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  • 1.
    Bixo Ottosson, Anna
    et al.
    Department of Internal Medicine, Västmanland County Hospital, Västerås, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Ilvered, Rosita
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Forsander, Gun
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Särnblad, Stefan
    Department of Paediatrics, University Hospital Örebro, Örebro, Sweden.
    Self-care management of type 1 diabetes has improved in Swedish schools according to children and adolescents2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 1987-1993Article in journal (Refereed)
    Abstract [en]

    Aim: Age-appropriate support for diabetes self-care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.

    Methods: This national study was based on questionnaires answered by children and adolescents aged 6–15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015.

    Results: Fewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13–15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001).

    Conclusion: Children and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia. 

  • 2.
    Cerqueiro Bybrant, Mara
    et al.
    Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Udén, Elin
    Lund University, Lund, Sweden.
    Frederiksen, Filippa
    Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Anna L.
    Children Clinic, Halland's Hospital, Halmstad, Sweden.
    Arvidsson, Carl-Göran
    Department of Pediatrics, Västmanland's Hospital, Västerås, Sweden.
    Fureman, Anna-Lena
    Children's clinic, Östersund Hospital, Sweden.
    Forsander, Gun
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Elding Larsson, Helena
    Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
    Ivarsson, Sten A.
    Department of Clinical Sciences, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden.
    Lindgren, Marie
    Department of Clinical Sciences, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden.
    Ludvigsson, Johnny
    Crown Princess Victoria's Children's and Youth Hospital, University Hospital, Linköping, Sweden.
    Marcus, Claude
    Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Pundziute Lyckå, Auste
    Department of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Persson, Martina
    Department of Medicine, Clinical Epidemiology, Karolinska University Hospital, Stockholm, Sweden.
    Samuelsson, Ulf
    Crown Princess Victoria's Children's and Youth Hospital, University Hospital, Linköping, Sweden.
    Särnblad, Stefan
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Örtqvist, Eva
    Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Carlsson, Annelie
    Department of Clinical Sciences, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden.
    Celiac disease can be predicted by high levels of tissue transglutaminase antibodies in children and adolescents with type 1 diabetes2021In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 22, no 3, p. 417-424Article in journal (Refereed)
    Abstract [en]

    Objectives: Children with type 1 diabetes (T1D) are not included in guidelines regarding diagnosis criteria for celiac disease (CD) without a diagnostic biopsy, due to lack of data. We explored whether tissue transglutaminase antibodies (anti-tTG) that were ≥ 10 times the upper limit of normal (10× ULN) predicted CD in T1D. Methods: Data from the Swedish prospective Better Diabetes Diagnosis study was used, and 2035 children and adolescents with T1D diagnosed between 2005–2010 were included. Of these, 32 had been diagnosed with CD before T1D. The children without CD were repeatedly screened for CD using anti-tTG antibodies of immunoglobulin type A. In addition, their human leukocyte antigen (HLA) were genotyped. All children with positive anti-tTG were advised to undergo biopsy. Biopsies were performed on 119 children and graded using the Marsh-Oberhüber classification. Results: All of the 60 children with anti-tTG ≥10x ULN had CD verified by biopsies. The degree of mucosal damage correlated with anti-tTG levels. Among 2003 screened children, 6.9% had positive anti-tTG and 5.6% were confirmed CD. The overall CD prevalence, when including the 32 children with CD before T1D, was 7.0% (145/2035). All but one of the children diagnosed with CD had HLA-DQ2 and/or DQ8. Conclusions: As all screened children and adolescents with T1D with tissue transglutaminase antibodies above 10 times the positive value 10x ULN had CD, we propose that the guidelines for diagnosing CD in screened children, when biopsies can be omitted, should also apply to children and adolescents with T1D as a noninvasive method.

  • 3.
    Kristiansen, E.
    et al.
    Department of Pediatrics, Region Kalmar County, Kalmar, Sweden.
    Wanby, P.
    Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Åkesson, Karin
    Futurum – Academy for Health and Care, Jönköping, Sweden.
    Blomstrand, Peter
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden.
    Brudin, L.
    Department of Clinical Physiology, Region Kalmar County, Kalmar, Sweden.
    Thegerström, J.
    Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Region Västra Götaland County, Gothenburg, Sweden.
    Assessing heart rate variability in type 1 diabetes mellitus—Psychosocial stress a possible confounder2020In: Annals of Noninvasive Electrocardiology, ISSN 1082-720X, E-ISSN 1542-474X, Vol. 5, no 25, article id e12760Article in journal (Refereed)
    Abstract [en]

    Background: Autonomic neuropathy (AN) commonly arises as a long-term complication in diabetes mellitus and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram recordings. Psychosocial stress also affects HRV and could be one of several confounders for cardiac AN. The present work investigated the impact of psychosocial stress on HRV in individuals with type 1 diabetes mellitus (T1DM) and assessed the use of salivary cortisol as a biomarker for psychosocial stress in this context.

