| 1. |
- Johansson, Karin, et al.
(författare)
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Patients' experiences of support for learning to live with diabetes to promote health and well-being : A lifeworld phenomenological study
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient's perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.
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| 2. |
- Stogianni, Anna, et al.
(författare)
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Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden
- 2019
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDiabetes during pregnancy is an increasingly common metabolic disorder, associated with significantly increased risks for both mother and child. Aim of this study was to compare maternal and perinatal outcomes in women with pregestational (PDM) type 1 (T1DM), type 2 diabetes (T2DM), gestational diabetes mellitus (GDM) and compare these to pregnancies not complicated with diabetes. This study also evaluated a specifically organized care-model mostly involving specialist diabetes nurses.MethodsRetrospective population-based records review 2009-2012. Rates of maternal (preeclampsia, pre-term delivery, cesarean section (CS)) and fetal outcomes (large for gestational age (LGA), macrosomia, congenital malformations/intrauterine death) were assessed and potential predisposing or contributing factors as maternal age, ethnicity, obesity, weight gain, parity, HbA1c levels, insulin types and doses.ResultsAmong 280 pregnancies 48 were PDM, 97 GDM and 135 without diabetes. Within the group with diabetes, early-pregnancy BMI was higher (p=0.0001), pregnancy weight gain lower (11.16.7kg vs 13.1 +/- 7.1kg, p=0.005), more delivered preterm (p=0.0001), by CS (p=0.05), and had more LGA neonates (p=0.06) than the group without diabetes. Among pregnancies with diabetes, GDM mothers gained less weight (9.9kg vs 13.5kg) (p=0.006), and rates of CS (p=0.03), preterm deliveries (p=0.001) and LGA (p=0.0001) were not increased compared to PDM; More T1DM infants were LGA, 60% vs. 27% in T2DM. In pregnancies with diabetes obesity, excessive weight gain and multiparity were associated with increased risk of LGA neonates, and mother's type of diabetes and gestational week were associated with higher rates of CS.Conclusion p id=Par4 Weight gain during pregnancy was lower in pregnancies with diabetes and prevalence of LGA, CS and preterm deliveries in GDM was not elevated, also for T2DM, except increased prevalence of LGA in T1DM that warrants increased clinical attention, indicating that this model of antenatal diabetes care may have contributed to improved maternal and fetal outcomes.
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| 3. |
- Lundberg, Jenny, 1976-, et al.
(författare)
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Early Signs of Diabetes Explored from an Engineering Perspective
- 2019
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Ingår i: Smart Industry & Smart Education. - Cham : Springer. - 9783319956787 - 9783319956770 ; , s. 22-31
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Konferensbidrag (refereegranskat)abstract
- Undetected diabetes is a global issue, estimated to over 200 million persons affected. Engineering opportunities in capturing early signs of diabetes has a potential due to the complexity to interpret early signs and link it to diabetes. Persons with untreated diabetes are doubled in risk of getting cardiovascular diseases and may also suffer other consequent diseases. In Sweden, approximately 450 thousand have diabetes where 80-90% are of type 2 with 1/4 unaware of it, i.e. approx. 100 thousand. Screening approaches, searching specifically for diabetes in persons not showing symptoms has been initiated with positive results. However, some general drawbacks of screening such as false sense of security are an issue. In this publication, we focus upon in home measurements and empowering of the individual in identifying early signs of diabetes. The methods in this publication are to gather data, evaluate and give suggestion if clinical test to confirm or reject diabetes. In home measurements, education process with companies for innovation possibilities.
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| 4. |
- Pagels, Peter, et al.
(författare)
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Influence of moderate, daily,physical activity upon body composition and blood lipid profile in swedish adults
- 2012
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Ingår i: Journal of Physical Activity and Health. - 1543-3080 .- 1543-5474. ; 9, s. 867-874
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health organizations suggest that adults ought to engage in at least 30 minutes of moderate-intensity daily physical activity. This study investigated the effects of a 30-minute single daily bout of brisk walking upon risk factors for CHD with blood lipid profile in particular. Methods: Thirty-three (25-45 y) adults, were randomly assigned into an exercise group (EG) (n=16, (9w) and a control group (CG) (n=17 (6w). The EG walked briskly 30 minutes daily during the 3 weeks test period. Compliance/adherence was maximal throughout the 3-week intervention due to stringent daily monitoring. Results: The EG showed a significant decrease in concentrations of low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) during the intervention period. A significant inverse correlation between Δ energy expenditure/day and Δ LDL-C (r = -0.39, P<0.05) and an improvement in weight and BMI in the EG was found. Average steps during 30 minutes brisk walking bout was 3669 steps/bout generating a mean energy expenditure of 191 kcal/bout. Conclusions: The most unique findings were that daily single bouts of moderate-intensity physical activity for 30 minutes, during 3 weeks, induced favourable effects upon body weight, BMI and blood concentration of LDL-C and TC in healthy adults.
