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Stenlund, Hans
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Publications (10 of 167) Show all publications
Li, X., Peng, Y., Li, Z., Christensen, B., Heckmanns, A. B., Stenlund, H., . . . Hernell, O. (2019). Feeding Infants Formula With Probiotics or Milk Fat Globule Membrane: A Double-Blind, Randomized Controlled Trial. Frontiers in Pediatrics, 7, Article ID 347.
Open this publication in new window or tab >>Feeding Infants Formula With Probiotics or Milk Fat Globule Membrane: A Double-Blind, Randomized Controlled Trial
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2019 (English)In: Frontiers in Pediatrics, ISSN 2296-2360, Vol. 7, article id 347Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate effects on growth and infection rates of supplementing infant formula with the probiotic Lactobacillus paracasei ssp. paracasei strain F19 (F19) or bovine milk fat globule membrane (MFGM).

Methods: In a double-blind, randomized controlled trial, 600 infants were randomized to a formula supplemented with F19 or MFGM, or to standard formula (SF). A breastfed group was recruited as reference (n = 200).The intervention lasted from age 21 ± 7 days until 4 months, and infants were followed until age one year.

Results: Both experimental formulas were well tolerated and resulted in high compliance. The few reported adverse events were not likely related to formula, with the highest rates in the SF group, significantly higher than for the F19-supplemented infants (p = 0.046). Weight or length gain did not differ during or after the intervention among the formula-fed groups, with satisfactory growth. During the intervention, overall, the experimental formula groups did not have more episodes of diarrhea, fever, or days with fever than the breastfed infants. However, compared to the breastfed infants, the SF group had more fever episodes (p = 0.021) and days with fever (p = 0.036), but not diarrhea. Compared with the breastfed group, the F19-supplemented infants but not the other two formula groups had more visits/unscheduled hospitalizations (p = 0.015) and borderline more episodes of upper respiratory tract infections (p = 0.048).

Conclusions: Both the MFGM- and F19-supplemented formulas were safe and well-tolerated, leading to few adverse effects, similar to the breastfed group and unlike the SF group. During the intervention, the MFGM-supplemented infants did not differ from the breastfed infants in any primary outcome.

Keywords
infant, breastfed, MFGM, F19, infection, safety, probiotics
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-163060 (URN)10.3389/fped.2019.00347 (DOI)000482056600002 ()31552203 (PubMedID)
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Lindholm, L., Stenling, A., Norberg, M., Stenlund, H. & Weinehall, L. (2018). A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort. BMC Public Health, 18, Article ID 452.
Open this publication in new window or tab >>A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort
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2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 452Article in journal (Refereed) Published
Abstract [en]

