetes / [ed] Mona Landin-Olsson, Lund: Studentlitteratur AB, 2020, 1, p. 381-390Chapter in book (Refereed)
    Abstract [sv]

    Diabetes mellitus har betydelse både för folkhälsan och för den enskilde individen. Boken Diabetes samlar det aktuella kunskapsläget från experi­mentell forskning till kliniskt omhändertagande. Ett flertal svenska experter har bidragit med sina specifika kunskaper.Boken är uppdelad i tre delar. Del I handlar främst om typ 1-diabetes och fokuserar på betydelsen av insulin för en normal energiomsättning och vilka effekterna blir om insulinnivån sjunker. Molekylära och fysio­logiska mekanismer presenteras, liksom handfasta kliniska råd avseende akuta diabeteskomplikationer, graviditet, diabetes hos barn och transplantation av pankreas. Del II fokuserar på typ 2-diabetes och här behandlas insulinets effekter på kroppens olika organ och varför insulinresistens uppkommer. I denna del beskrivs den snabba farmakologiska utvecklingens betydelse och möjligheter till individanpassad terapi. Dessutom belyses komplikationer som är generella för diabetessjukdomen liksom metabola sjukdomar associerade med diabetes. Del III behandlar diabetes i ett individ-, familje- och samhällsperspektiv. Hur är det att få diabetes, och hur påverkar det individens yrkesliv, fritid och sätt att leva? Vilka nya möjligheter för behandling och kontroll har öppnats genom den tekniska utvecklingen? Och på vilka sätt har de svenska diabetesregistren bidragit till en mera jämlik och förbättrad diabetesvård? Diabetes är framförallt riktad till läkare under utbildning och sjuksköterskor under specialistutbildning. Genom att de tre delarna av boken har olika fokus är boken också läsvärd för såväl specialister i diabetologi som andra yrkesgrupper vilka i sitt dagliga arbete kommer i kontakt med individer som har diabetes.

  • 29.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Uppsala University, Uppsala, Sweden.
    Överdödligheten vid diabetes minskar2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 7Article in journal (Other academic)
  • 30.
    Jansson, Stefan P. O.
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Andersson, D. K. G.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Svärdsudd, K.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mortality and cardiovascular disease outcomes among 740 patients with new-onset Type 2 diabetes detected by screening or clinically diagnosed in general practice2016In: 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 Laxa, 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.

  • 31.
    Jansson, Stefan P. O.
    et al.
    Örebro University, Department of Clinical Medicine.
    Andersson, D. K. G.
    Svärdsudd, K.
    Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up2007In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 50, no 4, p. 703-710Article in journal (Refereed)
    Abstract [en]

    Increasing diabetes prevalence has been reported in most European countries in the last 20 years. In this study we report on the development of prevalence and incidence of diabetes from 1972 to 2001 in Laxa, a rural community in central Sweden. A diabetes register was established at the primary healthcare centre (PHCC) in Laxa, beginning in 1972 and based on data from clinical records at the PHCC, nearby hospitals and private practitioners in the area. In addition, case-finding procedures involving 85% of the residents aged 35 to 79 years old was performed from 1983 onwards. During the study period a total of 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. The age-standardised incidence rates for type 1 diabetes mellitus and type 2 diabetes mellitus were 0.15 and 3.03 cases per 1,000 population, respectively. No increase in incidence over time was detected for either forms of diabetes. Age-standardised prevalence for women and men increased from 28.3 and 25.9, respectively, per 1,000 in 1972 to 45 and 46.3 per 1,000 in 1988 (p < 0.0001), thereafter falling to a mean of 43.5 per 1,000 for women, while men had a mean of 44.9 per 1,000 for the rest of the study period. The prevalence of diabetes mellitus in Laxa is high, but has not increased during the last 13 years. The incidence rate was relatively stable over the whole 30-year period.

  • 32.
    Jansson, Stefan P. O.
    et al.
    Örebro University Hospital. Family Medicine Research Centre.
    Andersson, Dan K. G
    Department of Public Health and Caring Sciences, Family Medicine, Uppsala University, Uppsala, Sweden; Department of Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Svärdsudd, Kurt F.
    Department of Public Health and Caring Sciences, Family Medicine, Uppsala University, Uppsala, Sweden; Department of Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    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 1464-5491, Vol. 30, no 3, p. 349-357Article 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.

