| 1. |
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| 2. |
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| 3. |
- Frid, Anders, et al.
(författare)
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Novel Assay of Metformin Levels in Patients With Type 2 Diabetes and Varying Levels of Renal Function Clinical recommendations
- 2010
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 33:6, s. 1291-1293
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Tidskriftsartikel (refereegranskat)abstract
- AbstractObjective: To study trough levels of metformin in serum and its intra individual variation in patients using a newly developed assay. Research Design and Methods: Trough serum levels of metformin was measured once using Liquid Chromatography Tandem Mass Spectrometry (LcMSMS) in 137 type 2 diabetes patients with varying renal function (99 men) and followed repeatedly during two months in 20 patients (16 men) with estimated GFR (eGFR) below 60 ml/min/1.73 m(2) body surface. Results: Patients with eGFR >60, 30-60, and <30 ml/min/1.73 m(2) had a median trough metformin concentration of 4.5 mumol/l (range 0.1-20.7, n=107), 7.71 mumol/l (0.12-15.15, n=21), and 8.88 mumol/l (5.99-18.60, n=9), respectively. The median intraindividual overall coefficient of variation (CV) was 29.4 % (range 9,8-74,2). Conclusions: Determination of serum metformin with the LCMSMS technique is useful in patients on metformin treatment. Few patients had values over 20 mumol/L. Metformin measurement is less suitable for dose titration.
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| 4. |
- Hjelm, Katarina, et al.
(författare)
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Beliefs about health and illness in women managed for gestational diabetes in two organisations.
- 2008
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 24:2, s. 168-192
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to explore beliefs about health, illness and health care in women with gestational diabetes mellitus (GDM) managed in two different organisations based on diabetology or obstetrics.Semi-structured interviews were made in two different clinics. clinic A: a specialist diabetes clinic with regular contact with a diabetologist and antenatal care provided by a midwifeclinic B: a specialist maternity clinic providing regular contact with a midwife, a structured programme for self-monitoring of blood glucose and insulin treatment, and a 1-day diabetes class by an obstetrician, a diabetologist, a midwife and a dietician. The clinics were located at two different university hospitals in Sweden.Participants were a consecutive sample of Swedish women diagnosed with GDM; 13 managed in clinic A and 10 managed in clinic B.The findings showed that women described their perceptions of as well-being, being healthy and freedom from disease. All respondents reported a delay in the provision of information about GMD and an information gap about GDM and the management of the condition, from diagnosis until the start of treatment at the specialist clinic. Respondents from clinic A expressed fear about future development of type 2 diabetes. Women from clinic B discussed different causes of GDM, and many claimed that health-care staff informed them that GDM was a transient condition during pregnancy. Respondents from clinic A reported a conflict in their treatment of pregnancy and GDM as two different conditions.Beliefs differed and were related to the health-care model chosen.
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| 5. |
- Lind, Marcus, 1976, et al.
(författare)
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Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections The GOLD Randomized Clinical Trial
- 2017
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Ingår i: Jama-Journal of the American Medical Association. - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 317:4, s. 379-387
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE The majority of individuals with type 1 diabetes do not meet recommended glycemic targets. OBJECTIVE To evaluate the effects of continuous glucose monitoring in adults with type 1 diabetes treated with multiple daily insulin injections. DESIGN, SETTING, AND PARTICIPANTS Open-label crossover randomized clinical trial conducted in 15 diabetes outpatient clinics in Sweden between February 24, 2014, and June 1, 2016 that included 161 individuals with type 1 diabetes and hemoglobin A(1c) (HbA(1c)) of at least 7.5%(58 mmol/mol) treated with multiple daily insulin injections. INTERVENTIONS Participants were randomized to receive treatment using a continuous glucose monitoring system or conventional treatment for 26 weeks, separated by a washout period of 17 weeks. MAIN OUTCOMES AND MEASURES Difference in HbA(1c) between weeks 26 and 69 for the 2 treatments. Adverse events including severe hypoglycemia were also studied. RESULTS Among 161 randomized participants, mean age was 43.7 years, 45.3% were women, and mean HbA(1c) was 8.6%(70 mmol/mol). A total of 142 participants had follow-up data in both treatment periods. Mean HbA(1c) was 7.92%(63 mmol/mol) during continuous glucose monitoring use and 8.35%(68 mmol/mol) during conventional treatment (mean difference, -0.43% [95% CI, -0.57% to -0.29%] or -4.7 [-6.3 to -3.1 mmol/mol]; P < .001). Of 19 secondary end points comprising psychosocial and various glycemic measures, 6 met the hierarchical testing criteria of statistical significance, favoring continuous glucose monitoring compared with conventional treatment. Five patients in the conventional treatment group and 1 patient in the continuous glucose monitoring group had severe hypoglycemia. During washout when patients used conventional therapy, 7 patients had severe hypoglycemia. CONCLUSIONS AND RELEVANCE Among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of continuous glucose monitoring compared with conventional treatment for 26 weeks resulted in lower HbA(1c). Further research is needed to assess clinical outcomes and longer-term adverse effects.
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| 6. |
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| 7. |
- Weng, Jianping, et al.
(författare)
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Screening for MODY mutations, GAD antibodies, and type 1 diabetes--associated HLA genotypes in women with gestational diabetes mellitus.
