Search

Supplemental Material, sj-pdf-1-dvr-10.1177_14791641211067418 for Real-world study of flash glucose monitoring among adults with type 2 diabetes within the Swedish National Diabetes Register by Katarina Eeg-Olofsson, Ann-Marie Svensson, Stefan Franzén, Hodan Ahmed Ismail, Michael Törnblom, and Fleur Levrat-Guillen in Diabetes and Vascular Disease Research

Additional file 1. Additional figures and tables.

Background: \ud Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM).\ud \ud Methods and Results: \ud In this register‐based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux‐en‐Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux‐en‐Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m2. The follow‐up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19–0.38), 41% for AF (HR, 0.59; CI, 0.44–0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12–0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12–0.43).\ud \ud Conclusions: \ud Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF.

Additional file 1: Table S1. Clinical characteristics of 24 male patients with type 2 diabetes who underwent a hyperinsulinaemic clamp procedure (CLAMP) and its comparison with estimated glucose disposal rate (eGDR) based on waist (eGDRwaist) and BMI (eGDRBMI), respectively. Table S2. 9th and 10th revision of international Classification of Diseases Codes (ICD-codes). Table S3. Hellers R2 (a measure of explained variance) calculated for HbA1c, waist, BMI and hypertension used as single main effects predictors in the Cox regression models (2). Table S4. Baseline characteristics of 205 482 patients with type 2 diabetes mellitus categorised in 4 groups of estimated glucose disposal rate (eGDR) based on BMI (eGDRBMI). Table S5. Event rates and relative risks for stroke, ischaemic stroke and haemorrhagic stroke, respectively, in 205 482 people with type 2 diabetes, stratified into four groups, depending on estimated glucose disposal rate (eGDR). Table S6. Event rates and relative risks unadjusted and adjusted for all-cause mortality and cardiovascular mortality in 205 482 people with type 2 diabetes, stratified into four groups, depending on estimated glucose disposal rate (eGDRBMI). Figure S1. Spearman association curves (r-value) between M-values for the hyperinsulinemic clamp (X-axis) and estimated glucose disposal rate (y-axis) based on waist (eGDRwaist) and BMI (eGDRBMI) top and bottom, respectively. Figure S2. Flowchart for the studied group. Figure S3. Adjusted hazard ratio (solid line) and 95% confidence intervals (dashed lines) for the association between baseline eGDR and stroke. The baseline eGDR level was modelled with restricted cubic splines in a Cox regression model adjusted for sex and age. Figure S4. Fully adjusted hazard ratios for stroke; on insulin treatment and not on insulin treatment, divided into all stroke (ischaemic and haemorrhagic stroke), ischaemic and haemorrhagic stroke, respectively in 104 697 individuals with type 2 diabetes according to eGDR (Reference eGDR

Additional file 1: Table S1. Codes of International Classification of Diseases, 9th Revision and 10th Revision for the outcomes assessed. Table S2. Crude number of events and event rate (events per 100 patient-years) according to quartiles of body weight variability for all the outcomes assessed.

Objectives/Interrogation: To evaluate if diabetes affects outcome after surgical treatment for cubital tunnel syndrome. Methods: Data from the National Quality Register for hand surgery procedures (HAKIR) were combined with data from the Swedish National Diabetes Register (NDR) to evaluate[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Supplemental Digital Content is available in the text., Background: Individuals with type 1 diabetes mellitus (T1DM) have a high risk of cardiovascular complications, but it is unknown to what extent fulfilling all cardiovascular treatment goals is associated with residual risk of mortality and cardiovascular outcomes in those with T1DM compared with the general population. Methods: We included all patients ≥18 years of age with T1DM who were registered in the Swedish National Diabetes Register from January 1, 1998, through December 31, 2014, a total of 33 333 patients, each matched for age and sex with 5 controls without diabetes mellitus randomly selected from the population. Patients with T1DM were categorized according to number of risk factors not at target: glycohemoglobin, blood pressure, albuminuria, smoking, and low-density lipoprotein cholesterol. Risk of all-cause mortality, acute myocardial infarction, heart failure hospitalization, and stroke was examined in relation to the number of risk factors at target. Results: The mean follow-up was 10.4 years in the diabetes group. Overall, 2074 of 33 333 patients with diabetes mellitus and 4141 of 166 529 controls died. Risk for all outcomes increased stepwise for each additional risk factor not at target. Adjusted hazard ratios for patients achieving all risk factor targets compared with controls were 1.31 (95% confidence interval [CI], 0.93–1.85) for all-cause mortality, 1.82 (95% CI, 1.15–2.88) for acute myocardial infarction, 1.97 (95% CI, 1.04–3.73) for heart failure hospitalization, and 1.17 (95% CI, 0.51–2.68) for stroke. The hazard ratio for patients versus controls with none of the risk factors meeting target was 7.33 (95% CI, 5.08–10.57) for all-cause mortality, 12.34 (95% CI, 7.91–19.48) for acute myocardial infarction, 15.09 (95% CI, 9.87–23.09) for heart failure hospitalization, and 12.02 (95% CI, 7.66–18.85) for stroke. Conclusions: A steep-graded association exists between decreasing number of cardiovascular risk factors at target and major adverse cardiovascular outcomes among patients with T1DM. However, risks for all outcomes were numerically higher for patients with T1DM compared with controls, even when all risk factors were at target, with risk for acute myocardial infarction and heart failure hospitalization statistically significantly higher.

