Marjolein Memelink Iversen

Background: People with type 1 diabetes are burdened by musculoskeletal hand and shoulder diagnoses and vascular late complications. We aimed to explore associations of musculoskeletal diagnoses, 30-year HbA1c and vascular complications with pain, fatigue, depression, and quality of life (QoL) in an increasing group of long-term survivors of type 1 diabetes. Methodology: This exploratory, observational study included 104 participants with type 1 diabetes ≥ 45 years’ duration who completed questionnaires assessing pain (RAND-36 bodily pain), fatigue (Fatigue Questionnaire), depression (Patient Health Questionnaire), overall QoL (WHOQoL–BREF) and diabetes-specific QoL (Audit of Diabetes-Dependent QoL). We used linear regression to estimate associations between hand and shoulder diagnoses, 30-year HbA1c ≥ 64 mmol/mol (8%) and vascular complications with PROs. Results: Compared to 30-year HbA1c and vascular complications, combined hand and shoulder diagnoses showed the strongest estimated association with bodily pain; [B (95% confidence interval)] [-17.4 (-32.8, -2.1)], followed by 30-year HbA1c ≥ 64 mmol/mol [10.9 (-21.9, 0.1)], microvascular complications alone [-11.3 (-24.8, 2.1)], and micro- and macrovascular complications combined [-5.9 (-21.9, 10.2)]. Vascular complications, particularly microvascular, were associated with worse overall QoL and diabetes-specific QoL. Conclusions: Musculoskeletal hand and shoulder diagnoses show stronger associations with bodily pain than vascular complications, while vascular complications appear more important for QoL in this cohort of long-term survivors with type 1 diabetes. Estimates where however uncertain due to limited sample size.

Background: Gestational diabetes mellitus (GDM) affects 1-in-7 pregnancies globally and is associated with significant short- and long-term health consequences. Although health behaviour change interventions can effectively reduce these risks, a significant implementation gap exists in translating this evidence into routine practice. Bump2Baby and Me (B2B&Me) was a mobile health (mHealth) coaching intervention provided to women at-risk of GDM from early pregnancy through to 1-year postpartum. B2B&Me Plus (B2B&Me+) aims to refine, implement and evaluate the implementation of this personalised intervention across 4 countries (Ireland, Spain, Poland and Norway) with differing health systems and population profiles. Methods: This study employs a hybrid type 3 implementation-effectiveness design using a non-randomised ABA block approach within a longitudinal cohort. Participants will be screened using the Monash machine learning GDM screening tool (MMLGDST). During the intervention (Block B), women at risk of developing GDM will be offered access to a smartphone-based coaching application featuring 1:1 synchronous sessions, asynchronous text and video messaging along with a Bluetooth-enabled weighing scale for self-monitoring. Support continues from early pregnancy through to nine months postpartum. The study’s primary objective is to evaluate reach, adoption, implementation and maintenance of the B2B&Me+ intervention programme when delivered within routine maternity care. Implementation success will be assessed using the RE-AIM framework, while secondary outcomes will assess intervention effectiveness. The study will examine population-level uptake at each site, evaluate the benefits and costs of implementation across varying contexts, and analyse how four different referral methods, randomised at the site level, affect uptake. In addition, a European implementation toolkit will be developed to provide health services with scalable strategies to bridge the evidence-to-practice gap. Discussion: This study will contribute to a growing literature on the implementation of a successfully trialled mHealth intervention in a real-world context. Understanding variation in both intervention and implementation success within a routine maternity care context across diverse settings will inform the development of an implementation toolkit to support health services in reducing the incidence of GDM and improving maternal and child health outcomes. This study was registered with ClinicalTrials.gov (NCT07189221) on 28 August 2025 ( https://clinicaltrials.gov/study/NCT07189221?cond=diabetes ).

