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This study aimed to examine the association between type 2 diabetes and poor self-rated oral health, and to investigate whether such association is modified by socioeconomic position. We conducted a cross-sectional study, including a population aged 18–75 years with self-reported type 2 diabetes (N = 41,884) and a sex-, age- and municipality-matched reference population from the Health in Central Denmark survey (2020). Multivariable logistic regression was used, and effect modification of indicators of socioeconomic position was examined. Oral health was rated as poor in 37.0% of the population with type 2 diabetes and in 23.8% of the reference population without diabetes. Individuals with diabetes had higher risk of poor oral health (adjusted odds ratio (OR) 1.46 (95% CI: 1.39; 1.53)) than references. Interaction was seen between type 2 diabetes and highest attained education (p < 0.001). Stratified analyses showed higher risk of poor oral health in people with type 2 diabetes across all educational levels. People with type 2 diabetes were more likely to rate their oral health as poor than the reference population. Low education strengthened the association between diabetes and poor oral health. • People with type 2 diabetes have an increased risk of self-rated poor oral health. • The effect of diabetes on poor oral health depends on educational attainment. • The risk of self-rated poor oral health increases with lower educational attainment. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, video consultations became a common method of delivering care in general practice. To date, research has mostly studied acute or subacute care, thereby leaving a knowledge gap regarding the potential of using video consultations to manage chronic diseases. Objective: This study aimed to examine general practitioners’ technology acceptance of video consultations for the purpose of managing type 2 diabetes in general practice. Methods: A web-based survey based on the technology acceptance model measuring 4 dimensions—perceived usefulness, perceived ease of use, attitude, and behavioral intention to use—was sent to all general practices (N=1678) in Denmark to elicit user perspectives. The data were analyzed using structural equation modeling. Results: The survey sample comprised 425 general practitioners who were representative of the population. Structural equation modeling showed that 4 of the 5 hypotheses in the final research model were statistically significant (P<.001). Perceived ease of use had a positive influence on perceived usefulness and attitude. Attitude was positively influenced by perceived usefulness. Attitude had a positive influence on behavioral intention to use, although perceived usefulness did not. Goodness-of-fit indices showed acceptable fits for the structural equation modeling estimation. Conclusions: Perceived usefulness was the primary driver of general practitioners’ positive attitude toward video consultations for type 2 diabetes care. The study suggests that to improve attitude and technology use, decision-makers should focus on improving usefulness, that is, how it can improve treatment and make it more effective and easier. [ABSTRACT FROM AUTHOR]

Aims: To determine the association between concurrent overall burden of disease, cardiovascular disease, cancer, self-rated health, HbA1c levels, and attendance at clinical follow-up of the Danish arm of the ADDITION-study.Methods: Logistic regression models were used to study factors proposed being associated with attendance in clinical follow-up. We used data from clinical examinations, questionnaires and national registers at a time-point near the follow-up examination.Results: A total of 1119 participants were eligible for the follow-up conducted a median of 12.8 years (IQR 11.6; 13.4) after type 2 diabetes diagnosis by screening. Concurrent high burden of disease was associated with lower attendance (OR 0.6 (95% CI: 0.4; 0.9) for high-versus no burden of disease). Concurrent cardiovascular disease and cancer showed no statistically significant association with attendance (OR 1.0 (95% CI: 0.7; 1.4)) and (OR 0.8 (95% CI: 0.6; 1.1) for (disease versus no disease). Similarly, self-rated health (OR 0.7 (95% CI: 0.5; 1.0) poor-versus good self-rated health) and HbA1c levels (OR 1.0 (95% CI: 0.9; 1.2 unit=10mmol/mol)) were not statistically significant associated with attendance.Conclusions: This study showed a lower attendance in clinical follow-up after nearly 13years among individuals with concurrent high burden of disease. No associations were found between concurrent CVD, cancer, self-rated health and Hba1c levels and attendance. [ABSTRACT FROM AUTHOR]

