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Publications (10 of 175) Show all publications
Sobiecki, J. G., Imamura, F., Davis, C. R., Sharp, S. J., Koulman, A., Hodgson, J. M., . . . Forouhi, N. G. (2023). A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study. PLoS Medicine, 20(4), Article ID e1004221.
Open this publication in new window or tab >>A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study
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2023 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 20, no 4, article id e1004221Article in journal (Refereed) Published
Abstract [en]

Background: Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet.

Methods and findings: We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22, 202 participants, of whom 9, 453 were T2D cases, with relevant biomarkers from an original case-cohort of 27, 779 participants sampled from a cohort of 340, 234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding.

Conclusions: These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Nutrition and Dietetics Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-209120 (URN)10.1371/journal.pmed.1004221 (DOI)000992518700002 ()37104291 (PubMedID)2-s2.0-85159241898 (Scopus ID)
Funder
EU Sixth Framework Programme for Research, LSHM_CT_2006_037197Wellcome trustEU, FP7, Seventh Framework Programme, HEALTHF2-2012-279233
Available from: 2023-06-07 Created: 2023-06-07 Last updated: 2023-09-05Bibliographically approved
Lillqvist, J., Nilsson Sommar, J., Gustafsson, P. E., Glader, E.-L., Hamberg, K. & Rolandsson, O. (2023). Are doctors using more preventive medication for cardiovascular disease?: A Swedish cross-sectional study. Scandinavian Journal of Primary Health Care, 41(3), 297-305
Open this publication in new window or tab >>Are doctors using more preventive medication for cardiovascular disease?: A Swedish cross-sectional study
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2023 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 3, p. 297-305Article in journal (Refereed) Published
Abstract [en]

Background: Despite decreasing mortality from cardiovascular disease (CVD), there are persistent inequities in mortality between socioeconomic groups. Primary preventative medications reduce mortality in CVD; thus, inequitable treatments will contribute to unequal outcomes. Physicians might contribute to inequality by prescribing preventative medication for CVD to themselves in a biased manner.

Aim: To determine whether primary medications for preventing CVD were prescribed inequitably between physicians and non-physicians.

Design and setting: This retrospective study retrieved registry data on prescribed medications for all physicians in Sweden aged 45–74 years, during 2013, and for reference non-physician individuals, matched by sex, age, residence, and level of education. The outcome was any medication for preventing CVD, received at least once during 2013.

Method: Age and the sex-specific prevalence of myocardial infarction (MI) among physicians and non-physicians were used as a proxy for the need for medication. Thereafter, to limit the analysis to preventative medication, we excluded individuals that were diagnosed with CVD or diabetes. To analyse differences in medication usage between physicians and matched non-physicians, we estimated odds ratios (ORs) with conditional logistic regression and adjusted for need and household income.

Results: MI prevalences were 5.7% for men and 2.3% for women, among physicians, and 5.4% for men and 1.8% for women, among non-physicians. We included 25,105 physicians and 44,366 non-physicians. The OR for physicians receiving any CVD preventative medication, compared to non-physicians, was 1.65 (95% confidence interval 1.59–1.72).

Conclusion: We found an inequity in prescribed preventative CVD medications, which favoured physicians over non-physicians.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
cardiovascular disease, epidemiology, Healthcare inequities, pharmacoepidemiology, prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-212491 (URN)10.1080/02813432.2023.2234439 (DOI)001029892800001 ()37467115 (PubMedID)2-s2.0-85165481697 (Scopus ID)
Funder
Västerbotten County Council
Available from: 2023-08-01 Created: 2023-08-01 Last updated: 2023-09-27Bibliographically approved
Badian, R. A., Ekman, L., Pripp, A. H., Utheim, T. P., Englund, E., Dahlin, L. B., . . . Lagali, N. (2023). Comparison of novel wide-field in vivo corneal confocal microscopy with skin biopsy for assessing peripheral neuropathy in type 2 diabetes. Diabetes, 72(7), 908-917
Open this publication in new window or tab >>Comparison of novel wide-field in vivo corneal confocal microscopy with skin biopsy for assessing peripheral neuropathy in type 2 diabetes
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2023 (English)In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 72, no 7, p. 908-917Article in journal (Refereed) Published
Abstract [en]

