Search

Introduction: Hyperglycaemia during hospitalisation is associated with a longer and more complicated admission and with increased mortality. Therefore, guidelines suggest that blood glucose should be less than 10 mmol/l. In this audit, we aimed to describe the prevalence of diabetes patients at four orthopaedic departments in the Capital Region of Denmark and to measure the quality of in-hospital diabetes management., Methods: We conducted audits of medical records in the electronic health record system for two months in 2019. All patients admitted were included in the audit. We gathered information on diabetes status, orthopaedic diagnosis, glycosylated haemoglobin and diabetes management., Results: Among 2,463 included patients, 10% had diabetes. The three most frequent diagnosis groups were infection, fracture of lower extremity and hospitalised for alloplastic surgery. The number of blood glucose measurements during 24-hour perioperative care was 6.5. Among patients analysed, 10-20% did not have their blood glucose measured in the days following surgery. Among patients, 64% received insulin 1-50% of the required times., Conclusion: We demonstrated that 10% of hospitalised patients suffer from diabetes. The audit also showed that blood glucose is generally measured according to guidelines, whereas the treatment of an elevated blood glucose is far from being given according to guidelines. This may potentially delay recovery and prolong hospitalisation., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Diabetes is a diverse and complex disease, with considerable variation in phenotypic manifestation and severity. This variation hampers the study of etiological differences and reduces the statistical power of analyses of associations to genetics, treatment outcomes, and complications. We address these issues through deep, fine-grained phenotypic stratification of a diabetes cohort. Text mining the electronic health records of 14,017 patients, we matched two controlled vocabularies (ICD-10 and a custom vocabulary developed at the clinical center Steno Diabetes Center Copenhagen) to clinical narratives spanning a 19 year period. The two matched vocabularies comprise over 20,000 medical terms describing symptoms, other diagnoses, and lifestyle factors. The cohort is genetically homogeneous (Caucasian diabetes patients from Denmark) so the resulting stratification is not driven by ethnic differences, but rather by inherently dissimilar progression patterns and lifestyle related risk factors. Using unsupervised Markov clustering, we defined 71 clusters of at least 50 individuals within the diabetes spectrum. The clusters display both distinct and shared longitudinal glycemic dysregulation patterns, temporal co-occurrences of comorbidities, and associations to single nucleotide polymorphisms in or near genes relevant for diabetes comorbidities., Competing Interests: IK, CS, KB, PH, AH, PJ, LJ, CR, MP, RE, HA, TA, JB, NG, KB, OP, FP, TH, RB, PR, SB No competing interests declared, (© 2019, Kirk et al.)

Aims To investigate the prevalence of symptomatic obstructive sleep apnoea in unselected patients with Type 2 diabetes referred to a tertiary diabetes clinic. Methods In a cross-sectional design, all newly referred patients were offered a stepwise screening for obstructive sleep apnoea with: (1) The Berlin questionnaire; then, if indicative: (2) overnight home monitoring with the ApneaLink™ device. Patients with an apnoea-hypopnoea index ⩾ 5/h were offered referral for diagnostic polygraphy and treatment initiation. Results A total of 200 patients participated (61% men; age 59.6 ± 10.5 years, diabetes duration 8.3 ± 6.3 years and BMI 31.7 ± 6.7 kg/m2). According to the questionnaire, 106 patients showed 'high risk' of obstructive sleep apnoea, and 72 of these were referred to polygraphy based on ApneaLink screening corresponding to a prevalence of symptomatic obstructive sleep apnoea of 39%. Patients with symptomatic obstructive sleep apnoea had significantly higher BMI, poorer glycaemic control and lower plasma HDL cholesterol levels as compared with patients unlikely to have obstructive sleep apnoea. The groups were not different with respect to sex, age, diabetes duration, blood pressure, diabetic complications or medication use. In multiple regression analyses, age, BMI and HDL cholesterol levels were all significant, independent predictors of obstructive sleep apnoea. Conclusions At least one third of people with Type 2 diabetes referred to a diabetes clinic in Denmark has symptomatic obstructive sleep apnoea. Our data suggest higher age, a compromised plasma lipid profile and a more obese phenotype in patients with Type 2 diabetes who have obstructive sleep apnoea, highlighting the need to focus on screening and treatment of obstructive sleep apnoea in these patients. [ABSTRACT FROM AUTHOR]

Aims Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes. Methods We studied major and minor lower-extremity amputations from 2000 to 2011 among 11 332 people with diabetes from the Steno Diabetes Center. Amputations were identified by linkage of the electronic medical system with the National Patient Registry. Sex-specific incidence rates of amputations by age, diabetes duration, calendar time and diabetes type were modelled by Poisson regression. Results From 2000 to 2011, 384 incident lower-extremity amputations (205 major, 179 minor) occurred during 100 495 years of patient follow-up. From 2000 to 2011, the incidence of all lower-extremity amputations decreased by 87.5% among men and 47.4% among women with Type 1 diabetes and by 83.3% among men and 79.1% among women with Type 2 diabetes ( P < 0.001). In particular, there was a decline in major lower-extremity amputations. In 2011, the incidence rates of major lower-extremity amputations were 0.25 (95% CI 0.07-0.82) among men and 0.21 (95% CI 0.06-0.71) among women per 1000 patient-years at age 50 years and 0.56 (95% CI 0.18-1.89) among men and 0.41 (95% CI 0.16-1.09) among women per 1000 patient-years at age 70 years. No significant change in incidence of minor amputations was observed. Conclusion The incidence of major lower-extremity amputations reduced significantly from 2000 to 2011 in Danish people with diabetes followed at a diabetes specialist centre. [ABSTRACT FROM AUTHOR]

