AIMS:To investigate the quality of diabetes care among persons with intellectual disabilities (ID) and type 2 diabetes (T2DM). METHODS:A nationwide matched cohort study including 4219 persons with ID and T2DM and 16,863 age- and sex-matched persons with T2DM but without ID. Quality of care was assessed through national guideline indicators, including process measures (HbA1c, low-density lipoprotein cholesterol (LDL-C), urine albumin-creatinine ratio (UACR), foot screening) and result measures (HbA1c and LDL-C targets) from 2015 to 2021. Associations were analysed with mixed-effects logistic regression and reported as odds ratios with 95% confidence intervals. RESULTS:Compared with persons without ID, those with ID had higher odds of annual HbA1c assessment (OR=1.58, 95% CI 1.38-1.80) and foot screening (OR=2.14, 95% CI 1.86-2.47), but lower odds of UACR (OR=0.64, 95% CI 0.60-0.70). LDL-C assessments were similar. Achievement of HbA1c ≤ 7.0% (≤53 mmol/mol) was comparable (OR=1.01, 95% CI 0.90-1.14), whereas high HbA1c ≥ 8.6% (≥70 mmol/mol) was more frequent among persons with ID (OR=1.39, 95% CI 1.22-1.58). LDL-C ≤ 2.5 mmol/L was more common among persons with ID (OR=1.36, 95% CI 1.20-1.53). CONCLUSIONS:Persons with ID and T2DM have higher odds of poor glycaemic control despite increased monitoring, highlighting the need for improved management tailored to specific needs.

Aims To examine dental service use among people with and without diabetes adjusted for socioeconomic factors. Methods Using Danish registers, we included 4,615,690 Danish adults (age 18+); 0.52% had type 1 diabetes (T1D) and 5.85% had type 2 diabetes (T2D). Main outcome was any record of visits at a dental hygienist or dentist within the past two years. Results Among people with T1D, the proportion who did not visit a dentist in the two-year period was 27.6%; among T2D it was 35.7%, whereas the proportion was 31.0% for the non-diabetes population. The adjusted relative risk (RR) for not having visited a dentist within the past two years was 0.93 (CI: 0.91 to 0.95) for persons with T1D and 1.25 (CI: 1.24 to 1.26) for persons with T2D, both compared to the non-diabetes population. The RR was twofold to threefold higher among people in the lowest income quintiles compared to the highest quintile for people with T1D and T2D, respectively. Conclusions Social inequality was evident in dental visits. Financial support as a solution to decrease social inequality is one possibility, but increased awareness among health care professionals or increased health literacy among people with diabetes could also be at stake.

BACKGROUND:Forensic psychiatric patients experience high rates of preventable physical illness. Integrating primary care within forensic settings may help address this gap, yet little is known about how patients experience such services. AIM:To explore how forensic psychiatric patients experienced an on-ward general practitioner (GP) service and how these experiences shaped engagement with integrated care. METHODS:We conducted a qualitative interview study with 14 patients from two Danish medium-secure forensic psychiatric wards. Semi-structured interviews were analyzed using reflexive thematic analysis to identify key patterns of meaning. RESULTS:Patients generally perceived the GP service as relevant and valued its distinct somatic focus, which countered perceptions that physical symptoms were overlooked by psychiatric staff. The GP's proximity and accessibility encouraged consultations, and the outsider role provided a less custodial relationship. However, engagement was conditional and barriers were experienced, such as limited continuity, perceptions of redundancy due to existing services, and discomfort during intimate examinations, especially when staff were present or of the opposite sex. CONCLUSIONS:While broadly welcomed, GP engagement remained reactive and dependent on trust and privacy. These findings suggest that future integrated care models may benefit from considering relational continuity, sensitive examination practices, and structures supporting preventive somatic care.

