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  • 1. Amsberg, Susanne
    et al.
    Wijk, Ingrid
    Livheim, Fredrik
    Toft, Eva
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Anderbro, Therese
    Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 11, artikkel-id e022234Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.

    METHODS AND ANALYSIS: This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.

    ETHICS AND DISSEMINATION: The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

    TRIAL REGISTRATION NUMBER: NCT02914496; Pre-results.

  • 2. Anderbro, Therese
    et al.
    Amsberg, Susanne
    Moberg, Erik
    Gonder-Frederick, Linda
    Adamson, Ulf
    Lins, Per-Eric
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes2018Inngår i: Endocrinology, Diabetes & Metabolism, ISSN 2057-3316Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To  investigate  fear  of  hypoglycaemia  (FoH)  longitudinally  in  a  cross-  sectional  study  of  adult  patients  with  type  1  diabetes.  Specifically,  we  investigated  two  sub-groups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.

    Methods: The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire  to  assess  hypoglycaemia  history  was  sent  by  mail  to  764  patients  in  2010. The responders in 2010 (n =   469) received another set of the same two ques-tionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥  75th percentile were included in   the    subgroup analyses. Statistical analyses included one- sample t tests, chi- square and McNemar’s test.

    Results: The absolute difference in the HFS total score (n =   347) between 2010 and 2014 was m =   ±7.6, SD ±   6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypogly-caemia in 2014 compared with the decreased FoH group. There were more subjects in the  increased  FoH  group  with  insulin  pumps  in  2014  and  in  2010.  In  the  decreased  FoH group, more patients had a high frequency of daily self- monitoring of blood glu-cose (SMBG) in 2010 and in 2014.

    Conclusions: Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking pa-tients about changes in hypoglycaemia experiences is of great importance.

  • 3. Anderbro, Therese
    et al.
    Moberg, E
    Gonder-Frederick, L
    Lins, P E
    Adamson, U
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    A longitudinal study of fear of hypoglycemia in type 1 diabetes2015Konferansepaper (Annet vitenskapelig)
  • 4. Anderbro, Therese
    et al.
    Moberg, Erik
    Adamson, Ulf
    Lins, Per-Eric
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Beliefs and experiences of fear of hypoglycemiaand use of uncooked cornstarch before bedtime in persons with type 1-diabetes2018Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 8, s. 795-810Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Among persons living with type 1-diabetes hypoglycemia and fear of hypoglycemia remain limiting barriers for achieving optimal glucose control and a good quality of life. Fear of hypoglycemia has been found stable over time if not treated. Uncooked cornstarch has been found to reduce the risk of hypoglycemia but has not been studied in relation to fear of hypogly-cemia. The aims of this study were to through clinical data, self-reported measures and clinical interviews explore subjects’ experience of using un-cooked cornstarch before bedtime and their beliefs and experiences of fear of hypoglycemia.

    Methods: Mixed methods with both quantitative and qualita-tive data were used. Self-reported measures of hypoglycemia and fear of hy-poglycemia were compared to subjects’ responses during a clinical interview. The interviews were analyzed with a functional behavior analytical approach.

    Results: A total of five subjects took part in the study. One subject perceived the uncooked cornstarch helpful in reducing hypoglycemia. Several subjects could recall frightening hypoglycemic episodes triggering their fear. Three out of the five subjects reported avoidance behaviors such as excessive self-monitoring of blood glucose or overeating related to fear of hypoglyce-mia. Conclusions: The uncooked cornstarch was found appetizing but was not perceived as having an effect on BG or hypoglycemia frequency. The clinical interviews confirmed previous research regarding experience of hy-poglycemia and fear of hypoglycemia.