  • 33.
    Jansson, Stefan P. O.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Assessment of Medical Technology in Örebro (CAMTÖ), Örebro University Hospital, Örebro, Sweden.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Lohse PT, Georg
    Centre for Assessment of Medical Technology in Örebro (CAMTÖ), Örebro University Hospital, Örebro, Sweden.
    Liljegren, Göran
    Örebro University Hospital. Centre for Assessment of Medical Technology in Örebro (CAMTÖ), Örebro, Sweden; Department of Surgery, University Hospital, Örebro, Sweden.
    Interventions for lifestyle changes to promote weight reduction, a randomized controlled trial in primary health care2013In: BMC Research Notes, E-ISSN 1756-0500, Vol. 16, no 1, article id 213Article in journal (Refereed)
    Abstract [en]

    Background: Overweight and obesity are growing public health problems in high income countries and is now growing at a dramatic pace in low and middle income countries, particularly in urban settings. The aim of this trial was to examine the effects of a weight reduction program in adults and to determine whether or not a more extensive intervention was superior to ordinary care.

    Methods: Patients seeking advice for overweight/obesity or illness related to overweight/obesity at eight primary health care centers in Sweden were randomized either to intervention or control care groups with both groups given dietary advice and individualized information on increased regular physical activity. In the intervention group advice was more extensive and follow-up more frequent than in the control group during the study period of two years. Main outcome measure was reduction in body weight of five percent or more from study start.

    Results: From October 2004 to April 2006, 133 patients, 67 in the intervention group and 66 in the control group, were randomized over a period of 18 months. Target weight was achieved at 12 months by 26.7% of the patients in the intervention group compared with 18.4% in the control group (p = 0.335). There was an average absolute weight loss of 2.5 kg in the intervention group and 0.8 kg in the control group at 12 months as compared with the weight at study entry. There were no significant differences between the groups in quality of life, blood glucose and lipids. At 24 months target weight was achieved in 21.9% versus 15.6%, with an average weight reduction of 1.9 kg and 1.2 kg in the two groups, respectively.

    Conclusions: Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome.

  • 34.
    Jansson, Stefan P. O.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Region Örebro County, Örebro, Sweden.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, O.
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Magnuson, A.
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wändell, P.
    Department of Neurobiology, Care Sciences and Society, Unit of Family Medicine, Karolinska Institutet, Huddinge, Sweden.
    Östgren, C. J.
    Division of Community Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Local Care West, County Council of Östergötland, Linköping, Sweden.
    Rolandsson, O.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden2015In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, no 10, p. 1319-1328Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the changes in prevalence and incidence of pharmacologically and non-pharmacologically treated diabetes in Sweden during 2005 to 2013.

    Methods: We obtained data on gender, date of birth and pharmacologically and non-pharmacologically treated diabetes from national registers for all Swedish residents.

    Results: During the study period a total of 240 871 new cases of pharmacologically treated diabetes was found. The age-standardized incidence during the follow-up was 4.34 and 3.16 per 1000 individuals in men and women, respectively. A decreasing time trend in incidence for men of 0.6% per year (0.994, 95% CI 0.989-0.999) and for women of 0.7% per year (0.993, 95% CI 0.986-0.999) was observed. The age-standardized prevalence increased from 41.9 and 29.9 per 1000 in 2005/2006 to 50.8 and 34.6 in 2012/2013 in men and women, respectively. This corresponds to an annually increasing time trend for both men (1.024, 95% CI 1.022-1.027) and women (1.019, 95% CI 1.016-1.021). The total age-standardized prevalence of pharmacologically and non-pharmacologically treated diabetes (2012) was 46.9 per 1000 (55.6 for men and 38.8 for women). This corresponds to an annually increasing time trend (2010-2012) for both men (1.017, 95% CI 1.013-1.021) and women (1.012, 95% CI 1.008-1.016).

