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  • 1. Cameron, A J
    et al.
    Zimmet, P Z
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Alberti, K G M M
    Sicree, R
    Tuomilehto, J
    Chitson, P
    Shaw, J E
    The metabolic syndrome as a predictor of incident diabetes mellitus in Mauritius.2007In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 12, p. 1460-1469Article in journal (Refereed)
  • 2. Dahlin, L. B.
    et al.
    Granberg, V.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Rosen, I.
    Dahlin, E.
    Sundkvist, G.
    Disturbed vibrotactile sense in finger pulps in patients with Type 1 diabetes-correlations with glycaemic level, clinical examination and electrophysiology2011In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 28, no 9, p. 1045-1052Article in journal (Refereed)
    Abstract [en]

    Aims In a cohort of men and women with Type 1 diabetes, prospectively followed for > 20 years, vibrotactile sense in fingers was investigated and related to neurophysiological tests, glycaemic level and clinical score. Methods Out of 58 patients, diagnosed at the age of 15-25 years and recruited 1984-1985, 32 patients (13 women, median age 52 years, range 44-75 years; 19 men, median age 52 years, range 39-69 years; median duration 33.5 years, range 21-52 years) accepted follow-up in 2006. Vibration thresholds were measured in finger pulps of index and little fingers bilaterally at seven frequencies and related to results of touch (monofilaments), tactile discrimination (two-point discrimination test), electrophysiology (median nerve function), glycaemic level (HbA(1c) levels since 1984-1985) and a clinical score. Results Vibrotactile sense was reduced in finger pulps, mainly in men, compared with an age-and gender-matched healthy control group with normal HbA(1c). Vibration thresholds were increased, particularly at 250 and 500 Hz, in both index and little finger pulps. Touch and tactile discrimination correlated with vibration thresholds, but not with each other or with electrophysiology. HbA(1c) levels (at follow-up or mean values from five follow-ups since recruitment) did not correlate with any nerve function variables. Clinical scores correlated with vibrotactile sense, particularly at higher frequencies (> 125 Hz), but not with total Z-scores of electrophysiology. Duration of disease did not correlate with any variables. Conclusions Examination of vibration thresholds in index and little finger pulps may be valuable to detect neuropathy, where thresholds correlate with symptoms and tests.

  • 3. Dawed, A. Y.
    et al.
    Franks, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Lund Univ, Dept Clin Sci, Skane Univ Hosp, Genet & Mol Epidemiol Unit,Diabet Ctr, Malmö, Sweden; Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA.
    Walker, M.
    Mari, A.
    Pearson, E. R.
    Determinants of glucagon-like peptide-1 (GLP-1) response in prediabetes and diabetes: an IMI-DIRECT study2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no Special Issue, Meeting Abstract: A15, p. 10-10Article in journal (Other academic)
  • 4.
    Edmundsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Toolanen, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Chronic exertional compartment syndrome in diabetes mellitus2011In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 28, no 1, p. 81-85Article in journal (Refereed)
    Abstract [en]

    Aims  Intermittent claudication is common in diabetes mellitus. However, a proportion of patients with diabetes have symptoms of claudication without signs of vascular disease and these patients were evaluated for chronic exertional compartment syndrome.

    Methods  Forty-two patients with diabetes (10 men, 32 women), earlier investigated at diabetic clinics because of claudication with no explanation for the symptoms, were examined. Their median age was 48 years (18–72 years) and the median duration of diabetes was 29 years (1–45 years). Thirty-one patients had Type 1 diabetes, 11 had Type 2 diabetes and 29 had diabetic complications. All were investigated clinically, with radiography, bone scan and intramuscular pressure measurements.

    Results  Thirty-eight of 42 patients with diabetes were diagnosed with chronic exertional compartment syndrome of the lower leg and 32 were treated surgically. Thirty-one patients were operated with fasciotomy of the anterior compartment and 18 also with fasciotomy of the posterior compartment. Additionally, one patient had only fasciotomy of the posterior compartment. Fourteen of 32 surgically treated patients (27 legs) were followed for more than 2 years and rated the post-operative outcome as excellent or good in 21 of the treated legs. The walking distance before lower leg pain increased in all but one patient and seven patients reported unrestricted walking ability.