  • 5. Eeg-Olofsson, Katarina
    et al.
    Svedbo Engström, Maria
    Borg, Sixten
    Palaszewski, Bo
    Lexell, Janeth
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Gudbjörnsdottir, Soffia
    Glycaemic control and patient-reported outcome measures (PROMs) in type 1 diabetes2016Konferansepaper (Annet vitenskapelig)
  • 6. Freyschuss, Bo
    et al.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Leksell, Janeth
    Steen Carlsson, Katarina
    Thorsén, Håkan
    Werkö, Sophie
    Wikblad, Karin
    Hammarlund, Cecilia
    Johansson, Ida
    Patientutbildning vid diabetes: en systematisk litteraturöversikt2009Rapport (Annet vitenskapelig)
  • 7. Hanås, R
    et al.
    Lindholm Olinder, A
    Olsson, P.O
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Jacobson, S
    Heintz, E
    Werkö, Sophie
    Persson, M
    CSII and SAP valuable tools in the treatment of diabetes: a Swedish health technology assessment2014Inngår i: Diabetes Technology & Therapeutics, ISSN 1520-9156, E-ISSN 1557-8593, Vol. 16, nr Suppl 1, s. A-56-Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Sophia Step Study2017Konferansepaper (Annet vitenskapelig)
  • 9.
    Johansson, Unn-Britt
    et al.
    Sophiahemmet Högskola.
    Hanås, Ragnar
    Olsson, Per-Olof
    Lindholm Olinder, Anna
    Persson, Martina
    Werkö, Sophie
    Jacobson, Stella
    Heintz, Emelie
    Akcan, Derya
    Attergren Granath, Anna
    Davidson, Thomas
    Insulinpumpar vid diabetes2013Rapport (Annet vitenskapelig)
    Abstract [sv]

    God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Vid typ 1-diabetes och en del fall av typ 2-diabetes krävs så kallad intensiv insulinbehandling med flera injektioner per dag. Den vanligaste komplikationen vid denna behandling är lågt blodglukos (hypoglykemi) vilket kan få allvarliga följder [1,2]. Ett alternativ till intensiv insulinbehandling med injektioner är kontinuerlig insulintillförsel med pump, så kallad kontinuerlig subkutan insulininfusion (CSII).

  • 10.
    Johansson, Unn-Britt
    et al.
    Sophiahemmet Högskola.
    Hanås, Ragnar
    Olsson, Per-Olof
    Lindholm Olinder, Anna
    Persson, Martina
    Werkö, Sophie
    Jacobson, Stella
    Heintz, Emelie
    Akcan, Derya
    Attergren Granath, Anna
    Davidson, Thomas
    Kontinuerlig subkutan glukosmätning vid diabetes2013Rapport (Annet vitenskapelig)
    Abstract [sv]

    God kontroll av blodglukosnivån är viktig för att undvika följdsjukdomar av diabetes. Blodglukos kan mätas av patienten själv med teststickor (self monitoring of blood glucose, SMBG) eller via en subkutan sensor (kontinuerlig subkutan glukosmätning, CGM). Vid typ 1-diabetes behövs rutinmässigt upprepade blodglukosmätningar varje dygn för att uppnå god glukoskontroll.

    SBU har utvärderat nytta och risk av behandling med kontinuerlig glukosmätning utan eller med insulinpump (SAP) vid diabetes hos barn, ungdomar och vuxna. I utvärderingen ingår också en hälsoekonomisk och etisk analys, samt en stor praxisundersökning som omfattade samtliga diabeteskliniker i Sverige

  • 11.
    Johansson, Unn-Britt
    et al.
    Sophiahemmet Högskola.
    Wredling, Regina
    Sophiahemmet Högskola.
    Adamson, Ulf
    Lins, Per-Eric
    A morning dose of insulin glargine prevents nocturnal ketosis after postprandial interruption of continuous subcutaneous insulin infusion with insulin lispro2007Inngår i: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 33, nr 6, s. 469-71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: The aim of this crossover trial was to evaluate the potential of partial substitution of basal insulin with glargine, administered once daily in the morning, to protect against nocturnal ketosis after postprandial interruption of continuous subcutaneous insulin infusion (CSII). METHODS: Seven patients with type 1 diabetes received 4 weeks of treatment with insulin lispro, administered by CSII, and 4 weeks of treatment with CSII and a partial basal replacement dose of insulin glargine administered in the morning. On day 28 of each treatment phase, patients were admitted to the research unit where dinner was served and their usual dinner insulin bolus dose given, after which CSII was discontinued at 7 pm. Plasma (p) beta-hydroxybutyrate and p glucose were measured every hour for 12 h thereafter. RESULTS: Plasma beta-hydroxybutyrate at 7 pm was 0.16+/-0.05 and 0.13+/-0.07 mmol/l with and without glargine, respectively, and increased to 0.17+/-0.10 and 0.60+/-0.3 mmol/l within 6 h (P=0.02). Plasma glucose increased without glargine, from 8.6+/-2.9 to 21.1+/-3.0 mmol/l (P=0.003), but did not rise significantly following glargine (13.6+/-4.7 vs. 12.6+/-5.6 mmol/l; P=0.65). CONCLUSIONS: Partial replacement with a morning dose of insulin glargine protects against the development of ketosis for as much as 12 h after postprandial interruption of CSII. This treatment strategy could, therefore, be useful for patients who are prone to ketosis but, for other reasons, are deemed suitable for CSII.

