| 1. |
- Hanås, Ragnar, et al.
(författare)
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Side effects and indwelling times of subcutaneous catheters for insulin injections : a new device for injecting insulin with a minimum of pain in the treatment of insulin-dependent diabetes mellitus
- 1990
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 10:1, s. 73-83
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Tidskriftsartikel (refereegranskat)abstract
- For 2 months we observed side-effects and indwelling times when using a subcutaneous catheter (Insuflon, Viggo AB, Sweden) for insulin injections. This method is used by approximately 600 children and adolescents with IDDM in Sweden today. 22 children and adolescents aged 4–19 years with a diabetes duration of 4.0 ± 3.0 (mean ± SD) years participated. Their HbA1c was 5.8 ± 1.0%. All used 4–6 dosages of insulin per day. The catheter was placed subcutaneously in the abdominal wall, and replaced by parents when home tests showed increased blood or urine glucose, when the child experienced pain or when skin changes were observed. The 22 patients used 239 catheters with a mean time between changing catheters of 4.8 ± 2.2 (range 0.5 – 17) days (= 1147 catheter days). Noted side effects were (% of catheter days): fixation problems, 5.6%; minor infection/irritation (= redness > 1 mm), 5.6%; pain, 2.8%; sore skin from plastic wings, 2.4%; itching/dry skin, 2.0%; eczema from band-aid, 1.7%; blocked catheter/injection needle, 1.6%; leakage of insulin, 1.3%, transient lipohypertrophies, 1.1%; hematoma/blood in catheter, 0.8%, and moist skin, 0.3%. No major infections requiring surgical or antibiotic treatment occurred. In conclusion, the use of indwelling insulin catheters seems to be a safe method to lessen the pain of insulin injections with a low frequency of side effects. The long-term metabolic control was not altered in this group of well-controlled children. We therefore find that we can recommend the use of indwelling catheters to children and adolescents who have difficulties with injections because of needle phobia or pain, particularly when using MIT.
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| 2. |
- Adolfsson, Peter, 1963, et al.
(författare)
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Automated Insulin Delivery Systems in Pediatric Type 1 Diabetes: A Narrative Review
- 2024
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Ingår i: JOURNAL OF DIABETES SCIENCE AND TECHNOLOGY. - : Diabetes Technology Society. - 1932-2968.
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Tidskriftsartikel (refereegranskat)abstract
- This narrative review assesses the use of automated insulin delivery (AID) systems in managing persons with type 1 diabetes (PWD) in the pediatric population. It outlines current research, the differences between various AID systems currently on the market and the challenges faced, and discusses potential opportunities for further advancements within this field. Furthermore, the narrative review includes various expert opinions on how different AID systems can be used in the event of challenges with rapidly changing insulin requirements. These include examples, such as during illness with increased or decreased insulin requirements and during physical activity of different intensities or durations. Case descriptions give examples of scenarios with added user-initiated actions depending on the type of AID system used. The authors also discuss how another AID system could have been used in these situations.
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| 3. |
- Adolfsson, Peter, 1963, et al.
(författare)
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Continuous subcutaneous insulin infusion: Special needs for children.
- 2017
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Ingår i: Pediatric diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 18:4, s. 255-261
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Tidskriftsartikel (refereegranskat)abstract
- Continuous subcutaneous insulin infusion (CSII) is a very common therapy for children with type 1 diabetes. Due to physiological differences they have other requirements for their insulin pump than adults. The main difference is the need for very low basal rates. Even though most available insulin pumps reach a high accuracy at usual basal rates, accuracy decreases for lower rates. In addition, the lowest delivered amount at 1 time is limiting the fine tuning of the basal rate as well as the option for temporary basal rates. Alarms in case of occlusions depend on accumulation of a certain amount of insulin in the catheter, and therefore the time until such an alarm is triggered is much longer with lower basal rates. Accordingly, the risk for hyperglycemia developing into diabetic ketoacidosis increases. The availability of bolus advisors facilitates the calculation of meal and correction boluses for children and their parents. However, there are some differences between the calculators, and the settings that the calculation is based on are very important. Better connectivity, for example with a system for continuous glucose monitoring, might help to further increase safety in the use of CSII in children. When selecting an insulin pump for a child, the features and characteristics of available pumps should be properly compared to ensure an effective and safe therapy.
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| 4. |
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| 5. |
- Agardh, Carl-David, et al.
(författare)
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Varning för okritisk användning av överviktskirurgi vid typ 2-diabetes
- 2012
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Ingår i: Läkartidningen. - Stockholm : Läkartidningen förlag. - 0023-7205 .- 1652-7518. ; 109:25, s. 1208-1209
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Tidskriftsartikel (refereegranskat)abstract
- Överviktskirurgi diskuteras nu som ett behandlingsalternativ även för patienter med typ 2-diabetes där BMI inte överstiger nuvarande indikationsgräns 35 kg/m2. Artikelförfattarna vill varna för en sådan utveckling i avvaktan på kritisk värdering av denna typ av kirurgi.
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| 6. |
- Anderson, B. J., et al.
(författare)
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Factors associated with diabetes-specific health-related quality of life in youth with type 1 diabetes: The global teens study
- 2017
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 40:8, s. 1002-1009
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Our objective was to characterize diabetes-specific health-related quality of life (D-HRQOL) in a global sample of youth and young adults with type 1 diabetes (T1D) and to identify the main factors associated with quality of life. RESEARCH DESIGN AND METHODS The TEENs study was an international, cross-sectional study of youth, 8-25 years of age, with T1D. Participants (N= 5,887)were seen in clinical sites in 20 countries across 5 continents enrolled for 3 predetermined age groups: 8-12, 13-18, and 19-25 years of age. To assess D-HRQOL, participants completed the PedsQL DiabetesModule 3.0 and were interviewed about family-related factors. Specifics about treatment regimen and self-management behaviors were collected from medical records. RESULTS Across all age groups, females reported significantly lower D-HRQOL than didmales. The 19-25-year age group reported the lowest D-HRQOL. Multivariate linear regression analyses revealed that D-HRQOL was significantly related to HbA1c; the lower the HbA1c, the better the D-HRQOL. Three diabetes-management behaviors were significantly related to better D-HRQOL: advanced methods used to measure food intake;more frequent daily blood glucose monitoring; and more days per week that youth had 30 min of physical activity. CONCLUSIONS In all three age groups, the lower the HbA1c, the better the D-HRQOL, underscoring the strong association between better D-HRQOL and optimal glycemic control in a global sample of youth and young adults. Three diabetes-management behaviors were also related to optimal glycemic control, which represent potentially modifiable factors for clinical interventions to improve D-HRQOL as well as glycemic control.
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| 7. |
- Anderzen, J., et al.