    Conclusions  Chronic exertional compartment syndrome should be considered as a differential diagnoses in patients with diabetes and exercise-related lower leg pain. The results after surgery are encouraging and the increased walking ability is beneficial in the treatment of diabetes.

  • 5.
    Fhärm, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Cederholm, Jan
    Family Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Eliasson, Björn
    Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Gudbjörnsdottir, Soffia
    Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Time trends in absolute and modifiable CHD risk in type 2 diabetes patients in the Swedish national diabetes register (NDR) 2003–20082012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 2, p. 198-206Article in journal (Other academic)
    Abstract [en]

    Aims: The aim was to evaluate treatment goal achievements early in the course of Type 2 diabetes, and their effect on 10-year risk of coronary heart disease in patients receiving usual care.

    Methods: Assessment of risk factor control 3 years after diagnosis in patients with Type 2 diabetes with no previous coronary heart disease included from the Swedish National Diabetes Register; a total of 19 382 patients (mean age 58 years) in cross-sectional surveys from 2003 to 2008, and a subgroup of 4293 patients followed individually from year of diagnosis to follow-up after a mean 2.6 years. Estimation of absolute 10-year risk of coronary heart disease using the UK Prospective Diabetes Study risk engine, and modifiable 10-year risk defined as percentage excess risk above patients with normal risk factor values.

    Results: Treatment goals for HbA1c, blood pressure, total and LDL cholesterol were achieved in 78.4, 65.5, 55.6% and 61.0%, respectively, in the cross-sectional survey in 2008, following a trend of generally improved control. In the individually followed patients in the subgroup, mean absolute 10-year coronary heart disease risk increased from 13.7% (men/women 16.9/9.5%) to 14.2 (men/women 17.6/9.6%) (P < 0.001) from year of diagnosis to follow-up after 2.6 years, while mean modifiable risk decreased from 37.7% (men/women 28.6/49.9%) to 19.1% (13.2/26.9%) (P < 0.001 in all).

    Conclusions: A high achievement of treatment goals and a low mean modifiable 10-year coronary heart disease risk was found at the 3-year follow-up, both in the cross-sectional survey in 2008 and in patients individually followed since diagnosis. This indicates the feasibility and significance of early multifactorial risk factor treatment.

  • 6. Gao, W G
    et al.
    Qiao, Q
    Pitkäniemi, J
    Wild, S
    Magliano, D
    Shaw, J
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Zimmet, P
    Chitson, P
    Knowlessur, S
    Alberti, G
    Tuomilehto, J
    Risk prediction models for the development of diabetes in Mauritian Indians2009In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 26, no 10, p. 996-1002Article in journal (Refereed)
    Abstract [en]

    AIMS: To develop risk prediction models of future diabetes in Mauritian Indians. METHODS: Three thousand and ninety-four Mauritian Indians (1141 men, aged 20-65 years) without diabetes in 1987 or 1992 were followed up to 1992 or 1998. Subjects underwent repeated oral glucose tolerance tests and diabetes was diagnosed according to 2006 World Health Organization/International Diabetes Federation criteria. Cox regression models for interval censored data were performed using data from 1544 randomly selected participants. Predicted probabilities for diabetes were calculated and validated in the remaining 1550 subjects. RESULTS: Over 11 years of follow-up, there were 511 cases of diabetes. Among variables tested, family history of diabetes, obesity (body mass index, waist circumference) and glucose were significant predictors of diabetes. Predicted probabilities derived from a simple model fitted with sex, family history of diabetes and obesity ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, area under the receiver operating characteristic (ROC) curve (AROC) of predicted probabilities was 0.62 (95% confidence interval, 0.56-0.68) in men and 0.64 (0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity were 0.72 (0.71-0.74) and 0.47 (0.45-0.49) in men and 0.77 (0.75-0.78) and 0.50 (0.48-0.52) in women, respectively. Addition of fasting plasma glucose (FPG) to the model improved the prediction slightly [AROC curve 0.70 (0.65-0.76) in men, 0.71 (0.67-0.76) in women]. CONCLUSIONS: A diabetes prediction model based on obesity and family history yielded moderate discrimination in Mauritian Indians, which was slightly inferior to the model with the FPG but may be useful in low-income countries to promote identification of people at high risk of diabetes.