- 2002
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 25:1, s. 68-71
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether genetic susceptibility to type 1 diabetes or maturity-onset diabetes of the young (MODY) increases susceptibility to gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We studied mutations in MODY1-4 genes, the presence of GAD antibodies, and HLA DQB1 risk genotypes in 66 Swedish women with GDM and a family history of diabetes. An oral glucose tolerance test was repeated in 46 women at 1 year postpartum. RESULTS: There was no increase in type 1 diabetes-associated HLA-DQB1 alleles or GAD antibodies when compared with a group of type 2 diabetic patients (n = 82) or healthy control subjects (n = 86). Mutations in known MODY genes were identified in 3 of the 66 subjects (1 MODY2, 1 MODY3, and 1 MODY4). Of the 46 GDM subjects, 2 had diabetes (4%) and 17 had impaired glucose tolerance (IGT) (37%) at 1 year postpartum. Of the two subjects who developed manifest diabetes, one carried a MODY3 mutation (A203H in the hepatocyte nuclear factor-1alpha gene). There was no increase in high-risk HLA alleles or GAD antibodies in the women who had manifest diabetes or IGT at 1 year postpartum. CONCLUSIONS: MODY mutations but not autoimmunity contribute to GDM in Swedish women with a family history of diabetes and increase the risk of subsequent diabetes.
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| 8. |
- Åberg, Anders E, et al.
(författare)
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Predictive factors of developing diabetes mellitus in women with gestational diabetes.
- 2002
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:1, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate which factors during gestational diabetes pregnancies correlate with the risk of developing impaired glucose tolerance or diabetes 1 year postpartum and to compare this risk in women with gestational diabetes and women with a normal oral glucose tolerance test during pregnancy. METHODS: Of 315 women with gestational diabetes, defined as a 2-hr blood glucose value of at least 9.0 mmol/l at a 75-g oral glucose tolerance test, who delivered in Lund 1991-99, 229 (73%) performed a new test 1 year postpartum. We compared maternal and fetal factors during pregnancy with the test value at follow up. A control group of 153 women with a 2-hr test value below 7.8 mmol/l during pregnancy were invited to a new test 1 year postpartum and 60 (39%) accepted. RESULTS: At 1 year follow up, 31% of the women with gestational diabetes but only one of the 60 controls showed pathologic glucose tolerance and one had developed diabetes. The following factors in women with gestational diabetes were identified as predicting impaired glucose tolerance or diabetes at 1 year follow up: maternal age over 40 and--in a multiple regression analysis, independent of each other--a high 2-hr value at oral glucose tolerance test during pregnancy and insulin treatment during pregnancy. CONCLUSION: The risk of developing manifest diabetes after gestational diabetes may be high enough to justify a general screening or diagnostic procedure in all pregnant women to identify women with gestational diabetes and a postpartum follow up program for them. This study did not identify any particular factor during pregnancy with enough precision to predict a later progression to diabetes.
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| 9. |
- Ambrazaitis, Gilbert, et al.
(författare)
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The prosody of contrastive topics in Southern Swedish
- 2012
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Ingår i: Proceedings FONETIK 2012 : The XXVth Swedish Phonetics Conference, May 30–June 1, 2012. - Gothenburg : Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg. - 9789163709852 ; , s. 1-4
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This paper presents a pilot study on the prosodic marking of a contrastive topic in Southern Swedish. A test sentence was elicited in three experimental conditions: initial focus; final focus; contrastive topic (initial word) plus focus (final word). F0 patterns were analysed in recordings of 10 speakers. A majority of the speakers distinguished clearly between the conditions, but speakers employed different strategies. The most common one involved modifying the range and/or level of the F0 patterns given by the lexical pitch accents. Another frequent strategy involved a rising pitch accent on the initial word, where the lexical pitch accent would normally stipulate a fall. This result was unexpected and indicates that Southern Swedish sentence intonation might be more complex than typically assumed.
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| 10. |
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| 11. |
- Anderberg, Eva, et al.
(författare)
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Prevalence of impaired glucose tolerance and diabetes after gestational diabetes mellitus comparing different cut-off criteria for abnormal glucose tolerance during pregnancy.
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 1252-1258
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine the prevalence of diabetes and impaired glucose tolerance after gestational diabetes mellitus in relation to different categories of glucose tolerance during pregnancy. Design. Prospective study. Setting. Four delivery departments and three hospitals in southern Sweden took part in recruitment and follow-up. Population. Women undergoing a 75 g oral glucose tolerance test during pregnancy delivering in 2003-2005. Methods. At first follow-up, 1-2 years after delivery, 29% of eligible women with abnormal glucose tolerance during pregnancy had an oral glucose tolerance test; 160 with gestational diabetes, 309 with gestational impaired glucose tolerance, in addition to 167 control women. Cut-off levels defining gestational diabetes and impaired glucose tolerance were 2-hour capillary blood glucose levels 9.0 and 7.8 mmol/l or plasma glucose 10.0 and 8.6 mmol/l, respectively. Main outcome measures. Frequency of abnormal test results at follow-up. Results: Diabetes was diagnosed in 11% and impaired glucose tolerance in 24% of women with gestational diabetes vs. 4% and 23% in those with gestational impaired glucose tolerance. Combining women with abnormal test results during pregnancy revealed diabetes or impaired glucose tolerance in 29% as compared to 10% among controls; the odds ratio (95% confidence interval) for having abnormal test results was 3.3 (1.8-5.9) in a multivariate logistic regression analysis. Conclusions: Lowering the cut-off level for gestational diabetes to also include the category of impaired glucose tolerance would identify a high percentage of women with diabetes and impaired glucose tolerance postpartum, they constitute target groups for intervention and/or diabetes prevention.
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| 12. |
- Annersten Gershater, Magdalena, et al.