Introduction The incidence of type 2 diabetes mellitus (T2DM) is increasing, in parallel with the epidemic of obesity. Although bariatric surgery, which profoundly affects T2DM, has increased 10-fold since the millennium, only a fraction of diabetics is offered this treatment option. Objective To investigate the association between clinical and socioeconomic factors in selecting patients with T2DM for bariatric surgery in a publicly financed healthcare system. Research design and methods Cohort study using prospectively registered data from two nationwide quality registers, the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish National Diabetes Register (NDR), and data from two government agencies. An age, gender and body mass index-matched case-control analysis containing 10 642 patients with T2DM was performed. Results Patients with T2DM having bariatric surgery had a higher education level (upper secondary school or college level, OR 1.42% and 95% CI (1.29 to 1.57) and 1.33 (1.18 to 1.51), respectively) as well as a higher income (OR 1.37 (1.22 to 1.53) to 1.94 (1.72 to 2.18) for quartile 2–4) than non-operated patients. Operated patients were more often married or had been married (OR 1.51 (1.37 to 1.66) and 1.65 (1.46 to 1.86), respectively) as well as natives (OR 0.84 (0.73 to 0.95) if born in the rest of Europe). Groups did not differ regarding relevant laboratory data and present medication, nor in former in-patient diagnoses. Conclusion Despite similar clinical data, superior socioeconomic status was associated with increased rate of bariatric surgery in patients with T2DM. We believe that this warrants actions, for example concerning referral patterns.

Objective To assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice. Design Cohort study using an active comparator, new user design and nationwide register data. Setting Sweden, Denmark, and Norway, 2013-18. Participants Cohort of 29 887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29 887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years. Exposures SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat. Main outcome measures The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome. Results The mean age of the study population was 61.3 (SD 10.5) years; 11 108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years; hazard ratio 0.42 (95% confidence interval 0.34 to 0.53); absolute difference-3.6 (-4.4 to-2.8) events per 1000 person years). In secondary outcome analyses, the hazard ratio for use of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors was 0.32 (0.22 to 0.47) for renal replacement therapy, 0.41 (0.32 to 0.52) for hospital admission for renal events, and 0.77 (0.26 to 2.23) for death from renal causes. In sensitivity analyses in each of the Swedish and Danish parts of the cohort, the model was further adjusted for glycated haemoglobin and estimated glomerular filtration rate (Sweden and Denmark) and for blood pressure, body mass index, and smoking (Sweden only); in these analyses, the hazard ratio moved from 0.41 (0.26 to 0.66) to 0.50 (0.31 to 0.81) in Sweden and from 0.42 (0.32 to 0.56) to 0.55 (0.41 to 0.74) in Denmark. Conclusions In this analysis using nationwide data from three countries, use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a significantly reduced risk of serious renal events.

Objectives Long-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications. Design This is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases. Setting After merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models. Participants We identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18–65 years, with BMI >27.5 kg/m² and followed for up to 9 years. Primary and secondary outcome measures We assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions. Results The results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group. Conclusions This nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.