  • 7. Garmo, A.
    et al.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Leksell, J.
    "The pump was a saviour for me." 'Patients' experiences of insulin pump therapy2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 6, p. 717-723Article in journal (Refereed)
    Abstract [en]

    Background and aim The present study formed part of a larger study examining the potential long-term effects of glycaemic control and treatment satisfaction in people with Type1 diabetes mellitus who changed from multiple daily insulin injections to insulin pump therapy. Individuals (n=46) who made the transition between May 1999 and February 2004 participated. The aim of the study was to describe experiences of the impact of insulin pump therapy in adults with Type1 diabetes mellitus after >5years' use of an insulin pump. Method During spring 2009, 16 of the individuals were interviewed through a narrative approach on the effects of insulin pump therapy on daily life. The interviews were analysed using content analysis. Results The overarching theme revealed that insulin pump therapy was experienced as both a shackle and a lifeline. Six sub-themes emerged: subjected vs. empowered; dependent vs. autonomous; vulnerable vs. strengthened; routinized vs. flexible; burdened vs. relieved; and stigmatized vs. normalized. Conclusions Users of insulin pump therapy have different views about and experience of having used the technical equipment over years. Both positive and negative views emerged. However, it is difficult to identify any general trends that cover all views and can predict which individuals will be able to manage pump therapy in the best way. Even so, the sub-themes and theme that emerged could be used by physicians and diabetes specialist nurses when counselling and planning educational programmes aimed at supporting self-management among people with insulin pump treatment.

  • 8. Grantham, N. M.
    et al.
    Magliano, D. J.
    Tanamas, S. K.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Schlaich, M. P.
    Shaw, J. E.
    Higher heart rate increases risk of diabetes among men: the Australian Diabetes Obesity and Lifestyle (AusDiab) Study2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 4, p. 421-427Article in journal (Refereed)
    Abstract [en]

    Aims A very limited number of prospective studies have reported conflicting data on the relation between heart rate and diabetes risk. Our aim therefore was to determine in a large, national, population-based cohort if heart rate predicts the development of diabetes. Methods The Australian Diabetes Obesity and Lifestyle study followed up 6537 people over 5years. Baseline measurements included questionnaires, anthropometrics and blood and urine collection. Heart rate was recorded in beats per min (Dinamap). An oral glucose tolerance test was performed at baseline and follow-up, and diabetes was defined using World Health Organization criteria. Results A total of 5817 participants were eligible for analysis, 221 of whom developed diabetes. Compared with participants with a heart rate <60bmin1, those with a heart rate 80bmin1 were more likely to develop diabetes (odds ratio1.89, 95%CI 1.073.35) over 5years, independent of traditional risk factors. This relationship was highly significant, particularly in non-obese men (odds ratio5.61, 95%CI 1.7517.98), but not in their obese counterparts or in women. Conclusions Resting heart rate is associated with an increased risk of diabetes over a 5-year period, particularly among non-obese men. This suggests that sympathetic overactivity may be a contributing factor to the development of diabetes, and that resting heart rate may be useful in predicting risk of Type2 diabetes in non-obese men.

  • 9.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Internal Medicine, Sunderbyn, Luleå, Sweden.
    Patients with diabetes are not more likely to have atypical symptoms when seeking care of a first myocardial infarction: an analysis of 4028 patients in the Northern Sweden MONICA Study2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 7, p. e82-e87Article in journal (Refereed)
    Abstract [en]

    Aim: To describe symptoms of a first myocardial infarction in men and women with and without diabetes.

