OBJECTIVE: To compare the number of ulcer-free days during 24 months in persons with diabetes and a healed foot ulcer below the ankle provided with adjusted therapeutic shoes who were given standard information and participated in participant-driven group education compared with standard information alone.

METHOD: A randomized controlled trial was designed to evaluate the number of ulcer-free days after participant-driven group education in addition to standard information compared to standard information alone. The number needed to treat (N=174) was not met, as only n=138 persons with diabetes and previously healed foot ulcer were recruited (age median 63 years [34-79], 101 male/37 female).

RESULT: 138 persons were recruited, of whom 107 (77.5%) completed the study, 7 (5%) dropped out, and 12 (9%) became deceased. No statistically significant difference was found between the intervention group compared to the control group after 6, 18, or 24 months. After 12 months, more patients in the intervention group had developed ulcers. Seventy-seven participants (56%) developed new foot ulcers, irrespective of side and site. Development of one ulcer appeared in 36 participants, two ulcers in 19, and 22 participants developed three ulcers. Forty-eight participants remained ulcer-free (35%) during the 24-month follow-up. Median ulcer-free days until first ulceration were 368 (4-720); until second ulceration, 404 (206-631); and until third ulceration, 660 (505-701). The participants wore prescribed therapeutic shoes during 88% of the follow-up visits.

CONCLUSION: One third of the participants remained ulcer free for 24 months. Patient-driven education in groups did not give better results than standard information in this underpowered study. The present study illustrates the challenges to perform comparative preventive studies in this group of patients with extensive comorbidity. Further studies are needed to evaluate interventions on ulceration in persons with a healed foot ulcer.

Aim: Type 2 diabetes is becoming more prevalent in many parts of the world. Malmö's population has increased in recent years mainly because of migration from other parts of Sweden and the world in addition to increased birth rates. We aimed to explore diabetes prevalence in Malmö in 2011-2018 as well as the achieved treatment targets for selected diabetes-related outcomes.

Method: The current study is a part of the Cities Changing Diabetes Malmö project. Prevalence data were retrieved from the region's primary care and hospital diagnosis register, and data on treatment targets were collected from the National Diabetes Register. The inclusion criteria were either being a resident of Malmö or using a primary healthcare centre located in Malmö.

Results: The prevalence of type 2 diabetes in 2018 doubled from 2011 in the entire Malmö population. During the same period, the prevalence of type 1 diabetes remained stable at 0.49 %. In 2011, the type 2 diabetes prevalence was 2.46 % (2.76 % for males and 2.28 % for females), and in 2018, it was 4.26 % (4.84 % for males and 3.82 % for females). The increase was 139 % for residents aged 0-29 years, 119.6 % for residents aged 30-39 years, 96.2 % for residents aged 40-49 years, 102 % for residents aged 50-59 years, 98.2 % for residents aged 60-69 years, and 115.5 % for those aged 70-79 years. Finally, the increase was 60.9 % for those aged 80-84 years and 90.7 % for residents 90 years of age and older. The National Diabetes Register reported that during 2019, 58 % of all patients with diabetes using primary care in Malmö reached HbA_1c <52 mmol/mol, 20 % had albuminuria, 36 % had retinopathy, and 21 % had not had their feet inspected by a healthcare professional during the last year. The median HbA_1c was 52.6 mmol/mol, and 17 % were registered as active smokers.

Conclusion: Diabetes prevalence in Malmö has increased markedly in recent years, exacerbated by a rise in type 2 diabetes mainly in the younger population. Targets regarding p-glucose lowering treatments were not met by 42 %. One patient out of three had microvascular complications in the eye, one out of five had impaired kidney function, one out of five had not had their feet inspected, and one out of five was an active smoker. Active diabetes treatments need to be improved to reduce the number of younger patients developing microvascular complications. Preventive activities need to target younger populations to counteract even more residents developing type 2 diabetes.

Illness perception and self-management might be of importance in proactive care for patients with type 2 diabetes.

Objective: The aim of the study was to examine the influences of socioeconomic status on the illness perception and self-management of Thai people with diabetes.

