BACKGROUND: Continuous glucose monitoring (CGM) is commonly used to monitor glucose levels in younger people with type 1 diabetes, but its use is less frequent among older adults. The aim of this study was to investigate the experiences of healthcare workers who have used CGM in the follow-up of glucose levels in older people with type 1 or type 2 diabetes living in nursing homes or receiving home healthcare services. METHODS: The study had a qualitative design, and four focus group interviews with a total of 16 healthcare workers were conducted. The interviews were analysed using Braun and Clarke’s thematic analysis. RESULTS: Through the analysis four themes with two or three subthemes each, were identified. The themes were (1) “CGM affects the workday and provides an overview” (subthemes “Detects hypoglycaemia”, “CGM with tracking function would be resource-saving” and “Varied experience with alarm function and trend arrows”); (2) “Practical training is important, but not sufficient” (subthemes: “Theoretical diabetes knowledge is a prerequisite for the full utilization of CGM” and “Access to a diabetes nurse is perceived as valuable and reassuring”); (3) “Improved dialogue and increased ability to participate in activities” (subthemes: “Avoids painful pricks which disrupts the dialogue”, “Increased focus on the patient” and “Less equipment to carry” and (4) “Changed roles and distribution of responsibilities” (subthemes: “Increased understanding of glucose values creates a sense of security” and “More independent patients and more reassured relatives”. CONCLUSIONS: This study revealed that CGM positively affected the workday of healthcare workers, the follow-up of patients, and the use of resources. The participants experienced that the use of CGM improved the dialogue between healthcare workers and patients and contributed to patients becoming more independent. However, increased knowledge about diabetes and CGM among healthcare workers is crucial to optimize the utilization of the CGM technology.

Purpose: The purpose of the study was to explore adolescents' experiences of being a sibling of a child with type 1 diabetes (T1D) and how diabetes affects the family. Methods: A descriptive qualitative study was conducted in Norway through individual, semistructured interviews with adolescents (16-20years) who had been siblings of a child with T1D before the age of 18.All interviews were audio recorded and transcribed verbatim. Thematic analysis, as described by Braun and Clarke, was used to analyze the data. Results: Four main themes were identified during the analysis, each comprising related subthemes. The main themes were (1) the start was difficult, but it gradually got better; (2) diabetes affects the atmosphere in the family; (3) a desire to be included; and (4) diabetes affects everyday life to a great extent. Conclusions: The findings of the study confirmed that T1D has a major impact on a family's everyday life, but the siblings experienced that it affected the family dynamics both positively and negatively. Siblings expressed a desire for more information and support from health care professionals and a desire to be included in the diabetes management of their sibling with T1D. The findings highlight the need for health care professionals to include siblings in diabetes education and follow-up.

Objectives To explore how individuals with long covid experienced various aspects of a micro-choice-based rehabilitation programme and if these experiences could facilitate behaviour change.Design A qualitative study with three focus groups was conducted, in mean 9.8 months after completing the rehabilitation programme. Data were analysed using systematic text condensation.Setting The study was conducted in a university setting.Participants 19 participants (aged 23–55 years, 15 women) were included between Spring 2021 and Autumn 2022.Intervention The participants in this study had participated in a 3-day concentrated micro-choice-based rehabilitation programme. One of the main features of this intervention was to support participants in shifting their focus from targeting symptoms to choosing alternative actions aimed at improving everyday functioning, referred to as micro-choices.Results Five themes were identified: (1) reduction in uncertainty achieved through reassurance and motivation; (2) ‘in the same boat’: sharing experiences and supporting each other; (3) knowledge about the body’s stress responses and micro-choices; (4) shifting between individual practice and close collaboration with the therapists; and (5) sustaining behaviour change is challenging. These themes illustrated how participants’ experiences with different aspects of the rehabilitation programme facilitated both the initiation and maintenance of behaviour change. The participants highlighted the importance of acknowledging their challenges, reducing fear, sharing experiences with peers, feeling understood and supported, collaborating with a skilled team, receiving personalised guidance and gaining insights through the exploration and implementation of micro-choices. Participants also highlighted that behaviour change is an ongoing process requiring sustained effort.Conclusion The findings showed how participants experienced various aspects of a concentrated micro-choice-based rehabilitation programme as supportive of behaviour change. The findings indicate that a concentrated rehabilitation programme may facilitate self-management and improve everyday function in individuals with long covid.Trial registration number NCT05234281.