Aim: To answer: (1) Do we have effective treatments to improve prognosis for those identified at risk of Type-2 diabetes? (2) Will prevention be cost-effective?Methods: A systematic search was done in PubMed using the following search strategy: "diabetes AND prevention AND (IFG OR IGT)". Restrictions were: "English, Meta-Analysis, Randomized Controlled Trial, Review, Humans".Results: Few randomised controlled preventive trials were found. Almost all were done in research settings in people with high risk of developing Type-2 diabetes. It seems possible to either delay or prevent Type-2 diabetes through lifestyle interventions and medication. Cost-utility analyses are few in number and come to very different conclusions as to whether health policy should promote prevention of Type-2 diabetes.Conclusion: Intervention studies using lifestyle counselling and drug therapy in research settings illustrate promising results with lowering of the incidence of Type-2 diabetes, meaning that Type-2 diabetes can be delayed or prevented. It is, however, questionable whether these interventions are cost-effective. We need studies in routine clinical settings evaluating morbidity, mortality and cost-effectiveness as primary outcomes. While waiting for these studies to prove cost-effective, patients with pre-diabetes should be treated according to their 10-year risk of cardiovascular disease following present guidelines. [ABSTRACT FROM AUTHOR]

Aims To examine whether socioeconomic position (SEP) was associated with change in cardiovascular risk factors and meeting treatment targets for cardiovascular risk factors among individuals with screen-detected Type 2 DM at six-year follow-up. Methods The study population was 1533 people with Type 2 DM identified from at stepwise diabetes screening programme in general practice during 2001–2006 in the ADDITION-Denmark study. The ADDITION-study was performed as a randomised trial but the two randomisation groups were analysed as one cohort in this study. Cardiovascular risk factors were measured at baseline and repeated at follow-up (mean: 5.9 [1.4] years). Information on SEP, redeemed antihypertensive and lipid-lowering treatment were obtained from Danish registers. Multivariate analyses were performed to estimate change in cardiovascular risk factors and difference in meeting treatment targets. Results The change in HbA 1c , cholesterol, blood pressure and BMI were virtually the same across educational level, income level, occupational status or cohabiting status. Overall, the ability to meet treatment targets for HbA 1c , cholesterol and blood pressure was not modified by SEP-group. A higher proportion of people with lower educational level or lower income level in the intensive care redeemed anti-hypertensive treatment compared to people with higher educational or income levels. Conclusion Screen-detection and early treatment onset did not introduce socioeconomic inequality in metabolic control in people with screen-detected Type 2 DM at six-year follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The social inequality gradient in the prognosis of diabetes is well-established but it is unclear whether this inequality gradient extends to the use of general practice among persons with diabetes. Methods: A nationwide, population-based cohort study was conducted including 137,492 persons with incident diabetes aged 40–79 years and 687,460 reference persons with no history of diabetes matched on gender and age. Information on diabetes was obtained from the National Diabetes Register, socioeconomic position (SEP) from Statistics Denmark and number of general practice consultations from the National Health Insurance Service Registry. Consultation rates for different SEP-groups during the first year after index day were compared. Results: Overall, persons with diabetes had 4.8 (95%CI: 4.7–4.8) more consultations in general practice during the first year after their diagnosis than reference persons with no history of diabetes. This additional consultation rate increased with decreasing SEP, e.g. 5.8 (95%CI: 5.6–6.0) for women aged 40–54 years with the lowest educational level and 4.9 (95%CI: 4.7–5.1) for women with the highest educational level. Conclusion: Persons with diabetes had nearly five additional consultations with their general practitioner during the first year after their diagnosis and the number was higher for those with the lowest SEP. [Copyright &y& Elsevier]