Methods: A cross-sectional descriptive method was used to study 220 people with type 2 diabetes in a suburban area in Thailand. The participants were selected using a multistage sampling method. Data were collected through the structured interviews using the revised versions of the Diabetes Illness Perception scale and Diabetes Self-Management scale. Independent sample t test or Mann-Whitney U test was used for income and education subgroups comparisons as well as multiple logistic regression was analyzed the predictors of illness perception and self-management.

Results: The results indicated that socioeconomic status, defined by income and educational level, showed the effects on some aspects of illness perception and self-management strategies in a type 2 diabetes population. Educational level demonstrated more effects on many subscales of illness perception and self-management than on income and was also shown to be a predictor of self-management (OR 2.047, 95% CI 1.014-4.131, p-value 0.046). 

Conclusion: The study found that socioeconomic status had an impact on the illness perception and self-management of people with type 2 diabetes. Educational level demonstrated a significant influence on the perceptions and management of Thai people with diabetes, which was also true concerning income level, although to a lesser extent. Illuminating socioeconomic status in the context of religious beliefs may increase health care professionals’ understanding of patients’ experiences and management of their diabetes. This is especially important when designing appropriate interventions for patients of low education.

OBJECTIVE: To identify predictors of prediabetes using feature selection and machine learning on a nationally representative sample of the US population.

MATERIALS AND METHODS: We analyzed n = 6346 men and women enrolled in the National Health and Nutrition Examination Survey 2013-2014. Prediabetes was defined using American Diabetes Association guidelines. The sample was randomly partitioned to training (n = 3174) and internal validation (n = 3172) sets. Feature selection algorithms were run on training data containing 156 preselected exposure variables. Four machine learning algorithms were applied on 46 exposure variables in original and resampled training datasets built using 4 resampling methods. Predictive models were tested on internal validation data (n = 3172) and external validation data (n = 3000) prepared from National Health and Nutrition Examination Survey 2011-2012. Model performance was evaluated using area under the receiver operating characteristic curve (AUROC). Predictors were assessed by odds ratios in logistic models and variable importance in others. The Centers for Disease Control (CDC) prediabetes screening tool was the benchmark to compare model performance.

RESULTS: Prediabetes prevalence was 23.43%. The CDC prediabetes screening tool produced 64.40% AUROC. Seven optimal (≥ 70% AUROC) models identified 25 predictors including 4 potentially novel associations; 20 by both logistic and other nonlinear/ensemble models and 5 solely by the latter. All optimal models outperformed the CDC prediabetes screening tool (P < 0.05).

DISCUSSION: Combined use of feature selection and machine learning increased predictive performance outperforming the recommended screening tool. A range of predictors of prediabetes was identified.

CONCLUSION: This work demonstrated the value of combining feature selection with machine learning to identify a wide range of predictors that could enhance prediabetes prediction and clinical decision-making.

OBJECTIVES: Using a nationally-representative, cross-sectional cohort, we examined nutritional markers of undiagnosed type 2 diabetes in adults via machine learning.

METHODS: A total of 16429 men and non-pregnant women ≥ 20 years of age were analysed from five consecutive cycles of the National Health and Nutrition Examination Survey. Cohorts from years 2013-2016 (n = 6673) was used for external validation. Undiagnosed type 2 diabetes was determined by a negative response to the question "Have you ever been told by a doctor that you have diabetes?" and a positive glycaemic response to one or more of the three diagnostic tests (HbA1c > 6.4% or FPG >125 mg/dl or 2-hr post-OGTT glucose > 200mg/dl). Following comprehensive literature search, 114 potential nutritional markers were modelled with 13 behavioural and 12 socio-economic variables. We tested three machine learning algorithms on original and resampled training datasets built using three resampling methods. From this, the derived 12 predictive models were validated on internal- and external validation cohorts. Magnitudes of associations were gauged through odds ratios in logistic models and variable importance in others. Models were benchmarked against the ADA diabetes risk test.