    Methods: A total of 167 individuals 6–60 years old (113 with T1DM and 54 healthy controls) underwent 24-hr ECG recordings with HRV analysis. Salivary cortisol was sampled thrice during the registration day. Perceived psychosocial stress along with other factors of possible importance for the interpretation of HRV was documented in a diary.

    Results: Heart rate variability (high-frequency power during sleep) was reduced (p <.05) with older age, longer diabetes duration, higher mean glucose levels, physical inactivity, and perceived psychosocial stress. Salivary cortisol levels in the evening were increased (p <.05) in women in ovulation phase, in individuals with preceding hypoglycemia or with hyperglycemia. The amplitude of salivary cortisol was reduced (p <.05) with the presence of perceived psychosocial stress, but only in adult healthy controls, not in individuals with diabetes.

    Conclusion: Psychosocial stress might be a confounder for reduced HRV when diagnosing cardiac AN in T1DM. Salivary cortisol is, however, not a useful biomarker for psychosocial stress in diabetes since the physiological stress of both hypoglycemia and hyperglycemia seems to overrule the effect of psychosocial stress on cortisol. 

  • 4.
    Nilsson, John
    et al.
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum—Academy for Health and Care, Jönköping County Council .
    Hanberger, Lena
    Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes Research Centre, Linköping University Hospital, Linköping, Sweden.
    High HbA1c at onset cannot be used as a predictor for future metabolic control for the individual child with type 1 diabetes mellitus.2017In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 18, no 8, p. 848-852Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To study how metabolic control at onset of type 1 diabetes correlates to metabolic control and clinical parameters during childhood until transition from pediatric care to adult diabetes care.

    MATERIALS AND METHODS: Data at onset, three months, one, three, and five years after diagnosis and at transition, on HbA1c and clinical parameters, on 8084 patients in the Swedish pediatric quality registry, SWEDIABKIDS, were used. Of these patients, 26% had been referred to adult diabetes care by 2014.

    RESULTS: Children with HbA1c < 72 mmol/mol (8.7%) (20% of patients, low group) at diagnosis continued to have good metabolic control during childhood, in contrast to children with HbA1c > 114 mmol/mol (12.6%) (20% of patients, high group) at diagnosis, who continued to have high HbA1c at follow-up. For the individual, there was no significant correlation between high HbA1c at onset and during follow-up. During follow-up, children in the high group were more often smokers, less physically active, and more often had retinopathy than children in the low group (P < .01, .01, .03 respectively).

    CONCLUSION: High HbA1c at onset was associated with high HbA1c during follow-up on a group level, but it cannot be used as a predictor of future metabolic control on an individual level. These results emphasize the important work done by the diabetes team in the first years after diagnosis. It is important to continuously set high goals for the achievement of tight metabolic control, in order to decrease the risk of microvascular complications.

  • 5.
    Peterson, Anette
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Hanberger, Lena
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatric, County Hospital Ryhov, Jönköping, Sweden.
    Bojestig, Mats
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden.
    Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden2014In: PLOS ONE, E-ISSN 1932-6203, Vol. 9, no 5(e97875), p. 1-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.

    METHODS:

    Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.

    RESULTS:

    All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities.

    CONCLUSIONS:

    By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.

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  • 6.
    Petersson, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Huus, Karina
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Enskär, Karin
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Hanberger, Lena
    Department of Medical and Health Sciences and Division of Nursing, Faculty of Medicine and Health Sciences, Linköping University, Sweden.
    Samulesson, Ulf
    Department of Medicine and Health Sciences, Linköping University, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Academy for Health and Care, Sweden.
    Impact of type 1 diabetes on health-related quality of life among 8–18-year-old children2016In: Comprehensive Child and Adolescent Nursing, ISSN 2469-4207, E-ISSN 2469-4193, Vol. 39, no 4, p. 245-255Article in journal (Refereed)
    Abstract [en]