BACKGROUND: We compared individuals with type 1 diabetes (T1D) to matched controls in order to examine how age at diagnosis of T1D relates to excess mortality and cardiovascular (CV) risk. METHODS: We studied 27,195 persons with T1D in the Swedish National Diabetes Registry, and 135,178 matched controls from the general population. Using Cox regression, and with adjustment for diabetes duration, we estimated excess risk of all-cause mortality, CV mortality, non-CV mortality, acute myocardial infarction (AMI), stroke, CVD (AMI and stroke), coronary heart disease (CHD), heart failure (HF) and atrial fibrillation (AF). Individuals with T1D were categorized into five groups, according to age at diagnosis: 0–9, 10–14, 15–19, 20–24 and 25–30 years. FINDINGS: A total of 27,195 persons with T1D and 135,178 controls were included; 924 persons with T1D and 1,405 controls died during follow-up, of which median was 10 years. Patients who developed T1D at 0–10 years of age displayed hazard ratios (95% CI) of 4.11 (3.24–5.22) for death, 7.38 (3.65–14.94) for CV death, 11.44 (7.95–16.44) for CVD, 30.50 (19.98–46.57) for CHD, 30.95 (17.59–54.45) for AMI, 6.45 (4.04–10.31) for stroke, 12.90 (7.30–22.51) for HF and 1.17 (0.62–2.20) for AF. Corresponding figures for those who developed T1D in the age-range 26–30 were 2.83 (2.38–3.37) for death, 3.64 (2.34–5.66) for CV death, 3.85 (3.05–4.87) for CVD, 6.08 (4.71–7.84) for CHD, 5.77 (4.08–8.16) for AMI, 3.22 (2.35–4.42) for stroke and 5.07 (3.55–7.22) for HF; hence excess risk differed up to 5-fold across the diagnosis age. The highest overall incidence rate, noted for all-cause mortality, was 1.9 (95% CI 1.71 to 2.11) per 100.000 person-years for patients with T1D. Developing T1D before 10 years of age resulted in a loss of 17.7 and 14.2 life years for women and men, respectively, whereas years lost were 10.1 and 9.4 in those diagnosed between 26-30 years of age. INTERPRETATION: Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in females. Greater focus on cardioprotection maybe warranted in those with early onset T1D. FUNDING: Swedish Heart and Lung Foundation

Objective: Type 2 diabetes is strongly associated with obesity, but the mortality risk related to elevated body weight in people with type 2 diabetes compared with people without diabetes has not been established.\ud Research Design and Methods: We prospectively assessed short- and long-term mortality in people with type 2 diabetes with a recorded diabetes duration ≤5 years identified from the Swedish National Diabetes Registry between 1998 and 2012 and five age- and sex-matched control subjects per study participant from the general population.\ud Results: Over a median follow-up of 5.5 years, there were 17,546 deaths among 149,345 patients with type 2 diabetes (mean age 59.6 years [40% women]) and 68,429 deaths among 743,907 matched control subjects. Short-term all-cause mortality risk (≤5 years) displayed a U-shaped relationship with BMI, with hazard ratios (HRs) ranging from 0.81 (95% CI 0.75-0.88) among patients with diabetes and BMI 30 to

Objectives To analyse the association between refill adherence to lipid-lowering medications, and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes mellitus. Design Cohort study. Setting National population-based cohort of Swedish patients with type 2 diabetes mellitus. Participants 86 568 patients aged ≥18 years, registered with type 2 diabetes mellitus in the Swedish National Diabetes Register, who filled at least one prescription for lipid-lowering medication use during 2007–2010, 87% for primary prevention. Exposure and outcome measures Refill adherence of implementation was assessed using the medication possession ratio (MPR), representing the proportion of days with medications on hand during an 18-month exposure period. MPR was categorised by five levels (≤20%, 21%–40%, 41%–60%, 61%–80% and >80%). Patients without medications on hand for ≥180 days were defined as non-persistent. Risk of CVD (myocardial infarction, ischaemic heart disease, stroke and unstable angina) and mortality by level of MPR and persistence was analysed after the exposure period using Cox proportional hazards regression and Kaplan-Meier, adjusted for demographics, socioeconomic status, concurrent medications and clinical characteristics. Results The hazard ratios for CVD ranged 1.33–2.36 in primary prevention patients and 1.19–1.58 in secondary prevention patients, for those with MPR ≤80% (p