RESULTS: The prevalence of undiagnosed type 2 diabetes was 5.26%. Four best-performing models (AUROC range: 74.9%-75.7%) classified 39 markers of undiagnosed type 2 diabetes; 28 via one or more of the three best-performing non-linear/ensemble models and 11 uniquely by the logistic model. They comprised 14 nutrient-based, 12 anthropometry-based, 9 socio-behavioural, and 4 diet-associated markers. AUROC of all models were on a par with ADA diabetes risk test on both internal and external validation cohorts (p>0.05).

CONCLUSIONS: Models performed comparably to the chosen benchmark. Novel behavioural markers such as the number of meals not prepared from home were revealed. This approach may be useful in nutritional epidemiology to unravel new associations with type 2 diabetes.

Bakgrund: Diabetes är en av de stora folksjukdomarna i världen. Över 500 000 personer har diabetes i Sverige idag. Cirka 90 procent har typ 2-diabetes, dvs cirka 4-5 % av befolkningen i Sverige har diabetes typ 2. 

Syfte: Litteraturstudiens syfte var att belysa patienters upplevelser av att leva med nyupptäckt diabetes typ 2. 

Metod: En litteraturstudie baserad på 10 vetenskapliga artiklar med kvalitativ studiedesign. Artiklarna hämtades från PubMed och Cinahl, båda med inriktning på omvårdnad. Artiklarna analyserades och sammanställdes enligt mall om dataanalys. 

Resultat: Ur analysen framkom tre huvudkategorier och 10 underkategorier identifierades. Huvudkategorierna var: Upplevelse vid en ny diagnos; Innebörden av egenvård; Motivation som drivkraft för förändring.

Konklusion: Upplevelserna av att leva med nydiagnostiserad diabetes typ 2 var individuell, men gemensamt för alla patienter var att livet påverkades. För att sjuksköterskan ska kunna möta patienternas behov samt ge bästa möjliga personcentrerad vård krävs en förståelse för patienternas upplevelser av att leva med nydiagnostiserad diabetes typ 2. 

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3-234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35-95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3-234) weeks; for auto-amputated, 48 (10-228) weeks; for minor amputated, 48 (6-234) weeks; and for major amputation, 32 (3-116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

Introduction: To minimize the risk of developing foot-ulcers, persons with diabetes are given the advice to daily inspect their feet and to apply skincare formulations. However, commercially available skincare products have rarely been developed and evaluated for diabetes foot care specifically. The primary aim of this randomized controlled trial (RCT) is to evaluate the effects in reducing foot xerosis in persons with diabetes without footulcers using two skincare creams containing different humectants (interventions) against a cream base nonhumectant (comparator). Secondary outcomes are to evaluate differences on skin barrier integrity, lowmolecular weight biomarkers and skin microbiota, microcirculation including transcutaneous oxygen pressure, degree of neuropathy, and HbA1c between intervention-comparator creams. Methods: Two-armed double-blind RCT, registered in ClinicalTrials.gov Identifier: NCT06427889. With 80 % power, two-tailed significance of 2.5 % in each arm, 39 study persons is needed in each arm, total 78 persons, 98 including dropouts, to be able to prove a reduction of at least one category in the Xerosis Severity Scale with the intervention creams compared to the comparator. In one arm, each participant will treat one foot with one of the intervention creams (Oviderm (R) or Canoderm (R)), while the opposite foot will be treated with the comparator cream (Decubal (R) lipid cream), twice a day. If needed, participants are enrolled after a wash-out period of two weeks. The participants will undergo examinations at baseline, day 14 and day 28. Discussion: This RCT evaluate the potential effects of humectants in skin creams against foot xerosis in persons with diabetes.

Purpose: Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients' expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet.

Patients and methods: The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade.

Results: Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU.

Conclusion: The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use.

OBJECTIVE While existing evidence supports beneficial cardiovascular effects of glucagon-like peptide 1 (GLP-1), emerging studies suggest that glucose-dependent insulinotropic peptide (GIP) and/or signaling via the GIP receptor may have untoward cardiovascular effects. Indeed, recent studies show that fasting physiological GIP levels are associated with total mortality and cardiovascular mortality, and it was suggested that GIP plays a role in pathogenesis of coronary artery disease. We investigated the associations between fasting and postchallenge GIP and GLP-1 concentrations and subclinical atherosclerosis as measured by mean intima-media thickness in the common carotid artery (IMTmeanCCA) and maximal intima-media thickness in the carotid bifurcation (IMTmaxBulb).