Purpose: Malnutrition increases the risk of developing alcohol-related complications. The aim of this study was to describe nutrient intake, nutritional status and nutrition-related complications in a Danish population of outpatients with alcohol dependency., Methods: This was a cross-sectional study with a 6-month follow-up enrolling persons with alcohol dependency (n = 80) admitted to a hospital-based outpatient clinic. Body mass index, the waist-to-hip ratio and handgrip strength (HGS) were measured, a 7-day food diary was collected, and biochemical testing was conducted. Dual-energy X-ray absorptiometry was performed to determine body composition and bone mineral density (BMD)., Results: In total, 64% of the patients with alcohol dependency had vitamin D insufficiency (25-OH-vit D <50 nmol/l). Compared with surveys of the general population, the patients with alcohol dependency had lower energy intake (p = 0.008), s-zinc levels (p < 0.001), s-magnesium levels (p = 0.02), Z-scores for BMD (lumbar spine, p = 0.03; total hip, p = 0.009) and HGS (p < 0.001). Osteopenia was observed in 52% of individuals, and overt osteoporosis was noted in 7%. Comparing baseline data with data from the follow-up (n = 30), we found a decrease in s-CRP (p = 0.002) and s-alanine amino transferase (p = 0.01) levels and an increase in s-parathyroid hormone levels (p = 0.02)., Conclusions: Patients with alcohol dependency have an altered nutritional status and risk of complications, as evidenced by osteopenia/osteoporosis and reduced muscle strength. Treatment at an outpatient clinic improved the variables related to liver function, but no change was observed in nutritional status over time. These findings suggest that specific screening and targeted treatment regimens for nutritional deficits could be beneficial.

Aims: To investigate the relationship between structural and functional social support and patient activation, diabetes-related emotional distress, perceived diabetes care, self-management behaviour and HbA(1c) levels among patients with Type 2 diabetes., Methods: Self-administered questionnaires were collected from 2572 patients with Type 2 diabetes. After adjusting for gender, age and education, Tobit and logistic regression models were used to examine associations between social network and patient activation, psychosocial problems, self-management behaviours and HbA(1c) levels., Results: Frequent contact with friends was associated with more positive scores for activation, fewer psychosocial problems, more positive assessment of care and health-promoting self-management behaviours such as frequent exercising and frequent foot examinations. Frequent contact with family was associated with more positive assessments of care. Living with a partner was associated with lower prevalence of smoking, a higher frequency of foot examinations and higher HbA(1c) levels. A poor functional social network, measured as perceived lack of help in the event of severe illness, was associated with low patient activation, greater emotional distress, negative assessment of care, less health-promoting eating habits and less frequent foot examinations., Conclusions: Good social support is significantly associated with health-promoting behaviours and well-being among patients with Type 2 diabetes. However, HbA(1c) levels are higher for cohabitant persons, indicating barriers for social support. Intervention research is needed to investigate the causal relationship between social networks and health-promoting behaviours. This knowledge should be used in clinical practice when targeting and designing education, support and care for patients with Type 2 diabetes., (© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.)

Background: This study investigates risk factors and the incidence of type 2 diabetes mellitus (type 2 DM) in both sexes of a northern European population., Methods: A total of 14,223 randomly selected men and women were studied from 1976 to 1978. Patients with diabetes (self-reported type 2 DM or non-fasting plasma glucose >11.1 mmol/l) were excluded. Some 6154 women and 4733 men were studied and followed up in 1981-1983 or in 1991-1994. The significance of risk factors was examined by multiple logistic regression analysis., Results: Initially, a higher proportion of men than women had high, non-fasting blood glucose and triglycerides. Significantly more men (242, 5.4%) than women (152, 2.5%) developed type 2 DM. The odds ratio (OR) for developing diabetes with a BMI above 30 kg/m(2) compared to a BMI of 20-25 kg/m(2) was 8.1 in women and 6.3 in men; for a non-fasting plasma glucose of 8.4-11.0 mmol/l compared to a plasma glucose of 5.5-6.4, the ORs were 7.8 in women and 4.7 in men. The OR for developing diabetes in persons with a non-fasting triglyceride level above 2.0 mmol/l compared to 1.0-2.0 mmol/l was 1.8 in both sexes; women with non -fasting triglycerides below 1.0 mmol/l had an OR of 0.4., Conclusion: In a randomly selected northern European population, significantly more men than women develop type 2 DM.

