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Background: Functional abdominal pain disorders (FAPDs) are common in youth and are often associated with depressive symptoms, school absenteeism, somatic symptoms, and low quality of life. This study aims to evaluate the effects of a dance and yoga intervention on abdominal pain frequency and associated symptoms over 24 months.

Methods: This study presents analyses from a randomized controlled trial including 121 girls aged 9-13 years who were diagnosed with FAPDs. The intervention consisted of twice-weekly group sessions over eight months, combining dance and yoga. The primary outcome, maximum abdominal pain at 8 months, was published in 2022. Abdominal pain, depressive symptoms, health-related quality of life, school absenteeism, and somatic symptoms were prespecified as secondary outcomes in this study's protocol. In the present manuscript, abdominal pain is analyzed as abdominal pain frequency. These secondary outcomes were assessed at 4, 8, 12, and 24 months. Both intention-to-treat and supportive per-protocol analyses were performed.

Results: The intention-to-treat analysis showed a reduction in abdominal pain frequency in the intervention group compared with controls, with a mean difference of -1.10 with respect to the 95% CI (days per week) (-2.03 to -0.16; p = 0.02) at 8 months and -1.34 (-2.28 to -0.40; p = 0.005) at 12 months. No significant group differences were observed in the other outcomes. Per-protocol analyses showed similar or greater positive effects of the intervention.

Conclusions: An intervention with combined dance and yoga has the potential to contribute to reductions in abdominal pain frequency at 8 and 12 months post-baseline in girls with FAPDs.

Background and Aims: This study aims to compare the incidence of fractures in young T1D individuals vs controls and to explore the association between the frequency of hypoglycemic events and fracture incidence. Previous research has indicated an elevated fracture incidence among individuals with T1D. The predominant hypothesis attributes this increased risk to a higher prevalence of osteoporosis.

Methods: Data on 22,077 (55% males) individuals diagnosed with T1D before the age of 18 years were retrieved from the Swedish National Diabetes Register (NDR) and compared with 110,390 age- and sex-matched controls.

Results: There is a significantly increased risk of fractures in T1D individuals compared to controls (Figure1). This elevated risk isńt seen before T1D diagnosis but is apparent already within the first few years after diagnosis. It is observed in both sexes, with females’ relative risk (RR) 1.4 (95%CI 1.35-1.47) and males’ RR 1.27 (95%CI 1.23-1.30) during the follow up period. In the National Patient Register 0.56 hypoglycemic events/T1D individual with at least one fracture vs 0.3/T1D individual without any fracture were reported. Mean age in the fracture group was 27 years, compared to 22 years in the non-fracture group. A logistic regression model, adjusted for age and duration of T1D, still showed a significantly higher frequency of hypoglycemic events throughout the follow-up period (p < 0.03).

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Conclusions: The increased incidence of fractures in individuals with T1D may, to some extent, be attributed to a higher risk of accidents resulting from hypoglycemic events. Continuous glucose monitoring systems with alarms could be crucial tools to reduce this risk.

Introduction: Previous research has indicated an elevated fracture incidence among individuals with T1D. The predominant hypothesis attributes this increased risk to a higher prevalence of osteoporosis.

Objectives: This study aims to compare the incidence of fractures in young T1D individuals vs controls and to explore the association between the frequency of hypoglycemic events and fracture incidence.

Methods: Data on 22,077 (55% males) individuals diagnosed with T1D before the age of 18 years were retrieved from the Swedish National Diabetes Register (NDR) and compared with 110,390 age- and sex-matched controls.

Results: There is a significantly increased risk of fractures in T1D individuals compared to controls (Figure1). This elevated risk isn´t seen before T1D diagnosis but is apparent already within the first few years after diagnosis. It is observed in both sexes, with females’ relative risk (RR) 1.4 (95%CI 1.35-1.47) and males’ RR 1.27 (95%CI 1.23-1.30) during the follow up period.

In the National Patient Register 0.56 hypoglycemic events/T1D individual with at least one fracture vs 0.3/T1D individual without any fracture were reported. Mean age in the fracture group was 27 years, compared to 22 years in the non-fracture group. A logistic regression model, adjusted for age and duration of T1D, still showed a significantly higher frequency of hypoglycemic events throughout the follow-up period (p < 0.03).

Conclusions: The increased incidence of fractures in individuals with T1D may, to some extent, be attributed to a higher risk of accidents resulting from hypoglycemic events. Continuous glucose monitoring systems with alarms could be crucial tools to reduce this risk.

AIMS: This study examined the possible association between numeracy skills and glycemic outcomes in children with type 1 diabetes.

METHODS: The study used a cross-sectional design and collected data from 7 centers of the Hvidoere Study Group. HbA1c was measured centrally. Numeracy was assessed using the specific 5-item Diabetes Numeracy Test (DNT-5) and the international, general Wordless Mathematical Test (WMT). The HbA1c predictive multivariate generalized linear model was constructed using the adjusted R-squared index for model selection. Pearson's correlation coefficient was calculated between observed and predicted HbA1c levels in the training and testing datasets.

