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Objectives Diabetes technology provides people with diabetes with new opportunities, but the transformations allowed by new technology do not necessarily provide improvements in clinical metrics applied in diabetes care. This study seeks to understand how everyday life impacts on the way people use diabetes technology and how this influences diabetes care. Methods Individual semi-structured qualitative interviews with 21 adults with type 1 diabetes treated with insulin pumps were recruited from two Danish diabetes outpatient clinics. Data were analyzed abductively and interpreted according to predetermined and emergent perspectives. Results Transformations in care practices derived from new technological therapies were generally well-supported by healthcare providers, but adaptation to everyday life was often challenging. More advanced technology enabled people to better control diabetes, but the control they sought was defined by individual life experiences/factors. Work involved in controlling blood glucose could cause a sense of feeling controlled by diabetes in everyday life. Discussion Everyday life with diabetes is often characterized by uncertainty and individual coping strategies are imbued with values that extend beyond purely clinical concerns and reflect the sociality of everyday life. The social values influencing individual decision-making regarding diabetes technology could be effectively expanded and enhanced with integrated peer-supported learning.

Background In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM’s main tasks and goals. Method Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%). Results The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM’s main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field. Conclusion The consensus on definition and scope of behavioral medicine and ISBM’s tasks and goals provides a foundational step toward achieving these goals.

Background The number of people of working age suffering from chronic disease is increasing. Chronic diseases such as diabetes can cause negative work-related consequences in the form of early retirement or absenteeism. Providing flexible workplace accommodations may enable the person with diabetes to retain their position in the labor market. However, the successfulness of such accommodations depends largely on the perceptions of those not suffering from diabetes. The purpose of this study was to examine preferences of a population of workers in Denmark for flexibility at the workplace, for people with diabetes and for people with chronic disease in general, measured as their willingness to pay (WTP). Methods Respondents were drawn from online panels and randomized to answer an online survey regarding flexibility at the workplace for people with diabetes or chronic disease in general. One thousand one hundred and three respondents were included in the analysis. Based on discrete choice experiments included in the survey, we analyzed WTP for five flexibility attributes: part-time, customizing job description, additional break with pay and time off for medical visits with and without pay. We further examined perceptions of the employer’s responsibility to ensure workplace flexibility for five different specific chronic diseases including diabetes. Finally, we analyzed differences in WTP for flexibility across subgroups. Results Respondents’ WTP was significantly higher for chronic disease in general compared to diabetes for the possibility of part-time (81€/month vs. 47€/month, p

Aims The aim was to understand diabetes-related barriers and successes that people with diabetes (PWD) have in the context of work outside the home. Methods The DAWN2 survey of adults with type 1 or type 2 diabetes mellitus contained open-ended items about living with diabetes. All responses to these questions were reviewed and references to worklife were extracted for analysis. An emergent coding schema was developed and validated by two independent coders (kappa = 0.875). Results In total, 328 PWD wrote about work, 93 (28%) with type 1 and 235 (72%) with type 2, of whom 90 took insulin. Analysis generated five themes: (1) Work as context for learning about diabetes; (2) Work as an arena for personal achievement and self-identity with diabetes; (3) The demands of work conflict with the demands of diabetes self-care; (4) Discrimination and stigma in the context of work; and (5) Social support in the context of work. Several of these themes identify challenges relating to the impact of diabetes upon work, and vice-versa. However, coping strategies and supportive social relations generated affirmative psychosocial experiences. Conclusion The challenges that diabetes, its treatment, and its complications can have for working adults highlights the importance of social support in the work environment.

OBJECTIVES: This study aimed to (i) estimate working life expectancies (WLE) and the number of working years lost (WYL) among individuals with type 1 and type 2 diabetes over a 30-year period and (ii) identify educational differences in WLE and WYL. METHODS: Individuals aged 18–65 years diagnosed with type 1 (N=33 188) or type 2 diabetes (N=81 930) in 2000–2016 and age- and gender-matched controls without diabetes (N=663 656) were identified in Danish national registers. WLE in years were estimated as time in employment from age 35–65 years. We used a life-table approach with multi-state (eg, disability pension, sickness absence, unemployment) Cox proportional hazard modeling. Analyses were performed separately for sex, cohabitation status, educational duration, and type of diabetes. Inverse probability weights accounted for differences between populations. RESULTS: People with diabetes had significantly shorter WLE and greater WYL compared to people without diabetes over the 30-year span. At age 35, cohabitant women with lower education and diabetes lost up to 8.0 years [95% confidence interval (CI) 5.0–11.0] and men 7.0 years (95% CI 4.0–8.7). WYL among women with higher education was 4.4 (95% CI 6.6–2.3) and 3.7 years among men (95% CI 1.5–4.5). Compared to people with type 2 diabetes, those with type 1 spend significantly more years in disability pension, but there were no significant differences in the other WYL estimates. CONCLUSIONS: The WYL among people with diabetes is substantial and characterized by social disparities. The WYL help identify intervention targets at different ages, types of diabetes, sex, educational and cohabitant status.