Rationale: Low body mass index (BMI) is a marker of poor prognosis in chronic obstructive pulmonary disease (COPD). In the general population, the harmful effect of low BMI is due to the deleterious effects of a low fat-free mass index (FFMI; fat-free mass/weight(2))., Objectives: We explored distribution of low FFMI and its association with prognosis in a population-based cohort of patients with COPD., Methods: We used data on 1,898 patients with COPD identified in a population-based epidemiologic study in Copenhagen. FFM was measured using bioelectrical impedance analysis. Patients were followed up for a mean of 7 yr and the association between BMI and FFMI and mortality was examined taking age, sex, smoking, and lung function into account., Main Results: The mean FFMI was 16.0 kg/m(2) for women and 18.7 kg/m(2) for men. Among subjects with normal BMI, 26.1% had an FFMI lower than the lowest 10th percentile of the general population. BMI and FFMI were significant predictors of mortality, independent of relevant covariates. Being in the lowest 10th percentile of the general population for FFMI was associated with a hazard ratio of 1.5 (95% confidence interval, 1.2-1.8) for overall mortality and 2.4 (1.4-4.0) for COPD-related mortality. FFMI was also a predictor of overall mortality when analyses were restricted to subjects with normal BMI., Conclusions: FFMI provides information in addition to BMI and assessment of FFM should be considered in the routine assessment of COPD.

Unlabelled: High level of total serum calcium within the normal range has been associated with increased cardiovascular risk. We wanted to evaluate whether the physiological active ionised form of calcium also was a risk factor for cardiovascular disease (CVD)., Methods: A total of 974 participants from a health survey in 1981 in Copenhagen had ionised serum calcium and different cardiovascular risk factors measured. The participants were followed until 1999 in The National Hospital Patients Registry and The National Death Registry in Denmark regarding the diagnosis ischemic heart disease (IHD) and a broader definition of CVD. Persons with ionised serum calcium in the highest quintile were compared with persons in the lower four quintiles., Results: In a univariate analysis persons with ionised serum calcium in the highest quintile had increased risk of IHD (p=0.001) and CVD (p=0.02) compared to persons in the lower quintiles. The increased risk disappeared when gender and cardiovascular confounders were included in a Cox proportional hazards analysis (p=0.20 for IHD and p=0.50 for CVD, respectively). In a separate analysis of men and IHD the result remained insignificant (p=0.07)., Conclusions: Serum ionised calcium in the upper quintile in women and men together did not seem to be a risk factor in development of IHD and CVD, but a non-significant tendency towards increased risk of IHD was observed in men with ionised calcium in the upper quintile compared to men in the lower four quintiles.

Background: Epidemiological studies have reported that patients with type 2 diabetes mellitus (DM) have increased mortality and morbidity from cardiovascular diseases, independent of other risk factors. However, most of these studies have been performed in selected patient groups. The purpose of the present study was prospectively to assess the impact of type 2 DM on cardiovascular morbidity and mortality in an unselected population., Methods: A total of 13,105 subjects from the Copenhagen City Heart Study were followed up prospectively for 20 years. Adjusted relative risks of first, incident, admission for, or death from ischemic heart disease, acute myocardial infarction, or stroke, as well as total mortality in persons with type 2 DM compared with healthy controls, were estimated., Results: The relative risk of first, incident, and admission for myocardial infarction was increased 1.5- to 4.5-fold in women and 1.5- to 2-fold in men, with a significant difference between sexes. The relative risk of first, incident, and admission for stroke was increased 2- to 6.5-fold in women and 1.5- to 2-fold in men, with a significant difference between sexes. In both women and men the relative risk of death was increased 1.5 to 2 times., Conclusions: In persons with type 2 DM, the risk of having an incident myocardial infarction or stroke is increased 2- to 3-fold and the risk of death is increased 2-fold, independent of other known risk factors for cardiovascular diseases.

Background and Aims: To assess the amount of food produced in a hospital kitchen and the amount wasted. To assess the amount of food eaten by patients in relation to their energy needs. To assess whether the food production and wastage could be reduced by training members of the staff., Methods: The study was carried out in a general district hospital in Denmark. The amount of food produced in the hospital kitchen and returned uneaten (wasted) was determined. In a representative sample of patients, the energy expenditure was calculated and in the same patients, the energy and protein intake was determined. Following training of the hospital staff the first part was repeated., Results: On average, 11.1 MJ and 112 g of protein were ordered per patient per day. From these amounts on average 3.1 MJ and 33 g protein were wasted per patient per day. The total average energy expenditure was calculated to be 7.5 MJ per patient per day; however, on average, the daily energy intake was only 4.5 MJ and daily protein intake 46 g per patient. Sixty percent of the patients showed evidence of malnutrition as judged from the hospital notes. However, the staff only drew attention to this in 20% of the cases. Following training of the hospital staff, a new investigation showed no significant changes in the amount of food ordered and wasted., Conclusion: Despite a supply of food, which was much higher than the patients' needs, the patients have only approx. 60% of their energy need covered. We suggest a reorganization of nutrition in hospitals, so that this is made the responsibility of specific staff members.

