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  • 1. Albertsson-Wikland, Kerstin
    et al.
    Aronson, A. Stefan
    Gustafsson, Jan
    Hagenäs, Lars
    Ivarsson, Sten A.
    Jonsson, Björn
    Kriström, Berit
    Marcus, Claude
    Nilsson, Karl Olof
    Ritzén, E. Martin
    Tuvemo, Torsten
    Westphal, Otto
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Dose-dependent effect of growth hormone on final height in children with short stature without growth hormone deficiency2008In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 93, no 11, p. 4342-4350Article in journal (Refereed)
    Abstract [en]

    CONTEXT: The effect of GH therapy in short non-GH-deficient children, especially those with idiopathic short stature (ISS), has not been clearly established owing to the lack of controlled trials continuing until final height (FH).

    OBJECTIVE: The aim of the study was to investigate the effect on growth to FH of two GH doses given to short children, mainly with ISS, compared with untreated controls.

    DESIGN AND SETTING: A randomized, controlled, long-term multicenter trial was conducted in Sweden.

    INTERVENTION: Two doses of GH (Genotropin) were administered, 33 or 67 microg/kg.d; control subjects were untreated.

    SUBJECTS: A total of 177 subjects with short stature were enrolled. Of these, 151 were included in the intent to treat (AllITT) population, and 108 in the per protocol (AllPP) population. Analysis of ISS subjects included 126 children in the ITT (ISSITT) population and 68 subjects in the PP (ISSPP) population.

    MAIN OUTCOME MEASURES: We measured FH sd score (SDS), difference in SDS to midparenteral height (diff MPHSDS), and gain in heightSDS.

    RESULTS: After 5.9+/-1.1 yr on GH therapy, the FHSDS in the AllPP population treated with GH vs. controls was -1.5+/-0.81 (33 microg/kg.d, -1.7+/-0.70; and 67 microg/kg.d, -1.4+/-0.86; P<0.032), vs. -2.4+/-0.85 (P<0.001); the diff MPHSDS was -0.2+/-1.0 vs. -1.0+/-0.74 (P<0.001); and the gain in heightSDS was 1.3+/-0.78 vs. 0.2+/-0.69 (P<0.001). GH therapy was safe and had no impact on time to onset of puberty. A dose-response relationship identified after 1 yr remained to FH for all growth outcome variables in all four populations.

    CONCLUSION: GH treatment significantly increased FH in ISS children in a dose-dependent manner, with a mean gain of 1.3 SDS (8 cm) and a broad range of response from no gain to 3 SDS compared to a mean gain of 0.2 SDS in the untreated controls. 

  • 2.
    Albertsson-Wikland, Kerstin
    et al.
    Goteborg Pediat Growth Res Ctr, Dept Pediat, Inst Clin Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Kriström, Berit
    Dept Clin Sci, Pediat Unit, Umeå Univ, Umeå, Sweden.
    Lundberg, Elena
    Dept Clin Sci, Pediat Unit, Umeå Univ, Umeå, Sweden.
    Aronson, A. Stefan
    Dept Pediat, Halmstad Cty Hosp, Halmstad, Sweden.
    Gustafsson, Jan
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Hagenäs, Lars
    Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden.
    Ivarsson, Sten-A.
    Dept Pediat, Lund Univ, Malmö, Sweden.
    Jonsson, Björn
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ritzen, Martin
    Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden.
    Tuvemo, Torsten
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Westgren, Ulf
    Dept Pediat, Lund Univ, Malmo, Sweden.
    Westphal, Otto
    Goteborg Pediat Growth Res Ctr, Dept Pediat, Inst Clin Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Growth hormone dose-dependent pubertal growth: a randomized trial in short children with low growth hormone secretion2014In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 82, no 3, p. 158-170Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Growth hormone (GH) treatment regimens do not account for the pubertal increase in endogenous GH secretion. This study assessed whether increasing the GH dose and/or frequency of administration improves pubertal height gain and adult height (AH) in children with low GH secretion during stimulation tests, i. e. idiopathic isolated GH deficiency.

    Methods: A multicenter, randomized, clinical trial (No. 88-177) followed 111 children (96 boys) at study start from onset of puberty to AH who had received GH(33) mu g/kg/day for >= 1 year. They were randomized to receive 67 mu g/kg/day (GH(67)) given as one (GH(67x1); n = 35) or two daily injections (GH(33x2); n = 36), or to remain on a single 33 mu g/kg/day dose (GH(33x1); n = 40). Growth was assessed as height SDS gain for prepubertal, pubertal and total periods, as well as AH SDS versus the population and the midparental height.

    Results: Pubertal height SDS gain was greater for patients receiving a high dose (GH(67), 0.73) than a low dose (GH(33x1), 0.41, p < 0.05). AH(SDS) was greater on GH(67) (GH(67x1), -0.84; GH(33x2), -0.83) than GH(33) (-1.25, p < 0.05), and height SDS gain was greater on GH(67) than GH(33) (2.04 and 1.56, respectively; p < 0.01). All groups reached their target height SDS.

    Conclusion: Pubertal height SDS gain and AH SDS were dose dependent, with greater growth being observed for the GH(67) than the GH(33) randomization group; however, there were no differences between the once-and twice-daily GH(67) regimens. (C) 2014 S. Karger AG, Basel.

  • 3.
    Allbrand, Marianne
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstet & Gynaecol, Örebro Univ Hosp, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University Hospital. Örebro University. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women2015In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, no 2, p. 159-164Article in journal (Refereed)
    Abstract [en]

    Objective: To survey the placental gene expression of inflammatory markers and growth factors in non-smoking obese women with an uncomplicated pregnancy without associated morbidity and delivery at term compared with normal weight women.

    Methods: Placental tissue samples from 32 obese women (body mass index, BMI >= 35.0 kg/m(2)) were compared with samples from 94 normal weight women (BMI 18.5-25.0 kg/m(2)) matched for age (+/- 1 year), gestational age (+/- 3 days), parity and mode of delivery. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to analyse toll receptor-2 and -4, interleukin-6 and -8, tumour necrosis factor-alpha, leptin, adiponectin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor.

    Results: There was no significant difference in gene expression in placental tissue samples from obese and normal weight women.