(författare)
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Treatment satisfaction with insulin glargine in patients with diabetes mellitus in a university hospital clinic in Sweden
- 2009
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Ingår i: European Diabetes Nursing. - : Wiley-Blackwell. - 1551-7853 .- 1551-7861. ; 6:1, s. 17-22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies evaluate patients' perspectives when a new drug is introduced to treat chronic diseases such as diabetes mellitus. The clinical role of a new insulin treatment, in terms of the relationship between higher cost and better treatment outcomes (as defined from the patient perspective) has been discussed. We sought to explore patient satisfaction with a new insulin treatment (insulin glargine). At its launch in 2002/3 it was purported to provide constant, peakless insulin release following once- or twice-daily administration, thus leading to fewer hypoglycaemic episodes while providing metabolic control equivalent to that achieved with NPH human basal insulin. Aims: To investigate the indications used for prescription of a new drug and its clinical effects on glycosylated haemoglobin (HbA1c) levels, perceived hypoglycaemic events and patient satisfaction. Methods: The Diabetes Treatment Satisfaction Questionnaire (Status Version, DTSQ-s), which measures satisfaction with treatment regimen, and perceived frequency of hyperglycaemia and hypoglycemia, was circulated to all living patients who had ever started treatment with insulin glargine at the Department of Endocrinology at Malmö University Hospital. Medical records of 913 patients were assessed for HbA1c levels at 0 and 12 months after starting insulin glargine therapy. Results: Completed questionnaires were returned by 615 of 960 patients (64%) who had ever started insulin glargine. The main indications for starting treatment were physicians' or nurses' initiatives, desire for fewer fluctuations and improved metabolic control. HbA1c levels fell by 0.41% for patients with type 1 diabetes and by 0.68% for those with type 2 diabetes. The mean DTSQ-s score was 28.45 for satisfaction, whereas the mean perceived hypoglycaemic/hyperglycaemic events score was 3. Conclusion: Treatment satisfaction was very high and perceived frequency of hypoglycaemia/hyperglycaemia was very low. The indications for treatment of insulin glargine are being followed in accordance with national recommendations..
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| 13. |
- Annersten, Magdalena, et al.
(författare)
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Insulin pens dribble from the tip of the needle after injection
- 2000
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Ingår i: Practical Diabetes International. - : John Wiley & Sons. - 1357-8170 .- 1528-252X. ; 17:4, s. 109-111
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To study different insulin pens regarding leakage from the tip of the needle after injection. Patients and method. Six pens were tested; Saline Pen 3.0 ml (Lilly), B-D Pen 3.0 ml, NovoLet 1.5 and 3.0 ml, NovoPen 1.5 and 3.0 ml. Twenty volunteers were injected with sterile saline and the needle was withdrawn after 1, 3, 5, or 7 s respectively. Any dribble was collected on a filter paper and weighed. The procedure was videotaped. Results. There was a minimum of dribbling from the 1.5 ml pens. Eight out of 20 NovoPen 3.0 ml and B-D Pen 3.0 ml, 16 out of 20 NovoLet 3.0 ml, and 19 out of 20 Saline Pen (Lilly) dribbled after a 7 s hold-in time. The 8 B-D Pen 3.0 ml had leaked 4.0 mg (2.4±18.8), the 8 NovoPen 3.0 ml 4.7 mg (3.8±6.7), the 16 NovoLet 3.0 ml 5.0 mg (3.1±16.6) and the 19 Saline Pen 3.0 ml had leaked 9.2 mg (4.9±19.1). Conclusion. There is a clinically significant leakage of fluid from the needle tip even after 7 s hold-in time. Patients should be taught to hold the needle in for at least 10 s to be assured they get the intended dose.
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| 14. |
- Annersten, Magdalena, et al.
(författare)
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Structured diabetes education in Sweden : a national inquiry involving 583 nurses working with diabetes patients in hospitals and primary care facilities.
- 2006
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Ingår i: Practical Diabetes International. - : John Wiley & Sons. - 1357-8170 .- 1528-252X. ; 23:3, s. 138-141
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Tidskriftsartikel (refereegranskat)abstract
- The overall goals for the treatment of diabetes are to prevent acute and long-term complications and maintain a good quality of life. The St Vincent Declaration and the Swedish National Guidelines for the Treatment of Diabetes Mellitus describe patient education in self-treatment as a prerequisite for the achievement of these goals. This survey aimed to evaluate the presence of structured patient education (in advance planned education), its organisation, staffing and goals, and the results in out-patient diabetes care in Sweden.A questionnaire consisting of 35 open and closed questions was mailed to 1250 diabetes educated nurses working in hospitals and primary health care in the entire country.Responses were received from 583 (47%) nurses. Structured diabetes patient education was performed by 486 nurses. It was usually organised by nurses and performed in co-operation with doctors (55%), dietitians (38%), chiropodists (36%), and social workers (9%). The sessions took place individually at pre-scheduled visits (80%), or as group education (26%). Fifty-one percent described explicit goals for the education, most commonly: general knowledge about diabetes, improved metabolic control and increased safety. The structured education was evaluated by 51% of which the HbA[1]c level at the next scheduled visit was the most frequently used evaluation method (44%), followed by home monitored blood glucose values (37%) and a structured evaluation form (17%). The goals had been achieved to a great or quite great extent by 67% of the responding nurses.To the extent that structured patient education takes place, nurses are usually responsible for its performance. It takes place individually as well as in groups. Many nurses lack evident goals for the education and sufficient evaluation methods.It was concluded that there is confusion about the content of structured education vs information activity.
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| 15. |
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| 16. |
- Björck, Inger, et al.
(författare)
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Cereal grains for nutrition and health benefits: Overview of results from in vitro, animal and human studies in the HEALTHGRAIN project
- 2012
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Ingår i: Trends in Food Science & Technology. - : Elsevier BV. - 1879-3053 .- 0924-2244. ; 25:2, s. 87-100
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological studies have linked whole grain intake to the prevention of the metabolic syndrome, obesity and associated chronic diseases such as CVD and T2D. The Nutrition module within the HEALTHGRAIN project, included 10 partners and undertook in vitro, animal and humanin vivo studies with the overall aims of elucidating the components and mechanisms underlying the health benefits of cereal grains. This review summarises the major outcomes of these studies, including yet unpublished findings.
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| 17. |
- Carlberger, Andreas, 1992, et al.