The reasons underlying a greater association of premature mortality with early-onset type 2 diabetes relative to late-onset disease are unclear. We evaluated the clinical characteristics at type 2 diabetes diagnosis and the broad trajectories in cardiometabolic risk factors over the initial years following diagnosis in relation to age at diagnosis.Our cohort consisted of 100,606 individuals with newly diagnosed type 2 diabetes enrolled in the Swedish National Diabetes Register from 2002 to 2012. The average follow-up time was 2.8 years. Analyses were performed using a linear mixed-effects model for continuous risk factors and a mixed generalised linear model with a logistic link function for dichotomous risk factors.The individuals diagnosed at the youngest age (18-44 years) were more often male and had the highest BMI (mean of 33.4 kg/mIndividuals who develop type 2 diabetes at a younger age are more frequently obese, display a more adverse lipid profile, have higher HbA

Aims/hypothesis: An excess cancer incidence of 20-25% has been identified among persons with diabetes, most of whom have type 2 diabetes. We aimed to describe the association between type 1 diabetes and cancer incidence.Methods: Persons with type 1 diabetes were identified from five nationwide diabetes registers: Australia (1997-2008), Denmark (1995-2014), Finland (1972-2012), Scotland (1995-2012) and Sweden (1987-2012). Linkage to national cancer registries provided numbers of incident cancers in people with type 1 diabetes and the general population. We used Poisson-models adjusting for age and start of follow-up to estimate rate ratios for cancer overall and for specific sites.Results: A total of 9,149 cancers occurred among persons with type 1 diabetes during 3.9 million person-years. Median age at cancer diagnosis was 51.1 years (IQR: 43.5, 59.5). The RRs associated with type 1 diabetes for all cancers combined were 1.01 (95% CI: 0.98, 1.04) among men (M) and 1.07 (1.04, 1.10) among women (F). RRs were increased for cancer of the stomach (RR=1.23 [1.04, 1.46] (M), 1.78 [1.49, 2.13] (F)), liver (RR=2.00 [1.67, 2.40] (M), 1.55 [1.14, 2.10] (F)), pancreas (RR=1.53 [1.30, 1.79] (M) 1.25 [1.02,1.53] (F)), endometrium (RR=1.42 [1.27,1.58]) and kidney (RR=1.30 [1.12,1.49] (M), 1.47 [1.23, 1.77] (F)). Reduced RRs were found for cancer of the prostate (RR: 0.56 [0.51, 0.61]) and breast (RR=0.90 [0.85, 0.94]). Cancer incidence declined with increasing diabetes duration.Conclusion: Type 1 diabetes was associated with differences in risk of several common cancers and the strength of the associations varied by duration of diabetes.