RESULTS: Overall,306 adolescents aged 12-18 (mean age 14.96 ± 1.68) years and diabetes duration of 6.57 (±3.75) participated in this study. Numeracy skills, as assessed by the WMT but not DNT-5, predicted the HbA1c levels after adjustment for sociodemographic and clinical factors. The correlation between observed and predicted HbA1c levels was consistent in both datasets and was 0.34 (N = 155) and 0.37 (N = 61) for the training and test datasets, respectively (p = 0.412). The effect size for the WMT-based predictive model of HbA1c adjusted for clinical and socioeconomic factors was significantly higher (p < 0.05) than the single-parameter-based model.

CONCLUSIONS: Numeracy, as assessed by an international general math test, is a good predictor of HbA1c in children and adolescents with type 1 diabetes. The basic and short WMT is a potentially effective tool in personalized clinical pediatric diabetes practice. Therapy planning should consider adjusting therapy to compensate for lower numeracy skills and/or training to improve the patient's numerical proficiency.

Introduction: In 2017 Sweden lowered the national HbA1c target for children with T1D to 48mmol/mol (6.5%), corresponding to an average glucose of 8mmol/L (144mg/dL).

The target was communicated to pediatric diabetes clinics andto families. Sweden has a population based National Diabetes Register where data on a group level from all the 42 pediatric clinics treating children with T1D are openly published.

Objectives: To investigate the time trend in Time in Tight Range (TITR) and change in CGM as well as in pump use and the proportion of overweight since 2017.

Methods: Population based data were retrieved from NDR. Significance levels were calculated using chi2 test and p <0.01 was considered significant.

Results: 99% (7630/7700) of the children were using a CGM device in 2023, compared with 91.5% (6620/7230) in 2017 and 96% (6890/7190) in 2019. During the same period, the proportion of pump users has increased from 63.5% (4575/7200) in 2017 to 69% (5000/7220) in 2019 and to 82% (6460/7880) in 2023. 48% of these children reached 50% or more TITR in 2023 compared to 30.5% in 2018 and 36% in 2019, p<0.01 (Fig 1a). During the same period the proportion of overweight including obesity is unchanged (Fig 1b).

Conclusions: The percentage of children reaching ≥ 50% TITR has increased by 60% since the national HbA1c target in Sweden was lowered to 48 mmol/mol and by 35% since 2019. Lowering the national HbA1c target, as well as an increased access to modern technology, that facilitates the possibility to reach TITR, are likely factors in achieving these improvements. A glucose control close to normal as well as preventing overweight are important factors to decrease the risk of long-term complications due to T1D.

AIMS/HYPOTHESIS: To study the progression of HbA1c after diagnosis of type 1 diabetes in children and adolescents during 2010-2019 with emphasis on HbA1c nadir 3-6 months after onset.

METHODS: Partial funding was secured for this study. The Swedish paediatric diabetes quality register SWEDIABKIDS has >95 % coverage of type 1 diabetes up to 18 years. A mixed model for repeated measurements was used to estimate differences in HbA1c between onset year periods.

RESULTS: We followed 6,891 patients over two years from onset (48,292 HbA1c values). We found a gradual decrease in mean HbA1c 24 months after onset from 56.0 mmol/mol (7.28 %) in 2010/11 to 50.5 mmol/mol (6.77 %) in 2018/19, which is at the level of several recent intervention studies. The initial drop in HbA1c from onset until 3 and 6 months has become more pronounced in recent years. There was a significant positive correlation between HbA1c at 3 and 6 months with 12, 18 and 24 months. Percentage of severe hypoglycaemic coma was higher (5.1 % vs 3.4 %; p = 0.023) in 2010/2011 than 2018/2019, but the absolute risk of ketoacidosis was essentially unchanged, (1.5 % to 0.8 %, p = 0.110)

Conclusions/interpretation: There was a continuous decrease in HbA1c over the study period 2010-2019, which coincides in time with an increased use of diabetes technology and lowering the HbA1c target to 48 mmol/mol (6.5 %). The decrease in 2-year HbA1c was preceded by a lower HbA1c nadir, which may set the trajectories for coming HbA1c and be a modifiable factor for a long-term improvement in metabolic control.

AIMS/HYPOTHESIS: To investigate the frequency and characteristics of partial remission in Swedish children with type 1 diabetes and whether insulin delivery method, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) affect incidence and duration of this period 2007-2011. Factors that increase the proportion of subjects that enter partial remission and extend this period can improve long-term metabolic control and reduce the risk of severe hypoglycemia, improve quality of life and in the long run reduce late complications.

METHODS: Longitudinal data from 2007-2020 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with all reported newly diagnosed children. Data on C-peptide from the participants in the Better Diabetes Diagnosis study (BDD) from 2007-2010 were used. The definition of partial remission was Insulin Dose Adjusted HbA1c (IDAA1c): HbA1c (%)+(4 x total daily insulin dose (U/kg/day)) ≤9.