    Methods: We conducted a population-based study of 4028 people aged 25-74 years, with first myocardial infarction registered in the Northern Sweden Multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) myocardial infarction registry between 2000 and 2006. Symptoms were classified as typical or atypical according to the World Health Organization MONICA manual.

    Results: Among patients with diabetes, 90.1% reported typical symptoms of myocardial infarction; the corresponding proportion among patients without diabetes was 91.5%. In the diabetes group, 88.8% of women and 90.8% of men had typical symptoms of myocardial infarction. No differences were found in symptoms of myocardial infarction between women with and without diabetes or between men with and without diabetes. Atypical symptoms were more prevalent in the older age groups (> 65 years) than in the younger age groups (< 65 years). The increases were approximately equal among men and women, with and without diabetes. Diabetes was not an independent predictor for having atypical symptoms of myocardial infarction.

    Conclusions: Typical symptoms of myocardial infarction were equally prevalent in patients with and without diabetes and there were no sex differences in symptoms among persons with diabetes. Diabetes was not a predictor of atypical symptoms.

    © 2011 The Authors. Diabetic Medicine© 2011 Diabetes UK.

  • 10. Jansson, S P
    et al.
    Fall, K
    Brus, O
    Magnuson, A
    Wändell, P
    Östgren, C-J
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Response to Carlsson et al.: Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 8, p. 1150-1152Article in journal (Refereed)
  • 11. Jansson, S P O
    et al.
    Fall, K
    Brus, O
    Magnuson, A
    Wändell, P
    Östgren, C J
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden2015In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, no 10, p. 1319-1328Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the changes in prevalence and incidence of pharmacologically and non-pharmacologically treated diabetes in Sweden during 2005 to 2013. Methods: We obtained data on gender, date of birth and pharmacologically and non-pharmacologically treated diabetes from national registers for all Swedish residents. Results: During the study period a total of 240 871 new cases of pharmacologically treated diabetes was found. The age-standardized incidence during the follow-up was 4.34 and 3.16 per 1000 individuals in men and women, respectively. A decreasing time trend in incidence for men of 0.6% per year (0.994, 95% CI 0.989-0.999) and for women of 0.7% per year (0.993, 95% CI 0.986-0.999) was observed. The age-standardized prevalence increased from 41.9 and 29.9 per 1000 in 2005/2006 to 50.8 and 34.6 in 2012/2013 in men and women, respectively. This corresponds to an annually increasing time trend for both men (1.024, 95% CI 1.022-1.027) and women (1.019, 95% CI 1.016-1.021). The total age-standardized prevalence of pharmacologically and non-pharmacologically treated diabetes (2012) was 46.9 per 1000 (55.6 for men and 38.8 for women). This corresponds to an annually increasing time trend (2010-2012) for both men (1.017, 95% CI 1.013-1.021) and women (1.012, 95% CI 1.008-1.016). Conclusions: The prevalence of pharmacologically treated diabetes increased moderately during 8 years of follow-up, while the incidence decreased modestly. This is in contrast to the results reported by most other studies. The total prevalence of diabetes (both pharmacologically and non-pharmacologically treated) in Sweden is relatively low, from a global viewpoint.

  • 12.
    Lilja, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Public Health and Clinical Medicine, Sunderby Unit, Umeå University, Umeå, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    A rightward shift of the distribution of fasting and post-load glucose in northern Sweden between 1990 and 2009 and its predictors. Data from the Northern Sweden MONICA study2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 9, p. 1054-1062Article in journal (Refereed)
    Abstract [en]

    Aims

    Most Swedish studies show stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Our aim was to explore trends in glucose distribution in northern Sweden; whether these trends were uniformly distributed throughout the spectrum of glucose concentrations; and to relate trends to traditional risk factors and the obesity-related adipokine leptin.

    Methods

    The project consisted of four cross-sectional surveys between 1990 and 2009, with 7069 participants aged 25–64 years. The overall participation rate was 74.4%. Trend analyses of glucose concentrations along the entire distribution and linear regression in relation to survey years and risk markers were used.