Background Although diabetes is among the most common causes of lifelong disability, no studies have yet outlined work disability from a life course perspective. This study estimated the number of years people with type 1 and type 2 diabetes lost in a work life span compared to people without diabetes Methods Individuals aged 18-65 years, diagnosed with type 1 (n = 33,188) or type 2 diabetes (n = 81,930) were identified from national registers from the entire Danish population and age and gender matched with controls without diabetes (n = 663,656), for period 2000-2017. WLE in years were estimated as time in employment from age 35 to 65. We used a life table approach with multi-state Cox proportional hazard modelling (95% Confidence Intervals: CI). Age was the underlying time-axis. Inverse probability weights accounted for differences between populations. Analyses were performed separately for sex, educational status, and types of diabetes in 5-year age intervals. Results Individuals with type 1 diabetes and type 2 diabetes had significantly shorter WLE compared to people without diabetes in the 30-year span. Type 1 diabetes: WLE ranged from 8 years shorter among women with short education [-8.0; CI:-11/-5.0] to 4 years shorter [-4.4; CI:-6.6/-2.3] with high education; WLE in men ranged from -6.4 [CI:-8.7/-4.0] with short education to -3.0 [CI:-4.5/-1.5] with high education. Type 2 diabetes: WLE ranged from -6.5 [CI: -8.9/-4.0] in women with short education to -2.9 [CI: -4.5/-1.3] with high education. WLE in men ranged from -7.0 [CI: -9.4/-4.5] with short education to -3.7 [CI: -5.4/-2.0] with high education. Conclusions The substantial number of years lost in a work life span for individuals with type 1 or type 2 diabetes, highlight need for new strategies that prevent work disability, particularly for individuals with short education. Key messages Individuals with type 1 diabetes and type 2 diabetes had between 9 and 3 years shorter work life expectancies compared to people without diabetes in a 30-year span. The work life spans are substantial shorter for individuals with type 1 or type 2 diabetes with short educations.

Objective/background Associations between exposure to effort-reward imbalance at work (eg, high time pressure/low appreciation) and risk of sleep disturbances have been reported, but the direction of the effect is unclear. The present study investigated changes in effort-reward imbalance and risk of concomitant and subsequent onset of sleep disturbances. Methods Participants with sleep disturbances at baseline were excluded. We included participants from a population-based cohort in Denmark (n = 8,464, 53.6% women, mean age = 46.6 years), with three repeated measurements (2012 (T0); 2014 (T1); 2016 (T2)). Changes in effort-reward imbalance (T0-T1) were categorized into ‘increase’, ‘decrease’ and ‘no change’. Self-reported sleep disturbances (difficulties initiating or maintaining sleep, non-restorative sleep, daytime tiredness) were dichotomized (presence versus absence). We regressed concomitant (T1) and subsequent (T2) sleep disturbances on changes in effort-reward imbalance (T0-T1) and calculated odds ratios (OR) and 95% confidence intervals, adjusted for sex, age, education and cohabitation. Results At follow-up, 8.4% (T1) and 12.5% (T2) reported onset of sleep disturbances. Increased effort-reward imbalance was associated with concomitant sleep disturbances (T1) (OR = 3.16, 2.56–3.81), whereas decreased effort-reward imbalance was not (OR = 1.22, 0.91–1.63). There was no association between increased effort-reward imbalance and subsequent sleep disturbances (T2) (OR = 1.00, 0.74–1.37). Results were similar for men and women. Conclusions Increased effort-reward imbalance was associated with a three-fold higher risk of concomitant onset of sleep disturbances at two-year follow-up, but not subsequent onset of sleep disturbances at four-year follow-up, indicating that changes in effort-reward imbalance have immediate rather than delayed effects on sleep impairment. It is possible that the results from the two-year follow-up were to some extent affected by reverse causality., Highlights • Psychosocial work stressors are discussed as risk factors for sleep disturbances. • Working conditions in which efforts exceeds rewards may elicit stress. • We studied the effect of changes in stressors on sleep in a large nationwide cohort. • Effort-reward imbalance was associated with 3-fold higher risk of sleep disturbances. • Changes in stressors had immediate rather than delayed effects on sleep impairment.

Background: Automated insulin delivery (AID) systems have been shown to be safe and effective in reducing hyper- and hypoglycaemia, but are not universally available, accessible, and affordable. Therefore, user-driven open-source AID systems are becoming increasingly popular. Methods: This study investigated motivations why people with diabetes or their caregivers decide to build and use a personalised open-source AID. A cross-sectional online survey was conducted to assess personal motivations and associated self-reported clinical outcomes. Findings: Of 897 participants from 35 countries, 80·4% were adults with diabetes and 19·6% were caregivers of children with diabetes. Primary motivations to commence open-source AID included: improving glycaemic outcomes (94% of adults, 95% of caregivers), reducing acute (87%/96%) and long-term (83%/91%) complication risk, interacting less frequently with diabetes technology (81%/76%), improving their/child’s sleep quality (72%/80%), increasing their/child’s life expectancy (72%/85%), lack of commercially available AID systems (71%/70%), and unachieved therapy goals with available therapy options (68%/69%). Improving their own sleep quality was an almost universal motivator for caregivers (94%). Significant improvements, independent of age and gender, were observed in self-reported HbA1C, 7·14±1·13% (54·5±12·4 mmol/mol) to 6·24±0·64% (44·7±7·0 mmol/mol; p