(författare)
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International benchmarking in type 1 diabetes: Large difference in childhood HbA1c between eight high-income countries but similar rise during adolescence-A quality registry study
- 2020
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Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 21:4, s. 621-627
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To identify differences and similarities in HbA1c levels and patterns regarding age and gender in eight high-income countries. Subjects 66 071 children and adolescents below18 years of age with type 1 diabetes for at least 3 months and at least one HbA1c measurement during the study period. Methods Pediatric Diabetes Quality Registry data from Austria, Denmark, England, Germany, Norway, Sweden, the United States, and Wales were collected between 2013 and 2014. HbA1c, gender, age, and duration were used in the analysis. Results Distribution of gender and age groups was similar in the eight participating countries. The mean HbA1c varied from 60 to 73 mmol/mol (7.6%-8.8%) between the countries. The increase in HbA1c between the youngest (0-9 years) to the oldest (15-17 years) age group was close to 8 mmol/mol (0.7%) in all countries (P < .001). Females had a 1 mmol/mol (0.1%) higher mean HbA1c than boys (P < .001) in seven out of eight countries. Conclusions In spite of large differences in the mean HbA1c between countries, a remarkable similarity in the increase of HbA1c from childhood to adolescence was found.
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| 8. |
- Boman, Åse
(författare)
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Fathers involved in children with type 1 diabetes : finding the balance between disease control and health promotion
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background:Type I diabetes is a chronic disease that places great demands on the child and family. Parental involvement has been found to be essential for disease outcome. However, fathers’ involvement has been less studied, even though high paternal involvement has been correlated with less disease impact on the family and higher quality of life among adolescents.Aim: The overall aim of the study was to explore and analyze constructions of fathers’ involvement in their child’s everyday life with type 1 diabetes from an ecological and health promotion perspective. Four specific aims were applied: 1) explore and describe discourses in health care guidelines for children with type 1 diabetes in Nordic countries, focusing on parents' positioning (I), 2) analyze how Swedish pediatric diabetes teams perceived and discussed fathers’ involvement in the care of their child with type 1 diabetes, and to discuss how the teams’ attitudes toward the fathers’ involvement developed during a focus group process (II), 3) explore and discuss how fathers involved in caring for their child with type 1 diabetes experience support from their pediatric diabetes team in everyday life with their child (III), and 4) analyze how involved fathers to children with type 1 diabetes understand their involvement in their child’s daily life and to discuss their perceptions from a health promotion perspective (IV).Material and methods: A qualitative and inductive approach was applied. Data were collected and analyzed during 2010-2012. The sample consisted of three pediatric guidelines originating from Norway, Denmark and Sweden (I), three Swedish pediatric diabetes teams (PDTs) (II), and 11 (III) and 16 (IV) fathers of children with type 1 diabetes who scored high involvement on the Parental Responsibility Questionnaire. Data were collected through repeated focus group discussions with the PDTs (II), online focus group discussions (III) and individual interviews (III, IV) with the fathers. Three analysis methods were applied: analysis of discourses (I), Constructivist Grounded Theory (II, III) and content analysis (IV).Findings: The findings illuminated the complex interaction between the pediatric guidelines, the PDTs and the fathers. Fathers highly involved in their child’s daily life experienced different levels of tension between the general recommendations and their personal experiences of living with a child with type 1 diabetes (III). The fathers regarded their involvement in their child’s diabetes care as additional to their general parenting, and a fine balance was identified between a health promotion perspective and a controlling involvement. The common denominator between the highly involved fathers was their use of parental leave (IV). The PDTs initially perceived fathers’ involvement as gendered and balanced on the mother’s agement, but as focus was set on fathers’ engagement the PDTs increased their awareness of this and started to identify and encourage their engagement II). At the macro-level, parents’ voices were diminished in Nordic pediatric diabetes guidelines in favor of an expert discourse (I).Conclusions: Fathers’ involvement concerning a child with type 1diabetes is constructed in a complex way, based on an interaction between the fathers’ perceptions of their additional involvement and the support provided by the PDTs; the PDTs’ perceptions of the fathers’ involvement; and how parents/fathers are constructed in pediatric diabetes guidelines. In order to promote the health and well-being of children with type 1 diabetes, fathers’ involvement needs to be taken into account in the pediatric guidelines as well as in clinical practice.
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| 9. |
- Boman, Åse, 1957-, et al.
(författare)
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If dad comes, we are happy - if mom fails to appear, we become desperate : A Grounded Theory study of Swedish diabetes teams perecption of fathers’ involvement in their child's everyday life
- 2011
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Ingår i: 4th International Research Seminar on SALUTOGENESIS and meeting of the IUP-GWG-SAL. ; , s. 1-12
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Konferensbidrag (refereegranskat)abstract
- Background: Since parental involvement is essential to the outcome of diabetes type 1 treatment in childhood and high paternal engagement in everyday life promote the child's health, it is of value to explore how professionals, the diabetes teams (DT), perceive fathers' involvement in their child with diabetes type 1.Method: The study design was Constructivist Grounded Theory and data was collected by Repeated Focus Groups discussions with three Swedish pediatric diabetes teams, between May 2010 and January 2011.Results: The core category for the diabetes teams' perception of fathers' involvement was If dad comes, we are happy – if mom fails to appear, we become desperate. The core category relied on three subcategories. Societal and cultural context where DTs perceived fathers involvement as having specific properties and specific areas of responsibility, Balancing where the DTs balanced the father's involvement against the mother's engagement and Becoming aware where the DTs raised awareness of the fathers from being a indistinct parents-unit till to identify and appreciate the father's engagement.Conclusions: Perceiving fathers as equal caregivers, and becoming aware of fathers as a health resource, could support an active health promotion perspective in pediatric diabetes care.
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| 10. |
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| 11. |
- Chaplin, John, 1955, et al.
(författare)
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Assessment of childhood diabetes-related quality-of-life in West Sweden
- 2009
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Ingår i: Acta Paediatrica. - 1651-2227. ; 98:2, s. 361-366
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate health-related quality-of-life (HrQoL) in childhood diabetes and the level of agreement between West Sweden and European reference data for the new multi-cultural European questionnaire - DISABKIDS. METHOD: Twenty percent of the Swedish paediatric diabetes population was included in the survey. Child-parent pairs completed the DISABKIDS chronic generic (37 questions) and diabetes modules (10 questions) during their routine clinic visit. A one-page results summary, based on positive domains, was used to provide feedback to clinicians. RESULTS: Three hundred and sixty-one child-parent pairs were included in the analysis. In Sweden, diabetes was perceived by the children as having less impact than the European average. Swedish parents rated the HrQoL of their children lower than did the European parents. Swedish girls had a lower HrQoL than boys and greater difficulty accepting their diabetes; adolescents had greater difficulty accepting the diagnosis than younger children. Parents reported greater impact of diabetes on their children than the children themselves but reported no difference between boys and girls. Parents reported better acceptance of treatment in boys. The child's reported quality-of-life (QoL) is related to age and gender. CONCLUSION: Our results confirm the applicability of DISABKIDS to the Swedish paediatric diabetes population.
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| 12. |
- Charalampopoulos, Dimitrios, et al.