We investigated the effect of repeated high volume plasma exchange with fresh donor plasma in 11 patients with fulminant hepatic failure, all initially in stage 3 or 4 encephalopathy. A daily exchange of a volume equal to the extracellular volume (20% of body weight) on three consecutive days was intended. We obtained an average of 2.6 exchanges each with a mean volume equal to 16% of the body weight. Five patients (46%, 95% confidence limits 17%-77%) survived, all with acetaminophen induced liver failure. Four of the 6 non-survivors showed a temporary improvement in cerebral function. Two of the patients woke up completely. The 6 non-survivors maintained a stable condition with a systolic blood pressure > 110 mm Hg for a mean of 6.9 days after initiating plasma exchange. Plasma exchange may be considered in acute liver failure in patients with residual liver function before transplantation is finally decided. In addition, plasmapheresis may be used to keep patients with definite liver failure clinically stable until a transplant can be performed.

Background: Individuals with severe chronic obstructive pulmonary disease (COPD) are often at risk of undernutrition with low health-related quality of life (HRQoL). Undernutrition can worsen COPD and other comorbidities, be an independent predictor of morbidity and functional decline resulting in increased healthcare consumption and increased risk of death. Especially exacerbations and acute infections result in unintentional weight loss. The aim is to investigate the effect of an individualized nutritional intervention among individuals with severe COPD. Methods: An open-label randomized controlled trial with two parallel groups. Participants are recruited from the pulmonary outpatient clinic at the Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark, and randomly allocated to either the intervention (intervention + standard of care) or control group (standard of care). The intervention has a duration of 3 months and combines individual nutritional care with adherence support and practical tools. It contains 4 elements including an individual nutritional plan, regular contacts, adherence support, and weight diary. The primary outcome is a difference in HRQoL (EQ-5D-5L) between the intervention and control group 3 months after baseline. Difference in functional capacity (grip strength, 30-s stand chair test, and physical activity), disease-specific quality of life (COPD Assessment Test), anxiety and depression (Hospital Anxiety and Depression Scale), nutritional parameters (energy and protein intake), anthropometry (weight, body mass index, waist, hip, and upper arm circumference), body composition (total fat-free and fat mass and indices), and prognosis (exacerbations, oxygen therapy, hospital contacts, and mortality) 3 months after baseline will be included as secondary outcomes. Data will be collected through home visits at baseline and 1 and 3 months after baseline. Discussion: Currently, nutritional care is a neglected area of outpatient care among individuals with severe COPD. If this patient-centered approach can demonstrate a positive impact on HRQoL, mortality, and hospital contacts, it should be recommended as part of end-of-life care for individuals with severe COPD. Trial registration: ClinicalTrials.gov NCT04873856. Registered on May 3, 2021. [ABSTRACT FROM AUTHOR]

In this study, we explored specific mechanisms of a board game developed to facilitate peer support among people with Type 2 diabetes attending group-based diabetes education. The game was tested with 76 people with Type 2 diabetes who participated in focus groups after the game. Data from observations of audio-recorded games and focus groups were analyzed using Interpretive Description. Six mechanisms facilitating peer support among people with Type 2 diabetes were identified: (a) entering a safe space of normality created by emotional in-game mirroring; (b) mutual in-game acknowledgment of out-of-game efforts; (c) forming relationships through in-game humor; (d) health care professionals using game rules to support group dialogues of interest to people with Type 2 diabetes; (e) being inspired by in-game exchange of tips and tricks; and (f) co-players guiding each other during the game. Peer support was inhibited by the mechanism of game rules obstructing group dialogues. [ABSTRACT FROM AUTHOR]

Aim: To map COVID‐19‐specific worries and overall psychosocial health among people with diabetes in the initial phase of the COVID‐19 pandemic in Denmark, and to explore characteristics of people with diabetes and high levels of worries related to the COVID‐19 pandemic. Methods: A cross‐sectional survey was conducted by distributing online questionnaires to 2430 adult members (> 18 years) of two user panels consisting of people with diabetes who have volunteered to share information about their life with diabetes. The questionnaire included items on COVID‐19‐specific worries as well as such worries related to diabetes, sociodemographic and health status, social relations, diabetes‐specific social support, diabetes distress and changes in diabetes‐specific behaviours. Responses were analysed with descriptive statistics and logistic regressions. Results: People with diabetes have COVID‐19‐specific worries related to their diabetes. More than half were worried about being overly affected due to diabetes if infected with COVID‐19, about one‐third about being characterized as a risk group due to diabetes and not being able to manage diabetes if infected. Logistic regressions showed that being female, having type 1 diabetes, diabetes complications and diabetes distress, feeling isolated and lonely, and having changed diabetes behaviours were associated with being more worried about COVID‐19 and diabetes. Conclusion: People with diabetes have COVID‐19‐specific worries related to their diabetes which is associated with poorer psychosocial health. These worries should be addressed through support targeting specific questions and needs of individuals with diabetes as well as frequent updates on new knowledge regarding COVID‐19 and diabetes. What's new?: Little is known about how worldwide pandemics affect the psychosocial health of people with diabetes.This study showed a high prevalence of diabetes‐specific worries related to COVID‐19, especially fear of being overly affected by the virus, labelling of people with diabetes as a high‐risk group, and inability to manage diabetes if infected.Female gender, type 1 diabetes, diabetes complications, isolation, loneliness, high diabetes distress and behaviour changes were associated with being more worried about COVID‐19 and diabetes.When providing information and support to people with diabetes in time of crisis, attention should be payed to crisis‐specific worries in specific groups. [ABSTRACT FROM AUTHOR]