PURPOSE:The purpose of this study was to explore experiences with an interdisciplinary micro-choice-based concentrated group intervention for people with type 2 diabetes. METHODS:A qualitative study with individual semistructured interviews were conducted with 14 adults (8 women, ages 45-74 years) with type 2 diabetes. Purposive sampling was used, and participants from 3 different intervention groups in the micro-choice-based concentrated group intervention were recruited. Thematic analysis was used for the data analysis. RESULTS:Three main themes were identified: (1) group intervention tailored to individual needs through friendly and skilled professionals, (2) valuable social interactions and an experience of fellowship, and (3) commitment to change through goal setting and conscious micro-choices. The participants described a readiness for change that was met by important knowledge from skilled professionals in the concentrated intervention. They reported that new knowledge, particularly about micro-choices and the focus on how insulin works in the body, led to change in their awareness and self-management. The concentrated group intervention was a preferred setting that contained a sense of community without compromising on meeting individual needs. Participants described internalized changes after the intervention and a willingness to adhere to changes necessary for their self-management. CONCLUSION:Study findings showed that a micro-choice-based concentrated group intervention for people with type 2 diabetes can be a valuable approach contributing to improved patient activation and diabetes self-management. The findings underpin the importance of increased diabetes knowledge and support from an interprofessional team to bring about significant changes in everyday life.

Studies have shown high rates of hypoglycaemia among home-dwelling older people receiving home care services. Hypoglycaemia can lead to severe consequences and in worst case, death. Therefore, knowledge about the factors associated with the occurrence of hypoglycaemia in this patient group is important. This study aimed to investigate the associations between hypoglycaemia and relevant diabetes and age-related factors among individuals with diabetes aged ≥ 65 years who received home care services. This prospective observational study included data from blinded continuous glucose monitoring to identify hypoglycaemia and glycaemic variability. Further, data from blood tests (HbA1c, serum creatinine), medication lists, and questionnaires on cognitive function, functional status with need of assistance, and nutritional status were collected. Data analysis was performed using Fisher’s exact tests and unadjusted logistic regression analyses. In total, 56 individuals participated (52

PurposeThe purpose of the study was to explore experiences with use of a continuous glucose monitor (CGM) in people with type 2 diabetes (T2DM).MethodsA qualitative study with individual semistructured interviews at 2 time points was conducted; first with 14 adults, ages 45 to 74 years (8 women) and second with 9 of the first interviewed adults (5 women) approximately 2 years later. Participants used CGM before, during, and 3 months after the concentrated group intervention. Thematic analysis was performed on the transcribed interviews.ResultsThree main themes were identified regarding the use of CGMs: (1) a gamechanger in diabetes education, (2) intermittent use is preferred, and (3) a balancing act. The participants described the use of CGMs as a valuable tool in diabetes education. It increased their understanding of insulin demand and sensitivity and strengthened their awareness of how to make more health-promoting micro-choices in everyday life. Intermittent use was described as the preferred way of using CGMs. Some experienced that CGMs could be challenging, and in periods of satisfactory glucose control, CGM use was experienced as unnecessary, underpinning intermittent use as appropriate.ConclusionStudy findings showed that participants with T2DM experienced CGMs as a valuable tool to gain deeper understanding of processes in the body, which could improve diabetes self-management. CGMs can facilitate more healthy micro-choices in life. Intermittent use of CGMs is most often the preferred approach for people with T2DM, but access to CGMs should take individual preferences into consideration.

