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Aim Methods Results Conclusions The aim of this study is to estimate the causally attributable one‐year healthcare costs for individuals getting a type 2 diabetes diagnosis compared to a matched sample and show the incurred costs of medication and in primary and secondary healthcare.Causal estimation using a difference‐in‐differences design to estimate the one‐year health care costs attributable to type 2 diabetes. Danish registry data consisting of the entire population in years 2016–2019. Newly diagnosed individuals with type 2 diabetes in 2018 were identified using a validated method. Sociodemographic and historical health data were used to identify a matched control group. Individuals were followed for two years before and one year after the date of diagnosis using. Three cost components were analysed: medication and primary and secondary healthcare costs.A total of 18,133 individuals were diagnosed with type 2 diabetes in 2018 and matched successfully 1:1 to a control group. The total attributable one‐year cost of type 2 diabetes was EUR 1316. The main cost component was hospital care (EUR 1004) and primary care (EUR 167). The total attributable cost of incident diabetes in Denmark in 2018 was approx. EUR 24 million.The majority of the first year health care cost of incident diabetes is incurred at the hospital level followed by primary care and medication. Our yearly cost estimate per newly diagnosed is considerably lower than estimates from the US and Australia. [ABSTRACT FROM AUTHOR]

Background: Sleep duration is associated with BMI and waist circumference. However, less is known about whether sleep duration affects different measurements of obesity differently. Objective: To investigate the association between sleep duration and different measures of obesity. Methods: In this cross‐sectional analysis 1309, Danish, older adults (55% men) completed at least 3 days of wearing a combined accelerometer and heart rate‐monitor for assessing sleep duration (hours/night) within self‐reported usual bedtime. Participants underwent anthropometry and ultrasonography to assess BMI, waist circumference, visceral fat, subcutaneous fat, and fat percentage. Linear regression analyses examined the associations between sleep duration and obesity‐related outcomes. Results: Sleep duration was inversely associated with all obesity‐related outcomes, except visceral‐/subcutaneous‐fat‐ratio. After multivariate adjustment the magnitude of associations became stronger and statistically significant for all outcomes except visceral‐/subcutaneous‐fat‐ratio, and subcutaneous fat in women. The associations with BMI and waist circumference demonstrated the strongest associations, when comparing standardized regression coefficients. Conclusions: Shorter sleep duration were associated with higher obesity across all outcomes except visceral‐/subcutaneous‐fat‐ratio. No specifically salient associations with local or central obesity were observed. Results suggest that poor sleep duration and obesity correlate, however, further research is needed to conclude on beneficial effects of sleep duration regarding health and weight loss. [ABSTRACT FROM AUTHOR]

Objective To explore health-care use in the 12 months preceding a diagnosis of RA in Denmark. Methods We conducted a population-based cohort study using data from national registries. Every patient diagnosed with RA in 2014–18 was matched to 10 reference individuals without RA from the Danish background population. Health-care use was defined as contacts to general practitioners, contacts to private practicing physiotherapists, and X-rays of hands and/or feet performed in primary or secondary care. We estimated the monthly contact rates for patients and references in the 12 months preceding the diagnosis, and we compared incidence rates for health-care use in each month between the two groups while adjusting for sociodemographic characteristics and comorbidity. Results We included 7427 patients with RA and 74 270 references. Patients with RA had increasing contact rates with general practitioners and physiotherapists from 6 to 8 months before the diagnosis. Compared with references, women with RA had statistically significantly more contacts to general practitioners and physiotherapists during all 12 months. A similar contact pattern was seen in men, albeit less distinct. The number of X-rays increased slightly from 8 months before the diagnosis, with a steep increase in the last 3 months. Conclusion Increased contacts to general practitioners and physiotherapists were seen in all 12 months preceding the RA diagnosis, intensifying in the last 6 to 8 months. Imaging increased from 3 months before the diagnosis. This indicates an opportunity to expedite referral to specialist care and ensure earlier diagnosis of RA. [ABSTRACT FROM AUTHOR]