  • 12. Lindholm Olinder, A
    et al.
    Hanås, R
    Heintz, E
    Jacobson, S
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Olsson, P.O
    Persson, M
    Werkö, Sophie
    CGM and SAP are valuable tools in the treatment of diabetes: a Swedish health technology assessment2014Inngår i: Diabetes Technology & Therapeutics, ISSN 1520-9156, E-ISSN 1557-8593, Vol. 16, nr Suppl 1, s. A-74-Artikkel i tidsskrift (Fagfellevurdert)
  • 13. Mc Laughlin, Sue
    et al.
    Chaney, David
    Belton, Anne
    Garst, Jilde
    International standards for education of diabetes health professionals2015Bok (Annet vitenskapelig)
  • 14.
    Rossen, Jenny
    Sophiahemmet Högskola.
    "But now it is a habit": Participants' experiences of Sophia Step Study2017Konferansepaper (Annet vitenskapelig)
  • 15.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Buman, Matthew P
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Yngve, Agneta
    Sophiahemmet Högskola.
    Ainsworth, Barbara
    Brismar, Kerstin
    Hagströmer, Maria
    Reallocating bouted sedentary time to non-bouted sedentary time, light activity and moderate-vigorous physical activity in adults with prediabetes and type 2 diabetes2017Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 7, artikkel-id e0181053Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: The aim of this study was to investigate the potential associations of reallocating 30 minutes sedentary time in long bouts (>60 min) to sedentary time in non-bouts, light intensity physical activity (LPA) and moderate- to vigorous physical activity (MVPA) with cardiometabolic risk factors in a population diagnosed with prediabetes or type 2 diabetes.

    METHODS: Participants diagnosed with prediabetes and type 2 diabetes (n = 124, 50% men, mean [SD] age = 63.8 [7.5] years) were recruited to the physical activity intervention Sophia Step Study. For this study baseline data was used with a cross-sectional design. Time spent in sedentary behaviors in bouts (>60 min) and non-bouts (accrued in <60 min bouts) and physical activity was measured using the ActiGraph GT1M. Associations of reallocating bouted sedentary time to non-bouted sedentary time, LPA and MVPA with cardiometabolic risk factors were examined using an isotemporal substitution framework with linear regression models.

    RESULTS: Reallocating 30 minutes sedentary time in bouts to MVPA was associated with lower waist circumference (b = -4.30 95% CI:-7.23, -1.38 cm), lower BMI (b = -1.46 95% CI:-2.60, -0.33 kg/m2) and higher HDL cholesterol levels (b = 0.11 95% CI: 0.02, 0.21 kg/m2. Similar associations were seen for reallocation of sedentary time in non-bouts to MVPA. Reallocating sedentary time in bouts to LPA was associated only with lower waist circumference.

    CONCLUSION: Reallocation of sedentary time in bouts as well as non-bouts to MVPA, but not to LPA, was beneficially associated with waist circumference, BMI and HDL cholesterol in individuals with prediabetes and type 2 diabetes. The results of this study confirm the importance of reallocation sedentary time to MVPA.

  • 16.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Yngve, Agneta
    Sophiahemmet Högskola.
    Sophia Step Study: en metod för att öka patienternas fysiska aktivitetsnivå2016Inngår i: BestPractice Diabets/Hjärt-kärlsjukdomar, Vol. 6, nr 19, s. 16-18Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 17.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Lööf, Helena
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Yngve, Agneta
    Exploration of study participants experiences following Sophia Step Study: A two-year physical activity intervention2016Konferansepaper (Annet vitenskapelig)
  • 18.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Lööf, Helena
    Yngve, Agneta
    Hagströmer, Maria
    Brismar, Kerstin
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Support for self-management of physical activity in persons with prediabetes and type 2 diabetes: Experiences from Sophia Step Study2017Konferansepaper (Annet vitenskapelig)
  • 19.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Lööf, Helena
    Sophiahemmet Högskola.
    Yngve, Agneta
    Hagströmer, Maria
    Brismar, Kerstin
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    'This is why I'm doing a lot of exercise': A qualitative study of participant's experiences of the Sophia Step Study2017Inngår i: International Diabetes Nursing, ISSN 2057-3316, E-ISSN 2057-3324, Vol. 14, nr 2-3, s. 99-104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Support for physical activity (PA) is central in diabetes care. The Sophia Step Study is a three-armed randomised controlled trial aiming to evaluate different levels of support for increased PA in prediabetes and Type 2 diabetes. With the purpose to reveal the programme components and the mediating factors from the participants’ perspective this paper aims to report a qualitative exploration of adhering participants’ experiences after two years’ study participation.