    Conclusion: We found no difference in the occurrence of inflammatory marker and growth factor mRNA levels in placental tissue samples from a large group of obese women without associated morbidity and with healthy infants compared to a closely matched control group of healthy normal weight women. Compared with the previous studies, this anomalous finding may be explained by the absence of associated morbidity in the obese women in our study.

  • 4.
    Allbrand, Marianne
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences.
    Adipocytokines in placenta and cord blood in relation to maternal obesity, and foetal and postnatal growth of the child2015In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 82, no Suppl. 1, p. 47-48Article in journal (Other academic)
    Abstract [en]

    Background: The nutritional and hormonal state in utero may be a link between maternal obesity and obesity in the offspring. The gene expression in placentae in pregnancies complicated by diabetes is reduced for leptin, but increased for ghrelin. It is not known whether these genes’ expressions in placentae are altered in maternal obesity.

    Objectives and hypotheses: To compare obese and normal-weight women and their children concerning gene expressions of leptin and ghrelin in placentae; leptin, ghrelin, adiponectin, and C-peptide levels in cord blood, birth size and postnatal growth. Changes in the expression of these adipocytokines may lead to an altered hypothalamic sensitivity to leptin and ghrelin resulting in an increased risk of obesity in the offspring.

    Method: 32 women with pre-pregnancy obesity, but otherwise healthy, were compared to 32 matched, normal-weight controls. Full-term placenta biopsies were analysed with qPCR for leptin mRNA and ghrelin mRNA. Cord blood samples were examined with ELISA for leptin, ghrelin, adiponectin, and C-peptide concentrations. Birth size and postnatal growth of the children were collected from clinical registers at the Child Health Care Units.

    Results: The leptin and ghrelin gene expressions in placentae did not differ between obese and normal-weight women. The leptin concentration in cord blood was higher in children of obese mothers (P=0.021). It correlated with birth weight Z-score (r=0.467, P<0.001) and C-peptide level in cord blood (r=0.446, P<0.001). Children of obese women were slightly heavier at birth, but postnatal growth did not differ between groups. Children with birth weight  ≤−0.67 Z-score had higher ghrelin levels in cord blood than heavier children (P=0.042). The leptin level in cord blood correlated negatively with weight gain at 6 months (r=−0.332, P=0.009). The ghrelin level in cord blood correlated with weight gain at 3 months in girls (r=0.611, P=0.001), but not in boys. The adiponectin level in cord blood correlated negatively with length gain at 3 years in the obese group (r=−0.571, P=0.033), but not in the normal-weight group.

    Conclusion: Leptin and ghrelin placental gene expressions are not altered in obese women, but foetal adipocytokine production may influence early postnatal growth, possibly by influencing hunger signalling or insulin levels

  • 5. Beraki, Åsa
    et al.
    Magnuson, Anders
    Samuelsson, Ulf
    Åman, Jan
    Särnblad, Stefan
    Örebro University, School of Medicine, Örebro University, Sweden.
    Ökad fysisk aktivitet är relaterat till lägre HbA1c -nivåer hos barn och ungdomar med typ 1-diabetes: Resultat från en studie baserad på det Svenska pediatriska kvalitets registret för barn och ungdomar med diabetes (SWEDIABKIDS)2014In: BestPractice ApS, ISSN 1902-7583, no 12Article in journal (Other academic)
  • 6.
    Beraki, Åsa
    et al.
    Linköping University, Linköping, Sweden.
    Magnusson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Särnblad, Stefan
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Centre, Linköping University, Linköping, Sweden.
    Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 105, no 1, p. 119-125Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes.

    Methods: Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7-18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA.

    Results: Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% +/- 1.5 (72 +/- 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% +/- 1.0 (60 +/- 11 mmol/mol)) (p < 0.001). An inverse dose-response association was found between PA and HbA1c (beta: -0.30, 95%CI: -0.34 to -0.26, p < 0.001). This association was found in both sexes and all age groups, apart from girls aged 7-10 years. Multiple regression analysis revealed that the relationship remained significant (beta: -0.21, 95% CI: -0.25 to -0.18, p < 0.001) when adjusted for possible confounding factors.

    Conclusions: Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.

  • 7. Cameron, F. J.
    et al.
    Skinner, T. C.
    de Beaufort, C. E.
    Hoey, H.
    Swift, P. G. F.
    Aanstoot, H.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Martul, P.
    Chiarelli, F.
    Daneman, D.
    Danne, T.
    Dorchy, H.
    Kaprio, E. A.
    Kaufman, F.
    Kocova, M.
    Mortensen, H. B.
    Njølstad, P. R.
    Phillip, M.
    Robertson, K. J.
    Schoenle, E. J.
    Urakami, T.
    Vanelli, M.
    Ackermann, R. W.
    Skovlund, S. E.
    Are family factors universally related to metabolic outcomes in adolescents with Type 1 diabetes?2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 4, p. 463-468Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess the importance of family factors in determining metabolic outcomes in adolescents with Type 1 diabetes in 19 countries.

    METHODS: Adolescents with Type 1 diabetes aged 11-18 years, from 21 paediatric diabetes care centres, in 19 countries, and their parents were invited to participate. Questionnaires were administered recording demographic data, details of insulin regimens, severe hypoglycaemic events and number of episodes of diabetic ketoacidosis. Adolescents completed the parental involvement scale from the Diabetes Quality of Life for Youth--Short Form (DQOLY-SF) and the Diabetes Family Responsibility Questionnaire (DFRQ). Parents completed the DFRQ and a Parental Burden of Diabetes score. Glycated haemoglobin (HbA(1c)) was analysed centrally on capillary blood.

    RESULTS: A total of 2062 adolescents completed a questionnaire, with 2036 providing a blood sample; 1994 parents also completed a questionnaire. Family demographic factors that were associated with metabolic outcomes included: parents living together (t = 4.1; P < 0.001), paternal employment status (F = 7.2; d.f. = 3; P < 0.001), parents perceived to be over-involved in diabetes care (r = 0.11; P < 0.001) and adolescent-parent disagreement on responsibility for diabetes care practices (F = 8.46; d.f. = 2; P < 0.001). Although these factors differed between centres, they did not account for centre differences in metabolic outcomes, but were stronger predictors of metabolic control than age, gender or insulin treatment regimen.