    Results

    Fasting and post-load glucose increased in women (both P < 0.001) and post-load glucose in men (P = 0.004). The increase was seen in most deciles of glucose concentrations. The prevalence of impaired glucose tolerance doubled in women to 14.5% and tripled in men to 10.1% (both P = 0.004). The prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (P < 0.001). The prevalence of diabetes was unchanged—6.4% in 2009. In men, leptin, together with traditional risk factors, explained 7.8 and 10.8% of the variance in fasting (P = 0.008) and post-load (P < 0.001) glucose, respectively.

    Conclusions

    Increasing fasting and post-load glucose concentrations were seen in most deciles of the glucose distribution, indicating a shift in the entire population. Leptin was significantly associated with fasting and post-load glucose in men.

  • 13.
    Lindmark, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
    Bjerle, P
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Eriksson, JW
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Does the autonomic nervous system play a role in the development of insulin resistance?: a study on heart rate variability in first-degree relatives of type 2 diabetes patients and control subjects2003In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 20, no 5, p. 399-405Article in journal (Refereed)
    Abstract [en]

    Aims To investigate dysregulation of the autonomic nervous system as a potential mechanism for early insulin resistance in the development of Type 2 diabetes.

    Methods Thirteen healthy individuals with first-degree relatives with Type 2 diabetes (R) were compared with 14 control subjects without family history of diabetes (C), matched for age, body mass index and sex. An oral glucose tolerance test and a hyperinsulinaemic euglycaemic clamp were performed. Analysis of heart rate variability during rest, controlled breathing, an orthostatic manoeuvre and a standardized physical stress (cold pressor test (CPT)), were used to evaluate the activity of the autonomic nervous system.

    Results Fasting blood glucose, HbA1c and serum insulin were similar in the R and C groups. The M-value, reflecting insulin sensitivity, did not differ significantly between the groups. Total spectral power and high-frequency power were lower in R during controlled breathing (P = 0.05 and P = 0.07, respectively), otherwise there were no significant differences between R and C in heart rate variability. However, low-frequency (LF)/high-frequency (HF) spectral power ratio during CPT, reflecting sympathetic/parasympathetic balance, was negatively associated with insulin sensitivity (r = −0.53, P = 0.006). When all subjects were divided into two groups by the mean M-value, the low M-value group displayed an overall higher LF/HF ratio (P = 0.04). HF power was lower in the low M-value group during controlled breathing and CPT (P = 0.01 and P = 0.03, respectively).

    Conclusion An altered balance of the parasympathetic and sympathetic nervous activity, mainly explained by an attenuated parasympathetic activity, might contribute to the development of insulin resistance and Type 2 diabetes.

  • 14. Ma, J
    et al.
    Möllsten, A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Prázny, M
    Falhammar, H
    Brismar, K
    Dahlquist, G
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Efendic, S
    Gu, H F
    Genetic influences of the intercellular adhesion molecule 1 (ICAM-1) gene polymorphisms in development of Type 1 diabetes and diabetic nephropathy.2006In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 23, no 10, p. 1093-1099Article in journal (Refereed)
    Abstract [en]

    AIM: The intercellular adhesion molecule-1 (ICAM-1) gene is located on chromosome 19p13, which is linked to Type 1 diabetes (T1D). ICAM-1 expression is related to development of T1D and diabetic nephropathy. The present study aims to evaluate the genetic influence of ICAM-1 gene polymorphisms on the development of T1D and diabetic nephropathy. METHODS: Five valid single nucleotide polymorphisms (SNPs) were genotyped in 432 T1D patients (196 patients had diabetic nephropathy) and 187 non-diabetic control subjects by using dynamic allele-specific hybridization (DASH) and pyrosequencing. RESULTS: SNPs rs281432(C/G) and rs5498 E469K(A/G) had high heterozygous indexes. They were significantly associated with T1D [P = 0.026, OR = 1.644 (95% CI 1.138-2.376) and P < 0.001, OR = 2.456 (1.588-3.8)]. Frequencies of the C allele in SNP rs281432(C/G) and the A allele in SNP rs5498 E469K(A/G) increased stepwise from non-diabetic control subjects to T1D patients without diabetic nephropathy and T1D patients with diabetic nephropathy. Further analysis for these two SNPs indicated that T1D patients had increased frequency of the common haplotype C-A, in comparison with non-diabetic control subjects (38.1 vs. 32.1%, P = 0.035). CONCLUSION: The present study provided evidence that SNPs rs281432(C/G) and rs5498 E469K(A/G) in the ICAM-1 gene confer susceptibility to the development of T1D and might also be associated with diabetic nephropathy in Swedish Caucasians.