Background: Several large scale community-based cardiovascular disease prevention programs were initiated in the 80s, and one was the Västerbotten Intervention Programme, Sweden. As an initial step in 1985, a pilot study was introduced in the Norsjö municipality that combined individual disease prevention efforts among the middle-aged population with community-oriented health promotion activities. All citizens at 30, 40, 50, and 60 years of age were invited to a physical examination combined with a healthy dialogue at the local primary health care centre. Västerbotten Intervention Program is still running following the same lines and is now a part of the ordinary public health in the county. The purpose of this study is to estimate the costs of running Västerbotten Intervention Programme from 1990 to 2006, versus the health gains and savings reasonably attributable to the program during the same time period. Methods: A previous study estimated the number of prevented deaths during the period 1990-2006 which can be attributed to the programme. We used this estimate and calculated the number of QALYs gained, as well as savings in resources due to prevented non-fatal cases during the time period 1990 to 2006. Costs for the programmes were based on previously published scientific articles as well as current cost data from the county council, who is responsible for the programme. Result: The cost per QALY gained from a societal perspective is SEK 650 (Euro 68). From a health care sector perspective, the savings attributable to the VIP exceeded its costs. Conclusion: Our analysis shows that Västerbotten Intervention Programme is extremely cost-effective in relation to the Swedish threshold value (SEK 500000 per QALY gained or Euro 53,000 per QALY gained). Other research has also shown a favorable effect of Västerbotten Intervention Programme on population health and the health gap. We therefore argue that all health care organizations, acting in settings reasonably similar to Sweden, have good incentive to implement programs like Västerbotten Intervention Programme.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Prevention, Community-based, Cost-effectiveness
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147306 (URN)10.1186/s12889-018-5339-3 (DOI)000429848700006 ()29618323 (PubMedID)
Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2018-08-21Bibliographically approved
Nyström, E., Asklund, I., Sjöström, M., Stenlund, H. & Samuelsson, E. (2018). Re: Treatment of stress urinary incontinence with a mobile app: factors associated with success [Letter to the editor]. International Urogynecology Journal, 29(6), 925-925
Open this publication in new window or tab >>Re: Treatment of stress urinary incontinence with a mobile app: factors associated with success
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2018 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 29, no 6, p. 925-925Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Springer, 2018
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-148011 (URN)10.1007/s00192-018-3632-4 (DOI)000431930700023 ()29594320 (PubMedID)
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-06-09Bibliographically approved
Nyström, E., Asklund, I., Sjöström, M., Stenlund, H. & Samuelsson, E. (2018). Treatment of stress urinary incontinence with a mobile app: factors associated with success. International Urogynecology Journal, 29(9), 1325-1333
Open this publication in new window or tab >>Treatment of stress urinary incontinence with a mobile app: factors associated with success
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2018 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 29, no 9, p. 1325-1333Article in journal (Refereed) Published
Abstract [en]

Introduction and hypothesis: Stress urinary incontinence is common among women. First-line treatment includes pelvic floor muscle training (PFMT) and lifestyle advice, which can be provided via a mobile app. The efficacy of app-based treatment has been demonstrated in a randomized controlled trial (RCT). In this study, we aimed to analyze factors associated with successful treatment.

Methods: Secondary analysis of data from the RCT. At baseline and 3-month follow-up, participants (n = 61) answered questions about symptoms, quality of life, background, and PFMT. Success was defined as rating the condition as much or very much better according to the validated Patient Global Impression of Improvement questionnaire. Factors possibly associated with success were analyzed with univariate logistic regression; if p < 0.20, the factor was entered into a multivariate model that was adjusted for age. Variables were then removed stepwise.

Results: At follow-up, 34 out of 61 (56%) of participants stated that their condition was much or very much better. Three factors were significantly associated with success: higher expectations for treatment (odds ratio [OR] 11.38, 95% confidence interval [CI] 2.02-64.19), weight control (OR 0.44 per kg gained, 95% CI 0.25-0.79), and self-rated improvement of pelvic floor muscle strength (OR 35.54, 95% CI 4.96-254.61). Together, these factors accounted for 61.4% (Nagelkerke R-2) of the variability in success.

Conclusion: These results indicate that app-based treatment effects are better in women who are interested in and have high expectations of such treatment. Also, the findings underline the importance of strengthening the pelvic floor muscles and offering lifestyle advice.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Mobile applications, Pelvic floor muscle training, Stress urinary incontinence, Self-management
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-152224 (URN)10.1007/s00192-017-3514-1 (DOI)000443429400014 ()29222718 (PubMedID)
Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2019-05-16Bibliographically approved
Kokkonen, H., Stenlund, H. & Rantapää-Dahlqvist, S. (2017). Cardiovascular risk factors predate the onset of symptoms of rheumatoid arthritis: a nested case-control study. Arthritis Research & Therapy, 19, Article ID 148.
Open this publication in new window or tab >>Cardiovascular risk factors predate the onset of symptoms of rheumatoid arthritis: a nested case-control study
2017 (English)In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 19, article id 148Article in journal (Refereed) Published
Abstract [en]