(författare)
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Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes
- 2018
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Ingår i: Diabetes Care. - : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 41:6, s. 1180-1187
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) across and within eight high-income countries to best inform international benchmarking and policy recommendations. RESEARCH DESIGN AND METHODS Data were collected between 2013 and 2014 from 64,666 children with T1D who were amp;lt; 18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed-and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and childrens glycemic control. RESULTS Sweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC amp;lt;= 4%). Germany and Austria had the next lowest mean HbA(1c) (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC similar to 15%). Centers in England, Wales, and the U.S. showed low-to-moderate variation around high mean values. In pooled analysis, differences between counties remained significant after adjustment for children characteristics and center effects (P value amp;lt; 0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA(1c) levels (5.6mmol/mol [0.5%] per 5mmol/mol [0.5%] increase in center SD of HbA(1c) values of all children attending a specific center). CONCLUSIONS A tsimilar average levels of HbA(1c), countries display different levels of center variation. The distribution of glycemic achievement within countries should be considered in developing informed policies that drive quality improvement.
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| 13. |
- Cherubini, V., et al.
(författare)
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Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents
- 2020
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 63, s. 1530-1541
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. Methods: An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status. Results: During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0years [5.5–11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia. Conclusions/interpretation: DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups. © 2020, The Author(s).
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| 14. |
- Danne, Thomas, et al.
(författare)
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A cross-sectional international survey of continuous subcutaneous insulin infusion in 377 children and adolescents with type 1 diabetes mellitus from 10 countries
- 2005
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Ingår i: Pediatric Diabetes. - 1399-543X .- 1399-5448. ; 6:4, s. 193-198
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To document current practices using continuous subcutaneous insulin infusion (CSII) by downloading electronically the 90-d pump data held within the pump memory and relating that to clinical data from children and adolescents in different pediatric diabetes centers from Europe and Israel. Methods: Data of patients (1-18 yr) treated with CSII in 23 centers from nine European countries and Israel were recorded with the ENCAPTURE software (PEC International, Frankfurt, Germany). The number of patients who participated was 377 (48% female, mean diabetes duration ± SD: 6.8 ± 3.7 yr, age: 12.9 ± 3.8 yr, preschool n = 33, prepubertal n = 95, adolescent n = 249, CSII duration: 1.6 ± 1.2 yr, local HbA1c: 8.1 ± 1.2%). Results: The total insulin dose was lower than previously reported for injection therapy (0.79 ± 0.20 U/kg/d). Covariance coefficient of daily total insulin was high in all age groups (adolescents 19 ± 9%, prepubertal 18 ± 8 and preschool 17 ± 8). The distribution of basal insulin infusion rates over 24 hr (48 ± 12% of total dose) varied significantly between centers and age groups. The number of boluses per day (7 ± 3) was not significantly different between the age groups (average daily bolus amount: 0.42 ± 0.16 U /kg). The rate of severe hypoglycemia (coma/convulsions) was 12.4 episodes per 100 patient-years and the number of diabetes-related hospital days was 124 per 100 patient-years. Discussion: Pediatric CSII patients show a high variability in their insulin therapy. This relates both to age-dependent differences in the distribution of basal insulin as to the age-independent day-to-day variation in prandial insulin. © Blackwell Munksgaard, 2005.
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| 15. |
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| 16. |
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| 17. |
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| 18. |
- Enander, Rebecka, et al.
(författare)
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Beta cell function after intensive subcutaneous insulin therapy or intravenous insulin infusion at onset of type 1 diabetes in children without ketoacidosis.
- 2018
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Ingår i: Pediatric diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 19:6, s. 1079-1085
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to see if IV insulin therapy at diagnosis preserves beta-cell function better than multiple subcutaneous (SC) injections.Fifty-four children 9.9 ± 3.5years (range 2.8-14.9) without ketoacidosis were included in a 2years, randomized multicenter study with insulin SC or 48 to 72hours IV initially. Thirty-three (61%) were boys, 22 (41%) were pubertal. Forty-eight subjects completed 12 months follow-up and 43 completed 24 months. At 1, 6, 12, and 24 months, hemoglobin A1c (HbA1c), C-peptide and insulin/kg/24 h were measured. At 24 months, a mixed-meal tolerance test (MMTT) was performed.HbA1c at diagnosis was 10.7%, (93mmol/mol) for IV, 10.7%, (94mmol/mol) for SC. During the first 2 full days of insulin therapy, mean plasma glucose was 8.2 mmol/L for IV, 9.5 for SC (P =.025). Mean insulin dose was 1.5 U/kg/d for IV vs 1.0 for SC (P =.001). Sixteen (7 in IV, 9 in SC group) started with insulin pumps during the follow-up. At 24 months, we saw no significant differences: HbA1c (7.5%, 58mmol/mol, for IV, 7.2%, 55mmol/mol, for SC; ns), insulin doses (0.79 vs 0.88U/kg/d; ns), fasting C-peptide (0.08 vs 0.12nmol/L; ns), maximal MMTT response (0.19 vs 0.25nmol/L; ns) and AUC (18.26 vs 23.9 nmol/L*min; ns). Peak C-peptide >0.2 nmol/L in the combined IV and SC groups correlated significantly with HbA1c and C-peptide at onset in a multiple regression.Residual beta cell function at 2years seems to be independent from initial insulin regimens but related to HbA1c and C-peptide at onset.
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| 19. |
- Enander, Rebecka, et al.
(författare)
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Carbohydrate counting with a bolus calculator improves post-prandial blood glucose levels inchildren and adolescents with type 1 diabetes using insulin pumps.
- 2012
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Ingår i: Pediatric diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 13:7, s. 545-551
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Carbohydrate counting (CC) is widely used in insulin pumps. The primary objectives of this study were improvement of HbA1c and meal-related plasma glucose (PG) levels when using CC. METHODS: Forty patients with pump treatment, aged 13.8±3.4yr (range 5.0-19.5) and diabetes duration 8.0±3.8 (1.8-16.8) years completed a 1-yr multi-center study. HbA1c at start was 7.6±0.9% Diabetes Control and Complications Trial (DCCT), 59±10mmol/mol International Federation for Clinical Chemistry and Laboratory Medicine (IFCC). They were randomized into (A) control group, (B) manual CC, and (C) CC with a bolus calculator in the pump for calculations. (B) and (C) received education in CC while (A) received equal hours of traditional dietary education. Glucose meters were downloaded at visits and the standard deviation (PG-SD) calculated. PG measurements from before and 2 h after meals were registered separately. RESULTS: We found no difference in HbA1c between the groups. Group C had a non-significant decrease in PG-SD (p=0.056) compared to start, and a significantly higher number of post-meal PG between 4 and 8mmol/L at 12months compared to group A (55.3% vs. 30.6%, p=0.014). The frequency of hypoglycemia was reduced for the whole study group (p=0.01), but with no significant difference between groups. (A) significantly increased their basal-insulin dosage at 12months. In (C), all subjects wanted to continue CC after the study. The insulin:carbohydrate ratio correlated significantly to the insulin-dose/24h (p=0.003) and the correction factor to the insulin-dose/24h (p=0.035) and age (p<0.001). CONCLUSIONS: We conclude that CC using a bolus calculator may help decrease PG-fluctuations and increase post-meal PG values within target.
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| 20. |
- Haby, Karin, 1960, et al.