    Measuring the health-related quality of life (HRQOL) is one way to understand an individual’s perspective on health, and, more specifically, how type 1 diabetes (T1D) affects a child’s everyday life. Early detection of poor HRQOL is considered a crucial factor for identifying children who are at risk of psychosocial problems. The aim of this study was to describe the differences in the HRQOL of children with T1D according to age, gender, and metabolic control (HbA1c). Cross-sectional data were collected from children with T1D using the DISABKIDS Chronic Generic Measure-37 (DCGM-37) and the diabetes specific module (DM-10). Non-parametric tests were used to investigate differences. There were differences between girls and boys, and girls reported lower HRQOL than boys (HRQOL total score: mean 74 and 67 respectively; p = .005). Adolescents described more worries and fears about the future compared with younger children. Children with poor metabolic control reported a lower HRQOL than those with better metabolic control (HRQOL total score:mean 68 and 76 respectively; p = .006), but the social dimensions were not affected. The findings of the present study elucidate the importance for paediatric nurses to explore potential problems in children with T1D and use this knowledge in clinical practice. Assessment of the HRQOL can provide the patient’s perspective on the quality of diabetes care. The HRQOL is correlated with HbA1c, gender, and age, and the HRQOL as well as HbA1c levels should be regularly assessed to establish a comprehensive care for children with T1D.

  • 7.
    Petersson, Christina
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Huus, Karina
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Enskär, Karin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Children's experiences about a structured assessment of health-related quality of life during a patient encounter2016In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 42, no 3, p. 424-432Article in journal (Refereed)
    Abstract [en]

    Background

    It has been stated that care for children with chronic health conditions tends to focus on condition-specific issues rather than how these children experience their health and everyday life functioning.

    Aim

    The aim of this study was to explore children's experiences about a structured assessment of health-related quality of life applied during a patient encounter.

    Methods

    Prior to the start of the study, a clinical intervention based on the questionnaire DISABKIDS Chronic Generic Measure (DCGM-37) was performed. A qualitative explorative design was chosen, and 25 children between 10–17 years of age were interviewed after the consultation at four different paediatric outpatient clinics. Data were analysed according to qualitative content analysis.

    Results

    The results were twofold: children experienced that the assessment was providing them with insights about their health, which motivated them to make lifestyle changes. When outcomes were discussed and requested, the children felt encouraged.

    Conclusions

    The use of an assessment of health-related quality of life may promote insights about health and encourage children with chronic health conditions to discuss their outcomes with healthcare professionals.

  • 8.
    Petersson, Christina
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Huus, Karina
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Enskär, Karin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    To promote child involvement – healthcare professionals' use of a health-related quality of life assessment tool during paediatric encounters2017In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 5, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Children and healthcare professionals should be provided with easy-to-use tools which could lead to actionable results.

    Objectives: There is increasing interest in the use of patient reported outcomes to aid management of individual care; therefore, the use of health-related qualityof life (HRQOL) assessments during consultations need to be studied. The aim of this study was to explore how healthcare professionals use a HRQOL assessment tool during paediatric encounters.

    Design: A descriptive, explorative design with a qualitative approach based on video recordings was chosen.

    Methods: Twenty-one video recordings, from nine different healthcare professionals’ consultations where an assessment tool of HRQOL were used were analysed by content analysis.

    Results: The healthcare professionals were using different strategies and when they combined these strategies three approaches emerged. The instructing approach was characterized by healthcare professionals giving a summary of the results, leading to children becoming passive bystanders in the encounter. Based on an inviting approach, the children’s perceptions of their situation were requested while the items were explored. This resulted in involving the children in the conversations. In the engaging approach, an open dialogue and a common interpretation were sought to guide further care which was interpreted as children becoming actively involved.

    Conclusions: The child’s involvement could be facilitated depending on which approach is being used. When an inviting and engaging approach is used, actions in a non-linear set of interactions is co-produced with the child.

    Relevance to practice: The use of an HRQOL assessment tool change the management during consultations and could promote child involvement dependent on which approach the healthcare professionals are using.