Diabetic peripheral neuropathy (DPN) is a serious complication of diabetes, where skin biopsy assessing intraepi-dermal nerve fiber density (IENFD) plays an important diagnostic role. In vivo confocal microscopy (IVCM) of the corneal subbasal nerve plexus has been proposed as a noninvasive diagnostic modality for DPN. Direct compari-sons of skin biopsy and IVCM in controlled cohorts are lacking, as IVCM relies on subjective selection of images depicting only 0.2% of the nerve plexus. We compared these diagnostic modalities in a fixed-age cohort of 41 participants with type 2 diabetes and 36 healthy participants using machine algorithms to create wide-field image mosaics and quantify nerves in an area 37 times the size of prior studies to avoid human bias. In the same partici-pants, and at the same time point, no correlation between IENFD and corneal nerve density was found. Corneal nerve density did not correlate with clinical measures of DPN, including neuropathy symptom and disability scores, nerve conduction studies, or quantitative sensory tests. Our findings indicate that corneal and intraepidermal nerves likely mirror different aspects of nerve degeneration, where only intraepidermal nerves appear to reflect the clinical status of DPN, suggesting that scrutiny is warranted concerning methodologies of studies using corneal nerves to assess DPN.

Place, publisher, year, edition, pages
American Diabetes Association, 2023
National Category
Endocrinology and Diabetes Ophthalmology
Identifiers
urn:nbn:se:umu:diva-212049 (URN)10.2337/db22-0863 (DOI)37058418 (PubMedID)2-s2.0-85163642420 (Scopus ID)
Funder
Umeå UniversityRegion VästerbottenDiabetesfonden
Available from: 2023-07-18 Created: 2023-07-18 Last updated: 2023-07-18Bibliographically approved
Rådholm, K., af Geijerstam, P., Woodward, M., Chalmers, J., Hellgren, M., Jansson, S. & Rolandsson, O. (2023). Dog ownership, glycaemic control and all-cause death in patients with newly diagnosed type 2 diabetes: a national cohort study. Frontiers In Public Health, 11, Article ID 1265645.
Open this publication in new window or tab >>Dog ownership, glycaemic control and all-cause death in patients with newly diagnosed type 2 diabetes: a national cohort study
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2023 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1265645Article in journal (Refereed) Published
Abstract [en]

Aims: To evaluate whether dog ownership from the time of type 2 diabetes diagnosis improved glycaemic control, increased achievement of major guideline treatment goals or reduced the risk of all-cause death.

Methods: Patients diagnosed with type 2 diabetes were followed by linkage of four Swedish national registers covering diabetes, dog ownership, socioeconomics, and mortality. Linear regression was used to estimate the mean yearly change in glycated haemoglobin (HbA1c). Cox survival analysis and logistic regression were used to analyse associations between dog ownership and all-cause death and achievement of treatment goals, respectively.

Results: Of 218,345 individuals included, 8,352 (3.8%) were dog-owners. Median follow-up was 5.2 years. Dog-owners had worse yearly change in HbA1c, and were less likely to reach HbA1c, low-density lipoprotein (LDL), and systolic blood pressure (SBP) treatment goals than non-dog-owners (adjusted odds ratios [95% CI] of 0.93 [0.88–0.97], 0.91 [0.86–0.95], and 0.95 [0.90–1.00], respectively). There was no difference in the risk of all-cause death (adjusted hazard ratio [95% CI] 0.92 [0.81–1.04], dog owners versus not).

Conclusion: Owning a dog when diagnosed with diabetes did not lead to better achievement of treatment goals or reduced mortality, but was in fact associated with a smaller reduction in HbA1c and reduced likelihood of achieving treatment goals.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
diabetes mellitus type 2, dogs, epidemiology, glycaemic control, lifestyle, mortality
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-219094 (URN)10.3389/fpubh.2023.1265645 (DOI)001133519300001 ()38162624 (PubMedID)2-s2.0-85180887003 (Scopus ID)
Funder
Region Östergötland, RÖ-601981Region VästerbottenUmeå University
Available from: 2024-01-10 Created: 2024-01-10 Last updated: 2024-01-10Bibliographically approved
Lampousi, A.-M., Carlsson, S., Löfvenborg, J. E., Cabrera-Castro, N., Chirlaque, M.-D., Fagherazzi, G., . . . Wareham, N. J. (2023). Interaction between plasma phospholipid odd-chain fatty acids and GAD65 autoantibodies on the incidence of adult-onset diabetes: the EPIC-InterAct case–cohort study. Diabetologia, 66(8), 1460-1471
Open this publication in new window or tab >>Interaction between plasma phospholipid odd-chain fatty acids and GAD65 autoantibodies on the incidence of adult-onset diabetes: the EPIC-InterAct case–cohort study
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2023 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 66, no 8, p. 1460-1471Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: Islet autoimmunity may progress to adult-onset diabetes. We investigated whether circulating odd-chain fatty acids (OCFA) 15:0 and 17:0, which are inversely associated with type 2 diabetes, interact with autoantibodies against GAD65 (GAD65Ab) on the incidence of adult-onset diabetes.