Background: The increasing prevalence of type 1 diabetes underscores the need for health literacy responsiveness, as effective self-management depends on understanding and using health information. The Ophelia process supports identifying diverse strengths and needs among people with type 1 diabetes. Objectives: To systematically identify health literacy strengths, needs, and preferences among individuals with type 1 diabetes attending specialized outpatient care using a mixed methods approach guided by phase 1, step 1 and 2 of the Ophelia process. Methods: Adults (≥18 years) with type 1 diabetes or subtypes (MODY/LADA) at a Danish specialist diabetes center were invited to complete a survey including the Health Literacy Questionnaire (HLQ) and three scales from the electronic HLQ (eHLQ). Cluster analysis and in-depth interview were integrated for the development of representative vignettes. Key Results: Of 1,193 eligible patients, 238 participated (response rate 19.9%). The mean age was 54.2 years and 52% were men. HLQ and eHLQ scores revealed a wide diversity in health literacy strengths and needs. Health literacy profiles ranged from higher health literacy with active self-management to lower health literacy with low engagement and high reliance on family support. Vignettes vividly illustrated archetypal patient experiences, supporting a tailored understanding of health literacy challenges in clinical practice. Conclusions: Seven distinct health literacy profiles were identified among adults with type 1 diabetes, showing significant variation in health literacy and low health literacy among nearly one fifth, with difficulties navigating the health care system being common. The findings underscore the necessity of developing tailored, person-centered, and health literacy responsive interventions to strengthen diabetes self-management and advance equity in health care access.

BACKGROUND:Substance use disorders (SUD) are prevalent among forensic psychiatric patients and contribute to a complex mental and somatic health burden. While barriers to healthcare access are well documented, little is known about how individuals with comorbid SUD use general practitioner (GP) and acute somatic hospital services before entering forensic psychiatric treatment. AIMS:To examine the association between SUD and use of GP and acute outpatient hospital services. METHODS:We identified all individuals with a forensic psychiatric measure initiated in 2021-2022 from the Danish National Patient Register. SUD was defined as any ICD-10 F1 diagnosis, excluding acute intoxication, recorded during 2013-2017. Outcomes were GP consultations and acute outpatient hospital contacts during 2018. Associations were examined using negative binomial regression adjusted for age, sex, region, and prior-year service use. RESULTS:The cohort included 829 patients (39% with SUD). Almost all had ≥1 GP contact in 2018 (90% vs 89%). SUD was not associated with GP utilization (adjusted IRR = 0.99, 95% CI: 0.88-1.12). Acute outpatient contacts were more frequent among patients with SUD (45% vs 32%), with higher rates (IRR = 1.43, 95% CI: 1.04-1.97), attenuating after adjustment for prior-year use (aIRR = 1.28, 95% CI: 0.97-1.68). CONCLUSIONS:Forensic psychiatric patients with SUD had greater use of acute outpatient hospital services, but similar GP utilization, compared with those without SUD, suggesting reliance on crisis-driven rather than preventive care.

Purpose To examine how self-reported depressive symptoms are affected by type 2 diabetes, and how this relationship may be mediated by insomnia and physical activity. Methods We used cross-sectional data from the Health In Central Denmark (HICD) cohort including persons with and without type 2 diabetes aged 18 to 75 years. Register-identified diabetes status was used as the exposure and The World Health Organization Five Well-Being Index (WHO-5) was used as the outcome measure for risk of depression. Insomnia severity index level and physical activity level were used as potential mediators. We performed logistic regression analyses and cross-sectional mediation analyses. Results In total, 45,988 participants were included. Of these, 19,907 had type 2 diabetes of which 1,396 were at risk of depression. Adjusted odds ratio (OR) for risk of depression in people with type 2 diabetes was 1.55 (95% confidence interval (CI): 1.19, 1.59). The strongest risk factor for depression was insomnia at an adjusted OR of 7.43 (CI: 6.63, 8.32). The relationship between diabetes and risk of depression may be mediated by both insomnia and physical activity, the proportion mediated being 42.1% for insomnia and 20.5% for physical activity, in our analyses. Conclusion Living with type 2 diabetes was associated with higher odds of depression, and insomnia and physical activity may mediate this relationship. Insomnia and physical activity may be important factors for healthcare professionals to consider in their treatment of people with type 2 diabetes.

