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  • 1.
    Anderzen, Johan
    et al.
    Ryhov County Hospital, Sweden.
    Samuelsson, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Gudbjornsdottir, Soffia
    University of Gothenburg, Sweden.
    Hanberger, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Akesson, Karin
    Ryhov County Hospital, Sweden; Futurum, Australia; Jonköping Academic Improvement Health and Welf, Germany.
    Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults2016In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 3, p. 533-536Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults. Methods: All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals. Results: Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p < 0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p < 0.001) and/or macroalbuminuria (p < 0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age. Conclusions: Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.

  • 2. Leksell, J.K.
    et al.
    Sandberg, G.E.
    Högskolan Dalarna, Dept. of Health and Social Sciences, S-791 88, Falun, Sweden.
    Wikblad, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Self-Care and Learning.
    Self-perceived health and self-care among diabetic subjects with defective vision: A comparison between subjects with threat of blindness and blind subjects2005In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 19, no 1, p. 54-59Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare self-perceived health among diabetic patients who experienced threat of blindness with those who had already gone blind. Another aim was to explore different aspects of self-care in relation to self-perceived health among the subjects. Twenty-one diabetic patients under threat of becoming blind and 23 with diabetes-related blindness agreed to participate in the study. The participants were compared with an age- and gender-matched nondiabetic reference group. Self-perceived health was measured using the 63-item Swedish Health-Related Quality of Life Survey (SWED-QUAL) questionnaire. Data on diabetes-related variables were collected from the patient's hospital records. An interview guide was created for measuring dimensions of self-care. Patients with threat of becoming blind showed better self-perceived health than blind patients, but no differences were found in comparison with the Swedish reference group. Blind patients scored lower in 6 of the 13 health domains and they reported more problems with diabetes self-care than patients with threat of becoming blind. One of the 13 health domains, role limitations due to physical health, seemed to be associated with impaired self-care although only a partial understanding could be demonstrated. The results show that blind patients need specific support to cope well with different self-care situations. A great challenge in future research in diabetes is to implement education programs suitable especially for patients who have gone blind because of diabetes. © 2005 Elsevier Inc. All rights reserved.

  • 3.
    Ljunggren, Philip
    et al.
    Linköping University, Faculty of Medicine and Health Sciences.
    Maahs, David M.
    University of Colorado, USA.
    Johansson, Per
    Linköping University, Faculty of Medicine and Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Pyle, Laura
    University of Colorado, USA.
    Sippl, Rachel
    University of Colorado, USA.
    Paul Wadwa, R.
    University of Colorado, USA.
    Snell-Bergeon, Janet
    University of Colorado, USA.
    Reduced brachial artery distensibility in patients with type 1 diabetes2016In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 5, p. 893-897Article in journal (Refereed)
    Abstract [en]

    Background and aims: In patients with type 1 diabetes mellitus (T1D), cardiovascular disease (CVD) events are more common and occur earlier in life than in non-diabetics. Reduced brachial artery distensibility (BrachD) is an independent risk factor for development of CVD. Our aim was to determine if adults with T1D have lower BrachD compared to adults without diabetes and also to determine how age and gender affect the relationship of BrachD with T1D status. Materials and methods: BrachD was measured using the Dynapulse instrument in 829 participants (352 with T1D, 477 non-diabetics). An ANCOVA model was used to test the association of BrachD with age, sex, and T1D, and the significance of an age*sex*T1D interaction. Results: Mean BrachD was lower in T1D patients vs. controls (6.43 +/- 1.46 vs. 7.16 +/- 1.48 % change per mmHg, p amp;lt; 0.0001). In a model adjusted for age, T1D, and sex, the interaction of age*T1D*sex was significant (p = 0.0045). Younger women both with and without T1D had higher BrachD than men with and without T1D, but older women with and without T1D had lower BrachD compared to older men with and without T1D. Women with T1D had a steeper decline in BrachD with age than nondiabetic women. Conclusions: BrachD is lower in T1D patients than in non-diabetics, indicating increased vascular stiffness. Younger females have higher BrachD than males, but the decline with age in BrachD is steeper for women, particularly among those with T1D. BrachD may be an inexpensive, non-invasive method to ascertain increased CVD risk in this population. (C) 2016 Elsevier Inc. All rights reserved.

  • 4.
    Samuelsson, Ulf
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Anderzen, Johan
    Ryhov County Hospital, Sweden.
    Gudbjornsdottir, Soffia
    University of Gothenburg, Sweden.
    Steineck, Isabelle
    Copenhagen University Hospital, Denmark.
    Akesson, Karin
    Ryhov County Hospital, Sweden; Jonköping County Council, Sweden.
    Hanberger, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood2016In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 5, p. 917-922Article in journal (Refereed)
    Abstract [en]

    Aims: To compare metabolic control between males and females with type 1 diabetes during adolescence and as young adults, and relate it to microvascular complications. Methods: Data concerning 4000 adolescents with type 1 diabetes registered in the Swedish paediatric diabetes quality registry, and above the age of 18 years in the Swedish National Diabetes Registry was used. Results: When dividing HbA1c values in three groups; amp;lt; 7.4% (57 mmol/mol), 7.4-93% (57-78 mmol/mol) and amp;gt;9.3% (78 mmol/mol), there was a higher proportion of females in the highest group during adolescence. In the group with the highest HbA1c values during adolescence and as adults, 51.7% were females, expected value 46.2%; in the group with low HbA1c values in both registries, 34.2% were females, p amp;lt; 0.001. As adults, more females had retinopathy, p amp;lt; 0.05. Females had higher mean HbAlc values at diagnosis, 112 vs. 10.9% (99 vs. 96 mmol/mol), p amp;lt; 0.03, during adolescence, 8.5 vs. 82% (69 vs. 66 mmol/mol) p amp;lt; 0.01, but not as young adults. Conclusions: Worse glycaemic control was found in adolescent females, and they had a higher frequency of microvascular complications. Improved paediatric diabetes care is of great importance for increasing the likelihood of lower mortality and morbidity later in life. (C) 2016 Elsevier Inc. All rights reserved.