    Conclusions: The prevalence of pharmacologically treated diabetes increased moderately during 8 years of follow-up, while the incidence decreased modestly. This is in contrast to the results reported by most other studies. The total prevalence of diabetes (both pharmacologically and non-pharmacologically treated) in Sweden is relatively low, from a global viewpoint.

  • 35.
    Jansson, Stefan P. O.
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Brus, O.
    Magnuson, A.
    Wändell, P.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Östgren, C. J.
    Division of Community Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Local Care West, County Council of Östergötland, Linköping, Sweden.
    Rolandsson, O.
    Department of Public Health and Clinical Medicine, Umea University, Umeå, Sweden.
    Response to Carlsson et al.: Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 8, p. 1150-1152Article in journal (Refereed)
  • 36.
    Jansson, Stefan P. O.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Örebro County Council, Örebro, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Svärdsudd, K.
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Andersson, D. K. G.
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    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-up2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 9, p. 1055-1063Article 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 Laxa 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.

  • 37.
    Jansson, Stefan P.O.
    et al.
    Örebro University, Department of Clinical Medicine. Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Clin Epidemiol Sect, Uppsala, Sweden.
    Andersson, Dan K.G.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Clin Epidemiol Sect, Uppsala, Sweden; Natl Board Hlth & Welf, Div Reg Supervis Author, Orebro, Sweden.
    Svärdsudd, Kurt
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Clin Epidemiol Sect, Uppsala, Sweden.
    Mortality trends in subjects with and without diabetes during 33 years of follow up2009In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 33, no 3, p. 551-556Article in journal (Refereed)
    Abstract [en]

    Objective: Mortality rates have declined substantially over the past decades in the general population, but the situation among diabetic subjects is less clear. The aim of this study was to analyze mortality trends in diabetic and nondiabetic subjects during 1972–2004.

    Research design and methods: Since 1972, all patients with diabetes are entered in a diabetes register at Laxå Primary Health Care Center; 776 incident cases were recorded up to 2001. The register has been supplemented with a nondiabetic population of 3,880 subjects and with data from the National Cause of Death Register during 1972 to 2004.

    Results: During the 33-year follow-up period, 233 (62.0%) diabetic women and 240 (60.0%) diabetic men and 995 (52.9%) nondiabetic women and 1,082 (54.1%) nondiabetic men died. The age-adjusted hazard ratio (HR) for all-cause mortality among diabetic and nondiabetic subjects was 1.17 (P < 0.0021) for all, 1.22 (P < 0.007) for women, and 1.13 (P = 0.095) for men. The corresponding cardiovascular disease (CVD) mortality HRs were 1.33 (P < 0.0001), 1.41 (P < 0.0003), and 1.27 (P < 0.0093), respectively. The CVD mortality reduction across time was significant in nondiabetic subjects (P < 0.0001) and in men with diabetes (P = 0.014) but not in diabetic women (P = 0.69). The results regarding coronary heart disease (CHD) were similar (P < 0.0001, P < 0.006, and P = 0.17, respectively). The CVD and CHD mortality rate change across time was fairly linear in all groups.

    Conclusions: Diabetic subjects had less mortality rate reduction during follow-up than nondiabetic subjects. However the excess mortality risk for diabetic subjects was smaller than that found in other studies.

  • 38.
    Jarl, Gustav
    et al.
    Örebro University Hospital. Örebro University, School of Health Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Carlberg, Michael
    Johannesson, Anton
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Lower limb amputations in Sweden: incidence; time trends; and regional variations2021Conference paper (Other academic)
  • 39.
    Jarl, Gustav
    et al.
    Örebro University Hospital. Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics; University Health Care Research Center.
    Johannesson, G. Anton
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Carlberg, Michael
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Incidence of lower-limb amputations in Sweden from 2008-20172022In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 64, no 2-3, p. 266-273Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study examines the recent national and regional incidence of lower limb amputations (LLAs) in Sweden and their annual changes.

    DESIGN: Observational study using Swedish national register data.

    METHODS: We identified all initial amputations in Sweden from 2008 to 2017 in individuals 18 years or older using the national inpatient register. The amputations were categorized into three levels: High proximal (through or above the knee joint), low proximal (through the tibia to through the ankle joint), and partial foot amputations. To examine the national and regional incidence and annual changes, the age-, sex- and region-specific population count each year was used as the denominator and Poisson regression or negative binomial regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) adjusted for age and sex.