Objective To examine the prospective relation between effort-reward imbalance at work and risk of type 2 diabetes. Methods We included 50,552 individuals from a national survey of the working population in Denmark, aged 30–64 years and diabetes-free at baseline. Effort-reward imbalance was defined, in accordance with the literature, as a mismatch between high efforts at work (e.g. high work pace, time pressure), and low rewards received in return (e.g. low recognition, job insecurity) and assessed as a continuous and a categorical variable. Incident type 2 diabetes was identified in national health registers. Using Cox regression we calculated hazard ratios (HR) and 95% confidence intervals (95% CI) for estimating the association between effort-reward imbalance at baseline and risk of onset of type 2 diabetes during follow-up, adjusted for sex, age, socioeconomic status, cohabitation, children at home, migration background, survey year and sample method. Results During 136,239 person-years of follow-up (mean = 2.7 years) we identified 347 type 2 diabetes cases (25.5 cases per 10,000 person-years). For each one standard deviation increase of the effort-reward imbalance score at baseline, the fully adjusted risk of type 2 diabetes during follow-up increased by 9% (HR: 1.09, 95% CI: 0.98–1.21). When we used effort-reward imbalance as a dichotomous variable, exposure to effort-reward imbalance was associated with an increased risk of type 2 diabetes with a HR of 1.27 (95% CI: 1.02–1.58). Conclusion The results of this nationwide study of the Danish workforce suggest that effort-reward imbalance at work may be a risk factor for type 2 diabetes.

Aim To evaluate labour market outcomes in type 1 or type 2 diabetes. Methods Individuals with type 1 (n = 431) and type 2 diabetes (n = 4047) were identified in Danish national registers from 1994 to 2011 and compared with individuals without diabetes (n = 101 295). Multi-state Cox proportional hazards analyses estimated hazard ratios (HR) with 95% confidence intervals (CI) for transitions between work, sickness absence, unemployment and disability pension. Results We observed significantly higher HR of sickness absence in type 1 diabetes (women: 1.34, 95% CI 1.12-1.62; men: 1.43, 1.01-2.03) and type 2 diabetes (women: 1.46, 95% CI 1.35-1.58; men: 1.64, 1.46-1.85) compared with people without diabetes. HR of unemployment was higher for men with type 1 diabetes (1.25, 95% CI 1.01-1.53) and women with type 2 diabetes (1.09, 95% CI 1.03-1.16) and men with type 2 diabetes (1.17, 95% CI 1.08-1.27). HR of disability pension was higher in type 1 diabetes (women: 1.90, 95% CI 1.46-2.46; men: 2.09, 1.38-3.18) and type 2 diabetes (women: 1.78, 95% CI 1.62-1.96; men: 2.11, 1.86-2.40). Only women with type 2 diabetes were less likely to return to work from sickness absence (HR 0.91, 95% CI 0.86-0.98) or unemployment (0.89, 95% CI 0.85-0.94). We found no significant difference between the two types of diabetes. Hazard ratios for diabetes regarding unemployment, sickness absence while unemployed and disability pension were significantly higher for men than for women. Conclusions Both type 1 and type 2 diabetes affect labour market outcomes, but future studies should also consider comorbidity and social gradient.

Aim To explore factors associated with non-disclosure of Type 2 diabetes to employers among Danish workers with Type 2 diabetes. Methods A total of 705 workers with Type 2 diabetes completed a Danish cross-sectional survey. Logistic regression models were used to estimate the associations between background characteristics and probability of non-disclosure of diabetes to the employer. The models were mutually adjusted for background characteristics, socioeconomic-, diabetes- and work-related factors. Results Among the participants, 23% had not disclosed their Type 2 diabetes to their current employer. Non-disclosure was associated with more sickness absence, more years with diabetes, greater use of diabetic medication, higher educational level and a perception of not being respected by superior. Personal traits such as gender, age and well-being were not associated with disclosure. Conclusions Among the feasible targets for interventions, good psychosocial work environment was associated with disclosure. This article is protected by copyright. All rights reserved.