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| 5. |
- Melin, Eva O., et al.
(författare)
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Depression was associated with younger age, female sex, obesity, smoking, and physical inactivity, in 1027 patients with newly diagnosed type 2 diabetes : a Swedish multicentre cross-sectional study
- 2022
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Ingår i: BMC Endocrine Disorders. - : BioMed Central (BMC). - 1472-6823. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. Methods Multicentre, cross-sectional study. Inclusion criteria: adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI >= 30 and >= 40 kg/m(2)), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. Results In 1027 T2D patients, aged 18-94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI >= 30 kg/m(2) (OR 1.7), BMI >= 40 kg/m(2) (OR 2.3), smoking (OR 1.9), physical inactivity (OR 1.8), and women (OR 1.6) (all p <= 0.013). Younger women (n = 113), <= 59 years, compared to younger men (n = 217) had higher prevalence of current depression (31% vs 12%), previous depression (43 vs 19%), anxiety (42% vs 25%), antidepressant use (37% vs 12%), BMI >= 30 kg/m(2) (73% vs 60%) and BMI >= 40 kg/m(2)) (18% vs 9%), and smoking (26% vs 16%) (all p <= 0.029). Older women (n = 297), >= 60 years, compared to older men (n = 400) had higher prevalence of previous depression (45% vs 12%), anxiety (18% vs 10%), antidepressant use (20% vs 8%), BMI >= 30 kg/m(2) (55% vs 47%), BMI >= 40 kg/m(2) (7% vs 3%) (all p <= 0.048), but not of current depression (both 9%). Compared to the Swedish general population (depression (women 11.2%, men 12.3%) and antidepressant use (women 9.8%, men 5.3%)), the younger women had higher prevalence of current depression, and all patients had higher prevalence of antidepressant use. Conclusions In patients with newly diagnosed T2D, the younger women had the highest prevalence of depression, anxiety, and obesity. The prevalence of depression in young women and antidepressant use in all patients were higher than in the Swedish general population. Three risk factors for CVD, obesity, smoking, and physical inactivity, were associated with depression.
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| 6. |
- Melin, Eva O., et al.
(författare)
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Depression differed by midnight cortisol secretion, alexithymia and anxiety between diabetes types : a cross sectional comparison
- 2017
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Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 17, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased prevalence of depression is found in both type 2 diabetes (T2D) and type 1 diabetes (T1D). Melancholia and atypical depression differ by cortisol secretion and clinical features. The aim was to compare the clinical presentation of T1D and T2D patients in relation to self-reported depression, self-reported anxiety, alexithymia, obesity, and midnight salivary cortisol (MSC). Methods: Comparative cross-sectional design. The participants were consecutively recruited from one hospital diabetes outpatient clinic: 24 T2D patients (31-59 years) and 148 T1D patients (32-59 years). Self-reported depression, anxiety and alexithymia were assessed by Hospital Anxiety and Depression scale and Toronto Alexithymia Scale-20. MSC, HbA1c, anthropometrics and data from medical records were collected. Multiple logistic regression analyses were performed. Results: Comparisons of prevalence between diabetes types showed for T2D/T1D: depression 25%/12% (P = 0.10); high MSC (>= 9.3 nmol/L) 38%/22% (P = 0.13); alexithymia 25%/13% (P = 0.12); anxiety 38%/35% (P = 0.82). The prevalence of high MSC did not differ between depressed and non-depressed T2D patients (17% vs. 44%, P = 0.35), but differed between depressed and non-depressed T1D patients (53% vs. 18%, P = 0.003). The alexithymia prevalence differed between depressed and non-depressed T2D patients (67% vs. 11%, P = 0.018), and between depressed and non-depressed T1D patients (47% vs. 11%, P < 0.001). The anxiety prevalence did not differ between depressed and non-depressed T2D patients (67% vs. 28%, P = 0.15), but differed between depressed and non-depressed T1D patients (76% vs. 30%, P < 0.001). The obesity prevalence (BMI >= 30 kg/m(2)) was 83% for depressed T2D patients and 6% for depressed T1D patients. In the T2D patients, depression was associated with alexithymia (Adjusted odds ratio (AOR) 15.0). In the T1D patients, depression was associated with anxiety (AOR 11.0), foot complications (AOR 8.5), HbA1C > 70 mmol/mol (AOR 6.4), and high MSC (>= 9.3 nmol/L) (AOR 4.8). Conclusions: The depressed T2D patients had traits of atypical depression, without associated high MSC (>= 9.3 nmol/L) and anxiety, but the association with alexithymia was strong. The depressed T1D patients had traits of melancholia with associated high MSC and anxiety. The obesity prevalence was high in depressed T2D patients and low in depressed T1D patients.