    RESULTS: The national annual incidence of LLAs was 22.1 per 100,000 inhabitants, with a higher incidence in men (24.2) than in women (20.0). The incidence of LLAs (all levels combined) declined during the study period, with an IRR of 0.984 per year (95% CI, 0.973-0.994). This was mainly due to a decrease in high proximal amputations (0.985, 95% CI 0.974-0.995) and low proximal amputations (0.973, 95% CI 0.962-0.984). No change in the incidence of partial foot amputations was observed (0.994, 95% CI 0.974-1.014). Such declines in LLA incidence (all levels combined) were observed in 9 out of 21 regions. Compared to the national average and with adjustment for age, sex, diabetes and artery disease, the regional IRR varied from 0.85-1.36 for all LLAs, from 0.67-1.61 for high proximal amputations, from 0.50-1.51 for low proximal amputations and from 0.13-3.68 for partial foot amputations.

    CONCLUSIONS: The incidence of LLAs has decreased in Sweden. However, regional variations in incidence, time trends, and amputation levels warrant more research.

  • 40.
    Jendle, Johan
    et al.
    Örebro University, School of Medical Sciences. Universitetssjukhuset, Örebro.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Brickebackens VC, Örebro.
    Kontinuerlig glukosmätning alternativ vid typ 2-diabetes [Continuous glucose monitoring (CGM) in type 2 diabetes]2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, article id 20158Article in journal (Refereed)
    Abstract [en]

    Continuous glucose monitoring (CGM) tracks glucose levels in real-time using a subcutaneous sensor, replacing intermittent blood sampling for self-monitoring of blood glucose (SMBG). CGM is a routine tool in type 1 diabetes management. In 2019, patients with type 2 diabetes were given the indication of CGM use by Swedish authorities; CGM can be considered when a patient despite multi-dose treatment with insulin does not achieve good glucose control and/or has problems with hypoglycaemia. Studies show that CGM provides improved glycaemic control compared to SMBG. The cost of CGM is higher than for SMBG and requires effort both by caregivers and patients. This should be gauged against the possible long-term health economic benefits of preventing diabetes complications.

  • 41.
    Jendle, Johan
    et al.
    Universitetssjukhuset Örebro, Örebro.
    Landin, Britta
    Karolinska universitetslaboratoriet, Stockholm.
    Jansson, Stefan P. O.
    Bricke­backens vårdcentral, Örebro.
    Nordin, Gunnar
    Equalis, Uppsala.
    När HbA1c inte stämmer: Olika metoder kan ge olika resultat – och ibland kan även resultat som stämmer överens ge fel bild av glukosbalansen2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, no 37, article id 20001Article, review/survey (Refereed)
    Abstract [en]

    Compared to the 1990s when HbA1c was established as a marker for glycemic control, the accuracy of the HbA1c assays has greatly improved and HbA1c is currently used also for the diagnosis of type 2 diabetes. For most patients, the agreement is excellent between glycemic status and HbA1c results achieved by various methods. However, for patients with increased erythrocyte turnover, HbA1c does not reflect the glycemic status. For patients with rare haemoglobin variants the HbA1c value might be falsely decreased or increased, depending on which HbA1c assay has been used. Recently, falsely increased HbA1c results due to aspirin interference in an ion-exchange method were reported. When misleading results are suspected comparison of results from different HbA1c methods using different analytical principles or continuous glucose monitoring might be useful. HbA1c is likely to remain the most important marker for glycemic control, but complementary tests have to be established.

  • 42.
    Karlsson, Jan
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Galavazi, Marije
    Örebro University, School of Medical Sciences.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Effects on body weight, eating behavior, and quality of life of a low-energy diet combined with behavioral group treatment of persons with class II or III obesity: A 2-year pilot study2021In: Obesity Science & Practice, E-ISSN 2055-2238, Vol. 7, no 1, p. 4-13Article in journal (Refereed)
    Abstract [en]

    Objective: Obesity is associated with reduced health-related quality of life (HRQoL). Outcomes of nonsurgical weight loss treatment on HRQoL are inconsistent and it is unclear how much weight reduction, or what type of treatment, is required for significant improvements. This study aimed to evaluate the effects of a lifestyle intervention program on weight, eating behaviors, and HRQoL, and to describe participants' experiences of treatment.