    CONCLUSIONS: Family factors, particularly dynamic and communication factors such as parental over-involvement and adolescent-parent concordance on responsibility for diabetes care appear be important determinants of metabolic outcomes in adolescents with diabetes. However, family dynamic factors do not account for the substantial differences in metabolic outcomes between centres 

  • 8.
    Ekelund, Ulf
    et al.
    Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden; Department of Physical Education and Health, Örebro University, Örebro, Sweden; .
    Åman, Jan
    Örebro University, School of Health and Medical Sciences. Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden; .
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden .
    Renman, Cecilia
    Department of Pediatrics, Örebro Medical Center, Örebro, Sweden .
    Westerterp, Klaas
    Department of Human Biology, Maastricht University, Maastricht, Netherlands.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden .
    Physical activity but not energy expenditure is reduced in obese adolescents: a case-control study2002In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 76, no 5, p. 935-941Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The influence of physical activity on body weight in children and adolescents is controversial.

    OBJECTIVE: The objective was to test the hypothesis that the intensity and duration of physical activity differ between obese and normal-weight adolescents, with no difference in estimated energy expenditure.

    DESIGN: We compared physical activity in 18 (8 males, 10 females) obese [body mass index (in kg/m(2)) > 30] adolescents (14-19 y) with that in a matched, normal-weight (BMI < 27) control group. Total energy expenditure (TEE) was measured with the doubly labeled water method, and physical activity was measured simultaneously by accelerometry. The physical activity level was determined as the ratio of TEE to the resting metabolic rate (RMR) and activity energy expenditure as 0.9 TEE minus RMR. Accelerometry data included total physical activity (counts x min(-1) x d(-1)), accumulated and continuous duration of activity, and continuous 10-min periods of physical activity of moderate intensity.

    RESULTS: There was no significant difference in adjusted (analysis of covariance) TEE, RMR, or AEE between groups. The physical activity level was significantly lower (P < 0.05) in the obese group. No sex x group interaction was observed. Differences in total physical activity (P < 0.001), accumulated time (P < 0.05), continuous time (P < 0.01), and continuous 10-min periods of physical activity of moderate intensity (P < 0.01) were observed between groups.

    CONCLUSIONS: Obese adolescents are less physically active than are normal-weight adolescents, but physical activity-related energy expenditure is not significantly different between groups. The data suggest that physical activity is not necessarily equivalent to the energy costs of activity.

  • 9.
    Fadl, Helena E.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gärdefors, Susanne
    Department of Obstetrics and Gynecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hjertberg, Ragnhild
    UltraGyn Clinic, Stockholm, Sweden.
    Nord, Eva
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Persson, Bengt
    Karolinska Institute, Stockholm, Sweden.
    Schwarcz, Erik
    Department of Internal Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid K.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hanson, Ulf S. B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Children’s and Women’s Health, Uppsala University, Uppsala, Sweden.
    Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, p. 1181-1187Article in journal (Refereed)
    Abstract [en]

    Introduction: A randomized multicenter study was conducted in the Stockholm-orebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia.

    Material and methods: Pregnant women with hyperglycemia defined as fasting capillary plasma glucose <7.0 mmol/L and a two-hour plasma glucose value 10.0 and <12.2 mmol/L following a 75-g oral glucose tolerance test (OGTT) diagnosed before 34 weeks of gestation were randomized to treatment (n=33) or controls (n=36). Women assigned to the control group were blinded for the OGTT results and received routine care. The therapeutic goal was fasting plasma glucose 4-5 mmol/L, and <6.5 mmol/L after a meal. Primary outcomes were size at birth and number of large-for-gestational age (>90th percentile) neonates. Secondary outcomes were pregnancy complications, neonatal morbidity and glycemic control.

    Results: The planned number of participating women was not reached. There was a significantly reduced rate of large-for-gestational age neonates, 21 vs. 47%, P<0.05. Group differences in pregnancy complications and neonatal morbidity were not detected because of limited statistical power. In total, 66.7% of the women in the intervention group received insulin. Of all measured plasma glucose values, 64.1% were in the target range, 7.2% in the hypoglycemic range and 28.7% above target values. There were no cases of severe hypoglycemia.

    Conclusions: Aiming for normalized glycemia in a pregnancy complicated by severe hyperglycemia reduces fetal growth but is associated with an increased rate of mild hypoglycemia.

  • 10.
    Hjern, Anders
    et al.
    Centre for Health Equity Studies (CHESS), Karolinska Institute Stockholm, Sweden; Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden.
    Söderström, Ulf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Mälarsjukhuset, Eskilstuna, Sweden.
    Åman, Jan
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    East africans in Sweden have a high risk for type 1 diabetes2012In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 35, no 3, p. 597-598Article in journal (Refereed)
    Abstract [en]

    Citing this article BMJ Open October 31, 2013 3:e003418

    Objective: To investigate the prevalence of type 1 diabetes in children with an origin inSub-Saharan Africa in Sweden.

    Research design and methods: Nationwide register study based on retrievedprescriptions of insulin during 2009 in children aged 0–18 years. The study population consistedof 35,756 children in families with an origin in Sub-Saharan Africa and 1,666,051 children withnative Swedish parents.

    Results: The odds ratio (OR) for insulin medication in Swedish-born children in familiesoriginating in East Africa was 1.29 (95% CI 1.02–1.63) compared with offspring of nativeSwedish parents, after adjustment for age and sex, and less common in children who themselveswere born in East Africa: 0.50 (0.34–0.73). Offspring of parents from other parts of Sub-SaharanAfrica had a comparatively low risk for insulin medication.

    Conclusions: This study indicates that Swedish-born children with an origin in EastAfrica have a high risk of type 1 diabetes.