Objective To investigate the relation between effort‐reward imbalance (ERI) at work and subsequent weight changes. Methods We included participants from a population‐based cohort of workers in Denmark (mean age = 47 years, 54% women) with two (n = 9005) or three repeated measurements (n = 5710). We investigated the association between (a) ERI (ie, the mismatch between high efforts spent and low rewards received at work) at baseline and weight changes after a 2‐year follow‐up (defined as ≥5% increase or decrease in body mass index (BMI) vs stable), and (b) onset and remission of ERI and subsequent changes in BMI. Using multinomial logistic regression we calculated risk ratios (RR) and 95% confidence intervals (CI), adjusted for sex, age, education, cohabitation, migration background, and follow‐up time. Results After 2 years, 15% had an increase and 13% a decrease in BMI. Exposure to ERI at baseline yielded RRs of 1.09 (95% CI: 0.95‐1.25) and 1.04 (95% CI: 0.90‐1.20) for the increase and decrease in BMI, respectively. There were no differences between sex and baseline BMI in stratified analyses. The onset of ERI yielded RRs of 1.04 (95% CI: 0.82‐1.31) and 1.15 (95% CI: 0.84‐1.57) for subsequent increase and decrease in BMI. The RRs for the remission of ERI and subsequent increase and decrease in BMI were 0.92 (95% CI: 0.71‐1.20) and 0.78 (95% CI: 0.53‐1.13), respectively. Of the ERI components, high rewards were associated with a lower risk of BMI increase. Conclusion ERI was not a risk factor for weight changes. Future studies may investigate whether this result is generalizable to other occupational cohorts and settings.

Objective: Little is known about why PwD leave traditional pathways and turn to DIY technology. This study aims to examine the motivations of Do-it-Yourself Artificial Pancreas System (DIYAPS) users and caregivers to build and maintain these systems. Methods: An online survey with 34 items was distributed to DIYAPS users and caregivers of children with DIYAPS through Facebook (“Looped” and regional subgroups) and Twitter (Diabetes Online Community). Results: 1058 participants from 34 countries responded to the survey. The majority were adult users (80.2%; 43% female; median age 41 years) with T1D (98.9%) for 25.2 years ±13.3. 19.8% were caregivers of children (47.4% female; median age 10 years) with T1D (99.4%) for 5.1 years ±3.9. With 10.1m ±17.6 on DIYAPS, HbA1c improved from 7.07% ±1.07 to 6.24% ±0.68 %. Time in Range improved from 63.21% ±16.27 to 83.07% ±10.11. Additional out-of-pocket costs of 712 USD/year were spent. Motivations to build a DIYAPS are shown in Fig.1. Conclusions: Improved glycemic control, need for an ‘autopilot’ and less acute and long-term complications were key motivations in both groups; as well as better sleep for caregivers. Users were also able to access and afford the required tools. These results may provide a better understanding of unmet needs of PwD and current challenges to uptake, in order to facilitate the involvement of patient-led and open source approaches in healthcare. Disclosure K. Braune: Advisory Panel; Self; Medtronic MiniMed, Inc. Speaker’s Bureau; Self; Dexcom, Inc. S. O’Donnell: None. B. Cleal: None. D.M. Lewis: Consultant; Self; Diabeloop SA, Roche Diabetes Care. A. Tappe: Consultant; Self; IME-DC GmbH. Employee; Self; Hi.health, Gruber-Debong GmbH. Speaker’s Bureau; Self; Dexcom, Inc., Roche Diabetes Care, Ypsomed AG. Other Relationship; Self; SOOIL Developments Co., Ltd. B. Hauck: Consultant; Self; Bayer AG, Eli Lilly and Company, LifeScan, Inc., Novo Nordisk A/S, Roche Diabetes Care, Roche Pharma. I. Willaing: None. R. Scibilia: Speaker’s Bureau; Self; Roche Diabetes Care. E. Rowley: None. W. Ko: None. G. Doyle: None. T.C. Skinner: None. K. Raile: Advisory Panel; Self; Abbott, Lilly Diabetes. Funding European Union

Background and Aim: Diabetes has been associated with considerable work disability, but different risks of disability have not been assessed systematically among people with type 1 (T1D) and type 2 diabetes mellitus (T2D). This study evaluated risks of long-term sickness absence (LTSA), unemployment, return to work and disability pension in individuals with T1D or T2D. Method: We observed individuals with T1D (n=431), T2D (n=4,047) and without diabetes (n=101,295) in Danish national registers of health, work and social benefits from 1994 -2011. In a multi-state model, Cox proportional analyses estimated hazard ratios (95% Confidence Intervals) of each transition between work, LTSA, unemployment and disability pension. Analyses were performed separately for men and women. Results: Compared to people without diabetes, women and men with T1D and T2D had significantly higher hazard ratios of LTSA and disability pension (Table 1). Except for women with T1D we observed significantly higher risks of unemployment. Women with T2D had significantly lower chances of returning to work from LTSA or unemployment. Conclusions: People with T1D and T2D have elevated risks of temporary and permanent work disability. Future studies should include all work-related outcomes to avoid underestimating the burden of living with T1D and T2D. Disclosure M.A. Nexo: None. J. Pedersen: None. B. Cleal: None. J.B. Bjorner: Employee; Self; Optum Patient Insights.