(författare)
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An iterative methodology for the prediction of dynamic vehicle–track interaction and long-term periodic rail wear
- 2018
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Ingår i: Proceedings of the Institution of Mechanical Engineers, Part F: Journal of Rail and Rapid Transit. - : SAGE Publications. - 0954-4097 .- 2041-3017. ; 232:6, s. 1718-1730
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Tidskriftsartikel (refereegranskat)abstract
- In this study, a versatile numerical method for the prediction of long-term growth of rail roughness is presented and its functionality is demonstrated for the development of rail corrugation on small radius curves. The procedure includes two sub-modules: (1) a time-domain model for the simulation of dynamic vehicle–track interaction in a wide range of frequencies by using a commercial software for multibody dynamics and (2) a post-calculation of sliding wear based on the Archard’s model in combination with a non-Hertzian and transient wheel–rail contact model. The structural flexibility of the wheelset is accounted for by using the finite element method. The rail wear generated by a large number of passing trains is assessed by recurrently updating the rail surface based on the wear depth calculated in each post- processing step. The current work sets out from a previous study in which a model for the prediction of long-term growth of rail roughness on small radius curves was developed in a general-purpose programming language. By transfer- ring the model into a commercial software, the aim is to develop an engineering tool that is more applicable for different operational conditions, such as various vehicle and track designs and track alignments. The proposed method is verified by comparing the simulation results against those obtained with the pre-existing software. Conditions similar to a 120 m radius curve on the Stockholm metro exposed to corrugation growth on the low rail are considered. The corrugation is found to be generated by the leading wheelsets. The prevailing wavelength-fixing mechanisms are identified and discussed.
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| 18. |
- Carlberger, Andreas, 1992, et al.
(författare)
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Numerical prediction of rail corrugation growth on curves
- 2016
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Ingår i: Proceedings of the 19h Nordic Seminar on Railway Technology, September 14 - 15, Luleå, Sweden (2016).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Rail corrugation (periodic surface irregularities at distinct wavelengths) is a problem experienced by many railway networks worldwide. Corrugation induces a pronounced dynamic wheel‒rail contact loading that leads to increased generation of noise and in severe cases even damage to vehicle and track components. The large magnitude creep forces and sliding between wheel and rail make corrugation especially prone to develop on curved track. The current work summarizes the results from a Master Thesis project performed in collaboration between Chalmers, ÅF Industry, Bombardier Transportation and Stockholm Public Transport. A time-domain model for the prediction of long-term growth of rail roughness has been developed, see Figure 1. Dynamic vehicle‒track interaction in a broad frequency range (at least up to 300 Hz) is simulated using the commercial software SIMPACK. Wheelset structural flexibility is accounted for by using modal parameters calculated for a finite element model. Non-Hertzian and non-steady wheel‒rail contact and associated generation of wear are calculated in a post-processing step in the software Matlab. Archard’s law is applied to model the sliding wear. A large number of train passages is accounted for by recurrent updating of the rail surface irregularity based on the calculated wear depth. The proposed prediction model is applied to investigate a curve on the Stockholm metro network exposed to severe corrugation growth.
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| 19. |
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| 20. |
- Costigliola, V., et al.
(författare)
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Needlestick injuries in European nurses in diabetes
- 2012
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Ingår i: Diabetes & Metabolism. - 1878-1780. ; 38:Suppl. 1, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- Aim. - With the June 2010 publication of EU Council Directive 2010/32/EU scrutiny is now being focused on the safety and protection of diabetes nurses. Methods. - We used a questionnaire to study the frequency and risks of Needlestick Injuries (NSI) associated with diabetic injections in European hospitals. 634 nurses participated from 13 western European countries and Russia. Results. - When patients with diabetes who self-inject at home are hospitalized injections are given always by the staff in 31% of cases, by the patients themselves where possible in 33%, initially by staff, then the patient takes over in 12% and both staff and patient throughout the stay in 21%. 86% of nurses said their hospitals had a written policy on the prevention of NSI but, where it was available, only 56% were familiar with it. 67% of the nurses had not attended any training on the prevention of NSI and only 13% had attended one in the last year. 7.1% of nurses report recapping needles and 5.9% report storing unprotected needles temporarily on a tray, trolley or cart. 32% of nurses report suffering a NSI while giving a diabetic injection at some point in the past. 29.5% of NSI occurred while recapping a used needle. 57% of nurses unscrew pen needles using their own fingers. In 80% cases the source patient's identity was known and the sharp item was "contaminated" (known previous percutaneous exposure to patient) in almost half the cases (43%). NSIs were reported to the proper authorities in only 2/3 of cases. Conclusion. - Our study shows that frequent NSI occur in European nurses treating people with diabetes in hospital settings. These injuries are a source of possible infection despite the small size of diabetes needles. The introduction of safety-engineered medical devices has been shown to reduce the risk of injury. A new European Directive that has now come into force specifically stipulates that wherever there is risk of sharps injury, the user and all healthcare workers must be protected by adequate safety precautions, including the use of "medical devices incorporating safety-engineered protection mechanisms". (C) 2012 Elsevier Masson SAS. All rights reserved.
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| 21. |
- Dorkhan, Mozhgan, et al.
(författare)
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A review of pioglitazone HCL and glimepiride in the treatment of type 2 diabetes.
- 2007
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 3:5, s. 721-731
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Forskningsöversikt (refereegranskat)abstract
- Type 2 diabetes (T2D) is a progressive disorder with a consistent and steady increase in glycosylated hemoglobin (HbA1c) over time associated with enhanced risk of micro- and macrovascular complications and a substantial reduction in life expectancy. There are three major pathophysiologic abnormalities associated with T2D: impaired insulin secretion, excessive hepatic glucose output, and insulin resistance in skeletal muscle, liver, and adipose tissue. These defects have been treated in clinical praxis by use of oral insulin secretagogues (sulfonylureas/ glinides) or insulin, biguanides, and thiazolidinediones (TZDs) respectively. Pioglitazone HCL is an insulin sensitizer in the TZD family and glimepiride is an insulin secretagogue in the SU family. This article reviews mechanisms of action and clinical data behind the use of these two commonly used oral hypoglycemic agents with documented efficacy and good safety profile of once-daily administration, alone or in combination with insulin or metformin, in the management of T2D in terms of glycemic and non-glycemic effects, tolerability and side effects, and impact on vascular health.
