Marit Graue

History of Foot Ulcer Increases Mortality Among Individuals With Diabetes Ten-year follow-up of the Nord-Trøndelag Health Study, Norway

OBJECTIVE To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population. RESEARCH DESIGN AND METHODS This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point. RESULTS During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy. CONCLUSIONS AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes.

Measuring self-reported, health-related, quality of life in adolescents with type 1 diabetes using both generic and disease-specific instruments.

Aims: To describe perceived functional health and well‐being and diabetes‐related impact, worry and satisfaction with life in relation to demographic and clinical variables in a population of adolescents with type 1 diabetes. To compare perceived functional health and well‐being between adolescents with diabetes and a group of healthy controls and to analyse the relationship between generic functional health and well‐being and diabetes‐related impact, worry and satisfaction with life. Methods: A total of 130 adolescents were invited to complete the Child Health Questionnaire (CHQ‐CF87) and the Diabetes Quality of Life (DQOL) questionnaire modified for youths. A total of 115 (88.5%) subjects participated in the study; mean age 14.5 y (SD 1.86), mean duration of diabetes 6.99 y (SD 3.77, range 1–16 y), mean HbA1c 9.3% (SD 1.62, range 6.2–14.0%). Forty‐eight percent of the subjects were girls. Results: When compared with healthy adolescents, subjects with diabetes reported a significantly lower degree of general health. The CHQ‐CF87 scales showed that higher age in adolescents with diabetes was associated with lower scores for mental health (p < 0.001), self‐esteem (p < 0.001), behaviour (p= 0.004) and general health (p < 0.001). Findings from the DQOL questionnaire showed that older adolescents were more worried (p < 0.001), perceived a greater impact of diabetes on daily life (p= 0.008) and lower diabetes‐related life satisfaction (p < 0.001). The scores for girls were lower than those for boys in assessment of mental health (p < 0.001), self‐esteem (p= 0.004) and family cohesion (p= 0.002). Girls also reported a greater impact of diabetes (p= 0.028), more worries (p= 0.001) and less satisfaction with life (p= 0.006) than boys. Neither HbA1c nor other clinical variables could sufficiently explain the variations in DQOL or CHQ‐CF87.

A History of Foot ulcer increases Mortality among Persons with Diabetes. 10-year Follow-up of the Nord-Trøndelag Health Study, Norway

OBJECTIVE To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population. RESEARCH DESIGN AND METHODS This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point. RESULTS During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy. CONCLUSIONS AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes.

Fear of hypoglycaemia in mothers and fathers of children with Type 1 diabetes is associated with poor glycaemic control and parental emotional distress: a population-based study

Diabet. Med. 27, 72–78 (2010)

Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes

OBJECTIVE Emotional problems are common in adults with diabetes, and knowledge about how different indicators of emotional problems are related with glycemic control is required. The aim was to examine the relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with glycosylated hemoglobin (HbA1c). METHODS Of the 319 adults with type 1 diabetes attending the endocrinology outpatient clinic at a university hospital in Norway, 235 (74%) completed the Diabetes Distress Scale, the Problem Areas in Diabetes Survey, the Hospital Anxiety and Depression Scale, and the World Health Organization-Five Well-Being Index. Blood samples were taken at the time of data collection to determine HbA1c. Regression analyses examined associations of diabetes-specific emotional distress, anxiety, depression, and overall well-being with HbA1c. The relationship between diabetes-specific emotional distress and HbA1c was tested for nonlinearity. RESULTS Diabetes-specific emotional distress was related to glycemic control (DDS total: unstandardized coefficient=0.038, P<.001; PAID total: coefficient=0.021, P=.007), but depression, anxiety, and overall well-being were not. On the DDS, only regimen-related distress was independently related to HbA1c (coefficient=0.056, P<.001). A difference of 0.5 standard deviation of baseline regimen distress is associated with a difference of 0.6 in HbA1c. No significant nonlinearity was detected in the relationship between diabetes-specific distress and HbA1c. CONCLUSIONS To stimulate adequate care strategies, health personnel should acknowledge depression and diabetes-specific emotional distress as different conditions in clinical consultations. Addressing diabetes-specific emotional distress, in particular regimen distress, in clinical consultation might improve glycemic control.

Perceived family burden and emotional distress: similarities and differences between mothers and fathers of children with type 1 diabetes in a population-based study.

Haugstvedt A, Wentzel‐Larsen T, Rokne B, Graue M. Perceived family burden and emotional distress: similarities and differences between mothers and fathers of children with type 1 diabetes in a population‐based study.

Diabetes-related emotional distress in adults: reliability and validity of the Norwegian versions of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS).