(författare)
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A Lifestyle Intervention During Pregnancy and Its Effects on Child Weight 2.5 Years Later
- 2022
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Ingår i: Maternal and Child Health Journal. - : Springer Science and Business Media LLC. - 1092-7875 .- 1573-6628. ; 26, s. 1881-1890
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to evaluate if overweight and obesity in the offspring is reduced by a low-intensity antenatal primary care intervention with focus on diet and physical activity for pregnant women with obesity, comparing children to mothers receiving the intervention with children to mothers who did not. Methods: This study is a follow-up of children 2.5years of age after their mothers’ participation in a non-randomised controlled intervention intending to limit gestational weight gain. All study participants received standard antenatal care. The intervention group received lifestyle support via motivational talks with midwife and support from dietician. Data on child weight were collected by medical records, letter and phone. Results: There was no significant difference between the groups 2.5years after intervention (International Obesity Task Force ISO-BMI 25 (child BMI corresponding to adult BMI of 25): 20% vs. 21%; ISO-BMI 30: 4.6% vs. 1.3%). The mother’s BMI at the beginning of pregnancy significantly influenced child BMI at 2.5years (r = 0.13, p = 0.014, r2 = 0.017). For each unit of increase in maternal BMI at enrollment, the probability of child ISO-BMI ≥ 25 increased by 7.5% (p = 0.021) and of ≥ 30, by 12.9% (p = 0.017). Conclusion: The frequency of overweight and obesity of the children at 2.5years of age was significantly correlated to the mother’s BMI, but not correlated to the mothers’ participation in the antenatal lifestyle intervention. Thus, it seems important to address obesity and lifestyle issues before and between pregnancies. Trial registration The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079.
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| 21. |
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| 22. |
- Haby, Karin, 1960, et al.
(författare)
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Lifestyle intervention in pregnant women with BMI ≥30
- 2018
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Ingår i: NEON, The Network in Epidemiology and Nutrition. From evidence to practice. April 18-19 2018.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes. Methods The intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790). Results In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG <7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (-0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population. Conclusion Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.
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| 23. |
- Haby, Karin, 1960, et al.
(författare)
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Mighty Mums - a Lifestyle intervention at primary care level reduces gestational weiht gain in women with obesity
- 2018
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Ingår i: BMC Obesity. - : Springer Science and Business Media LLC. - 2052-9538. ; 5:16
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Tidskriftsartikel (refereegranskat)abstract
- Background Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes. Methods The intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790). Results In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG <7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (-0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population. Conclusion Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.
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| 24. |
- Haby, K., et al.
(författare)
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Mighty Mums - An antenatal health care intervention can reduce gestational weight gain in women with obesity
- 2015
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 31:7, s. 685-692
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Tidskriftsartikel (refereegranskat)abstract
- Background: overweight and obesity are growing public health problems and around 13% of women assigned to antenatal health care (ARC) in Sweden have obesity (Body Mass Index, BMI >= 30). The risk of complications during pregnancy and childbirth increase with increasing BMI. Excessive gestational weight gain (GWG) among obese women further increases the risks of adverse pregnancy outcomes. In this pilot-study from ARC in Gothenburg, a co-ordinated project with standardised care, given by midwives and supported by dietitian and aiming at reducing weight gain in obese pregnant women, is evaluated. Objective: to evaluate the effects of a behavioural intervention programme for women with BMI 30, with emphasis on nutrition and physical activity, with regards to GWG and effect on weight at the post partum check-up. Methods: in the pilot study, the intervention group consisted of the first 50 enrolled obese pregnant women in a large life style project within the AHC in Gothenburg. The control group consisted of 50 obese pregnant women in the same city. The intervention included 60 minutes extra time with the midwife and also offered food discussion group, walking poles and pedometers. The intervention group was prescribed physical activity and could choose from food advice with different content. If needed, the woman was offered referral to the dietitian for a personal meeting. A network was formed with the surrounding community. Outcome measures were GWG, weight change at the postnatal check-up compared with when signing in to antenatal health care, and change in BMI during the same period. Findings: women in the intervention group had a significantly lower GWG (8.6 +/- 49 kg versus 12.5 +/- 5.1 kg; p=0.001) and a significantly lower weight at the postnatal check up versus the first contact with ARC (-0.2 +/- 5.7 kg versus +2.0 +/- 4.5 kg; p=0.032), as well as a decrease in BMI (-0.04 +/- 2.1 versus +0.77 +/- 2.0; p=0.037). More women in the intervention than in the control group managed GWG < 7 kg [18 (36%) versus 8(16%), p=0.039]. Conclusion: obese pregnant women adhering to a standardised life style project in primary care using restricted resources can limit their weight gain during pregnancy, and show less weight retention after pregnancy compared to controls. (C) 2015 Elsevier Ltd. All rights reserved.
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| 25. |
- Haby, Karin, 1960, et al.
(författare)
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Mighty Mums; can a ifestyle intervention for pregnant women with obesity have positive effects on weight gain during pregnancy?l
- 2016
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Ingår i: SAPC, Society for Academic Primary Care, Dublin, 8th of July, 2016.
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Konferensbidrag (refereegranskat)abstract
- The problem Maternal obesity is an increasing public health issue and 13% of women in antenatal care (AC) in Sweden have obesity (BMI≥30). The risk of complications during pregnancy and delivery, and for the child, increases with increasing BMI and is aggravated if the gestational weight gain (GWG) is high. From a public health perspective, the burden of obesity for the woman and her family is a challenge considering the complexity of factors associated with lifestyle choices and the impact on health care resources. The Approach A controlled low intensive lifestyle project, Mighty Mums (MM), was performed in a primary care setting in Gothenborg, Sweden, directed to pregnant women with BMI ≥30. All study participants (n=1165) received standard AC, and the intervention group (n= 465) additionally received support for changing to a more healthy life style. A log was used to register weight, activity and food. The primary aim was to evaluate whether a systematised counselling with the midwife, support from dietician, active guidance to local health centers and availability of pedometers and walking poles, can result in lower mean GWG and lower weight and BMI at the postnatal check-up. Findings A previously presented analysis of a pilot group of 50+50 women showed significant effect on GWG (8.6±4.9 kg vs. 12.5±5.1kg; p=0.001) in the intervention group, among whom a greater proportion managed to restrict their GWG to less than 7 kg (36% vs. 16%; p=0.039). The result from the full scale study will be presented and discussed at the conference. Consequences Our pilot study showed that with a modest and economically realistic effort - done with simple measures possible to adhere to also after the pregnancy - it is possible to guide the woman in AC towards lifestyle changes that decreases GWG. A project like MM would be of great advantage if incorporated in the regular AC, not only for the health of mothers and babies. This requires a general consensus in the health care organisation that obesity and overweight are important issues, and that the management of AC is supportive and implements an effective method of taking care of the women with overweight and obesity in routine AC.
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| 26. |
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| 27. |
- Hanås, Ragnar, 1951, et al.