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| 22. |
- Dorkhan, Mozhgan, et al.
(författare)
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Differences in effects of insulin glargine or pioglitazone added to oral anti-diabetic therapy in patients with type 2 diabetes What to add-Insulin glargine or pioglitazone?
- 2008
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 82, s. 340-345
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: While metformin is the first line treatment in type 2 diabetes, the best way to escalate therapy is not always clear, particularly whether to add one or two oral agents or to introduce insulin. METHODS: Thirty-six patients inadequately controlled on metformin and sulfonylurea/meglitinide were randomized to receive add-on therapy with insulin glargine or pioglitazone for 26 weeks. Insulin was up-titrated to achieve fasting plasma glucose <6mmol/l. Pioglitazone was increased to 45mg/day after 16 weeks if HbA1c>6.2%. beta-Cell function and insulin sensitivity were assessed by measuring insulin, proinsulin and adiponectin, and in a subgroup using a combined glucagon-stimulated C-peptide test and insulin tolerance test (GITT). Lipids and natriuretic peptides were measured at start and end of study. RESULTS: The reduction in HbA1c was slightly greater in the insulin glargine group and used as co-variate when analysing other variables. The effect on beta-cell function was more favourable with insulin glargine measured by proinsulin (42+/-48 to 19+/-16, p=0.01 vs. 36+/-26 to 27+/-16 p=0.04) while the improvement in insulin sensitivity measured by adiponectin (7.5+/-3.7 to 15+/-10, p<0.01 vs. 8.7+/-4 to 7.6+/-3, p=0.04) and HDL cholesterol (1.10+/-0.24 to 1.24+/-0.3, p<0.01 vs. 1.08+/-0.35 to 1.04+/-0.33, ns) (all p between groups <0.01) was more favourable in pioglitazone group. Pioglitazone caused significant increase in natriuretic peptides (BNP pmol/l 6.6+/-5.2 to 13.7+/-16.1, p=0.04 vs. 8.8+/-11.6 to 8.6+/-10.6, ns, p between groups 0.028). CONCLUSIONS: The results demonstrate characteristic differences in the effects of insulin glargine vs. pioglitazone on measures of beta-cell function and insulin sensitivity as well as cardiac load.
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| 23. |
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| 24. |
- Dorkhan, Mozhgan, et al.
(författare)
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Treatment with pioglitazone induced significant, reversible mitral regurgitation
- 2008
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Ingår i: Cardiovascular Diabetology. - : Springer Science and Business Media LLC. - 1475-2840. ; 7:12
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Tidskriftsartikel (refereegranskat)abstract
- There has in recent years been great concern about possible cardiac side effects of thiazolidinediones ( TZDs). We present a case-report of a 60 year-old male who developed significant mitral regurgitation during six months treatment with pioglitazone in parallel with laboratory indications of fluid retention. Echocardiography six months after discontinuation of medication showed regression of mitral regurgitation and the laboratory parameters were also normalized. It is noteworthy that six months treatment with pioglitazone could induce significant valve dysfunction, which was reversible, and this underlines the importance of carefully monitoring patients when placing them on treatment with TZDs.
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| 25. |
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| 26. |
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| 27. |
- Frid, Anders, et al.
(författare)
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Effect of oral pre-meal administration of betaglucans on glycaemic control and variability in subjects with type 1 diabetes
- 2017
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 9:9
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Tidskriftsartikel (refereegranskat)abstract
- We conducted a double-blind placebo-controlled crossover pilot study to investigate the effect of oat betaglucans (β-glucan) on glycaemic control and variability in adults with type 1 diabetes (T1D; n = 14). Stomacol® tablets (1.53 g of β-glucan) or placebo (Plac) were administered three times daily before meals for two weeks. Glucose levels were monitored during the second week by continuous glucose monitoring (CGM). There was an increase in basic measures of glycaemic control (maximal glucose value 341 ± 15 vs. 378 ± 13 mg/dL for Plac and β-glucan, p = 0.004), and average daily risk range (62 ± 5 vs. 79 ± 4 mg/dL for Plac and β-glucan, p = 0.003) favouring Plac over β-glucan, but no increase in the M-value (the weighted average of the glucose values) or other more complex measures. Basic measures of glucose variability were also slightly increased during β-glucan treatment, with no difference in more complex measures. However, glycaemic variability increased between the first and last two CGM days on Plac, but remained unchanged on β-glucan. In conclusion, in this pilot study we were unable to demonstrate a general positive effect of β-glucan before meals on glucose control or variability in T1D.
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| 28. |
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| 29. |
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| 30. |
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| 31. |
- Frid, Anders H., et al.
(författare)
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New Insulin Delivery Recommendations
- 2016
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Ingår i: Mayo Clinic Proceedings. - : Elsevier BV. - 0025-6196. ; 91:9, s. 1231-1255
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Forskningsöversikt (refereegranskat)abstract
- Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.
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| 32. |
- Frid, Anders, et al.