  • 11. Hoey, Hilary
    et al.
    McGee, Hannah M
    Fitzgerald, Michael
    Mortensen, Henrik B.
    Hougaard, Philip
    Lynggaard, Helle
    Skovlund, Sören E.
    Aanstoot, Henk-Jan
    Chiarelli, Francesco
    Daneman, Denis
    Danne, Thomas
    Dorchy, Harry
    Garandeau, Patrick
    Greene, Stephen
    Holl, Reinhard
    Kaprio, Eero
    Kocova, Mirjana
    Martul, Pedro
    Matsuura, Nobuo
    Robertson, Kenneth
    Schoenle, Eugen
    Sovik, Oddmund
    Swift, Peter
    Tsou, Rosa Maria
    Vanelli, Maurizio
    Åman, Jan
    Örebro University, Department of Clinical Medicine.
    Parent and health professional perspectives in the management of adolescents with diabetes: development of assessment instruments for international studies2006In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 15, no 6, p. 1033-1042Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Assessment of quality of life (QOL) in adolescents with diabetes requires patient, parent and health professional input. Psychometrically robust instruments to assess parent and professional perspectives are required. RESEARCH DESIGN AND METHODS: Questionnaires concerning adolescent QOL were developed for completion by parents and health professionals. In an international study assessing QOL in 2,101 adolescents with diabetes (median age 14 years, range 10-18; from 17 countries including Europe, Japan and North America), parents and health professionals completed their respective questionnaires between March and August 1998. RESULTS: Feasibility and acceptability of the new questionnaires were indicated by high questionnaire completion rates (adolescents 92%; parents 89%; health professionals 94%). Internal consistency was confirmed (Cronbach's alpha coefficients 0.80 parent; 0.86 health professional). Correlations of Diabetes Quality of Life Questionnaire for Youths (DQOLY) scores with parent and health professional global QOL ratings were generally low (r ranging from 0.12 to 0.36). Parent-rated burden decreased incrementally across adolescence, particularly for girls. Professional-rated burden followed a similar profile but only after age 15 years. Until then, burden was rated as uniformly high. Clinically relevant discrepancies in parent and professional burden scores were noted for one-parent families and families where adolescents had been referred for psychological help. In both cases, health professionals but not one-parent families perceived these as high burden situations. The clinical significance of this relates to the significantly poorer metabolic control recorded for adolescents in both situations. CONCLUSIONS: Parent and health professional questionnaires were found to have adequate internal consistency, and convergent and discriminant validity in relation to key clinical and QOL outcomes. The questionnaires are brief, easy to administer and score. They may also enable comparisons across countries and languages to facilitate development of international health outcome parameters. The inclusion of the parent and health professional perspectives completes a comprehensive assessment of adolescent QOL relevant to diabetes.

  • 12.
    Kaas, A.
    et al.
    Department of Paediatrics, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
    Pfleger, C.
    Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany.
    Kharagjitsingh, A. V.
    Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
    Schloot, N .C.
    Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany; Medical Faculty, Department of Metabolic Diseases, University of Düsseldorf, Düsseldorf, Germany .
    Hansen, L.
    Department of Paediatrics, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
    Buschard, K.
    Bartholin Institute, Rigshospitalet, Copenhagen, Denmark.
    Koeleman, B. P. C.
    Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
    Roep, B. O.
    Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
    Mortensen, H. B.
    Department of Paediatrics, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
    Alizadeh, B. Z.
    Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
    Association between age, IL-10, IFN gamma, stimulated C-peptide and disease progression in children with newly diagnosed Type 1 diabetes2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 6, p. 734-741Article in journal (Refereed)
    Abstract [en]

    AIMS: The relation of disease progression and age, serum interleukin 10 (IL-10) and interferon gamma (IFNγ) and their genetic correlates were studied in paediatric patients with newly diagnosed Type 1 diabetes.

    METHODS: Two hundred and twenty-seven patients from the Hvidoere Study Group were classified in four different progression groups as assessed by change in stimulated C-peptide from 1 to 6 months. CA repeat variants of the IL-10 and IFNγ gene were genotyped and serum levels of IL-10 and IFNγ were measured at 1, 6 and 12 months.

    RESULTS: IL-10 decreased (P < 0.001) by 7.7% (1 month), 10.4% (6 months) and 8.6% (12 months) per year increase in age of child, while a twofold higher C-peptide concentration at 1 month (p = 0.06), 6 months (P = 0.0003) and 12 months (P = 0.02) was associated with 9.7%, 18.6% and 9.7% lower IL-10 levels, independent of each other. IL-10 concentrations did not associate with the disease progression groups. By contrast, IFNγ concentrations differed between the four progression groups at 6 and 12 months (P = 0.02 and P = 0.01, respectively); patients with rapid progressing disease had the highest levels at both time points. Distribution of IL-10 and IFNγ genotypes was equal among patients from the progression groups.

    CONCLUSION: IL-10 serum levels associate inversely with age and C-peptide. As age and C-peptide also associate, a triangular association is proposed. Genetic influence on IL-10 production seems to be masked by distinct disease mechanisms. Increased serum IFNγ concentrations associate with rapid disease progression. Functional genetic variants do not associate with a single progression pattern group, implying that disease processes override genetically predisposed cytokine production.

  • 13.
    Kaas, Anne
    et al.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Andersen, Marie Louise Max
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Fredheim, Siri
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Hougaard, Philip
    Department of Statistics, University of Southern Denmark, Odense, Denmark.
    Buschard, Karsten
    Bartholin Institute, Rigshospitalet, Copenhagen, Denmark.
    Petersen, Jacob Steen
    Diabetes Biology and Pharmacology, Novo Nordisk A/S, Måløv, Denmark.
    de Beaufort, Carine
    Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg.
    Robertson, Kenneth J.
    Department of Paediatrics, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, United Kingdom.
    Hansen, Lars
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Mortensen, Henrik B.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Nielsen, Lotte B.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Proinsulin, GLP-1, and glucagon are associated with partial remission in children and adolescents with newly diagnosed type 1 diabetes2012In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 13, no 1, p. 51-58Article in journal (Refereed)
    Abstract [en]

    Objective: Proinsulin is a marker of beta-cell distress and dysfunction in type 2 diabetes and transplanted islets. Proinsulin levels are elevated in patients newly diagnosed with type 1 diabetes. Our aim was to assess the relationship between proinsulin, insulin dose-adjusted haemoglobin A1c (IDAA1C), glucagon-like peptide-1 (GLP-1), glucagon, and remission status the first year after diagnosis of type 1 diabetes.

    Methods: Juvenile patients (n = 275) were followed 1, 6, and 12 months after diagnosis. At each visit, partial remission was defined as IDAA1C = 9%. The patients had a liquid meal test at the 1-, 6-, and 12-month visits, which included measurement of C-peptide, proinsulin, GLP-1, glucagon, and insulin antibodies (IA).