RESEARCH DESIGN AND METHODS Participants at reexamination within the Malmö Diet and Cancer–Cardiovascular Cohort study (n = 3,734, mean age 72.5 years, 59.3% women, 10.8% subjects with diabetes, fasting GIP available for 3,342 subjects, fasting GLP-1 available for 3,299 subjects) underwent oral glucose tolerance testing and carotid ultrasound.

RESULTS In linear regression analyses, each 1-SD increment of fasting GIP was associated with increased (per mm) IMTmeanCCA (β = 0.010, P = 0.010) and IMTmaxBulb (β = 0.014; P = 0.040) in models adjusted for known risk factors and glucose metabolism. In contrast, each 1-SD increment of fasting GLP-1 was associated with decreased IMTmaxBulb (per mm, β = −0.016, P = 0.014). These associations remained significant when subjects with diabetes were excluded from analyses.

CONCLUSIONS In a Swedish elderly population, physiologically elevated levels of fasting GIP are associated with increased IMTmeanCCA, while GLP-1 is associated with decreased IMTmaxBulb, further emphasizing diverging cardiovascular effects of these two incretin hormones.

Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. Methods. A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy. Results. Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL. Conclusions. A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.

Aim To establish outcomes of a priority setting partnership between participants with diabetes mellitus and clinicians to identify the top 10 research priorities for preventing and treating diabetic foot ulcers (DFUs). Methods Due to the COVID-19 pandemic, the James Lind Alliance Priority Setting Partnership process was adapted into a digital format which involved a pilot survey to identify understandable uncertainties with high relevance for participants tested by calculating the content validity index; a main survey answered by 53 participants living with diabetes and 49 clinicians; and a final digital workshop to process and prioritise the final top 10 research priorities. Results The content validity index was satisfactory for 20 out of 25 uncertainties followed by minor changes and one additional uncertainty. After we processed the 26 uncertainties from the main survey and seven current guidelines, a list of 28 research uncertainties remained for review and discussion in the digital workshop. The final top 10 research priorities included the organisation of diabetes care; screening of diabetes, impaired blood circulation, neuropathy, and skin properties; vascular surgical treatment; importance of self-care; help from significant others; pressure relief; and prevention of infection. Conclusion The top 10 research priorities for preventing and treating DFUs represent consensus areas from persons living with diabetes and clinicians to guide future research. These research priorities can justify and inform strategic allocation of research funding. The digitalisation of James Lind Alliance methodology was feasible.

Levels of the male sex hormone testosterone are generally stable in the age interval 20 -70 years, but several studies indicate an earlier, age-dependent decline. Testosterone deficiency is often underdiagnosed and undertreated, but replacement therapy has nonetheless increased during the last couple of years. Owing to possible negative side effects, alternative treatments have been investigated, including different supplementation protocols. The aim of this study was to investigate the effect of probiotic supplementation on the testosterone level in healthy men aged between 55 and 65. Hence, 12 weeks randomized, double-blinded, placebo-controlled trial was conducted to investigate the effect on testosterone levels following supplementation of the recognized probiotic Limosilactobacillus reuteri ATCC PTA 6475 on testosterone levels, using high-, low- or placebo treatment. Venous blood samples were collected at baseline, 6 and 12 weeks, for analysis of bloodwork, lipid profile, hormones, and electrolytes. Subjects were also asked to complete a questionnaire. The supplementation had no effect on testosterone levels, neither using high- or low dose, nor placebo. However, a significant decrease of triglyceride levels was observed in the high-dose group. No other parameters showed any significant change. The present study does not support the hypothesis that a probiotic supplementation can increase testosterone levels in ageing men.