Abstract: Aims: To assess whether involvement of general practice nurses in type 2 diabetes care in Danish general practice is associated with improved adherence to national guidelines on regular type 2 diabetes monitoring, and with lower HbA1c and cholesterol levels in the type 2 diabetes population. Methods: The study was an observational study soliciting questionnaire data from 193 Danish general practices and register data on 12,960 patients with type 2 diabetes (age range 40–80 years) from a diabetes database and a laboratory database. Clustering was addressed in the analyses. Result: Practices with well-implemented nurse-led type 2 diabetes consultations and practices with no nurse(s) employed differed according to the mean proportions of patients whose HbA1c was measured (6.4%-points: 95% CI: 1.5 to 11.4), and the mean proportions of patients whose HbA1c was ≥8% (−3.7%-points: 95% CI: −6.7 to −0.6). Small non-significant differences were found in the cholesterol analyses. Conclusion: Compared with practices with no nurse(s) employed, the quality of diabetes management was generally higher in terms of that HbA1c was measured according to the guidelines in a larger proportion of the diabetes population and the proportion of patients with an HbA1c level ≥8% was lower in practices with well-implemented nurse-led type 2 diabetes consultations. [Copyright &y& Elsevier]

Abstract: Aim: To study all-cause mortality and pharmacological treatment intensity in relation to baseline glucose metabolism and HbA1c following high risk screening for diabetes in primary care. Methods: Persons aged 40–69 years (N =163,185) received mailed diabetes risk questionnaires. 20,916 persons without diabetes but with high risk of diabetes were stratified by glucose metabolism (normal glucose tolerance (NGT), dysglycemia (IFG or IGT) or diabetes) and by HbA1c at screening (<6%, 6.0–6.4% or ≥6.5%). Median follow-up was 6.6 years. Excess mortality was calculated by hazard ratio. Results: HR for all-cause mortality increased with increasing levels of HbA1c at screening in people with NGT and dysglycemia. In people with screen detected diabetes the opposite relation was found. In people with diabetes redeemed prescription rates for lipid-, blood pressure- and glucose-lowering drugs increased significantly following screening and prescription rates increased with increasing levels of HbA1c at screening. The same trend in redeemed prescriptions was seen for people with dysglycemia and NGT, but the absolute rates were significantly lower than those among people with screen detected diabetes. Conclusions: This study confirms HbA1c as an independent predictor of all-cause mortality in non-diabetic individuals. A likely explanation for the inverse relation found between all-cause mortality and HbA1c at screening among those with screen detected diabetes would be that intensive treatment near-normalizes mortality. The small group of people with NGT and HbA1c≥6.5%, who had the highest all-cause mortality, may benefit from being labelled and treated as having diabetes although this group may have special characteristics not accounted for in this study. [Copyright &y& Elsevier]

Abstract: Aim: To examine attendance, number of people with T2DM and costs of three different stepwise screening strategies for T2DM in general practice (GP). Methods: Diabetes risk questionnaires were mailed to individuals aged 40–69 years from 45 general practices in 2001–2002 and individuals at high risk for T2DM, were asked to contact their GP to arrange a screening test. In 2005–2006, 26 general practices were randomised into two different opportunistic screening programmes (OP-direct and OP-subsequent) and risk questionnaires were distributed to individuals aged 40–69 years during GP consultations. In the OP-direct approach, high-risk individuals were offered to start the screening during the actual consultation while high-risk individuals in the OP-subsequent approach, were invited to a screening test at a later date. We report attendance, number of people with T2DM and costs of each screening approach. Results: The mail-distributed approach identified 0.8% of the target population with T2DM, the OP-direct approach and the OP-subsequent approach, 0.9% and 0.5% respectively. Cost per person with T2DM was in the mail-distributed approach: € 1058, OP-direct approach: € 707 and the OP-subsequent approach: € 727. Conclusion: This study indicates that opportunistic screening identifies the same level of unknown diabetes as a mail-distributed approach but with lower costs. [ABSTRACT FROM AUTHOR]