  • 15.
    Nyström, Lennarth
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    'Dead in bed' in Norway1996In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 13, no 5, p. 495-496Article in journal (Refereed)
  • 16. Okin, PM
    et al.
    Hille, DA
    Wiik, BP
    Kjeldsen, SE
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Dahlöf, B
    Devereux, RB
    In-treatment HDL cholesterol levels and development of new diabetes mellitus in hypertensive patients: the LIFE study2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 10, p. 1189-1197Article in journal (Refereed)
    Abstract [en]

    Aims Although hypertensive patients with low baseline HDL cholesterol levels have a higher incidence of diabetes mellitus, whether changing levels of HDL over time are more strongly related to the risk of new diabetes in hypertensive patients has not been examined.

    Methods Incident diabetes mellitus was examined in relation to baseline and in-treatment HDL levels in 7485 hypertensive patients with no history of diabetes randomly assigned to losartan- or atenolol-based treatment.

    Results During 4.71.2years follow-up, 520 patients (6.9%) developed new diabetes. In univariate Cox analyses, compared with the highest quartile of HDL levels (>1.78mmol/l), baseline and in-treatment HDL in the lowest quartile (<1.21mmol/l) identified patients with >5-fold and >9fold higher risks of new diabetes, respectively; patients with baseline or in-treatment HDL in the 2nd and 3rd quartiles had intermediate risk of diabetes. In multivariable Cox analyses, adjusting for randomized treatment, age, sex, race, prior anti-hypertensive therapy, baseline uric acid, serum creatinine and glucose entered as standard covariates, and in-treatment non-HDL cholesterol, Cornell product left ventricular hypertrophy, diastolic and systolic pressure, BMI, hydrochlorothiazide and statin use as time-varying covariates, the lowest quartile of in-treatment HDL remained associated with a nearly 9-fold increased risk of new diabetes (hazard ratio8.7, 95%CI 5.0-15.2), whereas the risk of new diabetes was significantly attenuated for baseline HDL <1.21mmol/l (hazard ratio3.9, 95%CI 2.8-5.4).

    Conclusions Lower in-treatment HDL is more strongly associated with increased risk of new diabetes than baseline HDL level.

  • 17. Padaiga, Z
    et al.
    Tuomilehto, J
    Karvonen, M
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Podar, T
    Adojaan, B
    Urbonaite, B
    Zalinkevicius, R
    Brigis, G
    Virtala, E
    Kohtamäki, K
    Cepaitis, Z
    Tuomilehto-Wolf, E
    Seasonal variation in the incidence of Type 1 diabetes mellitus during 1983 to 1992 in the countries around the Baltic Sea.1999In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 16, no 9, p. 736-43Article in journal (Refereed)
    Abstract [en]

    The seasonal pattern with two cycles among older children and one cycle only among younger children may indicate different triggers of Type 1 diabetes mellitus for different age groups.

  • 18. Peterson, M.
    et al.
    Pingel, R.
    Lagali, N.
    Dahlin, L. B.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Association between HbA1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 12, p. 1756-1764Article in journal (Refereed)
    Abstract [en]

    Aims: To explore the association between HbA1c and sural nerve function in a group of people with normal glucose tolerance, impaired glucose tolerance or Type 2 diabetes.