Aim: This study examined age‐ and sex‐specific prevalence and trends in underweight among Norwegian children and adolescents during the pre‐pandemic period from 2010 to 2019 and COVID‐19 pandemic period from 2020 to 2022. Methods: Height and weight data from 78 024 children aged 2 to 13 years in Bergen from 2010 to 2022 were obtained from public health clinic and school health service records. Underweight grades 1 to 3 were defined using the International Obesity Task Force cut‐offs. Age‐ and sex‐specific prevalence was analysed longitudinally, and trends were assessed for boys and girls across age groups using regression analyses. Results: Underweight was most prevalent among 2‐year‐olds and declined with increasing age, more in girls than boys. Among girls, the prevalence decreased from 19.3% at age 2 years to 6.2% at age 13 years, and among boys from 13.3% to 8.6%. The interaction between sex and age was statistically significant. During the pre‐pandemic period, prevalence decreased significantly among 2‐year‐olds. During the pandemic period, increased prevalence of underweight was observed among 8‐year‐old girls. Conclusion: Underweight remains a relevant public health concern, with clear age‐ and sex‐specific patterns. These findings highlight the need for continued monitoring and targeted follow‐up in early childhood.

Background: Gestational diabetes mellitus (GDM) affects 1-in-7 pregnancies globally and is associated with significant short- and long-term health consequences. Although health behaviour change interventions can effectively reduce these risks, a significant implementation gap exists in translating this evidence into routine practice. Bump2Baby and Me (B2B&Me) was a mobile health (mHealth) coaching intervention provided to women at-risk of GDM from early pregnancy through to 1-year postpartum. B2B&Me Plus (B2B&Me+) aims to refine, implement and evaluate the implementation of this personalised intervention across 4 countries (Ireland, Spain, Poland and Norway) with differing health systems and population profiles. Methods: This study employs a hybrid type 3 implementation-effectiveness design using a non-randomised ABA block approach within a longitudinal cohort. Participants will be screened using the Monash machine learning GDM screening tool (MMLGDST). During the intervention (Block B), women at risk of developing GDM will be offered access to a smartphone-based coaching application featuring 1:1 synchronous sessions, asynchronous text and video messaging along with a Bluetooth-enabled weighing scale for self-monitoring. Support continues from early pregnancy through to nine months postpartum. The study’s primary objective is to evaluate reach, adoption, implementation and maintenance of the B2B&Me+ intervention programme when delivered within routine maternity care. Implementation success will be assessed using the RE-AIM framework, while secondary outcomes will assess intervention effectiveness. The study will examine population-level uptake at each site, evaluate the benefits and costs of implementation across varying contexts, and analyse how four different referral methods, randomised at the site level, affect uptake. In addition, a European implementation toolkit will be developed to provide health services with scalable strategies to bridge the evidence-to-practice gap. Discussion: This study will contribute to a growing literature on the implementation of a successfully trialled mHealth intervention in a real-world context. Understanding variation in both intervention and implementation success within a routine maternity care context across diverse settings will inform the development of an implementation toolkit to support health services in reducing the incidence of GDM and improving maternal and child health outcomes. This study was registered with ClinicalTrials.gov ( NCT07189221 ) on 28 August 2025 ( https://clinicaltrials.gov/study/NCT07189221?cond=diabetes ) Contributions to the literature: B2B&Me+ is the first multi-site European study testing how a mobile health coaching programme for women at-risk of gestational diabetes can be delivered within routine maternity care across four countries. The study tests four strategies for inviting women to join the programme, with the intent to identify which strategy most effectively reaches and engages them in practice. Using established implementation science frameworks, B2B&Me+ examines what drives or hinders delivery across four diverse European health systems, generating evidence applicable beyond the study settings. Findings will directly inform a practical European toolkit to support maternity services in adopting the programme at scale.

Introduction: For the total population and for groups of non‐immigrant and immigrant women, we examined the associations of maternal type 1 diabetes with adverse pregnancy outcomes among women who gave birth in Norway from 1999 to 2021. Further, we examined the associations between the two time periods 1999–2014 and 2015–2021 and adverse pregnancy outcomes, and whether these associations differed in women with or without type 1 diabetes. Material and Methods: In this nationwide population‐based observational study, with data from the Medical Birth Registry of Norway and Statistics Norway 1999–2021, we used logistic regression to examine the associations between type 1 diabetes and adverse pregnancy outcomes. Moreover, differences in ORs for adverse pregnancy outcomes between those with and without type 1 diabetes were compared for the two time periods 1999–2014 and 2015–2021 using interaction analyses. Analyses were performed for the overall population, as well as separately for non‐immigrant ( n = 964 542) and immigrant women ( n = 257 409). Results: Women with type 1 diabetes (non‐immigrant women n = 5067 and immigrant women n = 619) had higher ORs for almost all adverse pregnancy outcomes (OR 1.41–11.04) compared to women without diabetes in the period 1999–2021. In the time period 2015–2021, compared to 1999–2014, women with type 1 diabetes had a notably reduced OR of congenital malformations compared to those without diabetes ( p interaction : 0.006). Immigrant women with type 1 diabetes had a higher OR in 2015–2021 vs. 1999–2014 of having large for gestational age infants ( p interaction : 0.003). Conclusions: Women with type 1 diabetes had higher odds of most of the examined adverse pregnancy outcomes, though improvements were observed from 2015 to 2021 compared to 1999–2014, particularly a reduction in congenital malformations. In contrast, immigrants had higher odds of large for gestational age. These findings highlight the continued need for targeted interventions to reduce the burden of adverse outcomes in all women with type 1 diabetes.