  • 9.
    Ramfelt, Kerstin
    et al.
    Ryhov Hospital, Jönköping, Jönköping, Sweden.
    Petersson, Christina
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Experiences From a Coaching Program for Parents of Children and Adolescents With Type 1 Diabetes Developed Through Experienced-Based Co-Design (EBCD)2020In: Journal of Patient Experience, ISSN 2374-3735, Vol. 7, no 6, p. 1181-1188Article in journal (Refereed)
    Abstract [en]

    Many children and adolescents with type 1 diabetes (T1D) have difficulties reaching the national treatment goal for HbA1c (long-term blood sugar) which is associated with increased risk for complications. This makes it important to explore what patients and their caregivers describe important in coping with everyday life. The study has been conducted within a pediatric diabetes team in the south of Sweden. The aim was to explore how Experienced-Based Co-Design (EBCD) can be used to identify, test, and evaluate improvement efforts in order to support the family with a child with T1D. A modified variant of EBCD based on focus groups, workshops, and interviews with stakeholders was used. The improvement proposal parental coaching was tested and was appreciated by the participants. The qualitative content analysis of the interviews showed that the coaching program contributed to better confidence and self-efficacy. Both coaches and coachees described that the coaching contributed to better competence and a feeling of hope after attending the coach program. Experienced-Based Co-Design gave an opportunity to explore what?s important to improve, based on experiences and needs of several stakeholders.

  • 10.
    Samuelsson, Ulf
    et al.
    Linköping University, Linköping, Sweden.
    Lindell, Nina
    Linköping University, Linköping, Sweden.
    Bladh, Marie
    Linköping University, Linköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Carlsson, Annelie
    Lund University, Lund, Sweden.
    Josefsson, Ann
    Linköping University, Linköping, Sweden.
    Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish population-based study2015In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no 11, p. 2517-2524Article in journal (Refereed)
    Abstract [en]

    Aims/hypothesis Some studies have revealed a relationship between Caesarean section (CS) and type 1 diabetes, while other studies have not. By using the Swedish paediatric quality register we investigated whether birth by CS is related to the risk of developing type 1 diabetes during childhood. Methods All children diagnosed with type 1 diabetes from 2000 to 2012 and included in the register (n= 9,376) were matched with four controls by year, day of birth, sex and county of birth from the Swedish Medical Birth Register. Results Overall, 13.5% of deliveries were by CS. By group, 14.7% of children who developed type 1 diabetes were delivered by CS compared with 13.3% of control children (p < 0.001). Mothers with diabetes more often gave birth by CS than mothers without diabetes (78.8% vs 12.7%, p < 0.001). In a logistic regression model adjusting for maternal age, maternal diabetes and BMI in early pregnancy, the OR for CS was 1.0. A child who developed type 1 diabetes and had a mother with type 1 diabetes at the time of delivery had the highest OR to have been born by CS. Children of mothers without diabetes, delivered by CS, had no increased risk of developing type 1 diabetes. Maternal diabetes was the strongest predictor of childhood diabetes (OR 3.4), especially if the mother had type 1 diabetes (OR 7.54). Conclusions/interpretation CS had no influence on the risk of type 1 diabetes during childhood or adolescence. However, maternal diabetes itself strongly increased the risk of offspring developing type 1 diabetes.

  • 11.
    Samuelsson, Ulf
    et al.
    Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes, Research Centre, Linköping University, Linköping, Sweden.
    Westerberg, Lars
    IFM Biology, Linköping University, Linköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
    Birkebæk, Niels H.
    Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
    Bjarnason, Ragnar
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Drivvoll, Ann K.
    Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Skrivarhaug, Torild
    Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Svensson, Jannet
    Herlev University Hospital, CPH-Direct, Pediatric Department, Herlev, Denmark & University of Copenhagen, Faculty of Health and Medical Science, Copenhagen, Denmark.
    Thorsson, Arni
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Hanberger, Lena
    Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden.
    Geographical variation in the incidence of type 1 diabetes in the Nordic countries: A study within NordicDiabKids2020In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 21, no 2, p. 259-265Article in journal (Refereed)
    Abstract [en]

    Background: The incidence of type 1 diabetes (T1D) is high in the Nordic countries with geographic differences between as well as within countries. Objective: To describe the geographical distribution of the incidence of T1D among children in four Nordic countries, an area where the population is considered genetically similar.

    Methods: Data on children 0 to 14 years of age and diagnosed with T1D 2006 to 2011 was collected from four Nordic national pediatric quality diabetes registries. Data included year of diagnosis (2006-2011), sex, and age at diagnosis. Figures for number of children at risk during 2006 to 2011—as well as total population, proportion with foreign background and size of populated areas of geographic regions—were collected from official statistics.

    Results: The total incidence during the study period for all four countries was 35.7/100 000 person years but differed between the countries (range 18.2-44.1; P <.001). The incidence difference between the countries was most obvious in the highest age group, 10 to 14 years of age, whereas there was no difference in the youngest age group 0 to 5 years of age. Iceland had similar incidence in the entire country, whereas the other countries had areas with different incidence. Densely populated areas, such as major cities, had the lowest incidence.