Det övergripande syftet med avhandlingen var att utforska, beskriva och förstå äldre människors upplevelser och erfarenheter av välbefinnande utifrån intervjuer och berättelser, berättade på plats (insitu) vid särskilt boende för äldre (så kallat äldreboende). Intervjuer genomfördes med tjugo äldre personer inom boendeformen äldreboende, vilkas erfarenheter och berättelser ligger till grund för avhandlingens resultat. Studiedesignen är kvalitativ. Vid intervjuerna användes dels formen av vardagligt samtal (studie I) vilket analyserades enligt innehållsanalys, dels narrativ metod (studie II) vilken analyserades med hjälp av dialogisk performativ analys. Substantiellt bidrar avhandlingen till förståelse av hur äldremänniskor som bor på äldreboende upplever och beskriver sitt välbefinnande. Välbefinnandet beskrivs genom att ange olika kvalitativa värden. Det första värdet anger välbefinnandet som (i) att få behålla sin autonomi genom självbestämmande och deltagande i vardagslivets beslut, oavsett boende. Det andra värdet anger (ii) behovet av kontinuitet i den egna identiteten och det tredje värdet; (iii) att få vara individuell tillsammans med andra, dvs., att jag-känslan som identitetsupplevelse är viktig att hävda gentemot andra men att den känslan samtidigt är beroende av interaktion med andra. Denna identitetsupplevelse baseras på livsloppets individuella upplevelser av och i relationer med andra människor, där relationer med närstående är relationens innersta kärna. Vid äldreboendet är identitetsupplevelsen baserat på relationer till vårdarna. Välbefinnandet beskrivs som en totalupplevelse oavsett fysisk förmåga inom ramen för äldreboendet som ett hem och en vårdinstitution. Teoretiskt bidrar avhandlingen med kunskaper om det vårdvetenskapliga perspektivet på välbefinnande och då grundat i äldres upplevda och levda erfarenheter av välbefinnande, dels som upplevelse av autonomi, dels som upplevelse av kontinuitet inom identiteten. Välbefinnandet handlar då i sammanhanget ”äldreboende” om att vid äldreboendet få möjligheter till egenmakt och stöd för den egna jagkänslan. Begreppet välbefinnande som sådant, är direkt kopplat till sociala situationer och samtalsmöten med vårdare och den äldre. Välbefinnandet kan således ses som en dynamisk kategori. Avhandlingen ger därmed en bredare innebörd av välbefinnandet hos den äldre personen, än enbart upplevelser av hälsa. Avhandlingens teoretiska kunskapsbidrag till den vårdvetenskapliga omvårdnadsforskningen om äldres välbefinnande under den sista tiden i livet, bekräftar de sociala relationernas och interaktionernas betydelse. Studiens kunskapsbidrag namnges här som interaktionistisk vårdvetenskap vilken ger insikter i komplexiteten i de välbefinnandeupplevelser inom äldreboendet och som enligt de äldres beskrivningar framkom som producerade interaktivt och situerat (insitu). Praktiskt bidrar avhandlingen med kunskaper om hur äldres välbefinnande kan stödjas i vårdandet inom ramen för äldreboendet, både utifrån aspekten som ett hem och utifrån aspekten som en vårdinstitution. Stödet handlar då om att överföra avhandlingens teoretiska kunskapsbidrag till praktiskt vårdhandlande genom att stödja den äldres autonomi och kontinuitet i identiteten. Detta kan göras genom att den äldre får möjligheter till delaktighet i beslut (empowerment), möjligheter till sociala kontakter och att vara social i samvaro med andra (sociala interaktioner), samt att bli lyssnad till (presence). När det gäller praktiska överväganden inom ramen för äldreboendets vårdpolicy, bidrar avhandlingens resultat till kunskapen om att ta hänsyn till och efterfråga den äldres perspektiv på välbefinnande som utgångspunkt för vården. Detta kan göras genom att uppmuntra äldre personer att prata om sitt välbefinnande. Vårdares roll i detta sammanhang blir då i denna interaktion, att lyssna väl och inte endast ställa frågor. Slutsatsen som kan dras är att välbefinnande enligt de äldres upplevelser och beskrivningar relaterat till de kvalitativa värden för välbefinnandet som framkommit i denna studie, visar att den äldre blir mycket beroende av andra människor för att kunna uppleva välbefinnande. Detta, då den äldre kan ha en svag egen aktivitet och hälsa och saknar egen handlingskraft. Den äldres beroende av vårdpersonalen gör relationers och interaktioners betydelse i omvårdnaden och i omvårdnadshandlingar än mer betydelsefull för äldre människor. Detta i sin tur ställer krav på ökade kunskaper hos vårdare om vårdandets interaktiva betydelse, dvs. hur människor står i ett dynamiskt förhållande till sin omgivning både fysiologiskt och psykologiskt, trots svag egen aktivitet och hälsa. Emellertid, även om den äldres kropp och förmåga är svag, utgör den ett existentiellt villkor och roll i skapandet av välbefinnande i interaktion med andra. Välbefinnande kan därför stödjas i vårdandet genom social och emotionell stimulans. Intressant för vidare studier är då hur detta konkret görs. The aim of this thesis was to explore, describe and understand elderly people's experience of well-being, based on interviews and narratives and told in situ at nursing homes. This thesis is based on two studies, I) Elderly people’s descriptions of becoming and being respite care recipients. II) Elderly women’s subjective sense of well-being from their course of life perspective. Methods used were interviews conducted with 20 older residents whose experiences and stories form the basis of the results. The method was qualitative and the interviews were conducted in the form of casual conversations (Study I), and was analyzed by content analysis, and narrative method (Study II), which was analyzed using dialogic performative analysis. In substantial, this thesis contributes to an understanding of how elderly people living in nursing homes experience and describe their well-being. They did this by specifying different qualitative values for well-being. The first value indicates well-being that is (i) to retain their autonomy through self-determination and participation in everyday life decisions regardless of accommodation. The second value indicates (ii) the need for continuity of one's identity, and the third one (iii) dealt with being an individual along with others, i.e. the notion of the ego strength is important when to assert their individuality, but this notion is simultaneously dependent on the interaction with others. This identity is based on the experience in life and the individual experiences of relationships with other people, where relationships with family members are the relationship's innermost core. At the nursing home, identity-based experience is based on the relationship with the nursing aids. Well-being is described as a total experience regardless of physical ability, in the context of residential care which constitutes both a home and a care institution. From a theoretical viewpoint this thesis contributes to knowledge of a caring scientific perspective on well-being, with a foundation in the elderly’s experiences of well-being, autonomy and continuity of identity. The study contributes to knowledge here called Interactionistic Caring Science, and it provides insights into the complexity of the experience of well-being in the nursing home described by these elderly people as interactively and situated produced (in situ). Practically, this thesis contributes knowledge about how the well-being of elderly people can be supported in caring situations at nursing home, which are both a home and a health care institution. The conclusion show that the elderly are becoming very dependent on other people to experience their wellness. This, as the elderly often have weak intrinsic activity and health and suffer from lack of their own ability to act, this makes relations and interactions an important part of nursing and nursing acts, and even more important for old people. This in turn requires increased knowledge by caregivers about this interactive meaning of caring, i.e. how people interacts in a dynamic relationship with their environment, both physiologically and psychologically, despite weak intrinsic activity and health. The old person’s dependence in their nursing aides makes those relations and interactions of even more importance in the nursing caring and in the nursing acts of the elderly.