AIMS:We aimed to 1) assess the prevalence of low health literacy (HL) in people with and without T2D, 2) estimate the impact of HL on self-rated health, depression risk, and self-rated oral health, and 3) determine if these associations differ between people with and without type 2 diabetes (T2D). METHODS:We used data from the Health in Central Denmark survey 2022 among 7485 adults (3250 with T2D and 4235 without). Self-reported answers to four HL scales ('Information', 'Management', 'Engagement', 'Navigation') from the Health Literacy Questionnaire (HLQ), self-rated health (SF-12), depression risk (WHO-5), and self-rated oral health were assessed. Multivariable logistic regression (odds ratios (OR) with 95% confidence intervals (CI)) was used to adjust for confounders stratified by diabetes status. Effect modification by diabetes status was tested. RESULTS:Low HL ranged from 5.3% to 28.8% in people with T2D and 2.9-19.7% in those without, depending on the HL scale. Each one-unit increase in HL significantly reduced the odds of poor health outcomes in both groups. The strongest associations were between 'Information' and poor self-rated health (OR=0.28 (CI: 0.23;0.33) for people with diabetes and OR= 0.34 (CI: 0.28;0.40) for people without diabetes) and the weakest associations were between 'Navigation' and poor oral health (OR=0.68 (CI: 0.61;0.75) for people with diabetes and OR= 0.58 (CI: 0.52;0.65) for people without diabetes). No significant differences between groups were found, except for the association between two HL scales ('Management' (p-value=0.015) and 'Engagement' (p-value=0.004)) and oral health. CONCLUSIONS:Low HL was associated with poor health outcomes in both individuals with and without T2D. Improving HL, especially in healthcare navigation, could be essential for better health outcomes in both groups.

BACKGROUND:In Denmark, Type 2 Diabetes (T2D) care includes diabetes self-management programs (DSMPs) delivered by municipalities. Following a successful pilot study, a DSMP was expanded to include a digital platform and flexible educational materials. While exercise therapy is recognized as essential in T2D management, high-quality studies on DSMPs incorporating exercise are limited. This trial assesses the (cost)effectiveness of three interventions with escalating intensity, hypothesizing that higher intensity enhances diabetes management competence and reduces complication risk. METHODS/DESIGN:A pragmatic randomized controlled trial will assess three different DSMP interventions in six Danish municipalities acting as trial sites. Each site will implement one of three versions of Lev Livet: a short version (SLL), a full version (FLL), or the full version with high intensity exercise (FLL + H). At each site, 48 participants will be randomly assigned (2:1) to intervention or control groups. Primary outcome is perceived competence in diabetes (questionnaire). Other outcomes measure physical activity level (accelerometer),HbA1c, disease progression, physical function, and self-reported metrics. The trial is approved by the Danish National Center for Ethics (case no 1-10-72-107-23) and registered at ClinicalTrials.gov (NCT06091501). DISCUSSION:The LIVING trial has the potential to establish whether the Lev Livet program is effective and cost effective and how it can be implemented in municipalities. By analyzing dose-response relationships, the trial may refine intervention frequency and intensity, improve diabetes management, and inform both national and international guidelines for accessible, effective diabetes care.