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 < 0.001) and customizing job description (58€/month vs. 41€/month, p = 0.018) attributes, as well as for the overall average (49€/month vs. 36€/month, p = 0.008). Ensuring workplace flexibility for patients with a specific chronic disease other than diabetes (cancer, heart disease, arthritis and COPD) was to a higher degree considered a responsibility of the employer. Average WTP for flexibility varied across subgroups, consistently yielding a larger amount for chronic disease in general.Conclusions: The population examined in this study are willing to pay less for flexibility at the workplace for people with diabetes compared to people with chronic disease in general. This finding was evident in terms of specific flexibility attributes and on average across subgroups. [ABSTRACT FROM AUTHOR]

This article analyses the strategies that frail, home-dwelling older people who receive food from public institutions develop and use during eating situations, to gain an insight into how older people mobilise resources in relation to eating. The analysis is based on semi-structured interviews and participant observation sessions with 25 home-dwelling frail older men and women, aged 72–101, who live in Copenhagen and receive food from the municipality. Like healthier older people, frail older Danes develop and use strategies to create acceptable eating situations. The strategies are linked to the arrangement of the eating situation, their former lives and experience with food and eating, and their perception of their own body. The focus on strategies enables insights into how frail older people manage to mobilise resources to create meaningful eating situations. However, even though they mobilise resources to create and maintain eating strategies, these are not all equally appropriate with regards to supporting a healthy nutritional status. The eating strategies used by frail older people and the resources they entail are key to their experience with eating. Focusing on these strategies is useful when developing public care initiatives as this will precipitate an awareness of the resources of this group and how these are activated and contribute to or detract from a healthy nutritional status and a high quality of life. [ABSTRACT FROM AUTHOR]

Aim: To investigate approaches among healthcare providers (HCPs) that support or hinder person‐centredness in group‐based diabetes education programmes targeting persons with type 2 diabetes. Methods: Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in‐depth semi‐structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation. Results: Hindering approaches included a teacher‐centred focus on delivering disease‐specific information. Communication was dialog based, but HCPs primarily asked closed‐ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open‐ended questions. Discussion: Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person‐centredness involves redefined roles and responsibilities. Applying person‐centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person‐centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person‐centred approaches in a group context. Conclusion: Teacher‐centredness undermined person‐centredness because HCPs primarily delivered disease‐specific recommendations, leading to biomedical information overload for participants. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim To explore barriers to and motivators for physical activity in a group of overweight and obese individuals with dysregulated Type 2 diabetes. Methods Data were collected from the Steno Diabetes Center's outpatient clinic in Denmark. Four focus groups were conducted including 28 individuals with Type 2 diabetes aged 39-71 years. The facilitators used open-ended questions and probes such as images, statements and quotations about physical activity to foster active participation and interaction among participants. Focus groups were recorded on video and the discussions were transcribed and analysed thematically. Results We identified four main themes: 1) the body as a barrier to physical activity because of functional limitations; 2) logistical challenges, including lack of time and awareness of where to exercise in the local area; 3) being physically active with others, providing a sense of mutual commitment and enjoyment; and 4) goal-setting and self-tracking, which was seen as an opportunity to track physical improvement over time. Conclusions The findings suggest that, once people are active, a high level of social interaction may help maintain their activity levels. Further research is needed to investigate the effect of combining individually tailored exercise plans with the establishment of customized and locally based exercise communities that offer enjoyment and support. Additionally, it is relevant to explore experiences of using self-tracking technologies to review short- and long-term goals. [ABSTRACT FROM AUTHOR]

Aim To examine prescribing practices and predictors of glucose-lowering therapy within the first year following diagnosis of Type 2 diabetes mellitus in a clinical care setting. Methods We followed people enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort from outpatient hospital clinics and general practices throughout Denmark in 2010-2013. We used Poisson regression to compute age- and gender-adjusted risk ratios (RRs). Results Among 1158 new Type 2 diabetes mellitus patients, 302 (26%) did not receive glucose-lowering therapy within the first year, 723 (62%) received monotherapy [685 (95%) with metformin], and 133 (12%) received more than one drug. Predictors of receiving any vs. no therapy and combination vs. monotherapy were: age < 40 years [RR: 1.29 (95% CI: 1.16-1.44) and 3.60 (95% CI: 2.36-5.50)]; high Charlson Comorbidity Index [RRs: 1.20 (95% CI: 1.05-1.38) and 2.08 (95% CI: 1.16-3.72)]; central obesity [RRs: 1.23 (95% CI: 1.04-1.44) and 1.93 (95% CI: 0.76-4.94)]; fasting blood glucose of ≥ 7.5 mmol/l [RRs: 1.25 (95% CI: 1.10-1.42) and 1.94 (95% CI: 1.02-3.71)]; and HbA1c = 59 mmol/mol (≥ 7.5%) [RR: 1.26 (95% CI: 1.20-1.32) and 2.86 (95% CI: 1.97-4.14)]. Weight gain = 30 kg since age 20, lack of physical exercise and C-peptide of < 300 pmol/l also predicted therapy. Conclusions Comorbidity, young age, central obesity and poor baseline glycaemic control are important predictors of therapy one year after Type 2 diabetes mellitus debut. [ABSTRACT FROM AUTHOR]

