Anne Haugstvedt

Purpose: The purpose of the study was to explore adolescents’ experiences of being a sibling of a child with type 1 diabetes (T1D) and how diabetes affects the family. Methods: A descriptive qualitative study was conducted in Norway through individual, semistructured interviews with adolescents (16-20 years) who had been siblings of a child with T1D before the age of 18. All interviews were audio recorded and transcribed verbatim. Thematic analysis, as described by Braun and Clarke, was used to analyze the data. Results: Four main themes were identified during the analysis, each comprising related subthemes. The main themes were (1) the start was difficult, but it gradually got better; (2) diabetes affects the atmosphere in the family; (3) a desire to be included; and (4) diabetes affects everyday life to a great extent. Conclusions: The findings of the study confirmed that T1D has a major impact on a family’s everyday life, but the siblings experienced that it affected the family dynamics both positively and negatively. Siblings expressed a desire for more information and support from health care professionals and a desire to be included in the diabetes management of their sibling with T1D. The findings highlight the need for health care professionals to include siblings in diabetes education and follow-up.

Objectives To explore how individuals with long covid experienced various aspects of a micro-choice-based rehabilitation programme and if these experiences could facilitate behaviour change. Design A qualitative study with three focus groups was conducted, in mean 9.8 months after completing the rehabilitation programme. Data were analysed using systematic text condensation. Setting The study was conducted in a university setting. Participants 19 participants (aged 23–55 years, 15 women) were included between Spring 2021 and Autumn 2022. Intervention The participants in this study had participated in a 3-day concentrated micro-choice-based rehabilitation programme. One of the main features of this intervention was to support participants in shifting their focus from targeting symptoms to choosing alternative actions aimed at improving everyday functioning, referred to as micro-choices. Results Five themes were identified: (1) reduction in uncertainty achieved through reassurance and motivation; (2) ‘in the same boat’: sharing experiences and supporting each other; (3) knowledge about the body’s stress responses and micro-choices; (4) shifting between individual practice and close collaboration with the therapists; and (5) sustaining behaviour change is challenging. These themes illustrated how participants’ experiences with different aspects of the rehabilitation programme facilitated both the initiation and maintenance of behaviour change. The participants highlighted the importance of acknowledging their challenges, reducing fear, sharing experiences with peers, feeling understood and supported, collaborating with a skilled team, receiving personalised guidance and gaining insights through the exploration and implementation of micro-choices. Participants also highlighted that behaviour change is an ongoing process requiring sustained effort. Conclusion The findings showed how participants experienced various aspects of a concentrated micro-choice-based rehabilitation programme as supportive of behaviour change. The findings indicate that a concentrated rehabilitation programme may facilitate self-management and improve everyday function in individuals with long covid. Trial registration number NCT05234281.

Aims: To examine associations between sleep impairments and diabetes distress in men and women with type 2 diabetes (T2D) by using cross‐sectional data from the Trøndelag Health Study (HUNT).Methods: This population‐based cross‐sectional study consists of individuals ≥20 years with T2D participating in the HUNT4 survey (2017–2019; n = 1954). Sleep impairments (snoring, sleep apnoea, troubles falling asleep, wake up during the night, early wakening, difficulties coping during the daytime due to sleep problems and restless legs) were measured by the sleeping HUNT‐Questionnaire, along with a separate question on the number of hours of sleep at night. Diabetes distress was measured using the Problem Areas in Diabetes (PAID‐5) questionnaire. Diabetes distress prevalence, grouped by sleep impairment, was estimated with 95% confidence intervals. Multivariable linear regression models with distress as outcome and adjusted for demographic, clinical and mental health factors were used to examine associations with sleep.Results: Overall, sleep impairment was associated with increased diabetes distress. Regression coefficients B (95% CI) for higher distress score were 0.6 (95% CI 0.2, 0.9) for ≤7 h of sleep, 0.6 (95% CI 0.1–1.1) for snoring, 1.4 (95% CI 0.8–2.2) for troubles falling asleep, 1.1 (95% CI 0.6–1.6) for waking up during the night, 1.2 (95% CI 0.7–1.8) for early wakening, 2.6 (95% CI 1.7–3.6) for troubles coping during daytime due to sleep problems and 0.8 (95% CI 0.2–1.3) for restless legs.Conclusion: Multiple components of sleep impairment were significantly associated with high diabetes distress in individuals with T2D.