Methods: We used the European EPIC-InterAct case–cohort study including 11,124 incident adult-onset diabetes cases and a subcohort of 14,866 randomly selected individuals. Adjusted Prentice-weighted Cox regression estimated HRs and 95% CIs of diabetes in relation to 1 SD lower plasma phospholipid 15:0 and/or 17:0 concentrations or their main contributor, dairy intake, among GAD65Ab-negative and -positive individuals. Interactions between tertiles of OCFA and GAD65Ab status were estimated by proportion attributable to interaction (AP).

Results: Low concentrations of OCFA, particularly 17:0, were associated with a higher incidence of adult-onset diabetes in both GAD65Ab-negative (HR 1.55 [95% CI 1.48, 1.64]) and GAD65Ab-positive (HR 1.69 [95% CI 1.34, 2.13]) individuals. The combination of low 17:0 and high GAD65Ab positivity vs high 17:0 and GAD65Ab negativity conferred an HR of 7.51 (95% CI 4.83, 11.69), with evidence of additive interaction (AP 0.25 [95% CI 0.05, 0.45]). Low dairy intake was not associated with diabetes incidence in either GAD65Ab-negative (HR 0.98 [95% CI 0.94, 1.02]) or GAD65Ab-positive individuals (HR 0.97 [95% CI 0.79, 1.18]).

Conclusions/interpretation: Low plasma phospholipid 17:0 concentrations may promote the progression from GAD65Ab positivity to adult-onset diabetes. Graphical Abstract: [Figure not available: see fulltext.]

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2023
Keywords
Diabetes, GAD65Ab, Heptadecanoic, Islet autoimmunity, OCFA, Pentadecanoic
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-210204 (URN)10.1007/s00125-023-05948-x (DOI)2-s2.0-85161458065 (Scopus ID)
Funder
EU, European Research Council, LSHM_CT_2006_037197Umeå University, MC_UU_12015/1Region Västerbotten, MC_UU_12015/1Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00337Novo Nordisk Foundation, NNF19OC0057274Swedish Research Council, 2018- 03035Diabetesfonden, DIA2022-735
Available from: 2023-06-28 Created: 2023-06-28 Last updated: 2023-11-03Bibliographically approved
Terwee, C. B., Elders, P. J. M., Blom, M. T., Beulens, J. W., Rolandsson, O., Rogge, A. A., . . . Rutters, F. (2023). Patient-reported outcomes for people with diabetes: what and how to measure? A narrative review. Diabetologia, 66(8), 1357-1377
Open this publication in new window or tab >>Patient-reported outcomes for people with diabetes: what and how to measure? A narrative review
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2023 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 66, no 8, p. 1357-1377Article, review/survey (Refereed) Published
Abstract [en]