AimsTo assess the socio-economic distribution of comorbid depression and diabetes among the Danish workforce using national registry data.MethodsUsing national registers, all eligible Danish adults aged 18–59 years on 1 January 1996 were followed until 31 December 2010. Diabetes status was obtained from the Danish National Diabetes Register and information on purchase of prescription antidepressants from the Register of Medicinal Product Statistics. Data were also obtained on people's occupational status and gross annual income. The people included in the study were stratified according to their highest occupational group during the study period. Annual incomes were adjusted to 2013 levels and, using the distribution of the study population's incomes, we stratified participants into income quintiles.ResultsA total of 3 434 420 individuals met the inclusion criteria at baseline, with 98 006 developing diabetes during follow-up. There were 603 498 new prescriptions of antidepressants during follow-up; 19 849 (20.3%) among people with diabetes and 583 649 (17.5%) among those without. People with diabetes in all income quintiles (risk ratio 1.65; 95% CI 1.62–1.67) and all occupational groups (risk ratio 1.70; 95% CI 1.68– 1.73) had a significantly elevated risk compared with the general population. Risk ratios were significantly higher among the lowest occupational groups and income quintiles.ConclusionOur results provide robust data underlining the associations between diabetes, depression and socio-economic status. They highlight and encourage further focus on the issue of comorbid diabetes and depression, particularly among the most disadvantaged.

AIMS: While workplace wellness services are proactively established to improve well-being and reduce sickness absence, knowledge of reasons for using these services remains sparse. This study investigates which factors determine use of an in-house wellness service at a large organization (the Danish Police) with several departments in different geographical locations.METHODS: All potential users of the Wellness service ( n = 15,284) were invited to respond to a cross-sectional questionnaire. Of 6060 eligible respondents, 58% had used the service at least once (any use) and 17% had used the service at least three times (frequent users). Two items assessed the frequency of statements of justifications for using or not using the Wellness service. Associations between 32 demographic and psychosocial variables and use of the Wellness service were evaluated with unadjusted bivariate logistic regression analyses.RESULTS: The two primary justifications for using the Wellness service were: to get a blood pressure assessment (37%) and to rehabilitate injury (26%). The two most common justifications for not using the Wellness service were: no perceived need (44%) and already physically active (34%). Of the 32 demographical and psychosocial variables included, 28 were associated with any use and 24 with frequent use.CONCLUSIONS: Use of the Wellness service appears to be driven by a complex configuration of factors that resist easy translation into practical advice. Non-participation was accounted for in terms of both positive and negative barriers. Use of the service for purposes of primary prevention and health promotion was, relatively speaking, lagging behind.

Background The increasing number of people with chronic diseases challenges workforce capacity. Type 2 diabetes (T2D) can have work-related consequences, such as early retirement. Laws of most high-income countries require workplaces to provide accommodations to enable people with chronic disabilities to manage their condition at work. A barrier to successful implementation of such accommodations can be lack of co-workers’ willingness to support people with T2D. This study aimed to examine the willingness to pay (WTP) of people with and without T2D for five workplace initiatives that help individuals with type 2 diabetes manage their diabetes at work. Methods Three samples with employed Danish participants were drawn from existing online panels: a general population sample (n = 600), a T2D sample (n = 693), and a matched sample of people without diabetes (n = 539). Participants completed discrete choice experiments eliciting their WTP (reduction in monthly salary, €/month) for five hypothetical workplace initiatives: part-time job, customized work, extra breaks with pay, and time off for medical consultations with and without pay. WTP was estimated by conditional logits models. Bootstrapping was used to estimate confidence intervals for WTP. Results There was an overall WTP for all initiatives. Average WTP for all attributes was 34 €/month (95% confidence interval [CI]: 27–43] in the general population sample, 32 €/month (95% CI: 26–38) in the T2D sample, and 55 €/month (95% CI: 43–71) in the matched sample. WTP for additional breaks with pay was considerably lower than for the other initiatives in all samples. People with T2D had significantly lower WTP than people without diabetes for part-time work, customized work, and time off without pay, but not for extra breaks or time off with pay. Conclusions For people with and without T2D, WTP was present for initiatives that could improve management of diabetes at the workplace. WTP was lowest among people with T2D. Implementation of these initiatives seems feasible and may help unnecessary exclusion of people with T2D from work.

Objective: With previous studies indicating that diabetes affects employment status and life-time earnings, the aim of this study was to determine the impact on earnings in the immediate period after diagnosis. Recognising that earnings and employment status are dynamic over the life course, we matched people with diabetes to counterparts in the general population and compared nominal growth in earned income five calendar years after diagnosis. Research Design and Methods: The study draws upon Danish population registers. Residents aged 25-62 years between 1996 and 2007 were included in the study. We identified an indi-vidually matched control group from approximately 2,800,000 ‘diabetes-free’ Danish adults using propensity score matching. Matching was based on age, gender, residence, earned in-come, growth in earned income, and unemployment in the calendar year before diagnosis.Results: 91,090 people with diabetes were included in the study and matched to 91,090 con-trols in the general population. The analysis revealed highly significant loss of earnings for people with diabetes when compared with people without diabetes, with an overall relative loss of US $ 3,694 (8.01%) among men and US $ 924 (3.03%) among women. The effect was generally largest in the youngest age-group, in lower earners and among men.Conclusions: The results clearly indicate that a diagnosis of diabetes has a significant impact on earnings. Age and earnings at the time of diagnosis appear to play a moderating role.