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| 7. |
- Hultsjö, Sally, et al.
(författare)
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Organizing care for persons with psychotic disorders and risk of or existing diabetes mellitus type 2
- 2012
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126 .- 1365-2850. ; 19:10, s. 891-902
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Tidskriftsartikel (refereegranskat)abstract
- This literature review aimed to explore previous knowledge about specific care requirements for persons with psychotic disorders and risk of or existing type 2 diabetes.Methods: qualitative and quantitative studies in the area were identified and reviewed. Results: It were indicated that mental health nurses play an important role in motivating people to perform diabetes care as they are often known to and trusted by the patients. A holistic approach to the person's health, with close follow-ups by psychiatric care and cooperation with diabetes care, may have benefits for the person with diabetes. Screening for and treating psychotic symptoms is an important task for the mental health nurse, as these symptoms drain energy from the person and prevent diabetes self-care. Lifestyle and diabetes education needs to be practical, adapted to the individual and focused on maintaining a healthy diet, regular exercise, changing smoking habits and preventing diabetes complications. Treatment with antipsychotic drugs increases the need for follow-ups of glycaemic control.
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| 8. |
- Melin, Eva Olga, et al.
(författare)
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Lower HDL-cholesterol, a known marker of cardiovascular risk, was associated with depression in type 1 diabetes : a cross sectional study
- 2019
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Ingår i: Lipids in Health and Disease. - : BioMed Central (BMC). - 1476-511X. ; 18, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression, metabolic disturbances and inflammation have been linked to cardiovascular disease and mortality. Low levels of high-density lipoprotein cholesterol (HDL-cholesterol), a known marker of cardiovascular risk, have been observed in patients with major depression in psychiatric populations. Our main aim was to explore associations between depression, antidepressants, and metabolic and inflammatory variables in patients with type 1 diabetes (T1D). A secondary aim was to explore variables associated with HDL-cholesterol. Methods: Cross-sectional design. T1D patients (n = 292, men 55%, age 18-59 years, diabetes duration >= 1 year) were consecutively recruited from one specialist diabetes clinic. Depression was defined as 8 points for Hospital Anxiety and Depression Scale-Depression sub scale. Blood samples, anthropometrics, blood pressure, and data regarding medication and life style were collected from electronic health records. Non-parametric tests, multiple logistic and linear regression analyses were performed. Results: The depression prevalence was 10 and 8% used antidepressants. Median (q(1), q(3)) HDL-cholesterol (mmol/l) was for the depressed 1.3 (1.2, 1.5) and for the non-depressed 1.6 (1.3, 1.8), p = 0.001. HDL-cholesterol levels (per mmol/l) were negatively associated with depression (Adjusted odds ratio (AOR) 0.2, p = 0.007), and the use of antidepressants was positively associated with depression (AOR 8.1, p < 0.001). No other metabolic or inflammatory variables, or life style factors, were associated with depression when adjusted for antidepressants. Abdominal obesity was associated with antidepressants in women (AOR 4.6, p = 0.029). Decreasing HDL-cholesterol levels were associated with increasing triglyceride levels (p < 0.001), increasing high-sensitive C-reactive protein (hs-CRP) levels (p = 0.021), younger age (p < 0.001), male sex (p < 0.001), and depression (p = 0.045). Conclusions: Lower HDL-cholesterol levels, known predictors of cardiovascular disease, were associated with depression in patients with T1D. The use of antidepressants was associated with abdominal obesity in women. Depression, low-grade inflammation measured as hs-CRP, higher triglycerides, male sex, and lower age were independently associated with lower HDL-cholesterol levels.