    Results: Patients in remission at 6 and 12 months had significantly higher levels of proinsulin compared to non-remitting patients (p < 0.0001, p = 0.0002). An inverse association between proinsulin and IDAA1C was found at 1 and 6 months (p = 0.0008, p = 0.0022). Proinsulin was positively associated with C-peptide (p < 0.0001) and IA (p = 0.0024, p = 0.0068, p < 0.0001) at 1, 6, and 12 months. Glucagon (p < 0.0001 and p < 0.02) as well as GLP-1 (p = 0.0001 and p = 0.002) were significantly lower in remitters than in non-remitters at 6 and 12 months. Proinsulin associated positively with GLP-1 at 1 month (p = 0.004) and negatively at 6 (p = 0.002) and 12 months (p = 0.0002).

    Conclusions: In type 1 diabetes, patients in partial remission have higher levels of proinsulin together with lower levels of GLP-1 and glucagon compared to patients not in remission. In new onset type 1 diabetes proinsulin level may be a sign of better residual beta-cell function.

  • 14.
    Lindström, Caisa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Anderzen Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Science, Örebro University Hospital, Örebro, Sweden.
    Lindahl-Norberg, Annika
    Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Group intervention for burnout in parents of chronically ill children: a small-scale study2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 678-686Article in journal (Refereed)
    Abstract [en]

    Background: Long-term stress leading to burnout symptoms is prevalent in parents of chronically ill children. The aim of the study was to evaluate the effect of a group intervention by measuring changes in self-rated clinical burnout and performance-based self-esteem. In addition, the parental perceptions of the acceptability of the intervention were explored.

    Methods: Previously, we have explored the prevalence of clinical burnout in parents of patients 1–18 years with type 1 diabetes mellitus (T1DM) and inflammatory bowel disease (IBD) in the county of Örebro. All parents who exhibited clinical burnout symptoms in accordance with the Shirom–Melamed Burnout Questionnaire (SMBQ) were then invited to participate in a group intervention, which was evaluated in the present small-scale study. The group intervention consisted of eight sessions over a 12-week period, including education about behaviour, cognition and symptoms associated with burnout, intending to help the parents to develop adequate strategies for coping with and reducing stress. We evaluated the effect of the intervention in terms of self-rated clinical burnout and performance-based self-esteem (PBSE). In addition, the acceptability of the intervention was evaluated by analyses of recruitment and retention and self-reports from parents.

    Results: Sixteen parents (13 of children with TIDM and three of children with IBD) out of 104 reporting clinical burnout participated in the intervention. All participants completed the intervention, and the mean attendance rate at all sessions was 90%. Parents’ subjective evaluations were mainly positive, and SMBQ (p = 0.01) and PBSE scale (p = 0.04) measurements were significantly reduced, which effects remained 6 months after completion of the intervention.

    Conclusions: Despite the small-scale study, we consider that this intervention for parents with clinical burnout was appreciated and well accepted. The significant reduction in clinical burnout symptoms requires further evaluation in randomised controlled studies based on larger groups of parents.

  • 15.
    Lindström, Caisa
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Lindahl Norberg, Annika
    Karolinska Institute, Stockholm, Sweden.
    Increased prevalence of burnout symptoms in parents of chronically ill children2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 3, p. 427-432Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the prevalence of burnout symptoms in the context of parenting a chronically ill child. Methods: A total of 252 parents of children with Type 1 Diabetes Mellitus and 38 parents of children with Inflammatory Bowel Diseases participated in a population-based study. A control group consisted of 124 randomly selected parents of healthy children. We used self-report questionnaires to assess symptoms of burnout. Results: The main finding was that significantly more parents of children with chronic diseases (36%) scored for clinical burnout, compared with parents of healthy children (20%). Burnout symptoms were most prominent among mothers of children with diabetes, although fathers of children with diabetes and mothers and fathers of children with inflammatory bowel diseases also reported higher levels of various burnout symptoms. Conclusion: Burnout may be a useful model for understanding long-term parental responses and should be acknowledged among the different types of psychological consequences of the multi-faceted experience of parenting a child with chronic illness. Gender seems to influence the risk of burnout symptoms. Continued research about other background factors, and how the parents' situation changes over time are warranted. In the clinic, we need to draw attention to the group of parents who may suffer from burnout.

  • 16.
    Lindström, Caisa
    et al.
    Örebro University, School of Health and Medical Sciences.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Lindahl Norberg, Annika
    Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 7, p. 1011-1017Article in journal (Refereed)
    Abstract [en]

    Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population-based study. We used self-report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child's disease affects everyday life. Low self-esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long-term stress in parents of children with T1DM, we should recognize parents' attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day-to-day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.

  • 17.
    Lindström, Caisa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Lindahl Norberg, Annika
    Centre for occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Forssberg, M.
    Department of Pediatrics, Central hospital, Karlstad.
    Anderzén - Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Center, Region Örebro County, Örebro Sweden.
    “Mission impossible”: The mothering of a child with diabetes type 1 - from the perspective of mothers suffering from burnoutManuscript (preprint) (Other academic)
  • 18.
    Lodefalk, Maria
    et al.
    Department of Paediatric Diabetology and Endocrinology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm; Department of Paediatrics, Örebro University Hospital, Örebro.
    Åman, Jan
    Department of Paediatric Diabetology and Endocrinology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm; Department of Paediatrics, Örebro University Hospital, Örebro.
    Food habits, energy and nutrient intake in adolescents with Type 1 diabetes mellitus2006In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 23, no 11, p. 1225-1232Article in journal (Refereed)
    Abstract [en]

    AIMS: The aims were to describe the food habits of adolescents with Type 1 diabetes (Type 1 DM) and to compare them with healthy control subjects; to describe the distribution of energy-providing nutrients in patients and compare it with current recommendations and previous reports; and finally, to investigate associations between dietary intake and glycaemic control. METHODS: One hundred and seventy-four adolescents with Type 1 DM and 160 age- and sex-matched healthy control subjects completed a validated food frequency questionnaire, and 38 randomly chosen patients completed a prospective 4-day food record. RESULTS: Patients ate more regularly, and more often ate fruit and fruit juice, potatoes and root vegetables, meat, fish, egg, offal and sugar-free sweets than control subjects. Control subjects more often ate ordinary sweets and snacks. Patients chose coarse rye bread and dairy products with less fat to a greater extent than control subjects. Patients were heavier than control subjects. The intake of saturated fat was higher in patients compared with recommendations and, for boys with diabetes, the intake of protein was higher than recommended. Patients with poorer glycaemic control ate vegetables, fruit and fish less often than patients with better control. CONCLUSIONS: The food habits of adolescents with Type 1 DM were healthier than those of control subjects. The intake of energy-providing nutrients was in line with current recommendations and showed improvements compared with previous reports, with the exception of fibre intake. The association between dietary intake and glycaemic control needs further investigation in prospective studies.