(författare)
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A 2-yr national population study of pediatric ketoacidosis in Sweden: predisposing conditions and insulin pump use
- 2009
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Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 10:1, s. 33-7
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate triggering factors and insulin pump usage (continuous subcutaneous insulin infusion, CSII) at diabetic ketoacidosis (DKA). Data from 1999 and 2000 were collected retrospectively from Sweden. In 1999 and 2000, 7.4 and 11.0%, respectively, of children with diabetes used CSII. One hundred and forty-two episodes of DKA (pH < 7.30) were identified in 115 children (DKA at onset not included). Their hemoglobin A1c (HbA1c) was 10.1 +/- 2.0%, age 14.6 +/- 3.1 yr (range 1.5-19.9 yr), and diabetes duration 6.6 +/- 3.5 yr (range 0.4-17.7 yr). Fourteen persons (seven girls) had more than one episode of DKA. Reported causes of DKA were missed insulin doses (48.6%), gastroenteritis (14.1%), technical pump problems (12.7%), infection (13.4%), social problems (1.4%), unknown (5.6%), and not stated (4.2%). Alcohol was involved in eight episodes and drugs in one. Thirty of 115 patients (19 girls) used insulin pumps. The overall DKA incidence was 1.4/100 patient years in 1999 and 1.7/100 patient years in 2000. For insulin pump users, the DKA incidence was 3.2/100 patient years in 1999 and 3.6/100 patient years in 2000. HbA1c at DKA admission was lower for CSII users than patients who used injections (9.1 +/- 1.5 vs. 10.8 +/- 2.2%, p < 0.01), but pH and age did not differ. CSII had been used for 6 months (median) before the DKA episode. In conclusion, the DKA frequency in CSII users was approximately twice that of patients who used injections. Seventy-seven percent of the episodes occurred within 1 yr after CSII start. The high number of events reported to be caused by gastroenteritis is alarming because this may reflect a misinterpretation of DKA symptoms.
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| 28. |
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| 29. |
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| 30. |
- Hanås, Ragnar, 1951, et al.
(författare)
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Bolus Calculator Settings in Well-Controlled Prepubertal Children Using Insulin Pumps Are Characterized by Low Insulin to Carbohydrate Ratios and Short Duration of Insulin Action Time.
- 2017
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Ingår i: Journal of diabetes science and technology. - : SAGE Publications. - 1932-2968. ; 11:2, s. 247-252
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Tidskriftsartikel (refereegranskat)abstract
- The "500 rule" has been used extensively to find the insulin to carbohydrate ratio (ICR) for carbohydrate counting (CC). Duration of insulin action (DIA) is often recommended to be set to 4 hours. Data are lacking on validating these routines in young children.ICR was calculated by dividing carbohydrate grams by insulin units. Insulin sensitivity factor (ISF) was defined by the 100 rule (100 divided by total daily insulin dose [TDD]). DIA was set to 3 hours. ICR, ISF, and DIA were adjusted continuously. Data for this retrospective analysis were taken from pump downloads at a routine visit. ICR and ISF were recalculated to rules (ICR/ISF multiplied by TDD).A total of 21 prepubertal children aged 7.0 ± 2.3 (mean ± SD), range 2-10 years, with diabetes duration 3.0 ± 1.9, range 0.5-7.7 years, used the pump bolus calculator for CC. HbA1c IFCC (NGSP) was 53 ± 6 mmol/mol (7.0 ± 0.5%). None had experienced severe hypoglycemia (unconsciousness/seizures) since diabetes diagnosis. TDD was 0.7 ± 0.1 U/kg/24 h (range 0.5-1.0), and the percentage basal insulin 38 ± 11%. Median breakfast rule was 211 (Q, quartiles 162;310), and for other meals 434 (Q 301;496). Median ISF rule was 113 (Q 100;128) in the morning, and 120 (Q 104;134) during the rest of the day. DIA was 2.6 ± 0.5 h (range 2-3) and target BG 5.3 ± 0.4 mmol/l (range 5.0-6.0).Prepubertal children seem to need more bolus insulin for meals than calculated from the 500 rule, especially at breakfast, but less insulin for corrections than calculated from the 100 rule. Two to 3 hours seems to be the appropriate range for DIA in this age group.
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| 31. |
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| 32. |
- Hanås, Ragnar, 1951, et al.
(författare)
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Diabetic ketoacidosis and cerebral oedema in Sweden--a 2-year paediatric population study
- 2007
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Ingår i: Diabet Med. - : Wiley. - 0742-3071. ; 24:10, s. 1080-5
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to investigate diabetic ketoacidosis (DKA) and cerebral oedema in the Swedish paediatric diabetes population, and to measure laboratory parameters during treatment. METHODS: The Swedish National Paediatric Diabetes Registry (SWEDIABKIDS) indicates that 16% of patients < 18 years during 2000 to 2004 had DKA at onset of diabetes. Data from 1999 and 2000 was collected retrospectively from all of Sweden by questionnaire. RESULTS: We identified 292 cases of DKA (pH < 7.30) in 265 children (149 at diabetes onset), aged 0.8-19.9 years. The incidence of DKA in patients with previously diagnosed diabetes was 1.4/100 patient years in 1999 and 1.7/100 in 2000. Two patients, both 11 years old with newly diagnosed diabetes, had overt symptoms of cerebral oedema and one developed neurological sequelae. This corresponds to an incidence of 0.68% (2/292) with no mortality. Symptoms of subclinical cerebral oedema after admission (headache, vomiting, lethargy) were recorded in a further 16 cases. In two of these mannitol was given, and both recovered within 1-2 h. Laboratory data was available from 253/292 episodes. During treatment for DKA, hypokalaemia (< 3.5 mmol/l) was significantly more common at onset of diabetes than in patients with established diabetes (65 vs. 28%, P < 0.001; initial prescription of potassium was 20 mmol/l). CONCLUSIONS: We conclude that 16% of children with new-onset diabetes presented with DKA at diagnosis and that the incidence of DKA in children with established diabetes was 1.6/100 patient years. Cerebral oedema occurred in 0.68% of the DKA episodes.
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| 33. |
- Hanås, Ragnar, et al.
(författare)
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Diagnosis of the cause of malfunction of indwelling catheters for insulin injections by the use of digital fluoroscopy
- 2000
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Ingår i: Pediatric Radiology. - : Springer Science and Business Media LLC. - 0301-0449 .- 1432-1998. ; 30:10, s. 674-676
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Tidskriftsartikel (refereegranskat)abstract
- Background. Subcutaneous indwelling catheters are used for reducing pain when injecting insulin and other drugs.Objective. To use digital fluoroscopy for the diagnosis of catheter malfunction.Material and methods. Seven children (aged 5–11 years) with diabetes mellitus were studied. They used indwelling catheters (Insuflon) for insulin injections. Contrast medium was injected into the problem catheter.Results. The subcutaneous position of the catheter was correct in all cases, but we found two cases of delayed absorption caused by lipohypertrophy and one case of leakage.Conclusions. Digital fluoroscopy is a useful method for determining potential problems with indwelling catheters.
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| 34. |
- Hanås, Ragnar, et al.