This study investigates patient adherence to an integrated primary care intervention within medium secure forensic psychiatric services. Using a prospective cohort design, we evaluated the implementation of a 1-year integrated primary care intervention across seven medium secure wards in the Central Denmark Region. Using descriptive statistics, baseline data were analyzed to compare completers and non-completers, with a focus on somatic health indicators and preexisting attitudes toward primary care services. Of the 75 patients included in the intervention, almost 40

BACKGROUND:The identification of patients in forensic psychiatric care within national health registries has historically posed significant challenges, limiting research to small-scale studies and restricting its scope. This study aims to evaluate the utility of the Danish National Patient Register (DNPR) for research purposes by assessing the criterion concurrent validity of administrative trajectory markers for identifying incident patients receiving forensic psychiatric care. METHODS:We employed a population-wide design, analyzing data from the entire Danish population aged 15 years and older (almost 5 million individuals). Incident forensic psychiatric patients between January and December, 2022, were identified through a trajectory start marker in the DNPR. Validity was assessed by comparing these cases to confirmed cases from the Central Criminal Register (CCR). Test statistics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value, were calculated. RESULTS:A total of 323 forensic psychiatric patients were identified in the DNPR, of whom 289 (89.5%) were confirmed as incident cases in the CCR. The sensitivity of any trajectory start marker was .755 (.708-.797), and the PPV was .895 (.856, .926). PPV varied across the five Danish regions and between individual trajectory markers, with the highest PPV (.950) observed among patients sentenced to outpatient psychiatric treatment with the option of hospitalization. CONCLUSIONS:The findings suggest that trajectory markers are a promising approach for reliably identifying incident forensic psychiatric cases within Danish national health registers. Further studies are needed to confirm their validity across different contexts, informing clinical practice and policy decisions in forensic psychiatry.

OBJECTIVE:This article is based on a qualitative evaluation of a project offering intensive support to Danish adolescents with poorly regulated type I diabetes and their families. The article explores 1) how the project allowed for another approach to the families than what is possible in usual care at the hospital, and 2) how the nurse involved other professionals in caring for the adolescents. METHODS:The study involved interviews with four participating adolescents, four parents, a social worker, and the nurse running the project, along with a reading of the nurse's entries in the adolescents' electronic patient records. Data was analyzed within the framework of realistic evaluation. RESULTS:The findings showed that key mechanisms in the nurse's work was her open and flexible approach to the families, the way she anchored conversations about diabetes in here and now situations, and her efforts at engaging teachers, social and health care professionals in helping the adolescents. CONCLUSION:The strengths of the project were the nurse's special approach to the families and her ability to engage other professionals. PRACTICE IMPLICATIONS:A care manager providing individualized and flexible help can have positive results on the treatment of adolescents with poorly regulated type 1 diabetes.

AimsTo assess diabetes-related emotional distress (DD) in emerging adults with type 1 diabetes (T1D) and assess a group-based intervention's impact.MethodsTo investigate DD we used data from the Problem Areas in Diabetes Questionnaire comprising 20 items (PAID-20). Furthermore, changes in the WHO Well-Being Index comprising five items (WHO-5) and glycated haemoglobin (HbA1c) were analysed. The intervention was evaluated using follow-up data from the emerging adults who participated.ResultsFrom 2021 to 2023, we screened 180 emerging adults using PAID-20. DD (PAID-20≥30) was prevalent in 25.0 % (95 % CI 18.9; 32.0 %), and associated with the female sex, higher HbA1c and WHO-5 < 50. Continuous subcutaneous insulin infusion at baseline was associated with PAID-20<30. 21 individuals attended a group-based intervention. At one-week follow up PAID-20 was reduced (29.1 ± 15.4 vs. 41.3 ± 12.1 at baseline, p = 0.003), and at nine-twelve months' follow-up HbA1c was reduced (59.3 ± 15.3 mmol/mol vs. 68.0 ± 17.4 mmol/mol at baseline, p = 0.012).ConclusionsThis pilot study demonstrated that 25 % of the investigated emerging adults with T1D experienced DD (PAID-20≥30) associated with four clinical factors. We found a reduction in HbA1c and a short-term reduction in PAID-20 following the group-based intervention.