AimsPeople with diabetes have heightened levels of depressive symptoms, but less is known about the development of these symptoms in relation to diabetes duration. In this study, we examined the use of prescribed antidepressants in the first five years after diagnosis of diabetes among the working-age population in Denmark.MethodsAll Danish adults aged 18–54 years, diagnosed with diabetes in the study period were included. Diabetes status and purchase of prescription antidepressants were obtained from validated population registers. Data analysis focused on filled antidepressant prescriptions at ≤1 and ≤5 years from diagnosis with diabetes.Results35,677 people diagnosed with diabetes were included in the study. At ≤1 year post-diagnosis, 2.6% had filled antidepressant prescriptions. At ≤5 years, this figure rose to 10.4%. Overall, both female gender and lower socioeconomic status were associated with higher incidence of filled antidepressant prescriptions. Diabetes duration modified the degree of differences between men and women and socioeconomic strata.ConclusionDiagnosis with diabetes immediately impacts mental wellbeing, with higher rates of filled antidepressant prescriptions in the first year after diagnosis. People of working age diagnosed with diabetes face specific challenges and addressing such challenges would enhance patient experiences. Focus on mental health in the clinical encounter with people newly diagnosed with diabetes is warranted and important.

Thyroid diseases evoke a complex range of psychological and physical symptoms. The psychosocial aspects of living with diseases causing hypo- or hyperthyroidism are poorly understood. In this article, we report the findings of a qualitative interview study in which we explored the lived experiences of 16 people with hypo- or hyperthyroidism. We purposefully selected participants from Danish outpatient clinics according to their diagnosis (Hashimoto’s thyroiditis or Graves’ disease with or without orbitopathy), age (18 to 65 years), and duration of treatment (more than 6 months). We used interpretative phenomenological analysis (IPA) as a theoretical frame and analytical approach and identified three superordinate themes: losing control over mental and physical states, ambiguous signs of disease, and negotiating sickness. We discuss the findings in the context of the recent literature on chronic illness and argue that these themes play an important role in the conceptualization and management of thyroid diseases.

This qualitative systematic review investigated how individuals with chronic illness experience online peer-to-peer support and how their experiences influence daily life with illness. Selected studies were appraised by quality criteria focused upon research questions and study design, participant selection, methods of data collection, and methods of analysis. Four themes were identified: (a) illness-associated identity work, (b) social support and connectivity, (c) experiential knowledge sharing, and (d) collective voice and mobilization. Findings indicate that online peer-to-peer communities provide a supportive space for daily self-care related to chronic illness. Online communities provided a valued space to strengthen social ties and exchange knowledge that supported offline ties and patient–doctor relationships. Individuals used online communities to exchange experiential knowledge about everyday life with illness. This type of knowledge was perceived as extending far beyond medical care. Online communities were also used to mobilize and raise collective awareness about illness-specific concerns.

Objective. To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e., wellness service). Methods. Respondents to an electronic questionnaire who acknowledged wishing to change health behaviors in relation to smoking ( n = 845), alcohol ( n = 684), eating ( n = 4,431), and physical activity ( n = 5,179) were asked to choose up to three help alternatives on a predefined list. Results. In descending order, smokers preferred help from nicotine gum, no help, and help and support from family and friends. Alcohol consumers preferred no help or help and support from family and friends or “other” forms. Employees who wanted to change eating habits preferred a free fruit bowl, free nutritional guidance, and healthy food at work. Employees who wanted to change physical activity patterns preferred exercise at work, offers of free exercise, and exercise in a social/collegial context. Conclusion. Wishing to change health behaviors is not always accompanied by perceiving a need for assistance. The no-help option was selected fairly frequently and mostly in relation to alcohol and smoking. A fruit bowl was the most preferred option for help, followed by exercise at work and free exercise. Help from traditional health services was ranked low, possibly reflecting that they are primarily viewed as a solution for stopping disease rather than promoting health.

The aim of this study was to examine the extent and distribution of disability retirement among people with diabetes in the workforce. Using four population registries, the study examined the relative rates of disability retirement among employees in Denmark over a 10-year period. The findings highlight that the risk of disability retirement increases as occupational status decreases. With an ageing workforce and increasing prevalence of diabetes, it is important to target primary, secondary and tertiary prevention to the groups that need it most in attempts to prolong the working lives of individuals.

Objective. To examine the relationship between self-efficacy and not wanting help to change health behaviors. Method. All employees in the Danish police department were invited to respond to an electronic questionnaire. All respondents expressing a desire to change health behaviors in relation to smoking ( n = 845), alcohol ( n = 684), eating ( n = 4431), and physical activity ( n = 5179) and who subsequently responded to questions on self-efficacy were included. Results. Both the bivariate and multiple regression analyses showed that all four specific self-efficacy scores were positively related to reporting that one did not want help. Conclusion. A high belief in one’s own ability to change lifestyle behaviors in relation to smoking, alcohol, eating, and physical activity may lead to avoidance of help offers in a workplace setting.