    Conclusion: The incidence of T1D differed between the Nordic countries and also between the neighboring countries and generally decreased with population density. This indicates that environmental factors may contribute to the level of incidence of T1D.

  • 12.
    Samuelsson, Ulf
    et al.
    Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.
    Peterson, Anette
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Hanås, Ragnar
    The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Sweden.
    Hanberger, Lena
    Division of Nursing, Department of Medicine and Health Sciences, Linköping University, Sweden.
    Continued improvement of metabolic control in Swedish pediatric diabetes care.2018In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 1, p. 150-157Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To prospectively investigate if the grand mean HbA1c and the differences in mean HbA1c between centers in Sweden could be reduced, thereby improving care delivered by pediatric diabetes teams.

    METHODS: We used an 18-month quality improvement collaborative (QIC) together with the Swedish pediatric diabetes quality registry (SWEDIABKIDS). The first program (IQ-1), started in April 2011 and the second (IQ-2) in April 2012; together they encompassed 70% of Swedish children and adolescents with diabetes.

    RESULTS: The proportion of patients in IQ-1 with a mean HbA1c <7.4% (57 mmol/mol) increased from 26.4% before start to 35.9% at 36 months (P < .001), and from 30.2% to 37.2% (P < .001) for IQ-2. Mean HbA1c decreased in both participating and non-participating (NP) centers in Sweden, thereby indicating an improvement by a spatial spill over effect in NP centers. The grand mean HbA1c decreased by 0.45% (4.9 mmol/mol) during 36 months; at the end of 2014 it was 7.43% (57.7 mmol/mol) (P < .001). A linear regression model with the difference in HbA1c before start and second follow-up as dependent variable showed that QIC participation significantly decreased mean HbA1c both for IQ-1 and IQ-2. The proportion of patients with high HbA1c values (>8.7%, 72 mmol/mol) decreased significantly in both QICs, while it increased in the NP group.

    CONCLUSIONS: The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.

  • 13.
    Tompa, Andrea
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. Division of Diagnostics, Region Jönköping County, Jönköping, Sweden.
    Åkesson, Karin
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Karlsson, Sandra
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Faresjö, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Suppressed immune profile in children with type 1 diabetes in combination with celiac disease2019Conference paper (Refereed)
    Abstract [en]

    Introduction: Cytokines, chemokines, acute phase proteins (APP), adipocytokines and matrix metalloproteinases (MMP) are involved in different pathophysiological processes of inflammatory character. The role of the different immune markers and the peripheral immunoregulatory milieu in children diagnosed with type 1 diabetes (T1D) in combination with celiac disease (CD) is not fully understood and is not well studied. The purpose of the present study was therefore to acquire more knowledge and to gain deeper understanding on peripheral immunoregulatory milieu in children with T1D and/or CD.

    Methods: The study included children diagnosed with T1D in combination with CD (n=18), children with T1D (n=27) or CD (n=16), and reference children (n=42).

    Blood samples were collected, and serum stored in -80°C until analysis, avoiding multiple freeze-thaw cycles. The inflammatory cyto/chemokines (IL-1β, -5, -6, -8, -9, -10, -13, -15, -17A, -22, -25, -33, IFN-γ, TNF-α, G-CSF, MCP-1, MIP-1α, MIP-1β), diabetes related immune markers (visfatin, resistin), APP (procalcitonin (PTC), ferritin, tissue protein activator, fibrinogen, serum amyloid A) and matrix metalloproteinases (MMP-1, -2, -3) were analyzed with Luminex technique using Bio-Plex assays. Hierarchical cluster analysis was used to identify similarities/differences in immune profiles between children with double diagnosis and children with single diagnosis and reference children. Mann-Whitney U test was used for comparison of the different diagnosis groups within the clusters and whole cohort, respectively.

    Results: The largest cluster included 75% of the participants and the diagnose distribution in the cluster were very similar to the distribution in the whole study cohort. The remaining 25% were divided in two smaller clusters representing 15.5% and 6.5% respectively. The major finding of this study showed that children with double diagnosis had (1) lower serum levels of IL-22, MCP-1, PCT, visfatin and MMP-2 compared to children with T1D; and (2) lower serum levels of the APC associated chemokine MIP-1α compared to reference children, observed in the main cluster. Most of these observations were also seen in the whole cohort.  