  • 19.
    Lodefalk, Maria
    et al.
    Örebro University, School of Health and Medical Sciences. Paediatric Endocrinology and Diabetes Unit, Department of Woman and Child Health, Karolinska Institute, Stockholm; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences. Departm ent of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Bang, P.
    Paediatric Endocrinology and Diabetes Unit, Department of Woman and Child Health, Karolinska Institute, Stockholm.
    Effects of fat supplementation on glycaemic response and gastric emptying in adolescents with Type 1 diabetes2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 9, p. 1030-1035Article in journal (Refereed)
    Abstract [en]

    AIMS: To compare the glycaemic response to meals with different fat content in adolescents with Type 1 diabetes mellitus (T1DM) and to investigate associations with gastric emptying.

    METHODS: In this randomized, cross-over study, paired results were obtained from seven adolescents with T1DM who ingested on different days two meals with the same carbohydrate and protein content, but different fat and energy content (2 and 38 g fat, 320 and 640 kcal, respectively). Paracetamol was mixed into the meals and gastric emptying was estimated by the paracetamol absorption method. All subjects were normoglycaemic and given 7 IU insulin aspart at commencement of ingestion. Postprandial blood samples were taken during 4 h.

    RESULTS: The areas under the curves for plasma glucose and serum paracetamol concentrations were larger after the low-fat than after the high-fat meal during the first 2 h (P = 0.047 and P = 0.041, respectively). The difference between meals in time-to-peak in glucose and paracetamol concentrations did not reach statistical significance (high-fat vs. low-fat meal: 210 min (120-240) vs. 120 min (50-240), P = 0.080 and 120 min (75-180) vs. 60 min (60-120), P = 0.051, respectively). Changes in glucose concentrations correlated with simultaneous changes in paracetamol concentrations (P < 0.001).

    CONCLUSIONS: For the first time, we have shown that the initial glycaemic response is reduced after a meal with higher compared with a meal with lower fat content in adolescents with T1DM given a rapid-acting insulin analogue preprandially. The type and dose of preprandial insulin may need adjustment to the fat content of the meal to reach postprandial normoglycaemia.

  • 20. Ludvigsson, Johnny
    et al.
    Faresjö, Maria
    Hjorth, Maria
    Axelsson, Stina
    Chéramy, Mikael
    Pihl, Mikael
    Vaarala, Outi
    Forsander, Gun
    Ivarsson, Sten
    Johansson, Calle
    Lindh, Agne
    Nilsson, Nils-Östen
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Örtqvist, Eva
    Zerhouni, Peter
    Casas, Rosaura
    GAD treatment and insulin secretion in recent-onset type 1 diabetes2008In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 359, no 18, p. 1909-1920Article in journal (Refereed)
    Abstract [en]

    Background The 65-kD isoform of glutamic acid decarboxylase (GAD) is a major autoantigen in patients with type 1 diabetes mellitus. This trial assessed the ability of alum-formulated GAD (GAD-alum) to reverse recent-onset type 1 diabetes in patients 10 to 18 years of age. Methods We randomly assigned 70 patients with type 1 diabetes who had fasting C-peptide levels above 0.1 nmol per liter (0.3 ng per milliliter) and GAD autoantibodies, recruited within 18 months after receiving the diagnosis of diabetes, to receive subcutaneous injections of 20 μg of GAD-alum (35 patients) or placebo (alum alone, 35 patients) on study days 1 and 30. At day 1 and months 3, 9, 15, 21, and 30, patients underwent a mixed-meal tolerance test to stimulate residual insulin secretion (measured as the C-peptide level). The effect of GAD-alum on the immune system was also studied. Results Insulin secretion gradually decreased in both study groups. The study treatment had no significant effect on change in fasting C-peptide level after 15 months (the primary end point). Fasting C-peptide levels declined from baseline levels significantly less over 30 months in the GAD-alum group than in the placebo group (−0.21 vs. −0.27 nmol per liter [−0.62 vs. −0.81 ng per milliliter], P = 0.045), as did stimulated secretion measured as the area under the curve (−0.72 vs. −1.02 nmol per liter per 2 hours [−2.20 vs. −3.08 ng per milliliter per 2 hours], P = 0.04). No protective effect was seen in patients treated 6 months or more after receiving the diagnosis. Adverse events appeared to be mild and similar in frequency between the two groups. The GAD-alum treatment induced a GAD-specific immune response. Conclusions GAD-alum may contribute to the preservation of residual insulin secretion in patients with recent-onset type 1 diabetes, although it did not change the insulin requirement. (ClinicalTrials.gov number, NCT00435981.)

  • 21. Mortensen, Henrik B.
    et al.
    Hougaard, Philip
    Swift, Peter
    Hansen, Lars
    Holl, Reinhard W.
    Hoey, Hilary
    Bjoerndalen, Hilde
    de Beaufort, Carine
    Chiarelli, Francesco
    Danne, Thomas
    Schoenle, Eugen J.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    New definition for the partial remission period in children and adolescents with type 1 diabetes2009In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 32, no 8, p. 1384-1390Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To find a simple definition of partial remission in type 1 diabetes that reflects both residual beta-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS A total of 275 patients aged <16 years were followed from onset of type 1 diabetes. After 1, 6, and 12 months, stimulated C-peptide during a challenge was used as a measure of residual beta-cell function. RESULTS By multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient -0.21, P < 0.001) and insulin dose (-0.94, P < 0.001) was shown. These results suggested the definition of an insulin dose-adjusted A1C (IDAA1C) as A1C (percent) + [4 x insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C < or =9 corresponding to a predicted stimulated C-peptide >300 pmol/l was used to define partial remission. The IDAA1C < or =9 had a significantly higher agreement (P < 0.001) with residual beta-cell function than use of a definition of A1C < or =7.5%. Between 6 and 12 months after diagnosis, for IDAA1C < or =9 only 1 patient entered partial remission and 61 patients ended partial remission, for A1C < or =7.5% 15 patients entered partial remission and 53 ended, for a definition of insulin dose < or =0.5 units . kg(-1) . 24 h(-1) 5 patients entered partial remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months. CONCLUSIONS A new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual beta-cell function and has better stability compared with the conventional definitions.