Objectives To explore why people who have active work and who experience suboptimal health avoided using a multipurpose in-house health promotion service in the Danish police. Methods Data were first collected via an electronic survey (N=6060) and subsequently via 25 telephone interviews targeting nonusers who perceived their health to be suboptimal. Results Many nonusers with suboptimal health wished to change health behaviors, but did not use the service. Reasons were both individual (eg, laziness) and organizational (eg, delivery of the service). Conclusions Although many reported barriers are more individual in nature, increased information and accessibility could serve to increase participation.

Objectives: To investigate the relationship between diabetes, mortality and exit from work using various Danish Pension schemes. Methods: We linked the Danish National Diabetes register with socioeconomic and population-based registers and followed prevalent and incident cases of diabetes for ten years, adjusting for gender, age and socio-occupational group. We analysed the proportion of individuals with diagnosed diabetes before and after entering a normal retirement pen-sion, voluntary early retirement pension or disability pension. Risk ratios for entering pensions, emigration and mortali-ty were calculated using Poisson regression. Results: Among 1,628,087 adults between the ages of 30 and 59, the relative risk for mortality was increased for those with incident and prevalent diabetes by 11-145%, compared to individuals without diabetes. Voluntary early retirement pension was the most common path out of the workforce, especially for individuals with diabetes. Compared to those without diabetes, the relative risk of disability retirement for individuals with prevalent and incident diabetes was 2.98 (95% CI, 2.89 – 3.07) and 2.40 (95% CI, 2.34 – 2.45), respectively. More than one fifth of participants were diagnosed with diabetes after retirement. There was a marked negative socio-occupational gradient for mortality, voluntary early retirement and disability pension. Conclusions: Increasing the retirement age will increase the proportion of workers who develop diabetes while still in the workforce. Since the number and severity of complications are related to longer disease duration, it is likely that, under proposed retirement reforms, more employees will experience health problems managing their jobs, especially among the most vulnerable socioeconomic groups. therefore expected to become more important as the retirement age increases. However, there is only scarce knowledge of how the incidence and prevalence of diabetes are distributed among different pension schemes.

Aims: To investigate the extent and socioeconomic distribution of incident diabetes among the Danish working-age population. Methods: The Danish National Diabetes Register was linked with socioeconomic and population-based registers covering the entire population. We analysed the 12-year diabetes incidence using multivariate Poisson regression for 2,086,682 people, adjusting for gender, 10-year age groups, main population groups defined by country of origin, and seven socioeconomic groups: professionals, managers, technicians, workers skilled at basic level, unskilled workers, unemployed and pensioners. Results: The crude 12-year incidence of diabetes was 5.8%. The saturated multivariate model, adjusted for gender, age, country of origin and socioeconomic status; showed a relative risk (RR) for diabetes incidence of 1.44 for male (reference: female), 3.95 for the age range of 50–59 years (reference: 30–39 years), 2.07 for unskilled workers (reference: professionals) and 2.15 for people from countries of ‘non-Western origin’ (reference: Danish origin). Conclusions: Diabetes incidence increases with age, male gender and low socioeconomic status; and also among people from countries of ‘non-Western origin’. The results indicate that getting a more senior workforce will substantially increase the proportion of workers with diabetes, especially among already vulnerable groups.

Background: Diabetes is associated with an increased risk of diabetes distress, depression, anxiety and eating disorders. Still, health professionals working with diabetes often fail to identify patients with serious psychological problems and to address psychological issues in general. Our aim was to explore diabetologist’s perceived barriers to addressing psychological issues in diabetes consultations. Methods: We conducted qualitative semi-structured individual interviews with 12 diabetologists working in specialist diabetes clinics in four different Danish hospitals. All interviews were transcribed verbatim and analysed by systematic meaning condensation. Results: We identified three main categories of barriers: 1) the structural organisation of diabetes consultations, e.g. sparse consultation time, extensive screen work, and missing referral possibilities; 2) the relation between patients and physicians, e.g. the perception of patient attitudes or patient personality; and 3) the individual diabetologist, e.g. acquired and inherent skills, and the physicians perceived area of responsibility. Psychological aspects of diabetes were generally perceived as more important by younger diabetologists. More senior clinicians tended to regard psychological issues as of less importance and not within their core responsibility. Conclusion: The structural organisation of consultations, especially time constraints, and the perceived area of responsibility were the most prominent barriers to addressing mental health problems in diabetes consultations. Our study provides explanations for the gap between the widespread knowledge among diabetologists of the importance of psychological issues and the frequent failure to address such issues, and thus provides a basis for the development of strategies to facilitate a change of practice.