Background: Patients with rheumatoid arthritis (RA) are at increased risk of developing cardiovascular disease (CVD). Our aim was to evaluate the impact of factors related to CVD, such as smoking, lipid levels, hypertension, body mass index (BMI) and diabetes, in individuals prior to the onset of symptoms of RA. Methods: A nested case-control study was performed including data from 547 pre-symptomatic individuals (i.e. individuals who had participated in population surveys in northern Sweden prior to onset of symptoms of RA, median time to symptom onset 5.0 (interquartile range 2.0-9.0) years) and 1641 matched controls. Within the survey, health examinations prior to symptom onset were performed, blood samples were analysed for plasma glucose and lipids, and data on lifestyle factors had been collected with a questionnaire. CVD risk factors were extracted and further analysed with conditional logistic regression models for association with subsequent RA development, including hypertension, apolipoprotein (Apo) B/ApoA1 ratio, BMI, diabetes and smoking habits. Results: Smoking and BMI >= 25 (odds ratio (OR) (95% confidence interval (CI)) = 1.86 (1.48-2.35) and OR = 1.28 (1.01-1.62), respectively) were associated with increased risk for future RA development. In women, elevated ApoB/ApoA1 ratio (OR = 1.36 (1.03-1.80)) and smoking (OR = 1.82 (1.37-2.41)) were significantly associated with being pre-symptomatic for RA, whilst in men smoking (OR = 1.92 (1.26-2.92)) and diabetes (OR = 3.62 (95% CI 1.13-11.64)) were significant. In older (> 50.19 years) individuals, only smoking (OR = 1.74 (1.24-2.45)) was significantly associated with increased risk of future RA, whereas in younger individuals the significant factors were elevated ApoB/ApoA1 ratio (OR = 1.39 (1.00-1.93)), BMI >= 25.0 (OR = 1.45 (1.04-2.02)) and smoking (OR = 2.11 (1.51-2.95)). Pre-symptomatic individuals had a higher frequency of risk factors: 41.5% had >= 3 compared with 30.4% among matched controls (OR = 2.81 (1.78-4.44)). Conclusions: Several risk factors for CVD were present in pre-symptomatic individuals and significantly associated with increased risk for future RA. These factors differed in women and men. The CVD risk factors had a greater impact in younger individuals. These results urge an early analysis of cardiovascular risk factors for proposed prevention in patients with early RA.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Rheumatoid arthritis, Cardiovascular disease, Body mass index, Apolipoproteins, Diabetes mellitus, Smoking
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-138558 (URN)10.1186/s13075-017-1351-8 (DOI)000404797300003 ()28666478 (PubMedID)
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2018-06-09Bibliographically approved
Kokkonen, H., Johansson, L., Stenlund, H. & Rantapää-Dahlqvist, S. (2017). Inflammatory Markers in Relation to Risk Factors for Cardiovascular Disease in the Pre-Symptomatic Phase of Rheumatoid Arthritis. Paper presented at 2017 ACR/ARHP Annual Meeting, San Diego, CA, November 3–8, 2017. Arthritis & Rheumatology, 69
Open this publication in new window or tab >>Inflammatory Markers in Relation to Risk Factors for Cardiovascular Disease in the Pre-Symptomatic Phase of Rheumatoid Arthritis
2017 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 69Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background/Purpose: Individuals who later developed rheumatoid arthritis (RA) have increased levels and frequencies of risk factors for cardiovascular disease (CVD), years before onset of RA. The relationships between CVD risk factors and inflammatory markers, i.e., cytokines and chemokines, were analysed in individuals prior to onset of symptoms and compared with controls. Methods: A case-control study was based on population surveys from The Västerbotten Intervention Programme (VIP) and the WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) with data collected on socioeconomic and lifestyle factors, BMI, waist, blood pressure, and blood samples by a nurse. The register of patients with RA (ARA criteria) was co-analysed with the registers from the Medical Biobank and 469 pre-symptomatic individuals (median age 50.2 years; 67.8% women, median predating time 5.0 (IQR; 2.0-8.0) years), and 234 controls (median age 50.3 years; 67.1% women) were identified. CVD risk factors were defined as: hypertension (treatment or systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg), elevated ApoB/ApoA1 ratio (women ≥0.7, men ≥0.8, including lipid lowering treatment), BMI ≥25kg/m2, diabetes, and ever being smoker. Concentrations of eotaxin, interferon gamma-induced protein (IP-10), monocyt-chemoattractant protein 1 (MCP1), macrophage derived chemokine (MDC), interleukin (IL) 2, IL-4, IL-6, IL-8, and IL-10, were analysed in plasma using R&D systems' assays (Minneapolis, MN) according to the manufacturer's instructions. Results: Pre-symptomatic individuals had significantly higher levels of IL-6 compared with controls, both in women and men. IL-10 was significantly higher in pre-symptomatic men compared with controls. Cytokines/chemokines were significantly associated with the CVD risk factors in the cases e.g. IL-6 with each of the risk factors, eotaxin with smoking, IP-10 with increased BMI, being diabetes or having hypertension, whilst MDC was associated significantly with smoking and BMI≥25 kg/m2. After adjustments for sex and age only eotaxin concentrations were significantly associated with being ever smoker. In women, MDC was significantly associated with smoking, BMI≥25 kg/m2 and diabetes. Having the combination of several CVD risk factors was associated with significantly higher concentrations of MCP-1, MDC, and IL-6 in pre-symptomatic women. IL-6 increased further the relative risk in combinations with all CVD risk factors for the pre-symptomatic cases compared with controls. Conclusion: Increased concentrations of cytokines/chemokines were associated with CVD risk factors to a higher extent among the pre-symptomatic RA cases compared with controls. The pattern of association varied between the risk factors and the sex of the cases.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keywords
Cardiovascular disease, cytokines and rheumatoid arthritis (RA)
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-141829 (URN)000411824105196 ()
Conference
2017 ACR/ARHP Annual Meeting, San Diego, CA, November 3–8, 2017
Note