  • 22. Resic-Lindehammer, Sabina
    et al.
    Larsson, K.
    Örtqvist, E.
    Carlsson, A.
    Cederwall, E.
    Cilio, C. M.
    Ivarsson, S.-A.
    Jönsson, B. A.
    Larsson, H. E.
    Lynch, K.
    Neiderud, J.
    Nilsson, A.
    Sjöblad, S.
    Lernmark, Å.
    Aili, M
    Bååth, L. E.
    Carlsson, E.
    Edenwall, H.
    Forsander, G.
    Granstro, B. W.
    Gustavsson, I.
    Hanås, R.
    Hellenberg, L.
    Hellgren, H.
    Holmberg, E.
    Hörnell, H.
    Ivarsson, Sten-A.
    Johansson, C.
    Jonsell, G.
    Kockum, K.
    Lindblad, Birgitta
    Lindh, A.
    Ludvigsson, Jonas F
    Myrdal, U.
    Neiderud, J.
    Segnestam, K.
    Sjöblad, S.
    Skogsberg, L.
    Strömberg, L.
    Ståhle, U.
    Thalme, B.
    Tullus, K.
    Tuvemo, T.
    Wallensteen, M.
    Westphal, O.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Temporal trends of HLA genotype frequencies of type 1 diabetes patients in Sweden from 1986 to 2005 suggest altered risk2008In: Acta Diabetologica, ISSN 0940-5429, E-ISSN 1432-5233, Vol. 45, no 4, p. 231-235Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare the frequency of human leukocyte antigen (HLA) genotypes in 1-18-year-old patients with type 1 diabetes newly diagnosed in 1986-1987 (n = 430), 1996-2000 (n = 342) and in 2003-2005 (n = 171). We tested the hypothesis that the HLA DQ genotype distribution changes over time. Swedish type 1 diabetes patients and controls were typed for HLA using polymerase chain reaction amplification and allele specific probes for DQ A1* and B1* alleles. The most common type 1 diabetes HLA DQA1*-B1*genotype 0501-0201/0301-0302 was 36% (153/430) in 1986-1987 and 37% (127/342) in 1996-2000, but decreased to 19% (33/171) in 2003-2005 (P \ 0.0001). The 0501-0201/0501-0201 genotype increased from 1% in 1986-1987 to 7% in 1996-2000 (P = 0.0047) and to 5% in 2003-2005 (P > 0.05). This study in 1-18-year-old Swedish type 1 diabetes patients supports the notion that there is a temporal change in HLA risk.

  • 23. Samuelson, Gösta
    et al.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Lodefalk, Maria
    Detlofsson, Ingalill
    Cederholm, Ulla
    Vall, Helene
    Mat vid diabetes2008In: Barn- och ungdomsdiabetes / [ed] Sture Sjöblad, Lund: Studentlitteratur , 2008, 2, p. 93-101Chapter in book (Other academic)
  • 24. Stenninger, Erik
    et al.
    Lindqvist, A.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences.
    Östlund, I.
    Schvarcz, E.
    Continuous Subcutaneous Glucose Monitoring System in diabetic mothers during labour and postnatal glucose adaptation of their infants2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 4, p. 450-454Article in journal (Refereed)
    Abstract [en]

    Aims  To assess a new technique for continuous monitoring of glucose concentration during labour in diabetic mothers. A second objective was to study maternal glucose levels in relation to postnatal glucose adaptation and the need for intravenous (IV) glucose treatment in the newborn infant.

    Methods  Fifteen pregnant women with insulin-treated diabetes mellitus participated in this prospective pilot study. To measure their glucose control during labour we used the Continuous Subcutaneous Glucose Monitoring System (CGMS; Medtronic, Minneapolis, MN, USA) to calculate the mean glucose concentration and the area under the curve (AUC) in the last 120 min before delivery. All infants of these women were transferred to the neonatal care unit for early oral feeding and blood glucose measurements up to 14 h after delivery. Infants received IV glucose if blood glucose values were repeatedly < 2.2 mmol/l.

    Results  All women coped well with the CGMS monitoring. AUC 0–120 min before delivery, mean glucose concentration 0–120 min before delivery and cord plasma insulin level were all significantly associated with the need for IV glucose in the newborn children.

    Conclusions  In this study we found an association between maternal glucose concentrations during labour and postnatal glucose adaptation and need for IV glucose treatment in the infants. Online monitoring of glucose levels during delivery might help us to achieve maternal normoglycaemia and further reduce the risk of postnatal hypoglycaemia in the offspring.

  • 25.
    [Svensson] Lodefalk, Maria
    et al.
    Department of Paediatrics, Örebro University Hospital.
    Engström, Ingemar
    Department of Paediatrics, Örebro University Hospital; Psychiatric Research Centre, Örebro.
    Åman, Jan
    Department of Paediatrics, Örebro University Hospital.
    Higher drive for thinness in adolescent males with insulin-dependent diabetes mellitus compared with healthy controls2003In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, p. 114-117Article in journal (Refereed)
  • 26.
    Särnblad, Stefan
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Ekelund, Ulf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Medical Research Council Epidemiology Unit, Cambridge, U.K. .
    Åman, Jan
    Örebro University, Department of Clinical Medicine. Department of Pediatrics, University Hospital, Örebro, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Dietary fat intake predicts 1-year change in body fat in adolescent girls with type 1 diabetes2006In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 29, no 6, p. 1227-1230Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to determine whether objectively measured physical activity and dietary macronutrient intake differentially predict body fat in adolescent girls with type 1 diabetes and control girls.

    RESEARCH DESIGN AND METHODS: This study comprised 23 girls (12-19 years) with type 1 diabetes and 19 age-matched healthy control girls. At baseline, physical activity and energy intake were assessed for 7 consecutive days by accelerometry and a structured food diary, respectively. Body composition was measured by dual-energy X-ray absorptiometry at baseline and after 1 year.

    RESULTS: Fat intake was positively related to a 1-year change in percentage body fat (P = 0.006), after adjustment for total energy intake. No significant interaction was observed (case-control group x main exposure), indicating that the association between fat intake and gain in body fat was similar in both groups. Physical activity did not predict gain in body fat; however, total physical activity was positively associated with a gain in lean body mass (P < 0.01). Girls treated with six daily dosages of insulin increased their percentage of body fat significantly more than those treated with four daily injections (P < 0.05).

