Ragnhild Bjarkøy Strandberg

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.

Task shifting between health care providers is seen as a strategy for combating increased demands in primary healthcare. This study explored the perceptions and experiences of general practitioners (GPs) and nurses regarding vertical task shifting in Norwegian general practice. We employed a qualitative design. Data were collected through semi-structured interviews with nurses (n = 6) and GPs (n = 5) across six municipalities in Norway. The data were analysed using reflexive thematic analysis. The analysis resulted in two main themes, each with associated subthemes: 1) Trust plays a pivotal role in task shifting processes; (i) Time is essential for cultivating mutual trust, (ii) Increased knowledge and mutual respect strengthen trust in nurses competencies and responsibilities, and 2) Drivers and barriers to vertical task shifting; (i) Organizational structures influence utilization and perceived value of vertical task shifting, (ii) Choosing to work in interdisciplinary teams despite a lack of funding, (iii) Contextual factors and experience influenced attitudes towards vertical task shifting. Trust was described as pivotal to the success of vertical task shifting, with time and collaboration facilitating its development. In several cases, the process of task shifting expanded nurses' roles and strengthened interdisciplinary relationships. However, organizational structures and funding significantly influenced the utilization and perception of task shifting. Attitudes toward task shifting varied based on individual and contextual factors.

Background: Optimal treatment and support in family planning for women with type 1 diabetes (T1D) and follow-up during pregnancy are important, however, there is limited knowledge from the women’s perspective on their considerations of family planning, pregnancy, and motherhood. Objectives: To explore expectations and experiences of family planning, pregnancy, and motherhood among women with T1D. Design: We employed a qualitative study design with semi-structured interviews. Methods: We conducted semi-structured individual interviews (June to November 2022) with 17 women with T1D aged 18–45 at a diabetes outpatient clinic in Norway. We analyzed the data using thematic analysis. Results: Four main themes, each with sub-themes, linked to a timeline from planning the pregnancy to becoming a mother were identified: (1) Existential considerations in family planning; (2) Ambiguous information sources and the need for individualized guidance about pregnancy and T1D; (3) Preparations for pregnancy and balancing uncertainties during pregnancy; and (4) Motherhood intertwined with diabetes. Overall, the women expressed a need for support in handling and managing their glucose control in the phase of family planning, during pregnancy, and when preparing for the role of mother. Conclusion: Women with T1D reported many worries and concerns related to family planning, pregnancy, and motherhood, and thus, individualized information and support related to diabetes and reproductive health should be an integrated part of follow-up care. Women with T1D seem to have high expectations and strong commitment to their diabetes self-management during pregnancy, conditional on support and guidance from health care providers (HCPs). A sensitive approach from HCPs in clinical consultations is vital to meet the individual woman’s need for support. More research about reproductive health in women with T1D is needed, especially regarding how motherhood and diabetes intersect 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.

Introduction: This study assessed prevalence and time trends of pre‐pregnancy obesity in immigrant and non‐immigrant women in Norway and explored the impact of immigrants' length of residence on pre‐pregnancy obesity prevalence.Material and Methods: Observational data from the Medical Birth Registry of Norway and Statistics Norway for the years 2016–2021 were analyzed. Immigrants were categorized by their country of birth and further grouped into seven super regions defined by the Global Burden of Disease study. Pre‐pregnancy obesity was defined as a body mass index ≥30.0 kg/m², with exceptions for certain Asian subgroups (≥27.5 kg/m²). Statistical analysis involved linear regressions for trend analyses and log‐binomial regressions for prevalence ratios (PRs).Results: Among 275 609 pregnancies, 29.6% (N = 81 715) were to immigrant women. Overall, 13.6% were classified with pre‐pregnancy obesity: 11.7% among immigrants and 14.4% among non‐immigrants. Obesity prevalence increased in both immigrants and non‐immigrants during the study period, with an average yearly increase of 0.62% (95% confidence interval [CI]: 0.55, 0.70). Obesity prevalence was especially high in women from Pakistan, Chile, Somalia, Congo, Nigeria, Ghana, Sri Lanka, and India (20.3%–26.9%). Immigrant women from “Sub‐Saharan Africa” showed a strong association between longer residence length and higher obesity prevalence (≥11 years (23.1%) vs. <1 year (7.2%); adjusted PR = 2.40; 95% CI: 1.65–3.48), particularly in women from Kenya, Eritrea, and Congo.Conclusions: Prevalence of maternal pre‐pregnancy obesity increased in both immigrant and non‐immigrant women from 2016 to 2021. Several immigrant subgroups displayed a considerably elevated obesity prevalence, placing them at high risk for adverse obesity‐related pregnancy outcomes. Particular attention should be directed towards women from “Sub‐Saharan Africa”, as their obesity prevalence more than doubled with longer residence.

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.

OBJECTIVE: To estimate diabetes distress prevalence and associations with demographic and clinical variables among adults with type 1 diabetes in Norway. RESEARCH DESIGN AND METHODS: In this nationwide population-based registry study, the 20-item Problem Areas in Diabetes (PAID-20) questionnaire was sent to 16,255 adults with type 1 diabetes. Linear regression models examined associations of demographic and clinical variables with distress. RESULTS: In total, 10,186 individuals (62.7%) completed the PAID-20, with a mean score of 25.4 (SD 18.4) and 21.7% reporting high distress. Respondents endorsed worrying about the future and complications as the most problematic item (23.0%). Female sex, younger age, non-European origin, primary education only, unemployment, smoking, continuous glucose monitoring use, more symptomatic hypoglycemia, reduced foot sensitivity, treated retinopathy, and higher HbA1c were associated with higher distress. CONCLUSIONS: Diabetes distress is common among adults with type 1 diabetes and associated with clinically relevant factors, underlining that regular care should include efforts to identify and address distress.