Background: Little is known about variations in the provision of chronic care services in primary care.Aim: To describe the frequency of chronic care services provided by GPs and analyse the extent of non-random variation in service provision.Design and Setting: Nationwide cohort study undertaken in Denmark using data from 2016.Method: Information on chronic care services was obtained from national health registers, including annual chronic care consultations, chronic care procedures, outreach home visits, and talk therapy. The associations between services provided, patient morbidity, and socioeconomic factors were estimated. Service variations were analysed, and excess variation related to practice-specific factors was estimated while accounting for random variation.Results: Chronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status. Variation across practices ranged from 1.4 to 128 times more than expected after adjusting for differences in patient population and random variation. Variation related to practice-specific factors was present for all the chronic care services that were investigated. Older patients with lower socioeconomic status and multimorbidity were clustered in practices with low propensity to provide certain chronic care services.Conclusion: Chronic care was provided to patients typically in need of health care, that is, older adults, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices. GPs provided slightly fewer chronic care services than expected in practices where many patients with multimorbidity and low socioeconomic status were clustered, suggesting inverse care law mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: People of lower socioeconomic status (SES) are at higher risk of developing diabetes complications because they face more difficulties in taking care of their disease. People with another ethnic background than Danish are at particular high risk. The Western part of Aarhus, Denmark, is a community with a high proportion of vulnerable citizens, primarily people of low SES and/or another ethnic background, living with type 2 diabetes where it is urgent to improve diabetes management. During a two-year project, a diabetes-nurse employed in the municipality health center offered a tailored, person-centred intervention in collaboration with general practitioners. Methods: Using mixed methods, the aim was to (a) study how the integrated care model and diabetes-nurse work to support vulnerable citizens and (b) measure the effect of tailoring interventions to the individual. Quantitatively, the study uses data on patient outcomes, e.g. HbA1c levels, process measures, e.g., participation in program activities, and patient reported outcomes, e.g., SF12 (n=40). Qualitatively, the study uses ethnographic observations, e.g., shadowing health care professionals, and interviews with nurses (n=3), citizens (n=14) and GP's (n=3) to zoom in on experiences and experienced outcome, cross-sectoral cooperation, challenges, opportunities, and sustainability by shadowing the daily work of the diabetes-nurse. Highlights: The diabetes-nurse used three main drivers to support this diverse groups of citizens living with complex social and health related issues. (1) Relational work: build trust to actually start addressing diabetes-related issues. (2) Person-centred: start with the most pressing issues defined by the citizens themselves, thereby often dealing with issues unrelated to diabetes (3) Engaging the local community: take advantage of the community health center being placed within the citizens' neighborhood. Citizens highlight that they value the relationship with the diabetesnurse and that all their complex social and health related issues are managed by one health care professional who proactively guide them through the health care system. Preliminary quantitative results show that the average HbA1c levels decreased by 10 mmol/mol and that the proportion of citizens who experienced good well-being and high quality of life increased from 41% to 74%. Conclusions: Supporting vulnerable citizens with diabetes alongside other complex medical, social and cultural issues is challenging. This project used a model of integrated care where a diabetes nurse used a relational and patient-centered approach to help vulnerable citizens improve their diabetes self-care and clinical outcomes. Implications for applicability/transferability, sustainability, and limitations The project initially struggled with patient recruitment. The project is unable to document longerterm effects. Future studies are needed about the extent to which new habits and care outcomes are maintained. Covid-19 influenced the intervention in terms of citizens' motivation and participation in program activities. [ABSTRACT FROM AUTHOR]