    CONCLUSIONS: In this prospective case-control study, we found that fat intake predicted gain in percentage of body fat in both adolescent girls with type 1 diabetes and healthy control girls. The number of daily insulin injections seems to influence the accumulation of body fat in girls with type 1 diabetes.

  • 27.
    Särnblad, Stefan
    et al.
    Örebro University, School of Medical Sciences.
    Magnusson, Anders
    Ekelund, Ulf
    Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Medical Research Council Epidemiology Unit, Cambridge, UK.
    Jan, Åman
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual energy X-ray absorptiometry2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 10, p. 1211-1215Article in journal (Refereed)
    Abstract [en]

    Aim: Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual-energy X-ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age-matched controls.

    Methods: We included 49 healthy girls and 44 girls with diabetes aged 12 to 19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX-L scanner. The agreement between the methods was assessed by using an Bland-Altman plot.

    Results: The skinfold measurements were significantly higher in girls with diabetes (p=0.003) despite a non-significant difference in total %BF (p=0.1). A significant association between bias and %BF was found for all tested equations in the Bland-Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p=0.039) between the girls with diabetes and the healthy controls.

    Conclusion: The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criteron. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.

  • 28.
    Söderström, Ulf
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Mälarsjukhuset Hospital, Eskilstuna, Sweden.
    Samuelsson, Ulf
    Division of Paediatrics, Department of Molecular and Clinical Medicine, Linköping University, Linköping, Sweden; Department of Pediatrics, University Hospital in Linköping, Linköping, Sweden.
    Sahlqvist, Lotta
    Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Impaired metabolic control and socio-demographic status in immigrant children at onset of type 1 diabetes2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 11, p. 1418-1423Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status.

    Methods and design: This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type1 diabetes.

    Results: The proportion of low capillary pH (<7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P<0.001)]. HbA(1c) was also higher [95mmol/mol (10.8%) vs. 88mmol/mol (10.2%), respectively (P<0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA(1c) was 0.983 (95%CI 0.976-0.991) and for plasma glucose was 0.953 (95%CI 0.933-0.973).

    Conclusion: Children born to immigrant parents have lower capillary pH and higher HbA(1c) at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.

  • 29.
    Söderström, Ulf
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Mälarsjukhuset, Eskilstuna, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hjern, Anders
    Centre for Health Equity Studies (CHESS), Karolinska Institute, Stockholm, Sweden; Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden.
    Being born in Sweden increases the risk for type 1 diabetes: a study of migration of children to Sweden as a natural experiment2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 1, p. 73-77Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world.

    Methods: Register study in a Swedish study population in the age 6–25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24 252 international adoptees; 47 986 immigrants and 40 971 Swedish-born with two foreign-born parents and a comparison group of 1 770 092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression.

    Results: The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03–2.73).

    Conclusions: Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM

  • 30.
    Söderström, Ulf
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics Örebro University Hospital, Sweden.
    Samuelsson, Ulf
    Division of Paediatrics, Department of Molecular and Clinical Medicine, Linkoping University, Sweden; Department of Pediatrics, Linköping University Hospital, Linköping, Sweden.
    Sahlqvist, Lotta
    Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
    Immigrant childrenwith type 1 diabetes have impaired metabolic control after three years oftreatment: a nation-wide cohort study in Sweden2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To compare clinical status after three years of treatment and socio-demographic conditions at onset in children with diabetes born to immigrant parents with children to Swedish born parents. Design: Observational nationwide population based cohort-study on prospectively recorded registry data.

    Setting: All children with diabetes in Sweden and their parents between 2000 and 2010.

    Patients: 879 children with diabetes born to immigrant parents out of a total of 13 415 children, the immigrant cohort. To these we added 2627 children with diabetes of Swedish born parents, matched for gender, age and year of onset, the Swedish cohort.

    Main outcome: The immigrant children had a higher median HbA1c, 69 mmol/mol (8.5 %), compared to their Swedish peers 62 (7.8 %), p = 0.002, and the 75th percentile of 72 (8.8 %) vs 70 (8.5 %). There was however no difference in frequency of severe events of hypoglycemia or keto-acidosis between the two cohorts (p = 0.258). A linear regression model with HbA1c as dependent variable pointed out insulin units per kg BW as the main reason for inferior metabolic control, OR 11.410, CI 95% 7.418_15.402, p < 0.001.

    Conclusions: Children with diabetes born to immigrant parents have worse metabolic status three years after disease onset.

  • 31.
    Åman, Jan
    et al.
    Örebro University, School of Health and Medical Sciences.
    Skinner, T. C.
    de Beaufort, C. E.
    Swift, P. G. F.
    Aanstoot, H.-J.
    Cameron, F.
    Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes2009In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 10, no 4, p. 234-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Hvidoere Study Group on Childhood Diabetes has demonstrated persistent differences in metabolic outcomes between pediatric diabetes centers. These differences cannot be accounted for by differences in demographic, medical, or treatment variables. Therefore, we sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers. METHODS: An observational cross-sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants. Hemoglobin A1c (HbA1c) levels were assayed in one central laboratory. All individuals with diabetes aged 11-18 yr (49.4% female), with duration of diabetes of at least 1 yr, were invited to participate. Individuals completed a self-reported measure of quality of life (Diabetes Quality of Life - Short Form [DQOL-SF]), with well-being and leisure time activity assessed using measures developed by Health Behaviour in School Children WHO Project. RESULTS: Older participants (p < 0.001) and females (p < 0.001) reported less physical activity. Physical activity was associated with positive health perception (p < 0.001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis. The more time spent on the computer (r = 0.06; p < 0.05) and less time spent doing school homework (r = -0.09; p < 0.001) were associated with higher HbA1c. Between centers, there were significant differences in reported physical activity (p < 0.001) and sedentary behavior (p < 0.001), but these differences did not account for center differences in metabolic control. CONCLUSIONS: Physical activity is strongly associated with psychological well-being but has weak associations with metabolic control. Leisure time activity is associated with individual differences in HbA1c but not with intercenter differences.

  • 32.
    Åman, Jan
    et al.
    Örebro University, Department of Clinical Medicine.
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Preventivmedelsrådgivning2008In: Barn- och ungdomsdiabetes / [ed] Sture Sjöblad, Lund: Studentlitteratur , 2008, 2, p. 195-197Chapter in book (Other academic)
1 - 32 of 32
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