Context: The cardiac natriuretic peptides are involved in blood pressure regulation, and large cross-sectional studies have shown lower plasma levels of N-terminal pro-natriuretic peptide levels [N-terminal atrial natriuretic peptide (N-ANP) and N-terminal brain natriuretic peptide (N-BNP)] in patients with insulin resistance, obesity, and diabetes. Objective: In this study, we prospectively tested whether plasma levels of mid-regional ANP (MRANP) and N-BNP predict new-onset diabetes and long-term glucose progression. Design, Setting, and Patients: MR-ANP and N-BNP were measured in 1828 nondiabetic individuals of the Malmo Diet and Cancer cohort (mean age 60 yr; 61% women) who subsequently underwent a follow-up exam including an oral glucose tolerance test after a median follow-up time of 16 yr. Logistic regression was used to adjust for covariates. Results: During follow-up, 301 subjects developed new-onset diabetes. After full multivariate adjustment, MR-ANP was significantly inversely associated with incident diabetes (OR = 0.85; 95% CI = 0.73-0.99; P = 0.034) but not N-BNP (OR = 0.92; 95% CI = 0.80-1.06; P = 0.262). In fully adjusted linear regression models, the progression of fasting glucose during follow-up was significantly inversely related to baseline levels of MR-ANP (P = 0.004) but not N-BNP (P = 0.129). Quartile analyses revealed that the overall association was mainly accounted for by excess risk of incident diabetes in subjects belonging to the lowest quartile of MR-ANP. After full adjustment, the odds ratio for incident diabetes in the bottom compared with the top quartile of MR-ANP was 1.65 (OR = 1.08-2.51, P = 0.019) and 1.43 (OR = 1.04-1.96, P = 0.027) compared with all other subjects. Conclusion: Low plasma levels of MR-ANP predict development of future diabetes and glucose progression over time, suggesting a causal role of ANP deficiency in diabetes development. (J Clin Endocrinol Metab 97: 638-645, 2012)

Type 1 diabetes is an incurable autoimmune disease, which involves the loss of pancreatic beta cells, the only cells that produce insulin. When researching mechanisms that affect type 1 diabetes, a rat strain called BBDP is used.The rats with a double recessive predisposition to lymphopenia develop diabetes. It has been established that the lymphopenia is caused by a mutation on chromosome 4, which resulted in a frameshift mutation in the Gimap5 gene. The mutation of the Gimap5 gene probably leads to an incomplete protein that is necessary for normal development of T-cells in the thymus. In order investigate the genetic mechanisms further, through continued "cross-intercross" breeding, DR DNA has been successfully crossed first distal to the Gimap5 gene (sBBM) and now most recently also proximal to the mutation (xshBBM). The sBBM rats develop lymphopenia and diabetes, while the xshBBM rats develop neither lymphopenia nor diabetes. The aim of the study was to compare these two rat strains to detect possible differences in thymus weight, number of T-lymphocytes, expression of Gimap4 protein and the proportions of the different T-lymphocytes. Thymus was extracted from a total of 16 rats and minced before cell smearing and FACS analysis. After compensation for thymic involution, no difference was found in either thymus weight or the T-lymphocytes count. However, a difference was noted in the expression of the Gimap4 protein, with xshBBM expressing more of the protein than sBBM. Regarding the distribution of T-cells, there was no significant difference between CD4+ T-cells and double-negative T-cells between the strains. However, xshBBM had fewer double-positive T-cells and more CD8+ T-cells than sBBM, a difference that was significant. The conclusion is that the crossover changed the distribution of T-cells in the thymus.

Background: Diabetes mellitus type II is one of the fastest growing disease worldwide. It is a chronic endocrine disease that requires a lot of life changes and determination. It is characterized primarily by the pancreas producing insufficient insulin. The main cause of diabetes type II includes risk factors such as heredity and unhealthy lifestyle regarding poor diet, physical inactivity, obesity and age. Early symptoms of diabetes type II are increased thirst, frequent urinary, fatigue and dry mouth. Aim: The purpose was to explore nurses´ perception in caring of patients with diabetes mellitus type II. Method: A literature review of which 10 qualitative articles were critically analyzed and summarized. Searches derived from relevant keywords were made in PUBMED and CINAHL databases. This contributed to the finding of relevant articles that were conducted worldwide and were quality-reviewed. 