(författare)
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Experience of pain from insulin injections and needle-phobia in young patients with IDDM
- 1997
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Ingår i: Practical Diabetes International. - : Wiley. - 1357-8170 .- 1528-252X. ; 14:4, s. 95-99
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Tidskriftsartikel (refereegranskat)abstract
- We studied attitudes towards insulin injections, needle-phobia and the experience of pain when using syringes, pens, insulin pumps and in-dwelling subcutaneous catheters (Insuflon®, Maersk Medical, Lynge, Denmark).185 children and adolescents with IDDM aged 14.2±4.1 years with a HbA1c of 6.4±1.4% answered a questionnaire using 10 cm VAS scores (0 cm = hardly noticeable pain/not scared of needles at all, 10 cm=unbearable pain, very scared of needles).The VAS score of injections (median and quartiles) with syringes was 1.9 (1.1, 3.5) cm, with pens 0.4 (0.0, 1.3) cm, with in-dwelling catheters 0.4 (0.2, 1.7) cm, when taking a bolus dose with insulin pump 0.0 (0.0, 0.0) cm and when taking a blood glucose test 0.7 (0.1, 2.4) cm. The injection pain declined with increasing age but still several teenagers regarded the injection pain as almost unbearable. Injection pain correlated to HbA1c (p=0.033), age (p=0.0003), their own (p<0.0001) and their mother's (p=0.032) needle-phobia (but not father's) but not to diabetes duration or if parents had tried injections or blood glucose testing. Median needle-phobia score was 0.4 (0.1, 1.4) cm. Overall, 8.3% of the patients, 16.8% of the mothers and 17.7% of the fathers defined themselves as having pronounced needle-phobia (⩾5 cm). Those using in-dwelling catheters reported a higher needle-phobia but their injection pain was in the same low range as for other individuals.We conclude that, for most patients, the pain when injecting insulin is quite small irrespective of injection mode, but for some it is almost unbearable. Parents' attitudes are important for children's acceptance of injections. Injections through an in-dwelling injection aid enables children and adolescents to reduce the pain to levels comparable to those who are less needle-phobic.
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| 35. |
- Hanås, Ragnar, et al.
(författare)
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Hypoglycemia and ketoacidosis with insulin pump therapy in children and adolescents
- 2006
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Ingår i: Pediatric Diabetes. - 1399-543X .- 1399-5448. ; 7:Supp. 4, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- This review deals with the two most serious side effects encountered with insulin pump therapy, severe hypoglycemia and diabetic ketoacidosis (DKA). Although clinical follow-up studies reported decreased rates of severe hypoglycemia, randomized studies have not confirmed this, showing no difference between the pump and injection groups. Less-severe hypoglycemia (mild/moderate/symptomatic hypoglycemia) was found to be more common with pump use. Some patients have inadvertently dosed or overdosed while awake or during sleep, causing fatal outcome in rare cases. Population-based or retrospective clinical studies reported a low rate of DKA in pump users that was still a higher rate than those using injection therapy, at least in some countries. In research settings and for patients with good compliance and adequate family support, the risk of DKA seems lower; many short-term studies report no DKA at all, possibly due to the increased attention given to participants. The use of continuous subcutaneous insulin infusion (CSII) seems to decrease the risk in patients who had recurrent DKA before pump start. Most episodes of DKA occur early after pump start, suggesting a learning curve occurs in all new forms of treatment. Increased teaching and awareness programs are vital to prevent severe hypoglycemia and DKA in children and adolescents using insulin pumps.
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| 36. |
- Hanås, Ragnar, 1951, et al.
(författare)
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Indwelling catheters used from the onset of diabetes decrease injection pain and pre-injection anxiety
- 2002
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Ingår i: J Pediatr. - : Elsevier BV. - 0022-3476 .- 0022-3476 .- 1097-6833. ; 140:3, s. 315-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the use of indwelling catheters as injection aids at diabetes onset to reduce injection pain and pre-injection anxiety. STUDY DESIGN: Forty-one patients aged 8.1 +/- 3.7 years (range, 1-15) participated in this open, controlled randomized study. A 10-cm VAS with faces was used for scoring. A local anesthetic cream was used before all insertions. The control group used insulin pens with standard needles. After one week, the indwelling catheter group could choose regular injections but were included in the "intention to treat" analysis. RESULTS: Injection pain and anxiety decreased from day 1 to 15 in both groups (average, 4.1 injections/day). Pain was significantly lower for indwelling catheter injections when scored by parents (median, 1.2 cm vs 2.7 cm; P =.002), children/teenagers (0.8 cm vs 1.5 cm; P =.006), and nurses (1.4 cm vs 3.0 cm; P =.002). Parental pre-injection anxiety was also lower (1.2 cm vs 2.9 cm; P =.016). Taking injections, including inserting catheters, was found to be less problematic with an indwelling catheter (1.6 cm vs 3.3 cm;P =.009). During the 6-month follow-up, injection pain and injection problems were significantly lower in the catheter group. Mean catheter indwelling time was 3.7 days. Median pain for catheter insertion was 2.1 cm and for glucose testing was 0.9 cm. Sixteen of 20 patients continued to use indwelling catheters after 2 weeks, and 9 of 20 after 6 months. CONCLUSIONS: We found an evident relief of pre-injection anxiety and injection pain when using indwelling catheters for introducing insulin injections at the onset of diabetes.
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| 37. |
- Hanås, Ragnar, 1951, et al.
(författare)
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Insulin pumps in pediatric routine care improve long-term metabolic control without increasing the risk of hypoglycemia
- 2006
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Ingår i: Pediatr Diabetes. - 1399-543X .- 1399-543X. ; 7:1, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- Although continuous subcutaneous insulin infusion (CSII) has been used in pediatric practice for >20 yr, the technique is not widely used in many countries. The aim of this non-randomized population-based study was to evaluate CSII in routine pediatric care. In a 1-yr cross-sectional evaluation, 27/89 patients (30.3%, age 7-21 yr) used pumps (two during the night only), the others 4-6 injections/day. In patients with >2 yr of diabetes, pump users had higher HbA1c (8.9+/-1.0 vs. 8.2+/-1.6%, p=0.04), less insulin/24 h (0.9+/-0.1 vs. 1.0+/-0.2 U/kg, p=0.002), and longer diabetes duration (p=0.02). The higher HbA1c is explained by 67% of pump patients having high HbA1c (>8.5%) as the major indication for CSII. The overall incidence of severe hypoglycemia was 31.5/100 patient years, 40.3 for injection therapy, and 11.1 for pump therapy (p=not significant). The incidence of severe hypoglycemia with unconsciousness was 12.9/100 patient years and with seizures 9.7 for injection therapy, whereas no children on pumps experienced these complications during the cross-sectional study year. We had no admissions for ketoacidosis in either group during this year. The pump patients were followed for 5 yr after pump start. Two stopped using the pump after 2 and 3 yr. For the patients with high HbA1c as indication, mean HbA1c the year before pump was 9.5%. Mean HbA1c during the first year with pump was lowered to 8.9% (p=0.019), the second year 8.6% (p=0.017), the third year 8.6 (p=0.012), the fourth year 8.7 (p=0.062), and the fifth year 8.9% (p=0.28). We found six cases of ketoacidosis corresponding to 4.7/100 patient years. In conclusion, we found a long-term lowering of HbA1c after starting CSII in a pediatric population, decreased frequency of severe hypoglycemia, and a low risk of ketoacidosis.