Although self-reported health outcomes are of importance, attempts to validate a clinical applicable instrument (e.g., nomogram) combining sociodemographic and self-reported information on periodontitis have yet to be performed to identify periodontitis cases. Clinical and self-reported periodontitis, along with sociodemographic data, were collected from 197 adults. Akaike information criterion models were developed to identify periodontitis, and nomograms developed based on its regression coefficients. The discriminatory capability was evaluated by receiver-operating characteristic curves. Decision curve analysis was performed. Smoking [OR 3.69 (95%CI 1.89, 7.21)], poor/fair self-rated oral health [OR 6.62 (95%CI 3.23, 13.56)], previous periodontal treatment [OR 9.47 (95%CI 4.02, 22.25)], and tooth loss [OR 4.96 (95%CI 2.47, 9.97)], determined higher probability of having "Moderate/Severe Periodontitis". Age [OR 1.08 (95%CI 1.05, 1.12)], low educational level [OR 1.65 (95%CI 1.34, 2.23)], poor/fair self-rated oral health [OR 3.57 (95%CI 1.82, 6.99)], and previous periodontal treatment [OR 6.66 (95%CI 2.83, 15.68)] determined higher probability for "Any Periodontitis". Both nomograms showed excellent discriminatory capability (AUC of 0.83 (95%CI 0.75, 0.91) and 0.81 (95% CI 0.74, 0.88), good calibration, and slight overestimation of high risk and underestimation of low risk. Hence, our nomograms could help identify periodontitis among adults in Denmark.

Diabetes care in institutional settings is a significant challenge that affects the whole family as well as care workers and teachers. The present study is the ideation part of a rigorous development process in the KIds with Diabetes in School (KIDS) project. We have previously conducted a thorough three-part needs assessment in which we explored the problem area from the viewpoints of (1) municipal administrative staff, (2) preschool and school staff and (3) families. Based on the identified needs and to a great extent on the contents and shortcomings of existing guidelines, the objective of the present study is to explore and develop possible solutions and recommendations for addressing the challenges and problems. To meet this objective, we held comprehensive multistakeholder participatory workshops in each of the five Danish regions. Five main themes with multiple subthemes were identified as areas to be addressed: (1) training and knowledge, (2) communication and collaboration, (3) the designated contact/support person, (4) national guidelines, and (5) the Diabetes Coordinator. Our findings demonstrate that communicative structures and dynamics are at the very heart of the identified problems and challenges and that the possible solutions should revolve around improving existing structures and highlighting the importance of constantly working on understanding and developing communication strategies. We propose a set of recommendations for practice based on these communicative needs.

AIMS:This study aimed to examine the association between type 2 diabetes and poor self-rated oral health, and to investigate whether such association is modified by socioeconomic position. METHODS:We conducted a cross-sectional study, including a population aged 18-75 years with self-reported type 2 diabetes (N = 41,884) and a sex-, age- and municipality-matched reference population from the Health in Central Denmark survey (2020). Multivariable logistic regression was used, and effect modification of indicators of socioeconomic position was examined. RESULTS:Oral health was rated as poor in 37.0% of the population with type 2 diabetes and in 23.8% of the reference population without diabetes. Individuals with diabetes had higher risk of poor oral health (adjusted odds ratio (OR) 1.46 (95% CI: 1.39; 1.53)) than references. Interaction was seen between type 2 diabetes and highest attained education (p < 0.001). Stratified analyses showed higher risk of poor oral health in people with type 2 diabetes across all educational levels. CONCLUSIONS:People with type 2 diabetes were more likely to rate their oral health as poor than the reference population. Low education strengthened the association between diabetes and poor oral health.

Managing diabetes is complicated for many children. It often requires support from an adult during the school day. In Denmark, most children spend 30–35 h a week at school. Nevertheless, diabetes management in schools remains largely uninvestigated. This study aimed to examine the characteristics and organization of diabetes management in Danish primary schools from the personnel’s perspective. All primary schools in Denmark were invited to participate in the study (n = 2129), and 525 schools were included. A questionnaire was constructed and sent by email. Questionnaire data are presented in the descriptive statistics and compared with the ISPAD guidelines. According to 77.2% of respondents, school personnel had received training in diabetes management, and 78.5% of the schools had at least one person available for diabetes support every day. Respondents felt prepared to help the students with counting carbohydrates (38.9%), dosing insulin (39.1%), and helping the students during high (52.1%) or low (60.3%) blood sugar levels, insulin chock (35.2%), or during activities (36.3%). Yet, diabetes management was a challenging task. Only 61.7% had an action plan for diabetes management, 37.4% had face-to-face information meetings with the parents, and 55.1% of respondents reported having sufficient time to cooperate with the parents.