AIMS:To 1) evaluate information provided on the latent diabetes distress trait when using the Problem Areas In Diabetes, 20 item (PAID-20), PAID-11 or PAID-5, and 2) evaluate the information provided by each scale item. METHODS:Using nationwide registry data from 10,190 individuals with type 1 diabetes in Norway, we applied Item Response Theory (IRT) analyses to compare test information curves for PAID-20, PAID-11, PAID-5 and their scale items. RESULTS:The test information curve for PAID-20 captured an overall broader range of the latent distress trait compared to the other versions. At test information level ≥ 10, the ranges (SD under/above mean) were: PAID-20: -1.30 to 3.32; PAID-11; -1.17 to 2.76; and PAID-5: -0.59 to 2.27. Six PAID-20 items had flat information curves with limited contribution to the latent trait, whereas the PAID-11 included 11 of the 12 items most frequently reported as serious problem areas. CONCLUSIONS:The PAID-20 captures most information on the latent diabetes distress trait; however, the PAID-11 provides comparable information and captures the most serious problem areas. The PAID-5 provided limited information and covers limited aspects of distress. Overall, the PAID-11 may be a good choice for assessing diabetes distress in both research and clinical practice.

Abstract Background and aim The world-wide prevalence of diabetes distress varies, and studies are mainly undertaken in clinical settings. By using data from the Trøndelag Health (HUNT) study, we aimed to estimate diabetes distress prevalence, its determinants, and associations with anxiety and depression among adults with type 2 diabetes. Methods This population-based cross-sectional study consists of individuals ≥ 20 years with type 2 diabetes participating in the HUNT4 survey (2017–2019). Diabetes-distress prevalence with 95% confidence interval (CI) was calculated based on the five item Problem Areas in Diabetes (PAID-5) questionnaire. PAID-5 sum scores were rescaled to a 0-100 scale by multiplying the sum score by five. Linear and logistic regression models were used to examine associations of demographic, lifestyle- and clinical factors, with diabetes distress. Results In total, 1954 individuals completed the PAID-5 questionnaire, with a mean score of 15.2 (SD 18.3) and 11.9% (95% CI 10.6–13.4) reporting high diabetes distress (PAID-5 ≥ 40). Multivariable linear regression showed that diabetes distress was associated with a 0.2 (95% CI 0.2–0.3) lower score for each year older age, 7.6 (95% CI 5.4–9.7) higher score for current insulin use, and 9.3 (95% CI 5.3–13.2) higher score for a history of diabetes foot ulcers. High levels of anxiety and depression symptoms were associated with higher diabetes distress (Anxiety: B 16.0, 95% CI 13.6–18.4, Depression: B 13.3, 95% CI 10.7–16.0). Conclusions Diabetes distress is common and strongly associated with younger age at diabetes onset, insulin use, foot ulcer, and anxiety and depression symptoms. Identifying and addressing diabetes distress in diabetes follow-up may facilitate improving health outcomes and prevent more serious mental health issues in individuals with T2D. Nevertheless, the findings should be further examined in longitudinal studies.

AIMS:To examine associations between sleep impairments and diabetes distress in men and women with type 2 diabetes (T2D) by using cross-sectional data from the Trøndelag Health Study (HUNT). METHODS:This population-based cross-sectional study consists of individuals ≥20 years with T2D participating in the HUNT4 survey (2017-2019; n = 1954). Sleep impairments (snoring, sleep apnoea, troubles falling asleep, wake up during the night, early wakening, difficulties coping during the daytime due to sleep problems and restless legs) were measured by the sleeping HUNT-Questionnaire, along with a separate question on the number of hours of sleep at night. Diabetes distress was measured using the Problem Areas in Diabetes (PAID-5) questionnaire. Diabetes distress prevalence, grouped by sleep impairment, was estimated with 95% confidence intervals. Multivariable linear regression models with distress as outcome and adjusted for demographic, clinical and mental health factors were used to examine associations with sleep. RESULTS:Overall, sleep impairment was associated with increased diabetes distress. Regression coefficients B (95% CI) for higher distress score were 0.6 (95% CI 0.2, 0.9) for ≤7 h of sleep, 0.6 (95% CI 0.1-1.1) for snoring, 1.4 (95% CI 0.8-2.2) for troubles falling asleep, 1.1 (95% CI 0.6-1.6) for waking up during the night, 1.2 (95% CI 0.7-1.8) for early wakening, 2.6 (95% CI 1.7-3.6) for troubles coping during daytime due to sleep problems and 0.8 (95% CI 0.2-1.3) for restless legs. CONCLUSION:Multiple components of sleep impairment were significantly associated with high diabetes distress in individuals with T2D.