Supplement: 10

Meeting Abstract: 2354

Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2018-09-07Bibliographically approved
Asklund, I., Nyström, E., Sjöström, M., Umefjord, G., Stenlund, H. & Samuelsson, E. (2017). Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourology and Urodynamics, 36(5), 1369-1376
Open this publication in new window or tab >>Mobile app for treatment of stress urinary incontinence: a randomized controlled trial
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2017 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 36, no 5, p. 1369-1376Article in journal (Refereed) Published
Abstract [en]

AIMS: To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women.

METHODS: Randomized controlled trial, conducted 2013-2014 in Sweden. Community-dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow-up. Intervention was the mobile app Tät(®) with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ-UI SF]); and condition-specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]).

RESULTS: One hundred and twenty-three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ-UI SF score 11.1 (SD 2.8) and mean ICIQ-LUTSqol score 34.4 (SD 6.1) at baseline. At follow-up, the app group reported improvements in symptom severity (mean ICIQ-UI SF score reduction: 3.9, 95% confidence interval 3.0-4.7) and condition-specific quality of life (mean ICIQ-LUTSqol score reduction: 4.8, 3.4-6.2) and the groups were significantly different (mean ICIQ-UI SF score difference: -3.2, -4.3to -2.1; mean ICIQ-LUTSqol score difference: -4.6, -7.8 to -1.4). In the app group, 98.4% (60/61) performed PFMT at follow-up, and 41.0% (25/61) performed it daily.

CONCLUSIONS: The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first-line treatment and adherence to PFMT.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
mobile applications, pelvic floor muscle training, randomized controlled trial, self-management, stress urinary incontinence
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-127492 (URN)10.1002/nau.23116 (DOI)000404361100020 ()27611958 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2019-05-16Bibliographically approved
Carlsson, A., Svensson, Å., Anderson, C. D., Baranovskaya, I., Hindsén-Stenström, M., Holt, I., . . . Gånemo, A. (2017). Scoring of hand eczema: good reliability of hand eczema extent score. Acta Dermato-Venereologica, 97(2), 193-197
Open this publication in new window or tab >>Scoring of hand eczema: good reliability of hand eczema extent score
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2017 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 97, no 2, p. 193-197Article in journal (Refereed) Published
Abstract [en]