    Methods: We conducted a 10-year follow-up study in 87 out of an original 119 participants. At study commencement (2004), 64 men and 55 women (mean age 61.1 years) with normal glucose tolerance (n=39), impaired glucose tolerance (n=29), or Type 2 diabetes (n=51) were enrolled. At the 2014 follow-up (men, n=46, women, n=41; mean age 71.1 years), 36, nine and 42 participants in the normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes categories, respectively, were re-tested. Biometric data and blood samples were collected, with an electrophysiological examination performed on both occasions.

    Results: At follow-up, we measured the amplitude of the sural nerve in 74 of the 87 participants. The mean amplitude had decreased from 10.9 μV (2004) to 7.0 μV (2014; P<0.001). A 1% increase in HbA1c was associated with a ~1% average decrease in the amplitude of the sural nerve, irrespective of group classification. Crude and adjusted estimates ranged from –0.84 (95% CI –1.32, –0.37) to –1.25 (95% CI –2.31, –0.18). Although the mean conduction velocity of those measured at both occasions (n=73) decreased from 47.6 m/s to 45.8 m/s (P=0.009), any association with HbA1c level was weak. Results were robust with regard to potential confounders and missing data.

    Conclusions: Our data suggest an association between sural nerve amplitude and HbA1c at all levels of HbA1c. Decreased amplitude was more pronounced than was diminished conduction velocity, supporting the notion that axonal degeneration is an earlier and more prominent effect of hyperglycaemia than demyelination.

  • 19.
    Schölin, A
    et al.
    Institute of Medical Sciences, Uppsala University, Uppsala.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Arnqvist, H
    Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Bolinder, J
    Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Björk, E
    Institute of Medical Sciences, Uppsala University, Uppsala.
    Berne, C
    Institute of Medical Sciences, Uppsala University, Uppsala.
    Karlsson, F A
    Institute of Medical Sciences, Uppsala University, Uppsala.
    Proinsulin/C-peptide ratio, glucagon and remission in new-onset type 1 diabetes mellitus in young adults2011In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 28, no 2, p. 156-161Article in journal (Refereed)
    Abstract [en]

    Aims After initiation of treatment in Type 1 diabetes, a period with lower insulin requirement often follows, reflecting increased insulin sensitivity and improved insulin secretion. We explored if efficiency of proinsulin processing is associated with the remission phenomenon.

    Methods Seventy-eight patients with new-onset Type 1 diabetes were followed prospectively for 3 years. Daily insulin dosage, HbA(1c) , plasma glucose, proinsulin, C-peptide, glucagon concentrations and islet antibodies were determined at diagnosis and after 3, 6, 9, 12, 18, 24, 30 and 36 months. We studied remission, defined as an insulin dose ≤ 0.3 U kg(-1)  24 h(-1) and HbA(1c) within the normal range, in relation to the above-mentioned variables.

    Results A rise and subsequent decline in plasma proinsulin and C-peptide concentrations was observed. Forty-five per cent of the patients experienced remission at one or more times, characterized by higher proinsulin and C-peptide levels, and lower proinsulin/C-peptide ratios, indicating more efficient proinsulin processing, compared with those not in remission. Non-remission also tended to be associated with higher glucagon values. Patients entering remission were more often men, had higher BMI at diagnosis, but did not differ at baseline with respect to islet antibody titres compared with patients with no remission.

    Conclusions Remissions after diagnosis of Type 1 diabetes were associated with lower proinsulin/C-peptide ratios, suggesting more efficient proinsulin processing, and tended to have lower glucagon release than non-remissions. This indicates that, in remission, the residual islets maintain a secretion of insulin and glucagon of benefit for control of hepatic glucose production.

  • 20. Sparring, V
    et al.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Östman, J
    Wahlström, R
    Burström, K
    Jonsson, PM
    Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 6, p. 784-791Article in journal (Refereed)
    Abstract [en]

    Aims To describe healthcare utilization patterns in young and middle-aged patients with diabetes 1 year and 8 years after diagnosis and to compare with the general population at two time points, 16 years apart.

