Differences in glycemic control in type 1 diabetes children and adolescents : in a national and international perspective and the effect on microvascular complications in young adults

This thesis focuses on glycemic control measured as HbA1c in type 1 diabetes (T1D) patients during childhood and especially during adolescence, both in a Swedish and an international context, and relates the glycemic control to the risk of complications in young adults.   In studies I and II, the Swedish Pediatric Diabetes Quality Register (SWEDIABKIDS) and the Swedish National Diabetes Register (NDR) were used. More than 4000 young adults with T1D and data on HbA1c in NDR both in 2011 and 2012 as well as data on HbA1c in SWEDIABKIDS were used. The T1D patients with poor glycemic control during their teenage period had a risk for retinopathy several times higher than those with good glycemic control. The risk for micro- and macroalbuminuria was also higher in those with poor glycemic control and was most pronounced in the T1D patients with high HbA1c in both registers. Females had worse glycemic control than males during the teenage period and an increased risk of retinopathy as young adults.   In studies III and IV, pediatric diabetes quality register data from, respectively, eight and seven Western high-income countries were collected in the year 2013. Data on about 60 000 T1D patients were analyzed according to mean HbA1c levels in the countries and related to actual age and T1D duration to determine if there were differences in glycemic control between the countries. There were large differences in mean HbA1c between the countries, both when related to age and T1D duration. Despite the differences in mean HbA1c, the increase in mean HbA1c with increasing age and T1D duration was very similar in all countries.   The overall picture of these studies is that good glycemic control is very important to avoid complications of T1D as young adults, and it seems particularly important to maintain a good glycemic control during adolescence. Furthermore large differences in glycemic control in T1D patients in Western high-income countries were found. Despite the differences in glycemic control, the pattern of rising HbA1c with increasing age and duration of T1D was very similar in all countries. Females have worse glycemic control than males during their teenage period, both in Sweden and internationally, and they also have more retinopathy as young adults.    This thesis shows that it is of the utmost importance to treat T1D patients intensively directly after diagnosis, to treat the young T1D patients intensely and to reduce the rise in HbA1c with increasing age and duration of T1D in order to avoid complications early in life. Diabetes quality registers give the opportunity to compare results and share experiences, both within and between countries, so treatment of T1D can be designed in the best possible way and thereby minimize T1D complications.

Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions

Purpose: The purpose of this study was to investigate associations between motivation for return to work and actual return to work, or increased employability among people on long-term sick leave. Materials and methods: Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean = 7.9 years) due to pain syndrome or mild to moderate mental health conditions who had participated in a vocational rehabilitation intervention. The participants’ motivation for return to work was measured at baseline. At 12-month follow-up, change in the type of reimbursement between baseline and at present was assessed and used to categorise outcomes as: “decreased work and employability”, “unchanged”, “increased employability”, and “increased work”. Associations between baseline motivation and return to work outcome were analysed using logistic and multinomial regression models. Results: Motivation for return to work at baseline was associated with return to work or increased employability at 12-month follow-up in the logistic regression model adjusting for potential confounders (OR 2.44, 95% CI 1.25–4.78). Conclusions: The results suggest that motivation for return to work at baseline was associated with actual chances of return to work or increased employability in people on long-term sick leave due to pain syndrome or mild to moderate mental health conditions. Implication for rehabilitation High motivation for return to work seems to increase the chances of actual return to work or increased employability in people on sick leave due to pain syndrome or mild to moderate mental health conditions. The potential impact of motivation for return to work is suggested to be highlighted in vocational rehabilitation. Rehabilitation professionals are recommended to recognise and take into consideration the patient’s stated motivation for return to work. Rehabilitation professionals should be aware of that the patient’s motivation for return to work might have an impact on the outcome of vocational rehabilitation

Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions

<p><b>Purpose:</b> The purpose of this study was to investigate associations between motivation for return to work and actual return to work, or increased employability among people on long-term sick leave.</p> <p><b>Materials and methods:</b> Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean = 7.9 years) due to pain syndrome or mild to moderate mental health conditions who had participated in a vocational rehabilitation intervention. The participants’ motivation for return to work was measured at baseline. At 12-month follow-up, change in the type of reimbursement between baseline and at present was assessed and used to categorise outcomes as: “decreased work and employability”, “unchanged”, “increased employability”, and “increased work”. Associations between baseline motivation and return to work outcome were analysed using logistic and multinomial regression models.</p> <p><b>Results:</b> Motivation for return to work at baseline was associated with return to work or increased employability at 12-month follow-up in the logistic regression model adjusting for potential confounders (OR 2.44, 95% CI 1.25–4.78).</p> <p><b>Conclusions:</b> The results suggest that motivation for return to work at baseline was associated with actual chances of return to work or increased employability in people on long-term sick leave due to pain syndrome or mild to moderate mental health conditions.Implication for rehabilitation</p><p>High motivation for return to work seems to increase the chances of actual return to work or increased employability in people on sick leave due to pain syndrome or mild to moderate mental health conditions.</p><p>The potential impact of motivation for return to work is suggested to be highlighted in vocational rehabilitation.</p><p>Rehabilitation professionals are recommended to recognise and take into consideration the patient’s stated motivation for return to work.</p><p>Rehabilitation professionals should be aware of that the patient’s motivation for return to work might have an impact on the outcome of vocational rehabilitation.</p><p></p> <p>High motivation for return to work seems to increase the chances of actual return to work or increased employability in people on sick leave due to pain syndrome or mild to moderate mental health conditions.</p> <p>The potential impact of motivation for return to work is suggested to be highlighted in vocational rehabilitation.</p> <p>Rehabilitation professionals are recommended to recognise and take into consideration the patient’s stated motivation for return to work.</p> <p>Rehabilitation professionals should be aware of that the patient’s motivation for return to work might have an impact on the outcome of vocational rehabilitation.</p