  • 5. Sandberg, GE
    et al.
    Wikblad, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Science in Nursing.
    Oral dryness and peripheral neuropathy in subjects with type 2 diabetes2003In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 17, no 4, p. 192-198Article in journal (Refereed)
    Abstract [en]

    Two common complaints related to diabetes mellitus are oral dryness (xerostomia) and peripheral neuropathy (PN) and there is some evidence of a relationship between them. Therefore, we formulated a hypothesis that type 2 diabetic subjects with xerostomia in our study also exhibited PN. The study included 102 randomly sampled type 2 diabetic patients from a healthcare district in mid-Sweden. Besides clinical and X-ray examinations, patients were asked whether they experienced oral dryness. PN was defined through thorough foot examination and the use of a modified neuropathy symptom score (NSS) and neuropathy disability score (NDS). Other diabetes-related variables were extracted from medical records. More than half of the individuals (53.5%) reported oral dryness and 23.8% were diagnosed with PN. None of the variables in a stepwise regression analysis could explain the variance in oral dryness, besides "pain in the legs," which contributed with 5% to the explanation. Our hypothesis that type 2 diabetic subjects with xerostomia also were affected with PN could not be verified in this study, but the results must be interpreted with caution as relatively few subjects were affected with both oral dryness and PN (13.8%). Further and larger controlled studies are needed before the hypothesis can be definitely rejected. Despite our incomplete understanding about the relation between oral dryness and PN, professionals in oral health as well as in primary health have to strive for increased knowledge in this field. ⌐ 2003 Elsevier Inc. All rights reserved.

  • 6. Torffvit, Ole
    et al.
    Eriksson, Jan W
    Henricsson, Marianne
    Sundkvist, Göran
    Arnqvist, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Blohmé, Göran
    Bolinder, Jan
    Nyström, Lennart
    Östman, Jan
    Svensson, Maria
    Early changes in glomerular size selectivity in young adults with type 1 diabetes and retinopathy. Results from the Diabetes Incidence Study in Sweden2007In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 21, no 4, p. 246-251Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the relationship between early-onset retinopathy and urinary markers of renal dysfunction. Research Design and Methods: The Diabetes Incidence Study in Sweden (DISS) aims to register all new cases of diabetes in young adults (15-34 years). In 1987-1988, 806 patients were reported and later invited to participate in a follow-up study focusing on microvascular complications after ∼10 years of diabetes. In the present study, 149 patients with type 1 diabetes, completed eye examination, and urine sampling were included. Results: The patients with retinopathy (n=58, 39%) had higher HbA1c (P<.001) and urinary IgG2/creatinine (P<.05) and IgG2/IgG4 ratios (P<.05). Patients with maculopathy had the highest levels. No significant differences in urinary albumin/creatinine, glycosaminoglycans (GAGs)/creatinine, Tamm-Horsfall protein (THP)/creatinine, and IgG4/creatinine ratios were found. Women had higher urinary albumin/creatinine (P<.01) and urinary IgG2/creatinine ratios (P<.01) than men. Conclusions: Young adults with type 1 diabetes and early-onset retinopathy had higher IgG2/creatinine and IgG2/IgG4 ratios than patients without retinopathy indicating that retinopathy is associated with a change in glomerular size selectivity. This was found in association with normal urinary albumin and THP excretion and may be suspected to reflect early general vascular changes. © 2007 Elsevier Inc. All rights reserved.

  • 7.
    Wijkman, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Aortic pulse wave velocity predicts incident cardiovascular events in patients with type 2 diabetes treated in primary care2016In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 7, p. 1223-1228Article in journal (Refereed)
    Abstract [en]

    Aims: The aim was to evaluate the predictive value of aortic pulse wave velocity (aPWV) on incident cardiovascular events in patients with type 2 diabetes without previous cardiovascular disease who were treated in primary care, after adjustment for traditional risk factors. Methods: We measured aPWV in 627 patients who participated in the epidemiological study CARDIPP (Cardiovascular Risk Factors in Patients with Diabetes-a Prospective Study in Primary Care; ClinicalTrials.gov identifier NCT01049737) and who did not have previously known myocardial infarction or stroke. The outcome variable was a composite endpoint consisting of cardiovascular mortality, hospitalization for myocardial infarction and hospitalization for stroke. Results: During a median follow-up time of almost eight years, the unadjusted HR per each increment of aPWV by 1 m/s was 1.239 (95% CI 1.114-1.379, P amp;lt; 0.001) for the primary endpoint. Following adjustments for age, sex, diabetes duration, office systolic blood pressure, resting heart rate, total cholesterol, HbA1c, estimated glomerular filtration rate and smoking status, the adjusted hazard ratio was 1.142 (95% CI 1.003-1.301, P = 0.044). Conclusions: In primary preventive patients with type 2 diabetes treated in primary care, aPWV predicted a composite outcome of incident cardiovascular events independently of diabetes-specific and traditional risk factors. (C) 2016 Elsevier Inc. All rights reserved.

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