    Methods Four cohorts with disease duration of 1 year or 8 years were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the 15- to 34-year age group. Control subjects were selected from the population register matched by age, sex and county of residence. A postal questionnaire was sent to the 1983 and 1992 cohorts in 1991 and 1993, and to the 1999 and 2008 cohorts in 2007 and 2009. Nine hundred and thirteen patients with diabetes and 1679 control subjects responded.

    Results One year after diagnosis, 49% of patients with diabetes in the 1992 cohort compared with 4.2% in the 2008 cohort reported visits to departments of internal medicine and endocrinology. A similar pattern was seen 8 years after diagnosis. The use of day care was 45 times higher among patients with diabetes compared with control subjects. Utilization of outpatient hospital care was higher among patients with diabetes compared with control subjects, even when excluding visits to diabetes clinics.

    Conclusions Excess use of health care among patients with diabetes remained 16 years after the first follow-up. Utilization patterns were stable, except for a major decrease in inpatient care 1 year after diagnosis and an increase in day care 8 years after diagnosis. Observed changes probably reflect successive reforming of diabetes care in Sweden.

  • 21. Tabesh, M.
    et al.
    Shaw, J. E.
    Zimmet, P. Z.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
    Kowlessur, S.
    Timol, M.
    Joonas, N.
    Alberti, G. M. M.
    Tuomilehto, J.
    Shaw, B. J.
    Magliano, D. J.
    Meeting American Diabetes Association diabetes management targets: trends in Mauritius2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 12, p. 1719-1727Article in journal (Refereed)
    Abstract [en]

    Aims: To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015. Methods: Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA(1c), blood pressure and LDL cholesterol. Results: In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P <= 0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P= 0.27). Better control of HbA(1c) and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009. Conclusions: In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.

  • 22.
    Toppe, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Ryhov City Hospital, Department of Internal Medicin, Jönköping, Sweden.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Schon, S.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Socio-economic factors influencing the development of end-stage renal disease in people with Type 1 diabetes: a longitudinal population study2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 5, p. 676-682Article in journal (Refereed)
    Abstract [en]

    Aims: The development of end-stage renal disease (ESRD) in Type 1 diabetes is multifactorial. Familial socio-economic factors may influence adherence to and understanding of diabetes treatment, and also general health behaviour. We investigate how parental and personal education level and exposure to low economic status, indicated by the need for income support, influence the development of ERSD caused by Type 1 diabetes.

    Methods: Participants were retrieved from the nationwide Swedish Childhood Diabetes Registry, which was linked to the Swedish Renal Registry, to find people with ESRD caused by Type 1 diabetes, and to Statistic Sweden to retrieve longitudinal socio-economic data on participants and their parents. Data were analysed using Cox regression modelling.

    Results: Of 9287 people with diabetes of duration longer than 14 years, 154 had developed ESRD due to diabetes. Median diabetes duration (range) for all participants was 24.2 years (14.0-36.7 years). Low maternal education ( 12 years) more than doubled the risk of developing ESRD, hazard ration (HR) = 2.9 [95% confidence interval (95% CI): 1.7-4.8]. For people with a low personal level of education HR was 5.7 (3.4-9.5). In an adjusted model, the person's own education level had the highest impact on the risk of ESRD. If at least one of the parents had ever received income support the HR was 2.6 (1.9-3.6).

    Conclusions: Socio-economic factors, both for the parents and the person with diabetes, have a strong influence on the development of ESRD in Type 1 diabetes. It is important for caregivers to give enough support to more vulnerable people and their families.

  • 23.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Uusitalo, U
    Tuomilehto, J
    Shaw, J E
    Zimmet, P Z
    Kowlessur, S
    Pauvaday, V
    Magliano, D J
    High consumption of pulses is associated with lower risk of abnormal glucose metabolism in women in Mauritius2015In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, no 4, p. 513-520Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius.

    METHODS: Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed.

    RESULTS: Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI.

    CONCLUSIONS: High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials.

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