Background and aimsDiabetes-related foot ulcers (DFU) are a persistent healthcare challenge, impacting both patients and healthcare systems, with adverse effects on quality of life and productivity. Our primary aim was to examine the trends in lifetime prevalence of DFU, as well as other micro- and macrovascular complications in the Trøndelag Health Study (HUNT) in Norway.MethodsThis study consists of individuals ≥20 years with diabetes participating in the population-based cross-sectional HUNT surveys (1995-2019). Prevalence ratios, comparing the lifetime prevalence of DFU and other relevant micro- and macrovascular complications between the HUNT surveys, were calculated using Poisson regression.ResultsThe lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 11.0% (9.5-12.7) in HUNT2, 7.5% (6.3-8.8) in HUNT3 and 5.3% (4.4-6.3) in HUNT4. The decrease in DFU prevalence from 1995 to 2019 was observed in both men and women, for all age groups, and for both type 1 and type 2 diabetes. The highest lifetime prevalence of DFU was found among those with type 1 diabetes. The decrease in HbA1c from HUNT2 to HUNT4 did not differ between those with and without a DFU. The prevalence of chronic kidney disease (eGFR <60 mL/min/1.73 m2 (eGFR categories G3-G5)) increased in both individuals with and without a DFU.ConclusionResults from the HUNT surveys show a substantial decline in the lifetime prevalence of DFU from 1995 to 2019.

AimsThe aim of this study is to determine the prevalence of impaired awareness of hypoglycaemia (IAH) and examine risk factors for IAH in adults with type 1 diabetes.MethodsWe conducted a population-based registry study of 10,202 adults (>= 18 years) with type 1 diabetes using data from the Norwegian Diabetes Register for Adults. The registry used the 1-item Gold scale, measuring hypoglycaemia symptom awareness. We calculated the overall prevalence of IAH (Gold score >= 4) (95% CI) and prevalence for subgroups based on demographic and clinical variables. We estimated IAH prevalence based on continuous scales of age, diabetes duration and HbA1c using predicted probabilities from generalised additive logistic regression models. Finally, we quantified the associations of selected variables on IAH prevalence using log-binomial regression models.ResultsOverall, 18.0% reported IAH (95% CI 17.2, 18.7). The prevalence increased linearly with the participants' age, whereas the associations of diabetes duration and HbA1c with IAH were non-linear with higher prevalence in both lower and higher tails of their distributions. Multiple severe hypoglycaemic events, female sex, age >= 65 years, diabetes duration <= 4 years or >= 30 years, multiple DKA events and CGM use were associated with higher risk for IAH. HbA1c 65-74 mmol/mol (8.1-8.9%) was associated with lower risk for IAH.ConclusionsIn this nationwide study, the IAH prevalence was 18.0%. Multiple hypoglycaemic events, female sex and diabetes duration were identified as important risk factors for IAH. Study findings highlight the complexity of self-reported hypoglycaemia symptom awareness and emphasise the importance of routinely addressing symptom awareness in diabetes follow-up.

ObjectiveTo examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants' perceptions of participating in the intervention.Design and methodsIn line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019-2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) >= 15 or Body Mass Index (BMI) >= 30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data.ResultsThere was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: 'Meaningful perspectives on lifestyle changes' and 'Lifestyle change is not a linear process due to challenges faced along the way' putting ownership of their choices in life into picture.ConclusionThe negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.

Background The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes. Methods Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3–4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up. Results Of the 241 included participants (57% women, mean age 48 years, range 19–84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P <0.001. Conclusions Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial. Trial registration ClinicalTrials.gov NCT05234281

OBJECTIVE:To estimate diabetes distress prevalence and associations with demographic and clinical variables among adults with type 1 diabetes in Norway. RESEARCH DESIGN AND METHODS:In this nationwide population-based registry study, the 20-item Problem Areas in Diabetes (PAID-20) questionnaire was sent to 16,255 adults with type 1 diabetes. Linear regression models examined associations of demographic and clinical variables with distress. RESULTS:In total, 10,186 individuals (62.7%) completed the PAID-20, with a mean score of 25.4 (SD 18.4) and 21.7% reporting high distress. Respondents endorsed worrying about the future and complications as the most problematic item (23.0%). Female sex, younger age, non-European origin, primary education only, unemployment, smoking, continuous glucose monitoring use, more symptomatic hypoglycemia, reduced foot sensitivity, treated retinopathy, and higher HbA1c were associated with higher distress. CONCLUSIONS:Diabetes distress is common among adults with type 1 diabetes and associated with clinically relevant factors, underlining that regular care should include efforts to identify and address distress.