This study aimed to explore and understand foodservice professionals’ experiences and perceived barriers toward strategies of reducing food waste in large scale institutional kitchens. Explorative semi-structured individual interviews were conducted with eight foodservice professionals from four different foodservice institutions. Interviews were audio taped and transcribed verbatim. The results revealed nine main themes: forecasting and portion flexibility, routine monitoring, current strategies in use, enhancing internal awareness, collaboration through communication, taking on responsibility, attitude and habits, regulatory constraints and competing priorities. These findings highlight the importance of understanding barriers to overcoming the challenges foodservice professionals face in reducing food waste. [ABSTRACT FROM PUBLISHER]

Background New evidence indicates that increased dietary protein ingestion promotes health and recovery from illness, and also maintains functionality in older adults. The present study aimed to investigate whether a novel food service concept with protein-supplementation would increase protein and energy intake in hospitalised patients at nutritional risk. Methods A single-blinded randomised controlled trial was conducted. Eighty-four participants at nutritional risk, recruited from the departments of Oncology, Orthopaedics and Urology, were included. The intervention group ( IG) received the protein-supplemented food service concept. The control group ( CG) received the standard hospital menu. Primary outcome comprised the number of patients achieving ≥75% of energy and protein requirements. Secondary outcomes comprised mean energy and protein intake, body weight, handgrip strength and length of hospital stay. Results In IG, 76% versus 70% CG patients reached ≥75% of their energy requirements ( P = 0.57); 66% IG versus 30% CG patients reached ≥75% of their protein requirements ( P = 0.001). The risk ratio for achieving ≥75% of protein requirements: 2.2 (95% confidence interval = 1.3-3.7); number needed to treat = 3 (95% confidence interval = 2-6). IG had a higher mean intake of energy and protein when adjusted for body weight (CG: 82 kJ kg−1 versus IG: 103 kJ kg−1, P = 0.013; CG: 0.7 g protein kg−1 versus 0.9 g protein kg−1, P = 0.003). Body weight, handgrip strength and length of hospital stay did not differ between groups. Conclusions The novel food service concept had a significant positive impact on overall protein intake and on weight-adjusted energy intake in hospitalised patients at nutritional risk. [ABSTRACT FROM AUTHOR]

Background Undernutrition and insufficient energy and protein intake is a common problem in hospitalised patients. The aim of this pilot study was to investigate whether a novel hospital menu would be an effective strategy for increasing nutritional intake in patients at nutritional risk. Methods A historically controlled intervention pilot study was conducted. Forty patients at nutritional risk were offered a novel hospital menu as a supplement to the ordinary hospital menu. The menu consisted of 36 naturally energy-enriched small dishes served on demand 24 h a day. Energy and protein intake were calculated as the mean over a period of 3 days. Results No significant difference in energy and protein intake was observed between the groups; however, a significant ( P = 0.001) time gradient in total energy intake was observed in the intervention group. Moreover, a significant ( P = 0.03) time gradient in energy intake received from the novel menu was observed. The dishes from the novel menu were mainly ordered from 11.00 h to 14.00 h and from 17.00 h to 18.00 h. Conclusions No overall significant differences in energy and protein intake between the groups were found. However, the present pilot study revealed a significant time gradient in total energy intake ( P = 0.001) and in energy intake from the novel menu ( P = 0.03). This indicates the need to include a run-in period when investigating novel hospital menus as a support for patients at nutritional risk. Additionally, food service, available 24 h a day, appears to be unnecessary. [ABSTRACT FROM AUTHOR]

Aims: Poor social support and lack of social network are well-established risk factors for morbidity and mortality in general populations. Good social relations, such as social support and network contacts, are associated with better self-management and fewer psychosocial problems in persons with type 2 diabetes. The aim of this study was to investigate whether persons with type 2 diabetes have poorer social relations than the general population. Methods: We conducted a cross-sectional survey in three settings: a specialist diabetes clinic (SDC) (n = 1084), a web panel (WP) consisting of persons with type 2 diabetes (n = 1491) and a sample from the 2010 Danish Health and Morbidity Survey, representative of the general population (n = 15,165). We compared social relations using multivariate logistic regression. Results: Compared to the general population, persons with type 2 diabetes more often lived without a partner (SDC, OR 1.75, 95% CI 1.49–2.06; WP, OR 1.64, 95% CI 1.43–1.87), met with family less than once a month (SDC, OR 1.78, 95% CI 1.40–2.27; WP, OR 2.35, 95% CI 1.94–2.84) and were less certain they could count on help from others in case of illness (WP, OR 1.23, 95% CI 1.08–1.41). Conclusions: Our findings suggest that persons with type 2 diabetes have poorer social relations than the general population. From a public health point of view, special attention is needed with regards to strengthening existing networks and establishing alternative networks among persons with type 2 diabetes. [ABSTRACT FROM PUBLISHER]