Result: The articles acknowledged  that the majority of the nurses perceived a lack of strategy and inability to inform patients about lifestyle changes. The result also showed that person-centered care was crucial in order to provide effective care and improve patient participation. Conclusion: Nurses need more knowledge, competence and organizational conditions in order to provide effective person-centered care with treatment that supports a person living with type II diabetes. Nurses  also required more knowledge within cultural and social economic factors in order to provide optimal care and strengthen the patient’s abilities. Lack of effective collaboration between healthcare professionals in diabetes care was also identified as an obstacle to provide good care.

Background: Diabetes is a chronic disease that increases in prevalence across the world. For people with diabetes, self–care is an extensive part of daily life that requires engagement and knowledge to be able to live their best life. Nurses have a responsibility to provide patients with diabetes the support they need, so the patient has the internal resources and motivation to manage their diabetes in a sustainable way. Aim: The aim of this literature review was to highlight nurses’ experiences of supporting patients with diabetes with their self-care. Method: The literature review method was based on qualitative studies because the aim was to explore the phenomenon of subjective experience. The analysis was done using a qualitative content analysis. Results: The results were based on 13 scientific studies, of which the authors designed four main categories with a total of nine subcategories. The four main categories were “The care-relationship between patient and nurse”, “Nurses’ strategies”, “Nurses’ challenges, and “Nurses’ competence”. Conclusion: Nurses' experiences regarding the support towards patients with diabetes were similar across the studies included in the result. Nurses were aware of the importance of having a good care-relationship with the patient to be able to provide adequate support, and provided several support-strategies, with the person-centered care being the most discussed. Nurses also demonstrated the challenges they faced with disengaged patients, lack of time and work overload, and that the support provided was limited in its efficacy. A lack of competence and a need for more education around diabetes and self-care was expressed repeatedly. 

OBJECTIVE: Information on the relationship among dysglycemia (prediabetes or diabetes), myocardial infarction (MI), and periodontitis (PD) is limited. This study tests the hypothesis that undetected dysglycemia is associated with both conditions. RESEARCH DESIGN AND METHODS: The PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study included 805 patients with a first MI and 805 matched control subjects. All participants without diabetes (91%) were examined with an oral glucose tolerance test. Abnormal glucose tolerance (AGT) (impaired glucose tolerance or diabetes) was categorized according to the World Health Organization. Periodontal status was categorized from dental X-rays as healthy (>= 80% remaining alveolar bone height), moderate (79-66%), or severe (<66%) PD. Odds ratios (ORs) and 95% CIs were calculated by logistic regression and were adjusted for age, sex, smoking, education, marital status, and explored associated risks of dysglycemia to PD and MI, respectively. RESULTS: AGT was more common in patients than in control subjects (32% vs. 19%; P < 0.001) and was associated with MI (OR 2.03; 95% CI 1.58-2.60). Undetected diabetes was associated with severe PD (2.50; 1.36-4.63) and more strongly in patients (2.35; 1.15-4.80) than in control subjects (1.80; 0.48-6.78), but not when categorized as AGT (total cohort: 1.07; 0.67-1.72). Severe PD was most frequent in subjects with undetected diabetes, and reversely undetected diabetes was most frequent in patients with severe PD. CONCLUSIONS: In this large case-control study previously undetected dysglycemia was independently associated to both MI and severe PD. In principal, it doubled the risk of a first MI and of severe PD. This supports the hypothesis that dysglycemia drives two common diseases, MI and PD.

Managing blood glucose can affect important clinical outcomes during the intraoperative phase of surgery. However, currently available instruments for glucose monitoring during surgery are few and not optimized for the specific application. Here we report an attempt to exploit an enzymatic sensor in a vein replica that could continuously monitor glucose level in an authentic human bloodstream. First, detailed investigations of the superficial venous systems of volunteers were carried out using ocular and palpating examinations, as well as advanced ultrasound measurements. Second, a tubular glucose-sensitive biosensor mimicking a venous system was designed and tested. Almost ideal linear dependence of current output on glucose concentration in phosphate buffer saline was obtained in the range 2.2-22.0 mM, whereas the dependence in human plasma was less linear. Finally, the developed biosensor was investigated in whole blood under homeostatic conditions. A specific correlation was found between the current output and glucose concentration at the initial stage of the biodevice operation. However, with time, blood coagulation during measurements negatively affected the performance of the biodevice. When the experimental results were remodeled to predict the response without the influence of blood coagulation, the sensor output closely followed the blood glucose level.