Background: Around 10,000 adults who live in the area referred to as 'Midtklyngen' in the Central Denmark Region are diagnosed with type 2 diabetes. 'Midtklyngen' consists of three municipalities served by two out-patient diabetes clinics and 150 general practitioners. The burden of type 2 diabetes varies throughout the life of a patient, and the social inequalities associated with incidence, prevalence and risk of complications are well described. Furthermore, it is evident that cross-sectoral collaboration in connection with type 2 diabetes often causes fragmented care delivery. Thus, it is of great value to develop a model for collaboration across sectors; a model that promotes and supports the individual patient's chances of living a meaningful life, minimising the clinical consequences of type 2 diabetes through high-quality treatment and care. Purpose: The purpose of the present study was to develop a collaboration model, founded on the principle of joint population responsibility across the healthcare disciplines in Denmark, which are all involved in the cross-sectoral treatment of patients suffering from type 2 diabetes. Methods: Setting: The study was conducted in the three municipalities of Silkeborg, Skive and Viborg, often referred to as 'Midtklyngen', in the Central Denmark Region, and was performed in the hospitals, municipal healthcare centres and general practices in these three municipalities. Baseline was 1 January 2020 and the study will be completed by the end of March 2022. Population: All adults living in the municipalities of Silkeborg, Skive and Viborg who were diagnosed with type 2 diabetes. Design: The study was designed as a quality and improvement project. Data sources: Both quantitative population data and qualitative data which were collected through field studies and interviews were applied in the study. Interventions: The quantitative and qualitative data gave rise to four sub-projects. One sub-project was designed as a series of webinars, produced in collaboration with an endocrinologist from the hospital sector and offered to general practice as an educational tool to be used in the care of patients with type 2 diabetes. Two other interventions aimed at developing the collaboration between the GP clinics and the healthcare centres in the municipalities, with particular focus on patient participation and satisfaction, and also at maintaining healthier habits in the long-term secondary prevention of type 2 diabetes. Finally, the last intervention was an interview study where patients with type 2 diabetes were interviewed and asked about their attitudes towards collaboration between general practice, municipalities and hospital. The last intervention functioned as back ground material for the final collaboration model. Outcomes: Based on the four sub-projects, a cross-sectoral collaboration model for type 2 diabetes will be developed in late 2021. Results: The final work on the interventions and the cross-sectoral collaboration model for type 2 diabetes will be presented at the International Conference on Integrated Care, which will take place in Odense on 23-25 May 2022. [ABSTRACT FROM AUTHOR]

Healthcare systems face escalating capacity challenges and patients with repeated acute admissions strain hospital resources disproportionately. However, studies investigating the characteristics of such patients across all public healthcare providers in a universal healthcare system are lacking.To investigate characteristics of patients with repeated acute admissions (three or more acute admissions within a calendar year) in regard to sociodemographic characteristics, disease burden, and contact with the primary healthcare sector.This matched register-based case–control study investigated repeated acute admissions from 1 January 2014 to 31 December 2018, among individuals, who resided in four Danish municipalities. The study included 6169 individuals with repeated acute admissions, matched 1:4 to individuals with no acute admissions and one to two acute admissions, respectively. Group comparisons were conducted using conditional logistic regression.Receiving social benefits increased the odds of repeated acute admissions 9.5-fold compared with no acute admissions (odds ratio (OR) 9.5; 95% confidence interval (CI) 8.5; 10.6) and 3.4-fold compared with one to two acute admissions (OR 3.4; 95% CI 3.1; 3.7). The odds of repeated acute admissions increased with the number of used medications and chronic diseases. Having a mental illness increased the odds of repeated acute admissions 5.8-fold when compared with no acute admissions (OR 5.7; 95% CI 5.2; 6.4) and 2.3-fold compared with one to two acute admissions (OR 2.3; 95% CI 2.1; 2.5). Also, high use of primary sector services (e.g. nursing care) increased the odds of repeated acute admissions when compared with no acute admissions and one to two acute admissions. This study pinpointed key factors encompassing social status, disease burden, and healthcare utilisation as pivotal markers of risk for repeated acute admissions, thus identifying high-risk patients and facilitating targeted intervention. [ABSTRACT FROM AUTHOR]