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| 9. |
- Martinez, Cristina A., et al.
(författare)
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Expression of Stress-Mediating Genes is Increased in Term Placentas of Women with Chronic Self-Perceived Anxiety and Depression
- 2020
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Ingår i: Genes. - : MDPI. - 2073-4425. ; 11:8, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- Anxiety, chronical stress, and depression during pregnancy are considered to affect the offspring, presumably through placental dysregulation. We have studied the term placentae of pregnancies clinically monitored with the Beck's Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 classed patients into an Index group (>10,n= 23) and a Control group (<10,n= 23). Cortisol concentrations in hair (HCC) were periodically monitored throughout pregnancy and delivery. Expression differences of main glucocorticoid pathway genes, i.e., corticotropin-releasing hormone (CRH), 11 beta-hydroxysteroid dehydrogenase (HSD11B2), glucocorticoid receptor (NR3C1), as well as other key stress biomarkers (Arginine Vasopressin, AVP and O-GlcNAc transferase, OGT) were explored in medial placentae using real-time qPCR and Western blotting. Moreover, gene expression changes were considered for their association with HCC, offspring, gender, and birthweight. A significant dysregulation of gene expression for CRH, AVP, and HSD11B2 genes was seen in the Index group, compared to controls, while OGT and NR3C1 expression remained similar between groups. Placental gene expression of the stress-modulating enzyme 11 beta-hydroxysteroid dehydrogenase (HSD11B2) was related to both hair cortisol levels (Rho = 0.54;p< 0.01) and the sex of the newborn in pregnancies perceived as stressful (Index,p< 0.05). Gene expression of CRH correlated with both AVP (Rho = 0.79;p< 0.001) and HSD11B2 (Rho = 0.45;p< 0.03), and also between AVP with both HSD11B2 (Rho = 0.6;p< 0.005) and NR3C1 (Rho = 0.56;p< 0.03) in the Control group but not in the Index group; suggesting a possible loss of interaction in the mechanisms of action of these genes under stress circumstances during pregnancy.
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| 10. |
- Melin, Eva, et al.
(författare)
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Depression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes
- 2014
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Ingår i: BMC Endocrine Disorders. - : BioMed Central (BMC). - 1472-6823. ; 14, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Disturbances of the circadian rhythm of cortisol secretion are associated with depression, coronary calcification, and higher all-cause and cardiovascular mortality. The primary aim of this study was to test the associations between midnight salivary cortisol (MSC), depression and HbA1c, and control for behavioural, environmental and intra individual factors with possible impact on cortisol secretion, like smoking, physical inactivity, season, medication, diabetes duration, severe hypoglycemia episodes, age and gender in patients with type 1 diabetes. Secondary aims were to present MSC levels for a reference group of non-depressed type 1 diabetes patients with a healthy life style (physically active and non-smoking), and to explore seasonal variations. Methods: A cross-sectional population based study of 196 patients (54% men and 46% women) aged 18-59 years that participated in a randomized controlled trial targeting depression in type 1 diabetes. Depression was assessed by the Hospital Anxiety and Depression Scale-depression subscale. MSC, HbA1c, serum-lipids, blood pressure, waist circumference and data from medical records and the Swedish National Diabetes Registry were collected. Results: Thirty four patients (17%) had MSC >= 9.3 nmol/L, which was associated with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9), self-reported depression (AOR 3.1), and older age (per year) (AOR 1.08). HbA1c > 70 mmol/mol (>8.6%) (AOR 4.2) and MSC >= 9.3 nmol/L (AOR 4.4) were independently linked to self-reported depression. Season was strongly associated with MSC levels and no other variables studied showed seasonal variations. In a reference group of 137 non-depressed patients with a healthy life style (physically active, non-smoking) the median MSC level was 4.6 nmol/L (range 1.9-23.0). Conclusions: In this study of patients with type 1 diabetes high MSC was linked to smoking, physical inactivity, depression, season and older age. Thus a high cortisol value identified three major targets for treatment in type 1 diabetes.
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