Aims: the aims of the thesis were:- To investigate the prognostic influence of diabetes on short- and long-term mortality after an episode of unstable coronary disease - To evaluate the association between glycometabolic parameters on admission and during hospitalization and the 2 year mortality risk among diabetic patients with unstable coronary disease - To investigate the influence of diabetes on treatment and outcome in patients with acute myocardial infarction (AMI)- To determine long-term morbidity and mortality after hospitalization for unstable coronary disease in patients with and without diabetes Diabetes was associated with higher mortality: We investigated an unselected series of 4,341 patients with unstable angina or non-Q-wave myocardial infarction, of which 722 (17%) had diabetes. Diabetes was associated with increased mortality during initial hospitalization (10.2% vs 5.7%, p

Aims/hypothesis An excess cancer incidence of 20–25% has been identified among persons with diabetes, most of whom have type 2 diabetes. We aimed to describe the association between type 1 diabetes and cancer incidence. Methods Persons with type 1 diabetes were identified from five nationwide diabetes registers: Australia (2000–2008), Denmark (1995–2014), Finland (1972–2012), Scotland (1995–2012) and Sweden (1987–2012). Linkage to national cancer registries provided the numbers of incident cancers in people with type 1 diabetes and in the general population. We used Poisson models with adjustment for age and date of follow up to estimate hazard ratios for total and site-specific cancers. Results A total of 9,149 cancers occurred among persons with type 1 diabetes in 3.9 million person-years. The median age at cancer diagnosis was 51.1 years (interquartile range 43.5–59.5). The hazard ratios (HRs) (95% CIs) associated with type 1 diabetes for all cancers combined were 1.01 (0.98, 1.04) among men and 1.07 (1.04, 1.10) among women. HRs were increased for cancer of the stomach (men, HR 1.23 [1.04, 1.46]; women, HR 1.78 [1.49, 2.13]), liver (men, HR 2.00 [1.67, 2.40]; women, HR 1.55 [1.14, 2.10]), pancreas (men, HR 1.53 [1.30, 1.79]; women, HR 1.25 [1.02,1.53]), endometrium (HR 1.42 [1.27, 1.58]) and kidney (men, HR 1.30 [1.12, 1.49]; women, HR 1.47 [1.23, 1.77]). Reduced HRs were found for cancer of the prostate (HR 0.56 [0.51, 0.61]) and breast (HR 0.90 [0.85, 0.94]). HRs declined with increasing diabetes duration. Conclusion Type 1 diabetes was associated with differences in the risk of several common cancers; the strength of these associations varied with the duration of diabetes. Electronic supplementary material The online version of this article (doi:10.1007/s00125-016-3884-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users.