(författare)
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Influence of whey supplementation on glycaemic and hormonal excursions at breakfast and lunch in type II diabetic subjects
- 2005
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Ingår i: American Journal of Clinical Nutrition. - 1938-3207. ; 82:1, s. 69-75
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Tidskriftsartikel (refereegranskat)abstract
- Background:Whey proteins have insulinotropic effects and reduce the postprandial glycemia in healthy subjects. The mechanism is not known, but insulinogenic amino acids and the incretin hormones seem to be involved. Objective:The aim was to evaluate whether supplementation of meals with a high glycemic index (GI) with whey proteins may increase insulin secretion and improve blood glucose control in type 2 diabetic subjects. Design:Fourteen diet-treated subjects with type 2 diabetes were served a high-GI breakfast (white bread) and subsequent high-GI lunch (mashed potatoes with meatballs). The breakfast and lunch meals were supplemented with whey on one day; whey was exchanged for lean ham and lactose on another day. Venous blood samples were drawn before and during 4 h after breakfast and 3 h after lunch for the measurement of blood glucose, serum insulin, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like peptide 1 (GLP-1). Results:The insulin responses were higher after both breakfast (31%) and lunch (57%) when whey was included in the meal than when whey was not included. After lunch, the blood glucose response was significantly reduced [–21%; 120 min area under the curve (AUC)] after whey ingestion. Postprandial GIP responses were higher after whey ingestion, whereas no differences were found in GLP-1 between the reference and test meals. Conclusions:It can be concluded that the addition of whey to meals with rapidly digested and absorbed carbohydrates stimulates insulin release and reduces postprandial blood glucose excursion after a lunch meal consisting of mashed potatoes and meatballs in type 2 diabetic subjects.
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| 33. |
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| 34. |
- Frid, Anders, et al.
(författare)
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New injection recommendations for patients with diabetes.
- 2010
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Ingår i: Diabetes & Metabolism. - 1878-1780. ; 36 Suppl 1, s. 3-18
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Injections administered by patients are one of the mainstays of diabetes management. Proper injection technique is vital to avoiding intramuscular injections, ensuring appropriate delivery to the subcutaneous tissues and avoiding common complications such as lipohypertrophy. Yet few formal guidelines have been published summarizing all that is known about best practice. We propose new injection guidelines which are thoroughly evidence-based, written and vetted by a large group of international injection experts. METHODS: A systematic literature study was conducted for all peer-reviewed studies and publications which bear on injections in diabetes. An international group of experts met regularly over a two-year period to review this literature and draft the recommendations. These were then presented for review and revision to 127 experts from 27 countries at the TITAN workshop in September, 2009. RESULTS: Of 292 articles reviewed, 157 were found to meet the criteria of relevance to the recommendations. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include The Role of the Professional, Psychological Challenges, Education, Site Care, Storage, Suspension and Priming, Injecting Process, Proper Use of Pens and Syringes, Insulin analogues, Human and Pre-mixed Insulins, GLP-1 analogs, Needle Length, Skin Folds, Lipohypertrophy, Rotation, Bleeding and Bruising, Pregnancy, Safety and Disposal. CONCLUSION: These injecting recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure comfortable, effective and largely complication-free injections.
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| 35. |
- Frid, Anders, et al.
(författare)
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The Third Injection Technique Workshop in Athens (TITAN).
- 2010
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Ingår i: Diabetes & Metabolism. - 1878-1780. ; 36 Suppl 1, s. 19-29
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Tidskriftsartikel (refereegranskat)abstract
- The first Injection Technique workshop brought together endocrinologists and injection experts from around the world in Strasbourg in 1997. From its work came groundbreaking recommendations which advanced best practices in areas such as the use of a skin fold when injecting. The second Injection Technique workshop, with an expanded format including nurses and diabetes educators, took place in Barcelona in 2000. The initial stimulus to use shorter injecting needles can be said to date from this meeting. The third Injection Technique workshop was held in Athens in September 2009 and involved 127 experts from across the globe. After a comprehensive review of all publications since 2000 as well as several unpublished studies, the attendees divided into smaller groups to debate and draft new injecting recommendations based on the new data and their collective experience. This paper summarizes all the formal presentations given at this practical consensus workshop.
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| 36. |
- Frid, Christina, et al.
(författare)
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Long-term survival in children with atrioventricular septal defect and common atrioventricular valvar orifice in Sweden.
- 2004
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Ingår i: Cardiology in the young. - : Cambridge University Press (CUP). - 1047-9511 .- 1467-1107. ; 14:1, s. 24-31
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The survival for patients with atrioventricular septal defect has improved markedly over the last decades and, during the same period, the survival of children with Down's syndrome has also increased. The aim of our study was to investigate long-term survival in patients having atrioventricular septal defect with common valvar orifice, but without associated significant congenital heart defects, in the setting of Down's syndrome, comparing the findings to those in chromosomally normal children with the same malformation. METHODS AND RESULTS: In a population-based retrospective study, we scrutinised the medical records from 801 liveborn children with atrioventricular septal defect born in Sweden during the period 1973 through 1997. Data on gender, presence or absence of Down's syndrome, associated congenital heart defects, date of birth, operation and death were recorded and followed up until 2001. An isolated atrioventricular septal defect with common atrioventricular valvar orifice was present in 502 children, of whom 86% had Down's syndrome. We found a significant reduc tion over time in age at operation, and in postoperative mortality at 30 days, from 28 to 1%. Using a multiple logistic regression model, we found no significant differences in mortality between genders, nor between those with or without Down's syndrome. Early corrective surgery could not be identified as a significant independent factor for survival. The 5-year postoperative survival in patients with Down's syndrome increased from 65% over the period from 1973 through 1977, to about 90% in the period 1993 through 1997, and the same trend was observed in chromosomally normal patients. CONCLUSIONS: Survival in uncomplicated atrioventricular septal defect with common atrioventricular valvar orifice has greatly increased, and surgical correction is now equally successful in patients with Down's syndrome and chromosomally normal patients, and for both genders. Death in connection with surgery is no longer the major threat, and focus must now be on long-term follow-up.
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| 37. |
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| 38. |
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| 39. |
- Frid, Johan, et al.