Background: Hyperthyroidism has been associated with increased all-cause mortality. Whether the underlying cause of hyperthyroidism influences this association is unclear. Our objectives were to explore whether mortality risk and cause of death differ between Graves' disease (GD) and toxic nodular goiter (TNG). Methods: This is an observational cohort study, using record-linkage data from nationwide Danish health registers. A total of 1291 subjects with GD and 861 with TNG, treated in a hospital setting, were identified and followed for a mean period of 11 years. Cases were matched 1:4 with nonhyperthyroid controls with respect to age and sex. The hazard ratio (HR) for mortality was calculated using Cox regression analyses. All analyses were adjusted for comorbidity using the Charlson score. Results: Both GD (HR=1.42 [95% confidence interval (CI) 1.25-1.60]) and TNG (HR=1.22 [CI 1.07-1.40]) were associated with increased all-cause mortality. After stratification for the cause of death, GD was associated with increased mortality due to cardiovascular diseases (HR=1.49 [CI 1.25-1.77]) and lung diseases (HR=1.91 [CI 1.37-2.65]), whereas TNG was associated with increased cancer mortality (HR=1.36 [CI 1.06-1.75]). When analyzing mortality in GD using TNG individuals as controls, there was no significant difference in all-cause mortality between GD and TNG. However, GD was clearly associated with a higher cardiovascular mortality (HR=1.39 [CI 1.10-1.76]) compared to TNG. Conclusion: Both GD and TNG, treated in a hospital setting, are associated with increased all-cause mortality. The causes of death differ between the two phenotypes, with cardiovascular mortality being significantly higher in GD. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis is associated with an increased risk of infection and a poor prognosis, but the role of alcoholism in these outcomes is uncertain. This study looks at the short-term prognosis for bacteremia in patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism, compared with the prognosis for other bacteremia cases. Methods: All patients who were hospitalized with their first community-acquired bacteremia in North Jutland County, Denmark, in the period 1992 to 2002 were retrieved from a population-based bacteremia registry. Denmark's Hospital Discharge Registry then allowed us to disaggregate these patients into the following groups: 47 patients with alcoholic liver cirrhosis, 19 with nonalcoholic liver cirrhosis, 190 with alcoholism, and a comparison group of 3,535 other bacteremia cases. Using logistic regression, we estimated odds ratios (ORs) for 30-day case fatality for the main study variable, adjusted for gender, age, focus of infection, and comorbidity. Results: The case fatality rate (CFR) was 43% for patients with alcoholic liver cirrhosis, 32% for patients with nonalcoholic liver cirrhosis, 24% for patients with alcoholism, and 15% for other bacteremia patients. The adjusted OR estimates for patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism compared with other bacteremia cases were 6.3 (95% CI 3.3–11.7), 2.4 (95% CI 0.9–6.7), and 2.5 (95% CI 1.7–3.7), respectively. Focus of infection and group of bacteria did not noticeably affect the increased CFR. Conclusion: Liver cirrhosis and alcoholism were associated with a poor short-term prognosis for community-acquired bacteremia. Liver cirrhosis and alcoholism may have independent effects on the prognosis for patients with liver cirrhosis and bacteremia. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- Diabetes may influence the outcome of complicated peptic ulcer disease, due to angiopathy, blurring of symptoms, and increased risk of sepsis. We examined whether diabetes increased 30-day mortality among Danish patients hospitalized with bleeding or perforated peptic ulcers. RESEARCH DESIGN AND METHODS -- This population-based cohort study took place in the three Danish counties of North Jutland, Viborg, and Aarhus between 1991 and 2003. Patients hospitalized with a first-time diagnosis of peptic ulcer bleeding or perforation were identified using the counties' hospital discharge registries. Data on diabetes, other comorbidities, and use of ulcer-associated drugs were obtained from discharge registries and prescription databases. The Danish Civil Registry System allowed complete follow-up for mortality. The outcome under study was 30-day mortality in diabetic versus nondiabetic patients, adjusted for potential confounders. RESULTS -- We identified 7,232 patients hospitalized for bleeding ulcers, of whom 731 (10.1%) had diabetes. The 30-day mortality among diabetic patients was 16.6 vs. 10.1% for other patients with bleeding ulcers. The adjusted 30-day mortality rate ratio (MRR) for diabetic patients was 1.40 (95% CI 1.15-1.70). We also identified 2,061 patients with perforated ulcers, of whom 140 (6.8%) had diabetes. The 30-day mortality among diabetic patients was 42.9 vs. 24.0% in other patients with perforated ulcers, corresponding to an adjusted 30-day MRR of 1.51 (1.15-1.98). CONCLUSIONS -- Among patients with peptic ulcer bleeding and perforation, diabetes appears to be associated with substantially increased short-term mortality. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2005; 19; 259–267 Nutritional care of Danish medical inpatients – patients’ perspectives Many patients do not eat and drink sufficiently during hospitalization. Surveys have shown that 30–50% of the elderly patients are undernourished when hospitalized, and for the majority of these patients their protein and energy requirements are not met during hospitalization. Diseased people often experience reduced appetite, aversion against certain types of food or nausea, and these symptoms are part of the explanation for insufficient consumption of food and drinks. In order to locate other possible explanations, this study investigate medical inpatients’ experiences and satisfaction with the nutritional care. The patients included a total of 91 medical inpatients at two internal medical wards, Aarhus University Hospital, Denmark. Their average age was 72 ± 11 years. They were individually interviewed about the food service and the nutritional care upon discharge. Patient satisfaction with the meals was overall high (90%). About 80% found the meals to be very important, but they lacked information about the food service, and the patients–staff communication about the food service was poor. The results indicate that the nursing staff was exercising a ‘knowledge monopoly’ in relation to the food service. In conclusion, a majority of the patients did not perceive the nutritional care as part of the therapy and nursing care during their hospitalization. [ABSTRACT FROM AUTHOR]