    Methods: This 2-year intervention trial in persons with class II or III obesity comprised a 3-month liquid low-energy diet (880 kcal/d) followed by a 3-month reintroduction to regular foods, combined with behavioral group treatment.

    Results: Fifty-five participants (73% women) were included, mean (SD) age 43.2 (12.4) years, and mean body mass index 42.0 (6.0) kg/m(2). Mean weight loss at 6, 12, and 24 months was 18.9%, 13.7%, and 7.2%, respectively. Short- and long-term effects on eating behavior were favorable. Twelve of 14 HRQoL domains were improved at 6 months, compared to eight domains at 12 months. After 24 months, 2 of 14 domains, physical and psychosocial functioning, were improved. The treatment program was well accepted by the participants.

    Conclusions: Substantial weight loss after 6 months was associated with extensive improvements in HRQoL, comprising the physical, psychosocial, and mental domains. Significant weight regain was observed between 6 and 24 months follow-up. Modest weight loss after 24 months was associated with moderate improvement in physical functioning and large improvement in psychosocial functioning. The effect on psychosocial functioning is most likely related to both weight loss and behavioral treatment.

  • 43.
    Lilja, Mikael
    et al.
    FoU-enheten, Umeå universitet, Östersund, Sweden.
    Hellgren, Margareta
    Institutionen för medicin, enheten för allmänmedicin, Göteborgs universitet, Göteborg, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Universitetssjukvårdens forskningscent­rum, Region Örebro County, Örebro, Sweden.
    Diagnos och behandlingsmål vid diabetes typ 2 [Diagnosis and treatment goals in diabetes type 2]2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EYWXArticle in journal (Refereed)
    Abstract [sv]

    The article presents diagnostic criteria for diabetes and treatment goals for diabetes type 2.

  • 44.
    Lind, Alexander
    et al.
    Department of Clinical Sciences Malmö, Lund University, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Hesser, Hugo
    Örebro University, School of Behavioural, Social and Legal Sciences. School of Behavioural, Social and Legal Sciences, Center for Health and Medical Psychology, Örebro University, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Hårdstedt, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Vansbro Primary Health Care Center, Vansbro, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lernmark, Åke
    Department of Clinical Sciences Malmö, Lund University, Sweden.
    Sundqvist, Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Tsai, Cheng-ting
    Enable Biosciences Inc., South San Francisco CA, United States of America.
    Wahlberg, Jeanette
    Örebro University, School of Medical Sciences.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Anxiety, depression and quality of life in relation to SARS-CoV-2 antibodies in individuals living with diabetes during the second wave of COVID-192024In: Diabetes epidemiology and management, ISSN 2666-9706, Vol. 13, article id 100194Article in journal (Refereed)
    Abstract [en]

    Aims: The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic.

    Methods: Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays.

    Results: Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS-CoV-2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS-CoV-2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %).

    Conclusions: A higher SARS-CoV-2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