Physical activity and exercise therapy appear safe and beneficial for people with multimorbidity and should therefore be considered in the prevention and management of multimorbidity, as argued in this review. General practitioners and specialists should refer people with multimorbidity to supervised exercise therapy (2-3 times/week for 8-12 weeks, strengthening or aerobic exercise or a combination), while encouraging and educating patients to improve physical activity to improve overall health by e.g., integrating physical activity in everyday-life practices such as gardening, transportation, and house chores., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Objective: Physiologically, pregnancy-associated plasma protein-A (PAPP-A) serves to liberate bound IGF1 by enzymatic cleavage of IGF-binding proteins (IGFBPs), IGFBP4 in particular. Clinically, PAPP-A has been linked to cardiovascular disease (CVD). Stanniocalcin-2 (STC2) is a natural inhibitor of PAPP-A enzymatic activity, but its association with CVD is unsettled. Therefore, we examined associations between the STC2-PAPP-A-IGFBP4-IGF1 axis and all-cause mortality and CVD in patients with type 2 diabetes (T2D)., Design: We followed 1284 participants with T2D from the ADDITION trial for 5 years., Methods: Circulating concentrations of STC2, PAPP-A, total and intact IGFBP4 and IGF1 and -2 were measured at inclusion. End-points were all-cause mortality and a composite CVD event: death from CVD, myocardial infarction, stroke, revascularisation or amputation. Survival analysis was performed by Cox proportional hazards model., Results: During follow-up, 179 subjects presented with an event. After multivariable adjustment, higher levels of STC2, PAPP-A, as well as intact and total IGFBP4, were associated with all-cause mortality; STC2: hazard ratio (HR) = 1.84 (1.09-3.12) (95% CI); P = 0.023, PAPP-A: HR = 2.81 (1.98-3.98); P < 0.001, intact IGFBP4: HR = 1.43 (1.11-1.85); P = 0.006 and total IGFBP4: HR = 3.06 (1.91-4.91); P < 0.001. Higher PAPP-A levels were also associated with CVD events: HR = 1.74 (1.16-2.62); P = 0.008, whereas lower IGF1 levels were associated with all-cause mortality: HR = 0.51 (0.34-0.76); P = 0.001., Conclusions: This study supports that PAPP-A promotes CVD and increases mortality. However, STC2 is also associated with mortality. Given that STC2 inhibits the enzymatic effects of PAPP-A, we speculate that STC2 either serves to counteract harmful PAPP-A actions or possesses effects independently of the PAPP-A-IGF1 axis., Significance Statement: PAPP-A has pro-atherosclerotic effects and exerts these most likely through IGF1. IGF1 is regulated by the STC2-PAPP-A-IGFBP4-IGF1 axis, where STC2, an irreversible inhibitor of PAPP-A, has been shown to reduce the development of atherosclerotic lesions in mice. We examined the association of this axis to mortality and CVD in T2D. We demonstrated an association between PAPP-A and CVD. All components of the STC2-PAPP-A-IGFBP4-IGF1 axis were associated with mortality and it is novel that STC2 was associated with mortality in T2D. Our study supports that inhibition of PAPP-A may be a new approach to reducing mortality and CVD. Whether modification of STC2 could serve as potential intervention warrants further investigation.

Objective: To explore health-care use in the 12 months preceding a diagnosis of RA in Denmark., Methods: We conducted a population-based cohort study using data from national registries. Every patient diagnosed with RA in 2014-18 was matched to 10 reference individuals without RA from the Danish background population. Health-care use was defined as contacts to general practitioners, contacts to private practicing physiotherapists, and X-rays of hands and/or feet performed in primary or secondary care. We estimated the monthly contact rates for patients and references in the 12 months preceding the diagnosis, and we compared incidence rates for health-care use in each month between the two groups while adjusting for sociodemographic characteristics and comorbidity., Results: We included 7427 patients with RA and 74 270 references. Patients with RA had increasing contact rates with general practitioners and physiotherapists from 6 to 8 months before the diagnosis. Compared with references, women with RA had statistically significantly more contacts to general practitioners and physiotherapists during all 12 months. A similar contact pattern was seen in men, albeit less distinct. The number of X-rays increased slightly from 8 months before the diagnosis, with a steep increase in the last 3 months., Conclusion: Increased contacts to general practitioners and physiotherapists were seen in all 12 months preceding the RA diagnosis, intensifying in the last 6 to 8 months. Imaging increased from 3 months before the diagnosis. This indicates an opportunity to expedite referral to specialist care and ensure earlier diagnosis of RA., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This review focuses on communication about weight-related issues with patients with obesity in general practice. Primary care providers still lack knowledge and tools to address and communicate about the topic of weight and weight-related issues - with focus on minimizing stigmatization and a person centered approach. A few communication tools on the topic have been developed but it seems that the use of those is limited, suggesting an urgent need for making a fast, easy and simple tool for the use in general practice.