INTRODUCTION: This technology report introduces an innovative risk communication tool developed to support providers in communicating diabetes-related risks more intuitively to people with type 2 diabetes mellitus (T2DM).

METHODS: The development process involved three main steps: (1) selecting the content and format of the risk message; (2) developing a digital interface; and (3) assessing the usability and usefulness of the tool with clinicians through validated questionnaires.

RESULTS: The tool calculates personalized risk information based on a validated simulation model (United Kingdom Prospective Diabetes Study Outcomes Model 2) and delivers it using more intuitive risk formats, such as "effective heart age" to convey cardiovascular risks. Clinicians reported high scores for the usability and usefulness of the tool, making its adoption in routine care promising.

CONCLUSIONS: Despite increased use of risk calculators in clinical care, this is the first time that such a tool has been developed in the diabetes area. Further studies are needed to confirm the benefits of using this tool on behavioral and health outcomes in T2DM populations.

Bakgrund: Diabetes är en folksjukdom som drabbar allt fler i världen.Från år 1980 har antalet personer med diabetes ökat från ca 108 miljoner till 422miljoner år 2014. Diabetes typ 1 och diabetes typ 2 är de vanligast förekommandetyperna av diabetes. Diabetes typ 2 är i hög grad ärftlig men det finns fleralivsstilsförändringar människan kan göra för att förebygga eller minska risken förkomplikationer, bland annat ökad fysisk aktivitet. Vid diabetes typ 2rekommenderar Socialstyrelsen 30 minuter medelintensiv fysisk aktivitet per dageller 150 minuter medelintensiv fysisk aktivitet per vecka.Syfte: Syftet med litteraturstudien var att undersöka det vetenskapliga stödet förolika egenvårdsinsatser som sjuksköterskan kan rekommendera för att öka fysiskaktivitet hos patienter med diabetes typ 2.Metod: En litteraturstudie baserad på studier med kvantitativ ansats hargenomförts. Deltagarna i studierna var vuxna patienter med diabetes typ 2.Interventionernas syfte var att öka den fysiska aktiviteten hos deltagarna.Resultatet i litteraturstudien bygger på data från tio olika vetenskapliga artiklarfrån databaserna Cinahl och PubMed.Resultat: Olika former av insatser från sjuksköterskan exempelvis rådgivande,individuell- eller grupputbildning samt med hjälp av olika tekniska hjälpmedelsom komplement visade resultat i form av ökad fysisk aktivitet hos deltagarna.Konklusion: Det finns ett flertal insatser som kan hjälpa patienter med diabetestyp 2 att öka sin fysiska aktivitet och minska risken för diabetesrelateradekomplikationer. I genomförandet av dessa insatser har sjuksköterskan en viktigpedagogisk, motiverande och stödjande roll gentemot patienterna. 

Blood samples stored long-term in research studies could prove to be very valuable if it is possible to isolate good quality deoxyribonucleic acid (DNA) from them. The aim was to isolate and evaluate quality of DNA from 500 capillary blood samples, stored for 7 to 21 years in the DiPiS study. The samples were obtained from 5 different time-periods in the DiPiS study. DNA was isolated using QIAamp DNA Blood Mini Kit (Qiagen) and quantified using NanoQuant (Tecan). TapeStation (Agilent) was used to evaluate quality and fragmentation of n=100 DNA samples. It was found that it is possible to isolate good quality DNA from blood samples stored long-term, in the range of 7 to 21 years at -20 °C. There was significant difference in [260/280 nm] absorbance ratio between groups of samples stored for 7, 8, 12, 16 or 21 years and the quality control using n=100 samples revealed a significant difference in DNA integrity number (DIN) relative to storage time but not in fragment size. However, no correlation between sample quality and storage time could be found. The results suggest that good quality DNA can be isolated from the 7 to 21 years old blood samples in the DiPiS study and used in future analyses. The results from this study suggest that other studies that have blood samples stored long-term could isolate good quality DNA from these.