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| 38. |
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| 39. |
- Hanås, Ragnar, et al.
(författare)
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Metabolic Control Is Not Altered When Using Indwelling Catheters for Insulin Inactions
- 1994
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 17:7, s. 716-718
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To determine if the use of indwelling catheters for insulin injections affects the long- and short-term metabolic control of insulin-dependent diabetes mellitus (IDDM).RESEARCH DESIGN AND METHODS Sixteen children and adolescents 9–20 years of age were included in a randomized 10-week crossover study using indwelling catheters (Insuflon, Pharma-Plast, Lynge, Denmark; CHRONIMED, Minnetonka, Minnesota) for insulin injections. Their diabetes duration was 7.5 ± 3.3 years (range 2–14), and they used multiple injection therapy with 4–5 doses/day. C-peptide was <0.15 nM fasting and ≤0.30 nM postprandial.RESULTS We found no significant difference between those with and without Insuflon in degree of metabolic control reflected by HbA1c (with Insuflon, 7.3 ± 2.6%; without, 7.1 ± 2.2%), 24-h profiles of blood glucose and free insulin, 24-h samples of glucosuria, or ketonuria. Weight, insulin doses per kilogram per 24 h, and insulin antibodies were all the same in the two groups.CONCLUSIONS The long- and short-term metabolic control of IDDM was not altered by the use of indwelling catheters for insulin injections. Insuflon can be offered as an alternative to patients with IDDM who find regular injections uncomfortable.
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| 40. |
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| 41. |
- Hanås, Ragnar
(författare)
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Reducing injection pain in children and adolescents with type 1 diabetes : Studies on indwelling catheters and injection needles
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Insulin injections can be painful for many children, especially when using multiple daily injections. To reduce this procedural pain we in 1985 designed ao indwelling catheter for subcutaneous use when injecting insulin. This catheter has been well accepted by our patients. The aims of the present studies have been to further investigate the problems of pain associated with insulin injections in children and adolescents and to study side effects, metabolic control, and insulin absorption when using indwelling catheters (Insuflon®, Maersk Medical, Lynge, Denmark). Side effects and indwelling times were studied at home using questionnaires.Injection pain and needle phobia were studied using 10 cm VAS scales. Metabolic control was studied in a 10-week crossover study and insulin absorption with the help of an uncollimated gamma camera and 125I-insulin.The mean indwelling time was 4.8 ± 2.2 (range 0.5-17) days. Fixation problems and local redness at the insertion site were the most frequent side effects. No major infections requiring surgical or antibiotic treatment occurred. In the questionnaire of recalled pain, the VAS score of injections (median and quartiles) with syringes was 1.9 (1.1,3.5) cm, with pens 0.4 (0.2,1.3) cm, with indwelling catheters 0.4 (0.2, I. 7) cm, when taking a pump bolus dose 0.0 cm (0.0, 0.0), and when talcing a blood glucose test 0.7 (0.1, 2.4) cm. The injection pain and needle phobia declined with increasing age but some, both yOlmg children and teenagers, regarded the injection pain as almost unbearable. In the crossover study we found no significant difference between the arms with and without Insuflon in HbA1c, 24 hour profiles of blood glucose or serum free insulin. In the absorption study the patients used the same indwelling catheter for injections of short-acting insulin for 4 days. We found no significant difference in residual activity of 125 I-insulin after 60 min. or time to 50% remaining activity between injections day 1, 3 and 5, nor between catheter and ordinary injections on day 1, 3 and 5, respectively. HbA1c correlated significantly both to T-50% and residual activity of 125 I-insulin after 60 min. In the randomized multicenter study using Insuflon from the onset of diabetes, injection pain and parental pre-injection anxiety decreased from day 1-15 in both groups (in average 4.1 injections/day). Pain (median 1.7 cm vs. 2.7 cm, p=0.002) and parental pre-injection anxiety (1.2 cm vs. 2.9 cm, p=0.016) was lower for Insuflon users vs. ordinary injections. Talcing injections (including insertiug Insuflon) was found less problematic in the Insuflon group (1.6 cm vs. 3.3 cm, p=0.009). During the 6 month follow-up injection pain and injection problems were significantly lower in the Insuflon group. When comparing pen injector needles, the median VAS score ranged from 0. 7 cm to 1.2 cm in the first study where 27G and 28G needles were compared (n.s. ). In the following study, 280; 29G and 30G needles scored from 1.5 cm to 2.8 cm (n.s.). Placebo injections scored 0.1 cm (p=0.0001). Leakage of insulin was found in 14% of abdominal and 25% of thigh injections (p=0.0001) with no difference between the needles. VAS scores were higher in the later study which may be explained by the adding of faces to VAS, increasing the range of scores.In summary, most patients find the pain when injecting insulin quite small but for some it is almost unbearable. Needle diameter is of less importance for the expedenced injection pain. When using indwelling catheters from the onset of diabetes injection pain and pre-injection anxiety can be decreased significantly. The average indwelling time is 4-5 days and the frequency of side effects is low. Using indwelling catheters for up to 4 days does not affect the absorption of shmt-acting insulin when the catheter is inserted in an area free from lipohypertrophies and the long- and short-term metabolic control is not altered. We conclude that indwelling catheters can safely be used from the onset of diabetes to lessen injection pain in children and adolescents.
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| 42. |
- Hanås, Ragnar, et al.
(författare)
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Thinner needles do not influence injection pain, insulin leakage or bleeding in children and adolescents with type 1 diabetes
- 2000
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Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 1:3, s. 142-149
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To investigate pain, leakage and bleeding when injecting insulin with different diameters of needles.Methods: Sixty children and adolescents aged 9–21 yrs participated in study A and 40 aged 8–20 yrs in study B. Both were double-blind and randomized. In study A, we evaluated the pain when injecting with three needles [Novo 27G/13 mm (N27), B-D MicroFine IV 28G/13 mm (B28), NovoFine 28G/12 mm (N28)] and in study B, with three needles [NovoFine 28G/12 mm (N28), B-D MicroFine+ 29G/13 mm (B29), NovoFine 30G/8 mm (N30)] and one placebo injection (no needle mounted). Abdominal and thigh injections were given in a 45° angle with a lifted two-finger skinfold on two different visits, scoring pain on a 10-cm visual analog scale (VAS), and in study B faces were added to the scale.Results: The median VAS scores in study A were 1.2 cm (N27), 1.2 cm (B28) and 1.0 cm (N28) for abdominal injections, and 1.2 cm (N27), 0.7 cm (B28) and 1.1 cm (N28) (n.s.) for thigh injections. The median VAS scores in study B were 2.5 cm (N28), 2.3 cm (B29) and 2.8 cm (N30) (n.s.) for abdominal injections, and 2.0 cm (N28), 1.5 cm (B29) and 1.9 cm (N30) (n.s.) for thigh injections. The overall median score of placebo injections was 0.1 cm (p=0.0001). Bleedings were less common with the B29 needle (35.5%) than with the N28 needle (48.1%) (p=0.028) but with no difference compared to the N30 needle (39.2%). Leakage of insulin was found in 14% of abdominal and 25% of thigh injections (p=0.0001) with no difference between the needles. VAS scores were higher in study B which may be explained by the facial VAS scale increasing the range of answers.Conclusions: We found no difference in injection pain, preference, bleeding or insulin leakage between the needles. Decreasing the needle diameter from 0.4 to 0.3 mm (27–30G) does not seem to decrease pain perception in this age group.