With an ageing population and improved treatments people live longer with their chronic diseases, and primary care clinics face more costly and difficult-to-treat multimorbid patients. To meet these challenges, current guidelines for the management of type 2 diabetes suggest that an interprofessional team should collaborate to enhance the delivery of worthwhile self-management support interventions. In this study, we aimed to evaluate the effects of an empowerment-based interprofessional follow-up intervention in people with type 2 diabetes in primary care on patient-reported outcomes, biomarkers and weight, and to explore the experiences of patients attending the intervention. We invited patients during regular visits to their general practitioners. The 12-month intervention included 1) empowerment-based counselling; 2) a standardized medical report. The control group received consultations with physicians only. The primary outcome was the Patient Activation Measure, a patient-reported measure assessing individual knowledge, skills, and confidence integral to managing one's health and healthcare. After the trial we conducted qualitative interviews. We observed no difference in the primary outcome scores. On secondary outcomes we found a significant between-group intervention effect in favor of the intervention group, with mean differences in glycemic control after 12 months (B [95% CI] = -8.6 [-17.1, -0.1] mmol/l; p = 0.045), and significant within-group changes of weight (B [95% CI] = -1.8 kg [-3.3, -0.3]; p = 0.02) and waist circumference (B [95% CI] = -3.9 cm [-7.3, -0.6]; p = 0.02). The qualitative data showed that the intervention opened patients' eyes for reflections and greater awareness, but they needed time to take on actions. The patients emphasized that the intervention gave rise to other insights and a greater understanding of their health challenges. We suggest testing the intervention among patients with larger disease burden and a more expressed motivation for change.

Background and objectives: Data on time trends in diabetes-related foot ulcer (DFU) prevalence are limited. We aimed to determine trends in the lifetime prevalence of DFU in the Trøndelag Health Study (HUNT) conducted in three waves between 1995 and 2019. Research Design and Methods: This longitudinal population-based study consists of individuals ≥20 years with diabetes who participated in at least one of the three HUNT surveys from 1995-2019. Type 2 diabetes was defined as glutamic acid decarboxylase antibodies (GADA) <5 IU/mL (<0.09 ai) and age at diagnosis ≥30 years. Type 1 diabetes was defined as GADA ≥5 IU/mL (≥ 0.09 ai) and/or age at diagnosis <30 years. We used the following question to assess prevalence of DFU: “Have you had a foot ulcer that required more than three weeks to heal?”. The lifetime prevalence of DFUs was evaluated using cross-sectional data. Results: The total diabetes population was 1630 in HUNT2, 1824 in HUNT3 and 2393 in HUNT4. Approximately 85% of the participants had type 2 diabetes. Among those with type 2 diabetes, the lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 10.1% (8.5-11.8) in HUNT2, 7.4% (6.2-8.8) in HUNT3 and 5.0% (4.1-6.0) in HUNT4. Corresponding numbers in those with type 1 diabetes were 14.9% (11.1-19.8), 8.5% (5.4-13.3) and 7.2% (4.8-10.5), respectively. The decline in DFU prevalence persisted after adjusting for age, sex, educational level, marital status, work situation, body mass index, systolic blood pressure, smoking, and HbA1c. Conclusion: The results of this longitudinal population-based study suggest that the lifetime prevalence of DFUs in Norway has declined substantially during the past 25 years. Disclosure H.K.R.Riise: None. M.M.Iversen: None. J.Igland: Research Support; Pfizer Inc., Sanofi. M.Graue: None. A.Haugstvedt: Advisory Panel; Novo Nordisk. T.Ostbye: None. E.Søfteland: None. M.Hermann: None. S.Carlsson: None. B.O.Åsvold: None. Funding Western Norway Regional Health Authority (F-12131)