Patient-reported outcomes (PROs) are valuable for shared decision making and research. Patient-reported outcome measures (PROMs) are questionnaires used to measure PROs, such as health-related quality of life (HRQL). Although core outcome sets for trials and clinical practice have been developed separately, they, as well as other initiatives, recommend different PROs and PROMs. In research and clinical practice, different PROMs are used (some generic, some disease-specific), which measure many different things. This is a threat to the validity of research and clinical findings in the field of diabetes. In this narrative review, we aim to provide recommendations for the selection of relevant PROs and psychometrically sound PROMs for people with diabetes for use in clinical practice and research. Based on a general conceptual framework of PROs, we suggest that relevant PROs to measure in people with diabetes are: disease-specific symptoms (e.g. worries about hypoglycaemia and diabetes distress), general symptoms (e.g. fatigue and depression), functional status, general health perceptions and overall quality of life. Generic PROMs such as the 36-Item Short Form Health Survey (SF-36), WHO Disability Assessment Schedule (WHODAS 2.0), or Patient-Reported Outcomes Measurement Information System (PROMIS) measures could be considered to measure commonly relevant PROs, supplemented with disease-specific PROMs where needed. However, none of the existing diabetes-specific PROM scales has been sufficiently validated, although the Diabetes Symptom Self-Care Inventory (DSSCI) for measuring diabetes-specific symptoms and the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) for measuring distress showed sufficient content validity. Standardisation and use of relevant PROs and psychometrically sound PROMs can help inform people with diabetes about the expected course of disease and treatment, for shared decision making, to monitor outcomes and to improve healthcare. We recommend further validation studies of diabetes-specific PROMs that have sufficient content validity for measuring disease-specific symptoms and consider generic item banks developed based on item response theory for measuring commonly relevant PROs.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Diabetes, Patient-reported outcome, Patient-reported outcome measure, Review, Standardisation
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-209163 (URN)10.1007/s00125-023-05926-3 (DOI)000994500100001 ()37222772 (PubMedID)2-s2.0-85160270888 (Scopus ID)
Available from: 2023-06-12 Created: 2023-06-12 Last updated: 2023-12-05Bibliographically approved
Danquah, I., Mank, I., Hampe, C. S., Meeks, K. A. C., Agyemang, C., Owusu-Dabo, E., . . . Rolandsson, O. (2023). Subgroups of adult-onset diabetes: a data-driven cluster analysis in a Ghanaian population. Scientific Reports, 13(1), Article ID 10756.
Open this publication in new window or tab >>Subgroups of adult-onset diabetes: a data-driven cluster analysis in a Ghanaian population
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 10756Article in journal (Refereed) Published
Abstract [en]

Adult-onset diabetes mellitus (here: aDM) is not a uniform disease entity. In European populations, five diabetes subgroups have been identified by cluster analysis using simple clinical variables; these may elucidate diabetes aetiology and disease prognosis. We aimed at reproducing these subgroups among Ghanaians with aDM, and establishing their importance for diabetic complications in different health system contexts. We used data of 541 Ghanaians with aDM (age: 25–70 years; male sex: 44%) from the multi-center, cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study. Adult-onset DM was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, documented use of glucose-lowering medication or self-reported diabetes, and age of onset ≥ 18 years. We derived subgroups by cluster analysis using (i) a previously published set of variables: age at diabetes onset, HbA1c, body mass index, HOMA-beta, HOMA-IR, positivity of glutamic acid decarboxylase autoantibodies (GAD65Ab), and (ii) Ghana-specific variables: age at onset, waist circumference, FPG, and fasting insulin. For each subgroup, we calculated the clinical, treatment-related and morphometric characteristics, and the proportions of objectively measured and self-reported diabetic complications. We reproduced the five subgroups: cluster 1 (obesity-related, 73%) and cluster 5 (insulin-resistant, 5%) with no dominant diabetic complication patterns; cluster 2 (age-related, 10%) characterized by the highest proportions of coronary artery disease (CAD, 18%) and stroke (13%); cluster 3 (autoimmune-related, 5%) showing the highest proportions of kidney dysfunction (40%) and peripheral artery disease (PAD, 14%); and cluster 4 (insulin-deficient, 7%) characterized by the highest proportion of retinopathy (14%). The second approach yielded four subgroups: obesity- and age-related (68%) characterized by the highest proportion of CAD (9%); body fat-related and insulin-resistant (18%) showing the highest proportions of PAD (6%) and stroke (5%); malnutrition-related (8%) exhibiting the lowest mean waist circumference and the highest proportion of retinopathy (20%); and ketosis-prone (6%) with the highest proportion of kidney dysfunction (30%) and urinary ketones (6%). With the same set of clinical variables, the previously published aDM subgroups can largely be reproduced by cluster analysis in this Ghanaian population. This method may generate in-depth understanding of the aetiology and prognosis of aDM, particularly when choosing variables that are clinically relevant for the target population.