Background Atrial fibrillation is a common cardiac manifestation of hyperthyroidism. The relation between hyperthyroidism and atrial fibrillation has so far been analyzed in a limited number of selected patients, and the strength of the association has not been estimated. We examined the risk of atrial fibrillation among patients aged 20 to 89 years with hyperthyroidism diagnosed in hospitals in Denmark during a 20-year period. Methods We identified all patients with an incident hospital diagnosis of hyperthyroidism during the study period in the Danish National Registry of Patients, and among those we identified patients with a diagnosis of atrial fibrillation or flutter that occurred ±30 days from the date of the hospital diagnosis of hyperthyroidism. We used logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between sex, 10-year age group, cardiovascular diseases, and risk of atrial fibrillation or flutter. Results Among 40 628 patients diagnosed as having hyperthyroidism, 3362 (8.3%) were diagnosed as having atrial fibrillation or flutter within ±30 days from the date of the diagnosis of hyperthyroidism. The following factors were associated with risk of atrial fibrillation or flutter: male sex (OR, 1.8; 95% CI, 1.6-1.9), age (OR, 1.7; 95% CI, 1.7-1.8) per 10-year increment, ischemic heart disease (OR, 1.8; 95% CI, 1.6-2.0), congestive heart failure (OR, 3.9; 95% CI, 3.5-4.4), and heart valve disease (OR, 2.6; 95% CI, 1.9-3.4). Conclusion Male sex, increasing age, ischemic heart disease, congestive heart failure, and heart valve disease are associated with an increased risk of atrial fibrillation or flutter in patients with hyperthyroidism. [ABSTRACT FROM AUTHOR]

Background: The association between alcohol intake and liver disease is well known, but little is known about alcohol consumption and changes in liver-derived enzymes within 1 year. In a 1-year follow-up study we examined changes in liver-derived enzymes and their association with self-reported alcohol consumption. Methods: We recorded liver-derived enzyme values, self-reported alcohol consumption, and potential confounder variables at base line and at a 1-year follow-up in a representative sample of 822 persons (aged 30-50 years) from the survey of The Ebeltoft Health Promotion Project in Denmark, by using questionnaires, health examinations, and blood samples. Results: The prevalence of increased liver-derived enzyme values was 11.1% at base line and 11.8% at the 1-year follow-up. The incidence rate of increased liver-derived enzyme values was 5.1 per 100 person-years, and 34% of the cases of increased liver-derived enzyme values returned to normal within 1 year. We found an odds ratio of 4.0 for men and 8.0 for women of developing increased liver-derived enzyme values if alcohol consumption was more than 21 units a week. The risk seemed to be dose-dependent. Conclusions: The prevalence of increased liver-derived enzyme values in the population was high and increased slightly during the study period. There was a strong association between the incidence rate of increased liver-derived enzyme values and self-reported alcohol consumption in a dose-dependent relationship, also when adjusted for confounding by smoking and obesity. The persons with persistently increased enzyme values had a higher weekly alcohol consumption than the rest of the study population. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 176-184 Undernutrition has been seen in hospitalized patients at all times. Nurses have a central position in the nutritional care of the patient. Despite guidelines for nutritional practise and care, 20-55% of patients are still at risk of complications to insufficient nutrition intake. The aim of this study was to obtain knowledge of hospitalized patient's experiences of being undernourished, to understand implications this might have to quality of nutritional nursing care. Qualitative interviews were undertaken in 12 hospitalized patients at severe nutritional risk. Pain, no appetite, bad taste and side effects to medication were among reasons for poor eating. Nurses practically did not address or question symptoms that could influence poor eating and were only to a low degree involved at patient initiative. The patients appeared to divide into two groups; One 'Passive group', characterized with fatigue, lack of concentration and short term memory, were found insusceptible to increase nutrition intake by motivation and guidance. The overall motivation in the other 'Active' group was the setting of and achievement of goals, which had to be clear, communicated and followed up by nurses and physicians. This group furthermore found self-determination and active involvement determinant for a positive and fruitful cooperation between staff and themselves. Nurses were in progressive about clarifying why patients did not eat. Patients highly regarded nutrition registration when followed up, however, this was only practised to a low degree. Severely undernourished patients could be divided in two groups. The 'Passive group' should be attended to systematically. Artificial nutrition is often needed in this group. The 'Active group' should be cared for with individual, active involvement from nurses. Nurses should be able to distinct which nutritional care for which patient, and act upon it. [ABSTRACT FROM AUTHOR]