  • 45.
    Lindblad, U.
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Enheten för allmämedicin, Göteborgs universitet, Göteborg, Sverige; Skaraborg Institute, Skövde, Sweden.
    Lindberg, G.
    Department of Clinical Sciences, Clinical Research Centre, Malmö University Hospital, Lund University, Malmö, Sweden; The NEPI Foundation, Malmö, Sweden.
    Månsson, N.-O.
    Department of Clinical Sciences, Clinical Research Centre, Malmö University Hospital, Lund University, Malmö, Sweden.
    Ranstam, J.
    The NEPI Foundation, Malmö, Sweden; Swedish National Competence Centre for Musculoskeletal Disorders, Department of Orthopædics, Lund University Hospital, Lund, Sweden.
    Tyrberg, M.
    Department of Ophtalmology, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Jansson, Stefan
    Family Medicine Research Centre, Örebro University Hospital, Örebro, Sweden.
    Lindwall, K.
    The NEPI Foundation, Malmö, Sweden; The NEPI Foundation, Linköping, Sweden.
    Svärdh, M.
    Department of Clinical Sciences, Clinical Research Centre, Malmö University Hospital, Lund University, Malmö, Sweden; The NEPI Foundation, Malmö, Sweden.
    Kindmalm, L
    Skaraborg Institute, Skövde, Sweden; Skaraborg Primary Care, Skövde, Sweden.
    Melander, A.
    Department of Clinical Sciences, Clinical Research Centre, Malmö University Hospital, Lund University, Malmö, Sweden; The NEPI Foundation, Malmö, Sweden; Community Medicine, Clinical Sciences, Malmö, Sweden.
    Can sulphonylurea addition to lifestyle changes help to delay diabetes development in subjects with impaired fasting glucose? The Nepi ANtidiabetes StudY (NANSY)2011In: Diabetes, obesity and metabolism, ISSN 1462-8902, E-ISSN 1463-1326, Vol. 13, no 2, p. 185-8Article in journal (Refereed)
    Abstract [en]

    The Nepi ANtidiabetes StudY (NANSY) is a 5-year randomized, double-blind, placebo-controlled trial in Swedish primary care, examining whether the development of type 2 diabetes (T2D) and retinopathy (separately reported) would be delayed in 40- to 70-year-old subjects with impaired fasting glucose (IFG) who, in addition to lifestyle changes, were treated with either placebo or low-dosage sulphonylurea (SU) (1-mg glimepiride; Amaryl). Of 274 subjects (163 men, 111 women), 138 were allocated to placebo (46.0% men, 56.8% women) and 136 to glimepiride (54.0% men, 43.2% women). The primary endpoint was conversion to diabetes. Average follow-up time was 3.71 years; 96 subjects converted to diabetes, 55 allocated to placebo and 41 to glimepiride (absolute difference 9.8%; p = 0.072). In conclusion, the study failed to support the notion that low-dose SU added to lifestyle changes in IFG subjects would help to delay the conversion to diabetes.

  • 46.
    Lundqvist, Martin H.
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Patsoukaki, Vagia
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Norman, Henrietta
    Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Granstam, Elisabet
    Center for Clinical Research, Uppsala University/Region Västmanland, Västerås, Sweden.
    Svensson, Maria K.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Sundström, Johan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Eliasson, Björn
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; National Diabetes Register, Centre of Registries in Region Western Sweden, Gothenburg, Sweden.
    Eriksson, Jan W.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Health care registers can be instrumental for endpoint capture in clinical diabetes trials: example of microvascular complications in Swedish patients with type 2 diabetes2023In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 20, no 3, article id 14791641231179878Article in journal (Refereed)
    Abstract [en]

    AIMS: SMARTEST is a register-based randomized clinical trial (RRCT) that compares dapagliflozin to metformin in early-stage type 2 diabetes. The primary outcome includes progression of microvascular complications based on data from the Swedish National Diabetes Register (NDR). In this sub-study, the aim was to validate microvascular complication variables in the NDR against electronic health records (EHRs).

    METHODS: Data were extracted from EHRs of 276 SMARTEST participants with a median observation period of 3 years in the Uppsala, Örebro and Sörmland counties and compared with NDR data. Agreement was determined for all corresponding data entries as well as for progression of microvascular complications after randomization.

    RESULTS: The agreement for all corresponding data entries was 98.9% (Intraclass Correlation Coefficient 0.999) for creatinine and eGFR, 95.1% for albuminuria, 91.6% for foot-at-risk and 98.2% for retinopathy status (Kappa 0.67-0.91). The agreement for progression of microvascular complications was 98.0% for CKD stage, 98.9% for albuminuria grade, 96.3% for foot-at-risk grade and 99.6% for retinopathy grade progression (Gwet's AC1 0.96-1.00). CONCLUSION: Microvascular complication variables in the NDR show good agreement with EHR data. The use of a well-established national health care registry, exemplified by the NDR, for endpoint collection in RRCTs such as SMARTEST is supported by this study.