(författare)
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South Swedish diphthongisation: an articulographic and acoustic study of /u:/ in the Malmöhus dialect
- 2012
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Ingår i: Proceedings from FONETIK 2012. - 9789163709852 ; , s. 85-88
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Konferensbidrag (refereegranskat)abstract
- We investigated lip and tongue movements of diphthongisation of /uː/ in the Malmöhus dia- lect, which is spoken in the very south of Swe- den. Articulographic and acoustic data of ten native speakers were collected and analysed. Acoustic analysis revealed fairly stable F1 and F3, but a considerable F2 movement through- out the diphthongisation, indicating that /uː/ is realised dynamically. Articulographic results confirmed the acoustic results, showing signifi- cant differences in tongue displacement throughout the diphthong for all speakers, whereas lip displacement differences were sig- nificant for fewer speakers.
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| 40. |
- Frid, Johan, et al.
(författare)
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Tongue articulation of front close vowels in Stockholm, Gothenburg and Malmöhus Swedish
- 2015
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Ingår i: Proceedings of ICPhS 2015. - 2412-0669. - 9780852619414
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Konferensbidrag (refereegranskat)abstract
- Articulatory data were collected for the Swedish vowels /iː, yˌ, ʉ̟ː/ from nine speakers each of Stockholm, Gothenburg, and Malmöhus Swedish, and the tongue positions and their dynamics analysed using Functional Data Analysis (FDA). Results showed that the general tongue positions for /iː/ and /yː/ are similar and clearly different from /ʉ̟ː/ in all three dialects. Variation within the Stockholm and Gothenburg groups led to a subdivision into two types, where the tongue positions of type 1 resem-bled Malmöhus Swedish more. Several differences in tongue articulation between types 1 and 2 were observed, possibly explained by the presence of Viby-coloured /iː/ and /yː/ in type 2.
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| 41. |
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| 42. |
- Glerup, Mia, et al.
(författare)
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Long-term Outcomes of Temporomandibular Joints in Juvenile Idiopathic Arthritis.
- 2020
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Ingår i: The Journal of rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 47:4
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Tidskriftsartikel (refereegranskat)abstract
- To determine the prevalence of orofacial symptoms, dysfunctions, and deformities of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) 17 years after disease onset.Drawn from a prospective, population-based Nordic JIA cohort with disease onset from 1997-2000, 420 consecutive cases were eligible for orofacial evaluation of TMJ involvement. The follow-up visit included demographic data, a standardized clinical orofacial examination, and fullface cone-beam computed tomography (CBCT). For comparison, 200 age-matched healthy controls were used.Of 420 eligible participants with JIA, 265 (63%) were included (mean age 23.5 ± 4.2 years) and completed a standardized clinical orofacial examination. Of these, 245 had a full-face CBCT performed. At least one orofacial symptom was reported by 33%. Compared to controls, the JIA group significantly more often reported TMJ pain, TMJ morning stiffness, and limitation on chewing. Furthermore, among participants reporting complaints, the number of symptoms was also higher in the JIA. The mean maximal incisal opening was lower in the JIA group (p<0.001), and TMJ pain on palpation was more frequent. Condylar deformities and/or erosions were observed in 61% as assessed by CBCT, showing bilateral changes in about 70%. Risk factors of condylar deformities were orofacial dysfunction or biologic treatment; enthesitis-related arthritis was protective.This first study on long-term consequences of TMJ involvement in a population-based JIA cohort reports persistence of comprehensive symptoms, dysfunctions, and damage of the TMJ into adulthood. We suggest interdisciplinary follow-up of JIA patients also in adulthood.
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| 43. |
- Glerup, Mia, et al.
(författare)
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Longterm Outcomes of Temporomandibular Joints in Juvenile Idiopathic Arthritis : 17 Years of Followup of a Nordic Juvenile Idiopathic Arthritis Cohort
- 2020
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Ingår i: Journal of Rheumatology. - : J RHEUMATOL PUBL CO. - 0315-162X .- 1499-2752. ; 47:5, s. 730-738
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the prevalence of orofacial symptoms, dysfunctions, and deformities of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) 17 years after disease onset.Methods: Drawn from a prospective, population-based Nordic JIA cohort with disease onset from 1997 to 2000, 420 consecutive cases were eligible for orofacial evaluation of TMJ involvement. The followup visit included demographic data, a standardized clinical orofacial examination, and full-face cone-beam computed tomography (CBCT). For comparison, 200 age-matched healthy controls were used.Results: Of 420 eligible participants with JIA, 265 (63%) were included (mean age 23.5 +/- 4.2 yrs) and completed a standardized clinical orofacial examination. Of these, 245 had a full-face CBCT performed. At least 1 orofacial symptom was reported by 33%. Compared to controls, the JIA group significantly more often reported TMJ pain, TMJ morning stiffness, and limitation on chewing. Further, among participants reporting complaints, the number of symptoms was also higher in JIA. The mean maximal incisal opening was lower in the JIA group (p < 0.001), and TMJ pain on palpation was more frequent. Condylar deformities and/or erosions were observed in 61% as assessed by CBCT, showing bilateral changes in about 70%. Risk factors of condylar deformities were orofacial dysfunction or biologic treatment; enthesitis-related arthritis was protective.Conclusion: This study of the longterm consequences of TMJ involvement in a population-based JIA cohort reports persistence of comprehensive symptoms, dysfunctions, and damage of the TMJ into adulthood. We suggest interdisciplinary followup of JIA patients also in adulthood.
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| 44. |
- Grill-Wikell, Heidi, et al.