Purpose: To examine the generic European Quality of Life 5-Dimensions questionnaire (EQ-5D-5L) responsiveness to change in health status of patients with invasive prostate cancer (PCa) from pre- to post-treatment and compare these results with the responsiveness of disease-specific instruments assumed to be particularly sensitive to change in a large sample of PCa patients. Methods: In this nationwide registry study (2017–2019), PCa patients in Norway (n = 620) and a matched reference group from the general population without previous cancer history (n = 1776) were invited. All participants completed the EQ-5D-5L, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and the Expanded Prostate Cancer Index Composite short form (EPIC-26) pre- and post-treatment. Paired t-tests were performed with latent change scores in a structural equation model framework. Results: EQ-5D-5L showed minor changes from pre- to post-treatment for four dimensions and sum score (Cohen’s d ≤ 0.20). EORTC-QLQ-C30 revealed a moderate decline in social function (-9.85, p < 0.001, Cohen’s d -0.52). EPIC-26 showed a large decline in sexual function (-38.1, p < 0.001, Cohen’s d -1.42), and urine incontinency (-24.3, p < 0.001, Cohen’s d -1.86). Correlations between change in EQ-5D-5L and change in domains found to be important for participants with PCa (sexual function, urine incontinence and social function) revealed small to medium correlations for the PCa group. Conclusions: The low responsiveness indicates that the EQ-5D-5L is not sensitive enough in detecting health status changes due to significant problem areas in PCa patients. Adding disease-specific measures is pivotal to measuring these changes in health status.

Aims: The aim of this study is to determine the prevalence of impaired awareness of hypoglycaemia (IAH) and examine risk factors for IAH in adults with type 1 diabetes.Methods: We conducted a population‐based registry study of 10,202 adults (≥18 years) with type 1 diabetes using data from the Norwegian Diabetes Register for Adults. The registry used the 1‐item Gold scale, measuring hypoglycaemia symptom awareness. We calculated the overall prevalence of IAH (Gold score ≥4) (95% CI) and prevalence for subgroups based on demographic and clinical variables. We estimated IAH prevalence based on continuous scales of age, diabetes duration and HbA_1c using predicted probabilities from generalised additive logistic regression models. Finally, we quantified the associations of selected variables on IAH prevalence using log‐binomial regression models.Results: Overall, 18.0% reported IAH (95% CI 17.2, 18.7). The prevalence increased linearly with the participants' age, whereas the associations of diabetes duration and HbA_1c with IAH were non‐linear with higher prevalence in both lower and higher tails of their distributions. Multiple severe hypoglycaemic events, female sex, age ≥ 65 years, diabetes duration ≤4 years or ≥ 30 years, multiple DKA events and CGM use were associated with higher risk for IAH. HbA_1c 65–74 mmol/mol (8.1–8.9%) was associated with lower risk for IAH.Conclusions: In this nationwide study, the IAH prevalence was 18.0%. Multiple hypoglycaemic events, female sex and diabetes duration were identified as important risk factors for IAH. Study findings highlight the complexity of self‐reported hypoglycaemia symptom awareness and emphasise the importance of routinely addressing symptom awareness in diabetes follow‐up.

Objective The prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes. Design Registry-based study. Setting Adults with type 2 diabetes in Norway identified within the ‘Outcomes and Multimorbidity In Type 2 diabetes’ cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry. Participants We defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950–2013, and a temporal validation sample of 7085 adults diagnosed 2014–2016 to evaluate the index validity over time Primary outcome measure All-cause mortality Methods For the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots. Results In the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84). Conclusions The Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.