Aims To contribute to the research on diabetes and social inequality by presenting national data on incident diabetes mellitus, stratified according to socio-economic status. Methods National registers were combined, linking socio-economic status with incident diabetes over a 10-year period (2001–2010). The study population comprised employees in Denmark aged 20–59 years at baseline. Poisson regression analysis was used to estimate socio-economic rate ratios. Excess fraction analysis was used to determine the proportion of cases that would not have occurred if morbidity rates in each socio-economic group had been as low as those in the reference group. Monte Carlo simulation was used to calculate 95% CIs for excess fraction estimates Results A total of 1 005 572 men and 951 039 women were included in the analysis. The follow-up yielded 43 439 cases in 9 533 199 person-years at risk among men and 29 266 cases in 9 163 405 person-years at risk among women. Using ‘professionals’ as a reference group, higher levels of relative risk were observed among every other socio-occupational group. The excess fraction was, 0.342 (95% CI 0.329–0.354) among men and 0.359 (95% CI 0.349–0.369) among women. Conclusions Excess fraction analysis suggests that more than a third of cases of diabetes could be prevented if all employees were exposed to the same working conditions as the reference population. Acknowledging potential confounders, the observed levels of incident diabetes among the workforce highlight the potential gains to be had by better use of the workplace as an arena for prevention. Greater integration of occupational health and general healthcare is required to achieve this.

Objectives: To establish a detailed picture of injury pattern among professional goods-transport drivers in Denmark. Methods: For each calendar year over the period of 1995-2003, the age-standardized hospital contact ratios (SHRs) for injury were calculated for male drivers working for road goods-transport contractors in Denmark. The reference population was the male skilled/semiskilled subpopulation of the general workforce in Denmark. Results: No differences in the rate of injury-related hospital contact could be found between male goods-transport drivers and the reference population between 1995 and 1999. However, in the following period of 2000-2003, elevated rates of injury-related hospital contact were noted among goods-transport drivers, compared with the reference population. Furthermore, the injury-related SHR of goods-transport drivers showed a significant increase throughout the period of 1995-2003. Injuries to ankles/feet/toes were prominent among goods-transport drivers. Compared with the reference population, male goods-transport drivers had elevated rates of superficial injuries, dislocations/sprains/strains, fractures, and concussion. The superficial injuries were sustained most frequently in the ankles/feet/toes, open wounds in head/neck, dislocations/sprains/strains in ankles/feet/toes, and fractures in wrists/hands/fingers and ankles/feet/toes. Conclusion: There is a clear need for efforts to prevent work injuries among goods-transport drivers. Special attention should be paid to preventing fractures in wrists/hands/fingers and ankles/feet/toes, dislocations/sprains/strains in ankles/feet/toes, open wounds in head/neck, and concussion. Language: en

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, but have potentially serious adverse effects. We investigated the knowledge of patients with inflammatory arthritis with regards to risks associated with the combination of prescribed and over-the-counter (OTC) NSAIDs, of differences in side effects between acetaminophen and NSAIDs, and from which sources patients received information about side effects.Data from 170 questionnaires provided to consecutive patients with inflammatory arthritis at a rheumatologic outpatient clinic were collected through questionnaires (response rate 75%).Eighty-seven percent of patients had taken prescribed NSAIDs or OTC analgesics during the previous 2 weeks, 36% being NSAIDs, and 36% used analgesics regularly. Fifty-four percent would increase the dose of drugs in a bad period, and they were more likely to over-use the OTC drugs than the prescribed drugs (P = 0.002, Mann-Whitney). Factors recognized to increase the risk of side effects were: higher dose (81% of patients), long-term treatment (68%), previous side effects (57%), combination of NSAIDs (49%), and old age (31%). Twenty-three percent assumed that acetaminophen increased the risk of side effects. Information was obtained from package inserts (84%), the rheumatologist (80%), and the general practitioner (50%). They had greatest confidence in the rheumatologist, package leaflets, and the general practitioner.Incomplete knowledge and misconceptions of some patients suggests that more information on risk factors and side effects to NSAID treatment is needed to improve patient safety. This is especially true about the combination of prescribed and OTC drugs.

BACKGROUND: Goods-transport drivers in Denmark had an elevated rate of hospital contact due to injury compared with the skilled/semiskilled workforce in general in recent years. There is a need to elucidate the causes of their work injuries. METHODS: We analyzed the Danish National Work Injury Register for the 10-year period 1993-2002. RESULTS: The vast majority (92.6%) of the work injuries among goods-transport were sustained under non-traffic activities, that is, collecting, loading, unloading, and delivering goods. They fell from height (22.3%), suffered from overexertion (14.2%), got caught between/under objects (12.6%), collided with objects (12.0%), slipped/tripped (10.6%), or got struck by falling objects (9.0%). CONCLUSIONS: There is a clear need for efforts to prevent work injuries under non-traffic activities among goods-transport drivers in Denmark. For this end, it is necessary to involve not only the drivers' employers for reinforcement of safety procedures, but also the employers' customers for improvement of the physical environment, in which drivers collect, load, unload, and deliver goods. Language: en