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| 43. |
- 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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| 44. |
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| 45. |
- Johansson, Unn-Britt, et al.
(författare)
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Insulinpumpar vid diabetes
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Vid typ 1-diabetes och en del fall av typ 2-diabetes krävs så kallad intensiv insulinbehandling med flera injektioner per dag. Den vanligaste komplikationen vid denna behandling är lågt blodglukos (hypoglykemi) vilket kan få allvarliga följder [1,2]. Ett alternativ till intensiv insulinbehandling med injektioner är kontinuerlig insulintillförsel med pump, så kallad kontinuerlig subkutan insulininfusion (CSII).
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| 46. |
- Johansson, Unn-Britt, et al.
(författare)
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Kontinuerlig subkutan glukosmätning vid diabetes
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Blodglukos kan mätas av patienten själv med teststickor (self monitoring of blood glucose, SMBG) eller via en subkutan sensor (kontinuerlig subkutan glukosmätning, CGM). Vid typ 1-diabetes behövs rutinmässigt upprepade blodglukosmätningar varje dygn för att uppnå god glukoskontroll.SBU har utvärderat nytta och risk av behandling med kontinuerlig glukosmätning utan eller med insulinpump (SAP) vid diabetes hos barn, ungdomar och vuxna. I utvärderingen ingår också en hälsoekonomisk och etisk analys, samt en stor praxisundersökning som omfattade samtliga diabeteskliniker i Sverige
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| 47. |
- Ludvigsson, Johnny, et al.
(författare)
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Combined Etanercept, GAD-alum and vitamin D treatment: an open pilot trial to preserve beta cell function in recent onset type 1 diabetes
- 2021
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Ingår i: Diabetes-Metabolism Research and Reviews. - : Wiley. - 1520-7552 .- 1520-7560.
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Tidskriftsartikel (refereegranskat)abstract
- Aim We aimed to study the feasibility and tolerability of a combination therapy consisting of glutamic acid decarboxylase (GAD-alum), Etanercept and vitamin D in children and adolescents with newly diagnosed with type 1 diabetes (T1D), and evaluate preservation of beta cell function. Material and Methods Etanercept Diamyd Combination Regimen is an open-labelled multi-centre study pilot trial which enrolled 20 GAD antibodies positive T1D patients (7 girls and 13 boys), aged (mean +/- SD): 12.4 +/- 2.3 (8.3-16.1) years, with a diabetes duration of 81.4 +/- 22.1 days. Baseline fasting C-peptide was 0.24 +/- 0.1 (0.10-0.35) nmol/l. The patients received Day 1-450 Vitamin D (Calciferol) 2000 U/d per os, Etanercept sc Day 1-90 0.8 mg/kg once a week and GAD-alum sc injections (20 mu g, Diamyd (TM)) Day 30 and 60. They were followed for 30 months. Results No treatment related serious adverse events were observed. After 6 months 90-min stimulated C-peptide had improved in 8/20 patients and C-peptide area under the curve (AUC) after Mixed Meal Tolerance Test in 5 patients, but declined thereafter, while HbA1c and insulin requirement remained close to baseline. Administration of Etanercept did not reduce tumour necrosis factor (TNF) spontaneous secretion from peripheral blood mononuclear cells, but rather GAD65-induced TNF-alpha increased. Spontaneous interleukin-17a secretion increased after the administration of Etanercept, and GAD65-induced cytokines and chemokines were also enhanced following 1 month of Etanercept administration. Conclusions Combination therapy with parallel treatment with GAD-alum, Etanercept and vitamin D in children and adolescents with type 1 diabetes was feasible and tolerable but had no beneficial effects on the autoimmune process or beta cell function.
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| 48. |
- Ludvigsson, Johnny, 1943-, et al.
(författare)
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Combined vitamin D, ibuprofen and glutamic acid decarboxylase-alum treatment in recent onset Type I diabetes: lessons from the DIABGAD randomized pilot trial.
- 2020
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Ingår i: Future science OA. - London, United Kingdom : Future Science Ltd. - 2056-5623. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- Double-blind placebo-controlled intervention using glutamic acid decarboxylase (GAD)-alum, vitamin D and Ibuprofen in recent onset Type I diabetes (T1D).64 patients (T1D since <4months, age 10-17.99, fasting sC-peptide ≥0.12nmol/l, GADA-positive) were randomized intoDay(D) 1-90 400mg/day Ibuprofen, D1-450 vitamin D 2000IU/day, D15, 45 sc. 20μg GAD-alum; as A but placebo instead of Ibuprofen; as B but 40μg GAD-alum D15, 45; placebo.Treatment was safe and tolerable. No C-peptide preservation was observed. We observed a linear correlation of baseline C-peptide, HbA1c and insulin/per kilogram/24h with change in C-peptide AUC at 15months (r=-0.776, p<0.0001).Ibuprofen, vitamin D + GAD-alum did not preserve C-peptide. Treatment efficacy was influenced by baseline clinical and immunological factors and vitamin D concentration. Clinical Trial Registration: NCT01785108 (ClinicalTrials.gov).
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| 49. |
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| 50. |
- Ludvigsson, Johnny, et al.
(författare)
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GAD65 antigen therapy in recently diagnosed type 1 diabetes mellitus
- 2012
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 366:5, s. 433-442
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The 65-kD isoform of glutamic acid decarboxylase (GAD65) is a major autoantigen in type 1 diabetes. We hypothesized that alum-formulated GAD65 (GAD-alum) can preserve beta-cell function in patients with recent-onset type 1 diabetes.METHODS: We studied 334 patients, 10 to 20 years of age, with type 1 diabetes, fasting C-peptide levels of more than 0.3 ng per milliliter (0.1 nmol per liter), and detectable serum GAD65 autoantibodies. Within 3 months after diagnosis, patients were randomly assigned to receive one of three study treatments: four doses of GAD-alum, two doses of GAD-alum followed by two doses of placebo, or four doses of placebo. The primary outcome was the change in the stimulated serum C-peptide level (after a mixed-meal tolerance test) between the baseline visit and the 15-month visit. Secondary outcomes included the glycated hemoglobin level, mean daily insulin dose, rate of hypoglycemia, and fasting and maximum stimulated C-peptide levels.RESULTS: The stimulated C-peptide level declined to a similar degree in all study groups, and the primary outcome at 15 months did not differ significantly between the combined active-drug groups and the placebo group (P=0.10). The use of GAD-alum as compared with placebo did not affect the insulin dose, glycated hemoglobin level, or hypoglycemia rate. Adverse events were infrequent and mild in the three groups, with no significant differences.CONCLUSIONS: Treatment with GAD-alum did not significantly reduce the loss of stimulated C peptide or improve clinical outcomes over a 15-month period.
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