  • 47.
    Olafsdottir, Eydis
    et al.
    Department of Ophthalmology, The National University Hospital, Reykjavik, Iceland; University of Iceland, Reykjavik, Iceland; Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden.
    Andersson, Dan K G
    Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Dedorsson, Inger
    Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden.
    Svärdsudd, Kurt
    Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Jansson, Stefan P O
    Örebro University, School of Medical Sciences. Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Stefánsson, Einar
    Department of Ophthalmology, The National University Hospital, Reykjavik, Iceland; University of Iceland, Reykjavik, Iceland.
    Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy2016In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 94, no 3, p. 232-239Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care.

    Methods: A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination.

    Results: Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p < 0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002).

    Conclusions: Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.

  • 48.
    Ramstrand, Simon
    et al.
    Örebro University, School of Health Sciences. niversity Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, Sweden; Department of rehabilitation, School of Health and Welfare, Jönköping University, Sweden.
    Carlberg, Michael
    Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, Sweden.
    Jarl, Gustav
    Örebro University Hospital. Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden, Department of Prosthetics and Orthotics, Örebro, Sweden .
    Johannesson, Anton
    Össur Clinics Scandinavia, Stockholm, Sweden, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    RISK FACTORS FOR AMPUTATION IN PERSONS WITH DIABETES IN ASWEDISH CONTEXT: A RETROSPECTIVE COHORT DESIGN2022In: Programme and abstracts: Diabetic Foot Study Group, Diabetic Foot Study Group , 2022, p. 37-37, article id OP04Conference paper (Other academic)
  • 49.
    Rask, Eva
    et al.
    Institutionen för medicinska vetenskaper, Örebro universitet, Medicinska kliniken, Universitetssjukhuset Örebro, Sweden.
    Peters, H.
    Baggängens vårdcentral, Karlskoga, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Brickebackens vårdcentral, Örebro, Sweden.
    Hypoglykemi: problematisk komplikation av överviktskirurgi [Hypoglycemia following gastric bypass surgery: A case, causes and coping]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 8, article id 363Article in journal (Refereed)
    Abstract [en]

    Bariatric surgery is a well-documented and good alternative for treatment of obesity with and without type 2-diabetes. One of the documented complications is postprandial hypoglycemia, with possibly serious consequences. We present such a case, what is known of underlying mechanisms, and treatment options. © 2019, Swedish Medical Association. All rights reserved.

  • 50.
    Rådholm, Karin
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    Af Geijerstam, Peder
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Woodward, Mark
    The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, Imperial College London, London, United Kingdom.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
    Hellgren, Margareta
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; The Skaraborg Institute, Skövde, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rolandsson, Olov
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Dog ownership, glycaemic control and all-cause death in patients with newly diagnosed type 2 diabetes: a national cohort study2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1265645Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate whether dog ownership from the time of type 2 diabetes diagnosis improved glycaemic control, increased achievement of major guideline treatment goals or reduced the risk of all-cause death.

    METHODS: Patients diagnosed with type 2 diabetes were followed by linkage of four Swedish national registers covering diabetes, dog ownership, socioeconomics, and mortality. Linear regression was used to estimate the mean yearly change in glycated haemoglobin (HbA1c). Cox survival analysis and logistic regression were used to analyse associations between dog ownership and all-cause death and achievement of treatment goals, respectively.

    RESULTS: Of 218,345 individuals included, 8,352 (3.8%) were dog-owners. Median follow-up was 5.2 years. Dog-owners had worse yearly change in HbA1c, and were less likely to reach HbA1c, low-density lipoprotein (LDL), and systolic blood pressure (SBP) treatment goals than non-dog-owners (adjusted odds ratios [95% CI] of 0.93 [0.88-0.97], 0.91 [0.86-0.95], and 0.95 [0.90-1.00], respectively). There was no difference in the risk of all-cause death (adjusted hazard ratio [95% CI] 0.92 [0.81-1.04], dog owners versus not).

    CONCLUSION: Owning a dog when diagnosed with diabetes did not lead to better achievement of treatment goals or reduced mortality, but was in fact associated with a smaller reduction in HbA1c and reduced likelihood of achieving treatment goals.

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