Purpose: The purpose of this study was to explore experiences with an interdisciplinary micro-choice-based concentrated group intervention for people with type 2 diabetes. Methods: A qualitative study with individual semistructured interviews were conducted with 14 adults (8 women, ages 45-74 years) with type 2 diabetes. Purposive sampling was used, and participants from 3 different intervention groups in the micro-choice-based concentrated group intervention were recruited. Thematic analysis was used for the data analysis. Results: Three main themes were identified: (1) group intervention tailored to individual needs through friendly and skilled professionals, (2) valuable social interactions and an experience of fellowship, and (3) commitment to change through goal setting and conscious micro-choices. The participants described a readiness for change that was met by important knowledge from skilled professionals in the concentrated intervention. They reported that new knowledge, particularly about micro-choices and the focus on how insulin works in the body, led to change in their awareness and self-management. The concentrated group intervention was a preferred setting that contained a sense of community without compromising on meeting individual needs. Participants described internalized changes after the intervention and a willingness to adhere to changes necessary for their self-management. Conclusion: Study findings showed that a micro-choice-based concentrated group intervention for people with type 2 diabetes can be a valuable approach contributing to improved patient activation and diabetes self-management. The findings underpin the importance of increased diabetes knowledge and support from an interprofessional team to bring about significant changes in everyday life.

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.

Aim: The aim of this study was to explore the experiences of sexual health and sexual challenges in women with type 1 diabetes (T1D).Methods: We used a qualitative study design and conducted semistructured interviews with 15 women (26–57 years) with T1D. The participants were recruited based on their Female Sexual Function Index score that indicated sexual dysfunction. We used thematic analysis to analyse the data.Results: We generated three themes, each with subthemes: (1) Diabetes is present at all times (subthemes: having diabetes is onerous, and diabetes affects the relationship with my partner); (2) various challenges related to sexual health (subthemes: experiencing reduced sexual desire and physical challenges, and challenges related to sexual health affect the relationship with my partner); and (3) diabetes may affect sexual function (subthemes: glucose levels and technical devices may have an impact on sexual function, and sexual health should be addressed in diabetes follow‐up).Conclusions: The women with T1D experienced different challenges related to their sexual health. The most common were reduced sexual desire, vaginal dryness and pain during intercourse. The study emphasizes the importance of addressing sexual health in diabetes follow‐up to provide comprehensive health services to people with diabetes.

Aim: The aim of this study was to describe adolescents’ experiences with diabetes self-management and the use of carbohydrate counting as a tool for calculating insulin doses in everyday life with type 1 diabetes. Methods: We used a qualitative study design. Individual interviews were conducted with 14 adolescents (seven boys and seven girls, aged 16– 18 years) with type 1 diabetes by using a semi-structured interview guide. We used purposive sampling, recruiting the participants from one paediatric outpatient clinic in Norway. Thematic analysis was used for the data analysis. Findings: We identified two main themes, each comprising three subthemes: (1) “Diabetes treatment is difficult but can be well adapted” with subthemes “Diabetes influences my entire life, with a lot of fuss and takes time”, “Having diabetes turned out to be manageable”, and “Need some help and support, but not too much”; (2) “Carbohydrate counting is useful but often not used” with subthemes “One counts the carbs, then the pump calculates the insulin doses”, “Carbohydrate counting gives better blood glucose, but I do not always bother to use it”, and “After a while, one just uses one’s own experience.”. Conclusion: The study showed that adolescents with type 1 diabetes experienced that the diabetes treatment influenced their entire life in a substantial manner. Nevertheless, the demands of the disease and the treatment tasks were perceived very differently. Some articulated that carbohydrate counting was appreciated as a suitable tool for dosing insulin and optimizing glycaemic control. Others did not use carbohydrate counting at all and described to use their own experience. The findings support the importance of individualizing diabetes follow-up and adapt the training in treatment tools to everyone’s situation and preferences.

Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes. Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/32216

Aim: To estimate the prevalence of sexual dysfunction in women with type 1 diabetes (T1D) compared with women without diabetes and to analyse associations between sexual dysfunction and the presence of chronic physical diabetes complications, diabetes distress and depression in women with T1D.Methods: This cross‐sectional study was conducted in Norway, and 171 women with T1D and 60 controls completed the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). Diabetes distress was assessed with the Problem Areas in Diabetes (PAID) scale. Data on diabetes complications were retrieved from medical records. We performed logistic regression to estimate differences in the prevalence of sexual dysfunction (defined as FSFI ≤26.55) between women with T1D and women without diabetes and to examine associations of sexual dysfunction with chronic diabetes complications, diabetes distress and depression in women with T1D.Results: The prevalence of sexual dysfunction was higher in women with T1D (50.3%) compared with the controls (35.0%; unadjusted odds ratio [OR] 1.89 [95% confidence interval (CI) 1.06–3.37]; adjusted OR 1.93 [1.05–3.56]). In women with T1D, sexual dysfunction was associated with both diabetes distress (adjusted OR 1.03 [1.01–1.05]) and depression (adjusted OR 1.28 [1.12–1.46]), but there were no clear associations with chronic diabetes complications (adjusted OR 1.46 [0.67–3.19]).Conclusions: This study suggests that sexual dysfunction is more prevalent in women with T1D compared with women without diabetes. The study findings emphasize the importance of including sexual health in relation to diabetes distress and psychological aspects in diabetes care and future research.