RESULTS: Of the 3,887 patients, 56% were boys. More boys than girls were in partial remission throughout the follow-up period until 24 months after diabetes onset. Fewer children 0-6 years old had partial remission at 3 and 12 months but not at 24 months compared to older age groups. A larger proportion of patients using CSII at 12 and 24 months remained in partial remission compared to those with MDI (37% vs 33%, p=0.02 and 31% vs 27%, p<0.01 respectively). The level of C-peptide was higher in the group with partial remission and mean HbA1c was lower, both p<0.001. Partial remission at 12 months after diabetes onset was associated with CSII (OR:1.39 CI:1.13, 1.71), shorter diabetes duration (OR:0.80 CI:0.76, 0.84) and male sex (OR:1.23 CI:1.04, 1.46)

Conclusions/interpretation: Insulin through MDI, longer duration of diabetes, and female sex were associated with lower frequency of partial remission. Use of CSII seem to contribute to longer partial remission among Swedish children with type 1 diabetes.

Introduction: Pump usage is widespread among Swedish children and adolescents with diabetes. However, there is a considerable variation in pump usage between clinics. Over many years, mean HbA1c in pump and injection users has been at almost the same level In Sweden. In pediatric care, we have used the more physiologic Time In Tight Range (TITR, 3.9-7.8 mmol/l, 70-140 mg/dl). TIR 70% equals ~ TITR 50%.

Objectives: The aim of this study was to investigate how pump usage relates to TITR and HbA1c in Swedish pediatric clinics.

Methods: The Swedish National Diabetes Register (NDR) collects pediatric data every ~3 months and has > 95% coverage up to age 18 years. We used online data (“Knappen” at ndr.registercentrum.se), extracting the latest available center HbA1c and CGM data that included ≥ 70% of the time, capturing percentage of patients with TITR ≥ 50% (TITR50).

Results: The national mean HbA1c was in March 2024 52.4±0.2 mmol/mol (range 45.8-56.5) (6.6%, 6.4-7.4). For pump users it was 52.1±0.2 mmol/mol (range between clinics 45.4-56.5) (6.9, 6.3-7.4) and for injections 53.7±0.6 (range 47.5-61.7) (7.1%, 6.5-7.8). Pump usage varied from 37 to 95% between clinics while the remainder of patients used multiple daily injections. There was a significant positive correlation between clinic pump usage and TITR50 (figure), but not with HbA1c. However, there was a wide variation in pump usage between clinics that managed to have percentage with TITR above 50%. NDR does not display online data on time below or above range, which is a limitation.

Conclusions: Although both are taken at the same time, HbA1c reflects the metabolic control over 2-3 months while TITR only mirrors the past 2 weeks. The significant correlation between percentage of clinic pump use and time above TITR50 indicates that although mean glucose and HbA1c may be at similar levels, injection users seem to have more values below and above 3.9-7.8 mmol/l. Both HbA1c and TITR are valuable for evaluation at clinic visits.

BACKGROUND: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.

AIM: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.

METHOD AND MATERIAL: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater's perception of the present graduates' required level of supervision when performing the activity. Free-text comments were also included and analyzed.

RESULTS: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as "important" by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported "independent". The three themes of the free text comments were: 'relevant target areas and content'; 'definition of the activities'; and 'clinical practice and learning'.

CONCLUSION: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

Background: Functional abdominal pain disorders (FAPDs) affect children, especially girls, all over the world. The evidence for existing treatments is mixed, and effective accessible treatments are needed. Dance, a rhythmic cardio-respiratory activity, combined with yoga, which enhances relaxation and focus, may provide physiological and psychological benefits that could help to ease pain.

Objectives: The aim with this study was to evaluate the effects of a dance and yoga intervention on maximum abdominal pain in 9- to 13-year- old girls with FAPDs.

Methods: This study was a prospective randomised controlled trial with 121 participants recruited from outpatient clinics as well as the general public. The intervention group participated in dance and yoga twice weekly for 8 months; controls received standard care. Abdominal pain, as scored on the Faces Pain Scale–Revised, was recorded in a pain diary. A linear mixed model was used to estimate the outcomes and effect sizes.

Results: Dance and yoga were superior to standard healthcare alone, with a medium to high between-group effect size and significantly greater pain reduction (b = −1.29, p = 0.002) at the end of the intervention.

Conclusions: An intervention using dance and yoga is likely a feasible and beneficial complementary treatment to standard health care for 9- to 13-year-old girls with FAPDs.

Significance:  FAPDs affect children, especially girls, all over the world. The negative consequences such as absence from school, high consumption of medical care and depression pose a considerable burden on children and their families and effective treatments are needed. This is the first study examining a combined dance/yoga intervention for young girls with FAPDs and the result showed a reduction of abdominal pain. These findings contribute with new evidence in the field of managing FAPDs in a vulnerable target group.