BACKGROUND Regular assessment of diabetes-related emotional distress is recommended to identify high-risk people with diabetes and to further prevent negative effects on self-management. Nevertheless, psychological problems are greatly under diagnosed. Translating and testing instruments for psychosocial assessment across languages, countries and cultures allow for further research collaboration and enhance the prospect of improving treatment and care. OBJECTIVES To examine the psychometric properties of the Norwegian versions of the Problem Areas in Diabetes Scale and the Diabetes Distress Scale. DESIGN Cross-sectional survey design. SETTINGS A sample comprising adults with diabetes (response rate 71%) completed the Problem Areas in Diabetes Scale and the Diabetes Distress Scale, which were translated into Norwegian with standard forward-backwards translation. PARTICIPANTS The study included 292 participants with type 1 (80%) and type 2 diabetes (20%) aged 18-69 years, 58% males, mean diabetes duration 17.3 years (11.6), mean HbA(1c) 8.2% (1.6). METHODS We used exploratory factor analysis with principal axis factoring and varimax rotation to investigate the factor structure and performed confirmatory factor analysis to test the best fit of a priori-defined models. Convergent and discriminate validity were examined using the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale and demographic and disease-related clinical variables. We explored reliability by internal consistency and test-retest analysis. RESULTS Exploratory factor analysis supported a four-factor model for the Diabetes Distress Scale. Confirmatory factor analysis indicated that the data and the hypothesized model for the Diabetes Distress Scale fit acceptably but not for the Problem Areas in Diabetes Scale. Greater distress assessed with both instruments correlated moderately with lower health-related quality of life and greater anxiety and depression. The instruments discriminated between those having additional health conditions or disabilities, foot problems or neuropathy. Women and participants with higher HbA(1c) levels reported significantly higher diabetes-related emotional distress. CONCLUSIONS The Norwegian versions of the Problem Areas in Diabetes Scale and the Diabetes Distress Scale have satisfactory psychometric properties and can be used to map diabetes-related emotional distress for diagnostic or clinical use. The Diabetes Distress Scale also contributes to identifying sub-domains of distress and seems promising for use in clinical trials.

Health related quality of life after extremely preterm birth: a matched controlled cohort study

BackgroundThe majority of infants born before the last trimester now grow up. However, knowledge on subsequent health related quality of life (HRQoL) is scarce. We therefore aimed to compare HRQoL in children born extremely preterm with control children born at term. Furthermore, we assessed HRQoL in relation to perinatal and neonatal morbidity and to current clinical and sociodemographic characteristics.MethodThe Child Health Questionnaire (CHQ-PF50) and a general questionnaire were applied in a population based cohort of 10 year old children born at gestational age ≤ 28 weeks or with birth weight ≤ 1000 grams in Western Norway in 1991-92 and in term-born controls, individually matched for gender and time of birth. The McNemar test and paired t-tests were used to explore group differences between preterms and matched controls. Paired regression models and analyses of interaction (SPSS mixed linear model) were used to explore potential effects of sociodemographic and clinical characteristics on HRQoL in the two groups.ResultsAll 35 eligible preterm children participated. None had major impairments. Learning and/or attention problems were present in 71% of preterms and 20% of controls (odds ratio (OR): 7.0; 95% confidence interval (CI): 2.2 to 27.6). Insufficient professional support was described by 36% of preterm vs. 3% of control parents (OR: infinite; CI: 2.7 to infinite). Preterms scored lower on eight CHQ-PF50 sub-scales and the two summary scores, boys accounting for most of the deficits in areas of behavior, psychosocial functioning and parental burden. HRQoL was associated with learning and/or attention problems in both preterm and control children, significantly more so in preterms in areas related to health and parental burden. Within the preterm group, HRQoL was mostly unrelated to perinatal and neonatal morbidity.ConclusionsHRQoL for children born extremely preterm, and particularly for boys, was described by parents to be inferior to that of children born at term, and sufficiently poor to affect the daily life of the children and their families. Learning and/or attention problems were reported for a majority of preterms, strongly influencing their HRQoL.

Evaluation of a programme of group visits and computer-assisted consultations in the treatment of adolescents with Type 1 diabetes

Aim  To examine the effects of group visits and computer‐assisted consultations on quality of life and glycaemic control in adolescents with Type 1 diabetes.

The impact of continuous subcutaneous insulin infusion on health-related quality of life in children and adolescents with type 1 diabetes

Aim: To study the impact of continuous subcutaneous insulin infusion (CSII) therapy on health‐related quality of life in children and adolescents with type 1 diabetes. Methods: 31 children and adolescents with poorly regulated type 1 diabetes (mean HbA1c 10.4%, SD 1.8), mean age 14.4 (1.5) y (range 9.7–17.1) and mean diabetes duration of 6.8 (3.2) y (range 1.3–14.6) were consecutively assigned to CSII therapy. Data for generic (CHQ‐CF87) and diabetes‐specific quality of life (DQOL) were obtained before initiating pump therapy and twice during 15 mo of treatment. HbA1c, BMI and episodes of severe hypoglycaemia and ketoacidosis were recorded over 15 mo prior to and 15 mo during pump therapy. Results: Analysis showed improvements on the family activity scale (p=0.041) and change in health score (p=0.042) (CHQ‐CF87). Mean HbA1c decreased from 10.4% (1.8) to 9.0% (0.9) after 3 mo, increasing to 9.6% (1.2) after 15 mo. The number of overweight and obese children increased from 4 and 2 before CSII, to 6 and 3 after 15 mo (IOTF criteria). There was a reduction in severe hypoglycaemia episodes from 43.8 to 5.2 per 100 patient years, but no change in ketoacidosis episodes.