    Conclusion: Our observations indicate decreased serum levels of IL-22, MIP-1α, MCP-1, PCT, visfatin and MMP-2 in children diagnosed with T1D in combination with CD. These results indicate a suppressed immune profile including Th17 cytokines, chemokines, acute phase proteins, diabetes-related and matrix metalloproteinase immune markers. Functional studies of the involved immune cells (CD4+ Treg, CD8+ Treg, NK-cells and dendritic cells) could contribute to elucidate the heterogeneous immunological processes in children with more than one autoimmune disease.

    Download full text (pdf)
    Poster
  • 14.
    Åkesson, Karin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Ryhov City Hospital, Jönköping.
    Hanberger, Lena
    Linköping University Hospital.
    Samuelsson, Ulf
    Linköping University Hospital.
    The influence of age, gender, insulin dose, BMI, and blood pressure on metabolic control in young patients with type 1 diabetes2015In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 16, no 8, p. 581-586Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore the relationship between certain clinical variables and metabolic HbA1c at diagnosis correlated to HbA1c at follow-up (p < 0.001). There was a clear gender difference regarding HbA1c. Girls had higher values both at diagnosis and at follow-up (p < 0.001). Girls also had lower BMI and pH at diagnosis than boys (p < 0.001). In contrast, girls with the highest body mass index (BMI) at follow-up had higher mean HbA1c at follow-up in 2010 (p < 0.001). Having a mother and/or a father with high BMI implied higher HbA1c at diagnosis (p < 0.003).

    Conclusions

    HbA1c at diagnosis seems to predict metabolic control years later. There is a gender difference at diagnosis as female patients have higher HbA1c than males at diagnosis as well as at follow up. As metabolic control is very much correlated to complications there is a need to early identify patients at risk of poor metabolic control. Even though we do not know whether a high HbA1c level is mainly due to severity of the disease or to behavioral patterns, new ways to treat and support these children, especially girls, are needed.

  • 15.
    Åkesson, Karin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatrics, Ryhov County Hospital; Futurum – the Academy for Health and Care in Jönköping County Council.
    Tompa, Andrea
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. Futurum – the Academy for Health and Care in Jönköping County Council; Division of Medical Diagnostics, Ryhov County Hospital.
    Rydén, A
    Faresjö, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. Futurum – the Academy for Health and Care in Jönköping County Council; Division of Medical Diagnostics, Ryhov County Hospital.
    Low expression of CD39+/CD45RA+ on regulatory T cells (Treg) cells in type 1 diabetic children in contrast to high expression of CD101+/CD129+ on Treg cells in children with coeliac disease2015In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 180, no 1, p. 70-82Article in journal (Refereed)
    Abstract [en]

    Type 1 diabetes (T1D) and coeliac disease are both characterized by an autoimmune feature. As T1D and coeliac disease share the same risk genes, patients risk subsequently developing the other disease. This study aimed to investigate the expression of T helper (Th), T cytotoxic (Tc) and regulatory T cells (Treg) in T1D and/or coeliac disease children in comparison to healthy children. Subgroups of T cells (Th:CD4+ or Tc:CD8+); naive (CD27+CD28+CD45RA+CCR7+), central memory (CD27+CD28+CD45RA-CCR7+), effector memory (early differentiated; CD27+CD28+CD45RA-CCR7- and late differentiated; CD27-CD28-CD45RA-CCR7-), terminally differentiated effector cells (TEMRA; CD27-CD28-CD45RA+CCR7-) and Treg (CD4+CD25+FOXP3+CD127-) cells, and their expression of CD39, CD45RA, CD101 and CD129, were studied by flow cytometry in T1D and/or coeliac disease children or without any of these diseases (reference group). Children diagnosed with both T1D and coeliac disease showed a higher percentage of TEMRA CD4+ cells (P<0·05), but lower percentages of both early and late effector memory CD8+ cells (P<0·05) compared to references. Children with exclusively T1D had lower median fluorescence intensity (MFI) of forkhead box protein 3 (FoxP3) (P<0·05) and also a lower percentage of CD39+ and CD45RA+ within the Treg population (CD4+CD25+FOXP3+CD127-) (P<0·05). Children with exclusively coeliac disease had a higher MFI of CD101 (P<0·01), as well as a higher percentage of CD129+ (P<0·05), in the CD4+CD25hi lymphocyte population, compared to references. In conclusion, children with combined T1D and coeliac disease have a higher percentage of differentiated CD4+ cells compared to CD8+ cells. T1D children show signs of low CD39+/CD45RA+ Treg cells that may indicate loss of suppressive function. Conversely, children with coeliac disease show signs of CD101+/CD129+ Treg cells that may indicate suppressor activity.

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