There is good agreement between dermatological staff and patients using the Hand Eczema Extent Score (HEES). The aim of this study was to assess inter- and intra-observer reliability of the HEES in dermatologists and intra-observer reliability of the HEES in patients with hand eczema. Six dermatologists assessed 18 patients twice. Only the hands of the patients were visible to the assessors. Patients performed a self-assessment twice. Inter- and intra-observer reliability was tested with intraclass correlation coefficient (ICC). The mean HEES score for all dermatologists' assessments was 21.0 (range 3.6-46.3). The corresponding mean scores for all patients' own assessments were 24.9 (range 4.0-54.0). Inter-observer reliability in the dermatologists' observations ICC classification was very good, median value 0.82 (range 0.56-0.92). The overall intra-observer reliability for the 6 dermatologists' ICC classification was very good (range 0.88-0.94). Intra-observer reliability in the patients' 2 self-assessments ICC classification was very good (ICC 0.95). In conclusion, HEES is a reliable tool for both dermatologists and patients to grade the extent of hand eczema.

Keywords
dermatitis, inter-observer reliability, intra-observer reliability, self-assessment, severity
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-127493 (URN)10.2340/00015555-2521 (DOI)000393895500006 ()27563701 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-06-09Bibliographically approved
Lindh, A., Sjöström, M., Stenlund, H. & Samuelsson, E. (2016). Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year. International Urogynecology Journal, 27(12), 1857-1865
Open this publication in new window or tab >>Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year
2016 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 27, no 12, p. 1857-1865Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION AND HYPOTHESIS: The objective was to determine predictors of long-term success in women with stress urinary incontinence (SUI) treated with a 3-month pelvic floor muscle training (PFMT) program delivered via the Internet or a brochure.

METHODS: We included 169 women with SUI ≥1 time/week who completed the 1-year follow-up (n = 169, mean age 50.3, SD 10.1 years). Three outcome variables defined success after 1 year: Patient Global Impression of Improvement (PGI-I), International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), and sufficient treatment. Using logistic regression, we analyzed data from the baseline, and from the 4-month and 1-year follow-ups, for potential predictors of success.

RESULTS: Of the participants, 77 % (129 out of 169) were successful in ≥1 of the outcomes, 23 % (37 out of 160) were successful in all 3. Participants with successful short-term results were more likely to succeed in the corresponding outcome at 1 year than those without successful short-term results (adjusted odds ratios [ORs]: PGI 5.15, 95 % confidence interval [CI] 2.40-11.03), ICIQ-UI SF 6.85 (95 % CI 2.83-16.58), and sufficient treatment 3.78 (95 % CI 1.58-9.08). Increasing age predicted success in PGI-I and sufficient treatment (adjusted OR 1.06, 95 % CI 1.02-1.10, and 1.08, 95 % CI, 1.03-1.13 respectively). Compared with not training regularly, regular PFMT at 1 year predicted success for PGI and sufficient treatment (adjusted OR 2.32, 95 % CI 1.04-5.20, and 2.99, 95 % CI 1.23-7.27 respectively).

CONCLUSION: The long-term success of a non-face-to-face treatment program for SUI with a focus on PFMT can be predicted by successful short-term results, increasing age, and the performance of regular PFMT after 1 year.

Place, publisher, year, edition, pages
Springer London, 2016
Keywords
eHealth, Long-term, Pelvic floor muscle training, Predictors, Self-management, Stress urinary incontinence
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-127494 (URN)10.1007/s00192-016-3050-4 (DOI)000389203200011 ()27260323 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2019-05-20Bibliographically approved
Jutterström, L., Hörnsten, Å., Sandström, H., Stenlund, H. & Isaksson, U. (2016). Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study. Patient Education and Counseling, 99(11), 1821-1829
Open this publication in new window or tab >>Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study
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2016 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 11, p. 1821-1829Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes.

METHODS: 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011.

RESULTS: HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group.

CONCLUSION: Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes.

PRACTICE IMPLICATIONS: It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.

National Category
Endocrinology and Diabetes Nursing
Identifiers
urn:nbn:se:umu:diva-127491 (URN)10.1016/j.pec.2016.06.016 (DOI)000391222100011 ()27372525 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2019-04-26Bibliographically approved
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