    Methods: Semi-structured interviews were conducted with 18 participants (men, n = 11, women, n = 7, prediabetes, n = 5, Type 2 diabetes, n = 13, median age 68.5 years) who completed a two-year multi-component (n = 7), singlecomponent (n = 6) intervention or served as controls (n = 5) at a primary care center in Stockholm, Sweden. The interviews were analysed using content analysis with an inductive approach. Sophia Step Study is registered at ClinicalTrials.gov with Identifier: NCT02374788.

    Results: The participants recalled the frequent study assessments as providing feedback of health outcomes; positive reinforcement; a sense of sentinel and a personalised approach. Group meetings, pedometers and health check-ups were valued as resources for increased awareness and motivation of PA; establishment of new routines and control over the own health. The long program duration allowed for maintenance of awareness and routines for PA

    Conclusion: Adhering participants in theory-based interventions, but also in the control group, identified key mediators to support for PA. Feedback of results, personalised encouragement, emotional support and selfmonitoring should be regarded in self-management of PA to optimise patient motivation and outcomes.

  • 20.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Lööf, Helena
    Sophiahemmet Högskola.
    Yngve, Agneta
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Brismar, Kerstin
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Using pedometers for self-management of physical activity: Participants' experiences from Sophia Step Study: A physical activity promotion intervention in pre- and type 2 diabetes2017Konferansepaper (Annet vitenskapelig)
  • 21.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Yngve, Agneta
    Sophiahemmet Högskola.
    Hagströmer, M
    Brismar, Kerstin
    Ainsworth, B
    Möller, P
    Iskull, C
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Sophia step study: An RCT using pedometers to increase daily steps in subjects with pre and type 2 diabetes2015Konferansepaper (Annet vitenskapelig)
  • 22. Svedbo Engström, Maria
    et al.
    Leksell, Janeth
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Eeg-Olofsson, Katarina
    Borg, Sixten
    Palaszewski, Bo
    Gudbjörnsdottir, Soffia
    A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: Development and evaluation of content validity, face validity, and test-retest reliability2018Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, nr 1, s. 139-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the development and evaluation of the content and face validity and test-retest reliability of a disease-specific questionnaire that measures patient-reported outcomes and experiences for the Swedish National Diabetes Register for adult patients who have type 1 or type 2 diabetes.

    METHODS: In this methodological study, a questionnaire was developed over four phases using an iterative process. Expert reviews and cognitive interviews were conducted to evaluate content and face validity, and a postal survey was administered to evaluate test-retest reliability.

    RESULTS: The expert reviews and cognitive interviews found the disease-specific questionnaire to be understandable, with relevant content and value for diabetes care. An item-level content validity index ranged from 0.6-1.0 and a scale content validity/average ranged from 0.7-1.0. The fourth version, with 33 items, two main parts and seven dimensions, was answered by 972 adults with type 1 and type 2 diabetes (response rate 61%). Weighted Kappa values ranged from 0.31-0.78 for type 1 diabetes and 0.27-0.74 for type 2 diabetes.

    CONCLUSIONS: This study describes the initial development of a disease-specific questionnaire in conjunction with the NDR. Content and face validity were confirmed and test-retest reliability was satisfactory.

    PRACTICE IMPLICATIONS: With the development of this questionnaire, the NDR becomes a clinical tool that contributes to further understanding the perspectives of adult individuals with diabetes.

  • 23. Svedbo Engström, Maria
    et al.
    Leksell, Janeth
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Gudbjörnsdottir, Soffia
    Development of a patient reported outcome measure for the Swedish national diabetes register2016Konferansepaper (Annet vitenskapelig)
  • 24.
    Svedbo Engström, Maria
    et al.
    Högskolan Dalarna.
    Leksell, Janeth
    Högskolan Dalarna.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Gudbjörnsdóttir, Soffia
    Göteborgs universitet.
    Utveckling av patientrapporterade utfallsmått (PROM) för NDR. I: Nationella Diabetesregistret - Årsrapport 2012 års resultat2013Annet (Annet vitenskapelig)
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