Purpose: We aimed to examine whether wellbeing, health behavior , youth life among young people (YP) with co-occurrence of physical-mental conditions, that is, multimorbidity differ from YP with exclusively physical or mental conditions.Methods: The population included 3,671 YP reported as having a physical or/and mental condition from a Danish nationwide school-based survey (aged 14-26 years). Wellbeing was measured by the five-item World Health Organization Well-Being Index , life satisfaction by the Cantril Ladder. YP's health behavior and youth life were evaluated in seven domains: home, education, activities/friends, drugs, sleep, sexuality, and self-harm/suicidal thoughts, in accordance with the Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety acronym. We performed descriptive statistics and multilevel logistic regression analysis.Results: A total of 52% of YP with physical-mental multimorbidity reported a low level of well-being, compared to 27% of YP with physical conditions and 44% with mental conditions. YP with multimorbidity had significantly higher odds of reporting poor life satisfaction, compared to YP with exclusively physical or mental conditions. YP with multimorbidity had significantly higher odds for psychosocial challenges and health risk behavior, compared to YP with physical condi-tions, along with increased odds for loneliness (23.3%), self-harm (63.1%), and suicidal thoughts (54.2%), compared to YP with mental conditions.Discussion: YP with physical-mental multimorbidity had higher odds for challenges and low wellbeing and life satisfaction. This is an especially vulnerable group and systematic screening for multimorbidity and psychosocial wellbeing is needed in all healthcare settings. (c) 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Introduction. Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the version for teenagers has not been translated into Danish and validated before now. Objective. This study describes the translation into Danish of the PAID-T scale, which was developed to measure emotional distress in teenagers with diabetes. Materials and Methods. The study was conducted in two phases. First, the PAID-T was translated into Danish based on the guidelines from the International Society for Pharmacoeconomics and Outcome Research and a forwardbackward translation procedure. Second, cognitive interviews were conducted, and the Danish version of the PAID-T was modified to ensure linguistic equivalence with the original scale in English. Results. The Danish version of the PAID-T questionnaire was found to be understandable and relevant for adolescents with T1D. No questions were found to be irrelevant. However, the cognitive interviews showed that the issue of balancing alcohol intake and blood sugar levels was not covered by PAID-T, although this was found relevant in the Danish target group. Conclusion. This study described the translation and linguistic validation of the PAID-T scale into Danish. After modifications based on the feedback from the cognitive interviews, the Danish version was found to be linguistically equivalent to the original English version.

AimsTo examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment.Research Design and Methods: We conducted a cross-sectional study with a population of 41,181 people with type 2 diabetes resident in the Central Denmark Region in 2019, identified through Danish registers using a prespecified diabetes algorithm. Descriptive statistics and multiple logistic regression were used to examine the attendance at dentist, ophthalmologist, and podiatrist, controlling for sociodemographic and clinical factors. Attendance at dentist, ophthalmologist, and podiatrist were examined separately.ResultsThe majority (59.7%) had attended the ophthalmologist at least once in the preceding year, whereas 46.5% and 34.2% had visited the dentist/dental hygienist and podiatrist, respectively. Disposable household income increased attendance significantly, with a clear gradient in the OR of attending the dentist (p<0.001), whereas age significantly magnified the OR of podiatrist and ophthalmologist attendance (p<0.001).ConclusionsThis study provides circumstantial evidence that co-payment can increase inequality in health care attendance, especially for dental attendance, and it further shows that there is significant sociodemographic inequality in healthcare utilisation among people with type 2 diabetes.