Place, publisher, year, edition, pages
Nature Publishing Group, 2023
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-212236 (URN)10.1038/s41598-023-37494-2 (DOI)37402743 (PubMedID)2-s2.0-85164146235 (Scopus ID)
Funder
EU, FP7, Seventh Framework Programme, 278901Region VästerbottenUmeå UniversityEU, European Research Council, 772244
Available from: 2023-07-21 Created: 2023-07-21 Last updated: 2023-07-21Bibliographically approved
Otten, J., Tavelin, B., Söderberg, S. & Rolandsson, O. (2022). Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer mortality. Diabetes/Metabolism Research Reviews, 38(3), Article ID e3512.
Open this publication in new window or tab >>Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer mortality
2022 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 38, no 3, article id e3512Article in journal (Refereed) Published
Abstract [en]

Aims: We assessed the association between insulin resistance and blood glucose concentrations at type 2 diabetes diagnosis and future development of diabetes-related complications and mortality.

Materials and Methods: This retrospective cohort study included 864 individuals with type 2 diabetes (median age 60 years) whose fasting C-peptide and HbA1c were measured at diabetes diagnosis. The median follow-up time until death or study end was 16.4 years (interquartile range 13.3−19.6). The association between C-peptide and mortality/complications was estimated by Cox regression adjusted for sex, age at diabetes diagnosis, smoking, hypertension, BMI, total cholesterol, and HbA1c. C-peptide and HbA1c were converted to Z scores before the Cox regression analysis.

Results: An increase by one standard deviation in fasting C-peptide at diabetes diagnosis was associated with all-cause (hazard ratio [HR] 1.33; 95% confidence intervals [CI] 1.12–1.58; p = 0.001) and cancer mortality (HR 1.51; 95% CI 1.13–2.01; p = 0.005) in the fully adjusted model. An increase by one standard deviation in HbA1c at diabetes diagnosis was associated with all-cause mortality (HR 1.24; 95% CI 1.07–1.44; p = 0.005), major cardiovascular events (HR 1.20; 95% CI 1.04–1.39; p = 0.015), stroke (HR 1.36; 95% CI 1.09–1.70; p = 0.006), and retinopathy (HR 1.54; 95% CI 1.34–1.76; p < 0.0001) in the fully adjusted model.

Conclusions: Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer-related mortality. Thus, treatment of type 2 diabetes should focus not only on normalising blood glucose levels but also on mitigating insulin resistance.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
cancer mortality, diabetes mellitus type 2, insulin resistance, mortality
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-190001 (URN)10.1002/dmrr.3512 (DOI)000720975500001 ()34780669 (PubMedID)2-s2.0-85119586636 (Scopus ID)
Funder
Norrbotten County CouncilRegion Västerbotten
Available from: 2021-12-07 Created: 2021-12-07 Last updated: 2022-07-12Bibliographically approved
Brännholm Syrjälä, M., Bennet, L., Dempsey, P., Fhärm, E., Hellgren, M., Jansson, S., . . . Wennberg, P. (2022). Health effects of reduced occupational sedentary behaviour in type 2 diabetes using a mobile health intervention: a study protocol for a 12-month randomized controlled trial—the ROSEBUD study. Trials, 23(1), Article ID 607.
Open this publication in new window or tab >>Health effects of reduced occupational sedentary behaviour in type 2 diabetes using a mobile health intervention: a study protocol for a 12-month randomized controlled trial—the ROSEBUD study
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2022 (English)In: Trials, E-ISSN 1745-6215, Vol. 23, no 1, article id 607Article in journal (Refereed) Published
Abstract [en]

Background: Short-term trials conducted in adults with type 2 diabetes mellitus (T2DM) showed that reducing sedentary behaviour by performing regular short bouts of light-intensity physical activity enhances health. Moreover, support for reducing sedentary behaviour may be provided at a low cost via mobile health technology (mHealth). There are a wide range of mHealth solutions available including SMS text message reminders and activity trackers that monitor the physical activity level and notify the user of prolonged sitting periods. The aim of this study is to evaluate the effects of a mHealth intervention on sedentary behaviour and physical activity and the associated changes in health in adults with T2DM.