(författare)
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Pain in connection with capillary blood test at different sites in the palm
- 2005
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Ingår i: European Diabetes Nursing. - : Wiley-Blackwell. - 1551-7853 .- 1551-7861. ; 2:2, s. 65-68
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Tidskriftsartikel (refereegranskat)abstract
- There are studies suggesting that fear of blood and injury is associated with less frequent self-testing; by reducing pain when measuring blood glucose the number of measurements can probably increase. The aim of this study was to investigate whether or not there were any differences regarding pain at different test sites in the palm. Twenty type 1 diabetes subjects pricked themselves at four different sites in the palm in the non-dominant hand in a randomised order with the Freestyle® punction device loaded with BD Microfine+ lancets. Pain was evaluated by the subjects using the Pain-O-Meter®. The result (n=80) showed no statistically significant difference in pain score between the investigated sites. The level of sensory pain was reported: shooting (n=36), no pain (n=27), searing (n=8), soaring (n=5), pressing (n=2), aching (n=1) and burning (n=1); 86% (n=69) of the pricked sites were experienced as no pain at all. This study shows that pain in connection with capillary blood test is low as measured by the Pain-O-Meter. There are no significant differences in the pain experienced at different sites in the palm. More studies need to be done using different punction devices and more sites need to be investigated
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| 45. |
- Gustafsson, Rita, et al.
(författare)
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Esophageal Dysmotility is More Common Than Gastroparesis in Diabetes Mellitus and is Associated With Retinopathy.
- 2011
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Ingår i: Review of Diabetic Studies. - 1614-0575. ; 8:2, s. 268-275
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Tidskriftsartikel (refereegranskat)abstract
- Gastroparesis is a well-known complication of diabetes mellitus, both in symptomatic and asymptomatic patients. Esophageal dysmotility has also been described, but is not as well-characterized. The etiology and effect of these complications need to be clarified. The aim of the present study was to evaluate esophageal and gastric motility, complications, gastrointestinal symptoms, and plasma biomarkers in a cross-sectional study comprising patients with diabetes mellitus.
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| 46. |
- Hanås, Ragnar, et al.
(författare)
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Unchanged Insulin Absorption After 4 Days' Use of Subcutaneous Indwelling Catheters for Insulin Injections
- 1997
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 20:4, s. 487-490
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Since 1985, we have used indwelling catheters (Insuflon, Maersk Medical, Lynge, Denmark; Chronimed, Minnetonka, MN) to lessen pain when injecting insulin. However, some patients experience a rise in blood glucose after using indwelling catheters for a few days. We therefore studied the absorption of 125I-labeled insulin when using indwelling catheters.RESEARCH DESIGN AND METHODS Five men and five women participated (age 18–25 years, C-peptide negative, HbA1c 9.0 ± 1.0% [mean ± SD, DCA-2000 method], diabetes duration 5–21 [median 9.5] years). After thyroid blockage with potassium iodide, we injected 5IU of 125I-labeled short-acting insulin subcutaneously in the abdomen (“ordinary injection”) and 5 IU on the contralateral side through an indwelling catheter (“catheter injection”). The injection/insertion area was free of lipohyper- and lipohypotrophies. Disappearance rate was measured for 180 min with a gamma camera. The patients injected all premeal injections of short-acting insulin through the same indwelling catheter in the following 4 days. The investigation procedure was repeated day 3 and 5.RESULTS We found no statistically or clinically (95% CI) significant difference in residual activity of 125I-insulin after 60 min or in time for 50% of the injected depot to disappear (T-50%) among catheter injections on day 1, 3, and 5; ordinary injections on days 1, 3, and 5; or catheter and ordinary injections on days 1, 3, and 5, respectively. HbA1c correlated both to T-50% (r = 0.73, P = 0.016) and residual activity of 125I-insulin after 60 min (r = 0.69, P = 0.028), indicating that patients with a slower absorption will have a less ideal metabolic control when using premeal bolus injections.CONCLUSIONS We conclude that using indwelling subcutaneous catheters for insulin injections for up to 4 days does not affect the absorption of short-acting insulin.
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| 47. |
- Hermanides, J, et al.
(författare)
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Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled Type 1 diabetes; a randomized controlled trial.
- 2011
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Ingår i: Diabetic Medicine: A journal of the British Diabetic Association. - : Wiley. - 1464-5491. ; 28, s. 1158-1167
-
Tidskriftsartikel (refereegranskat)abstract
- Aims To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes. Methods In this investigator-initiated multi-centre trial (the Eurythmics Trial) in eight outpatient centres in Europe, we randomized 83 patients with Type 1 diabetes (40 women) currently treated with multiple daily injections, age 18-65 years and HbA(1c) ≥ 8.2% (≥ 66 mmol/mol) to 26 weeks of treatment with either a sensor-augmented insulin pump (n = 44) (Paradigm(®) REAL-Time) or continued with multiple daily injections (n = 39). Change in HbA(1c) between baseline and 26 weeks, sensor-derived endpoints and patient-reported outcomes were assessed. Results The trial was completed by 43/44 (98%) patients in the sensor-augmented insulin pump group and 35/39 (90%) patients in the multiple daily injections group. Mean HbA(1c) at baseline and at 26 weeks changed from 8.46% (sd 0.95) (69 mmol/mol) to 7.23% (sd 0.65) (56 mmol/mol) in the sensor-augmented insulin pump group and from 8.59% (sd 0.82) (70 mmol/mol) to 8.46% (sd 1.04) (69 mmol/mol) in the multiple daily injections group. Mean difference in change in HbA(1c) after 26 weeks was -1.21% (95% confidence interval -1.52 to -0.90, P < 0.001) in favour of the sensor-augmented insulin pump group. This was achieved without an increase in percentage of time spent in hypoglycaemia: between-group difference 0.0% (95% confidence interval -1.6 to 1.7, P = 0.96). There were four episodes of severe hypoglycaemia in the sensor-augmented insulin pump group and one episode in the multiple daily injections group (P = 0.21). Problem Areas in Diabetes and Diabetes Treatment Satisfaction Questionnaire scores improved in the sensor-augmented insulin pump group. Conclusions Sensor augmented pump therapy effectively lowers HbA(1c) in patients with Type 1 diabetes suboptimally controlled with multiple daily injections.
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| 48. |
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| 49. |
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