Methods: A dual-arm, 12-month, randomized controlled trial (RCT) will be conducted within a nationwide Swedish collaboration for diabetes research in primary health care. Individuals with T2DM (n = 142) and mainly sedentary work will be recruited across primary health care centres in five regions in Sweden. Participants will be randomized (1:1) into two groups. A mHealth intervention group who will receive an activity tracker wristband (Garmin Vivofit4), regular SMS text message reminders, and counselling with a diabetes specialist nurse, or a comparator group who will receive counselling with a diabetes specialist nurse only. The primary outcomes are device-measured total sitting time and total number of steps (activPAL3). The secondary outcomes are fatigue, health-related quality of life and musculoskeletal problems (self-reported questionnaires), number of sick leave days (diaries), diabetes medications (clinical record review) and cardiometabolic biomarkers including waist circumference, mean blood pressure, HbA1c, HDL-cholesterol and triglycerides.

Discussion: Successful interventions to increase physical activity among those with T2DM have been costly and long-term effectiveness remains uncertain. The use of mHealth technologies such as activity trackers and SMS text reminders may increase awareness of prolonged sedentary behaviour and encourage increase in regular physical activity. mHealth may, therefore, provide a valuable and novel tool to improve health outcomes and clinical management in those with T2DM. This 12-month RCT will evaluate longer-term effects of a mHealth intervention suitable for real-world primary health care settings.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Accelerometer, Behaviour change, Interventions, mHealth, Occupational sitting, Physical activity, Randomized controlled trial, Sedentary behaviour, Type 2 diabetes, Workplace
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-198481 (URN)10.1186/s13063-022-06528-x (DOI)000831214700009 ()35897022 (PubMedID)2-s2.0-85135188006 (Scopus ID)
Funder
Diabetesfonden
Available from: 2022-08-11 Created: 2022-08-11 Last updated: 2024-01-17Bibliographically approved
Kohls, M., Freisling, H., Charvat, H., Soerjomataram, I., Viallon, V., Davila-Batista, V., . . . Arnold, M. (2022). Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study. BMC Cancer, 22(1), Article ID 546.
Open this publication in new window or tab >>Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study
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2022 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 22, no 1, article id 546Article in journal (Refereed) Published
Abstract [en]

Background: Body mass index (BMI) and cardiometabolic comorbidities such as cardiovascular disease and type 2 diabetes have been studied as negative prognostic factors in cancer survival, but possible dependencies in the mechanisms underlying these associations remain largely unexplored. We analysed these associations in colorectal and breast cancer patients.

Methods: Based on repeated BMI assessments of cancer-free participants from four European countries in the European Prospective Investigation into Cancer and nutrition (EPIC) study, individual BMI-trajectories reflecting predicted mean BMI between ages 20 to 50 years were estimated using a growth curve model. Participants with incident colorectal or breast cancer after the age of 50 years were included in the survival analysis to study the prognostic effect of mean BMI and cardiometabolic diseases (CMD) prior to cancer. CMD were defined as one or more chronic conditions among stroke, myocardial infarction, and type 2 diabetes. Hazard ratios (HRs) and confidence intervals (CIs) of mean BMI and CMD were derived using multivariable-adjusted Cox proportional hazard regression for mean BMI and CMD separately and both exposures combined, in subgroups of localised and advanced disease.

Results: In the total cohort of 159,045 participants, there were 1,045 and 1,620 eligible patients of colorectal and breast cancer. In colorectal cancer patients, a higher BMI (by 1 kg/m2) was associated with a 6% increase in risk of death (95% CI of HR: 1.02–1.10). The HR for CMD was 1.25 (95% CI: 0.97–1.61). The associations for both exposures were stronger in patients with localised colorectal cancer. In breast cancer patients, a higher BMI was associated with a 4% increase in risk of death (95% CI: 1.00–1.08). CMDs were associated with a 46% increase in risk of death (95% CI: 1.01–2.09). The estimates and CIs for BMI remained similar after adjustment for CMD and vice versa.

Conclusions: Our results suggest that cumulative exposure to higher BMI during early to mid-adulthood was associated with poorer survival in patients with breast and colorectal cancer, independent of CMD prior to cancer diagnosis. The association between a CMD diagnosis prior to cancer and survival in patients with breast and colorectal cancer was independent of BMI.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Body mass index, Breast cancer, Cardiovascular disease, Cohort study, Colorectal cancer, Comorbidity, Cumulative exposure, Diabetes, Survival
National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-203749 (URN)10.1186/s12885-022-09589-y (DOI)000796063100003 ()35568802 (PubMedID)2-s2.0-85130038163 (Scopus ID)
Funder
European Commission
Available from: 2023-01-19 Created: 2023-01-19 Last updated: 2023-01-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1341-6828

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