Bakgrund Patienter med diabetes typ 2 kan reducera riskerna för framtida komplikationer som till exempel hjärtsjukdomar och stroke med hjälp av egenvård. En förbättring av följsamhet till egenvård kan leda till ett minskat lidande hos patienten och bidra till en bättre livskvalitet. Syfte Syftet är att sammanställa forskningsbaserad kunskap om vilka faktorer som påverkar vuxna patienters följsamhet till egenvårdsråd vid diabetes typ 2. Metod Examensarbetet är en strukturerad litteraturstudie med en inslag av den metodologi som används vid systematiska översikter. Databasen Cinahl har använts i artikelsökningen där 14 artiklar analyserats. Resultat Följsamhet till egenvård påverkas av olika faktorer varav tre identifierades: Informationsförmedling till patient, telekommunikation som hjälpmedel samt personliga och sociala faktorer som alla bidrog till en god följsamhet till egenvårdsråd. Slutsats Det är betydelsefullt att försöka uppmärksamma individens förutsättningar för att utbildning, digitala tjänster och involvering av familj kan ske anpassad efter den enskilde individen. Att stärka självtilltien hos individen är dessutom en avgörande faktor för en god följsamhet. / Background Patients with diabetes type 2 can reduce the risks for further complications like for instance cardiovascular disease and stroke by self-care. By improving adherence to selfcare the suffering can be decreased and in the same time contribute to improve the health and quality of life for the patient. Aim The purpose of this literature review was to describe factors that can influence adult patient´s compliance to self-care in type 2 diabetes. Method The database Cinahl has been used to this literature review with 14 scientific articles included. Results Compliance to self-care is influated by different factors which are dissemination of information to the patient, telecommunications assistance and personal and social factors. These factors all contribute to better adherence to self-care. Conclusions To notice the characteristics of patients is an important factor to adjust education, digital services and the involvment of the family. Another key factor to improve compliance is to strenghten the patients self-efficacy.

Gender Dysphoria (GD) is defined as significant distress or impairment caused by the discrepancy between an individual's experienced gender and the sex assigned at birth. This work explores the etiology and outcomes of GD through two studies. The first assesses its prevalence in different twin categories, and the second examines the incidence of idiopathic intracranial hypertension (IIH) in individuals undergoing gonadotropin-releasing hormone analogue (GnRHa) treatment for GD. The first study utilizes a population-based approach to analyze the prevalence of GD in twins, using data from a Swedish population-based cohort collected over a 16-year period. The objective is to assess the influence of genetic and environmental factors on the development of GD by comparing its prevalence in different-sex twins, same-sex twins, and non-twin siblings. The results indicate a higher prevalence of GD in different-sex twins and suggest a potential influence of intrauterine factors in the development of GD, necessitating further examination of current genetic and environmental theories. The second study focuses on evaluating the occurrence of IIH in individuals undergoing treatment with GnRHa for GD in Sweden between 2006 and 2016. The study did not observe any cases of IIH within the studied cohort. While better-powered studies are needed to clarify any potential association between GnRHa and IIH, the study results do not present substantial evidence to support this association.

Bakgrund: Diabetes typ 1 är en obotlig sjukdom som kan orsaka allvarliga hälsorelaterade komplikationer. En stor del av behandlingen består av egenvård. Sjukdomsdebuten sker oftast i pubertetsålder, och vid övergången till vuxen kan det vara extra utmanande att hantera sjukdomen. Mer förståelse för det stora egenansvaret som diabetes typ 1 kräver gör att sjuksköterskor kan stötta unga vuxna på bästa sätt under övergångsperioden. Syfte: Att beskriva unga vuxna upplevelser av egenvård vid diabetes mellitus typ 1.   Metod: Litteraturöversikt med kvalitativ, induktiv ansats. Tolv vetenskapliga artiklar analyserades med Fribergs (2022) femstegsmodell. Datainsamlingen utfördes via databaserna Cinahl och MEDLINE.   Resultat: Unga vuxna med typ 1-diabetes genomgick en känslosam övergång när de tog över egenvårdsansvaret från föräldrarna. Stöd från närstående och vårdpersonal var avgörande för att främja god diabeteskontroll, medan bristande förståelse eller överdrivet involverande från närstående kunde leda till försämrad egenvård. Unga vuxna upplevde ofta en rädsla för att vara annorlunda och kunde kompromissa med sin egenvård för att undvika stigma eller passa in i sociala sammanhang.   Slutsats: Unga vuxna med typ 1-diababetes möter tuffa utmaningar vid övergången till vuxenlivet eftersom de måste ta ansvar för sin egenvård samtidigt som de möter andra typiska utmaningar i livet. Balansgången mellan egenvård och det vardagliga livet, samt behovet av stöd från familj- och vänner, påverkar deras känslor av frustration och uppgivenhet. / Background: Diabetes type 1 is an incurable disease that can cause serious health related complications. Treatment mainly consists of self-care. Disease onset usually occurs during puberty, and the transition to adulthood can be particularly challenging to manage with diabetes type 1. Understanding the great personal responsibility required by diabetes mellitus type 1 allows nurses to best support young adults during this transition.   Aim: Describe young adults experiences of self-care in diabetes mellitus type 1.   Method: A literature review with a qualitative and inductive approach. Twelve scientific articles were analyzed according to Friberg’s (2022) five-step model. Data were conducted through the Cinahl and MEDLINE databases.   Results: Young adults with type 1 diabetes experienced an emotional transition when taking over self-care responsibilities from their parents. Support from family and healthcare professionals was crucial in promoting effective diabetes management, while lack of understanding or excessive involvement from family members lead to deteriorated self-care. Young adults feared being different and sometimes compromised their self-care to avoid stigma or fit into social contexts.   Conclusion: Young adults with type 1 diabetes face tough challenges during the transition to adulthood as they must take responsibility for their self-care while encountering typical life challenges. The balance between self-care and everyday life, as well as the need for support from family and friends, influences their feelings of frustration and resignation.

Background Type 2 diabetes is a common chronic disease with a two-fold increased risk for cardiovascular morbidity and mortality and has an increasing prevalence worldwide. This thesis is based on a study conducted in primary health care in Östergötland and Jönköping, Sweden. The aim of the thesis was to evaluate new risk markers to identify patients with high risk of developing cardiovascular disease in middle-aged men and women with type 2 diabetes. Methods Data from the cohort study CArdiovascular Risk in type 2 DIabetes – a Prospective study in Primary care (CARDIPP) was used. In paper III data were also used from CARDIPP-Revisited where all participants in the CARDIPP study were invited four years after the baseline investigation for a re-investigation. In paper IV data were used from CAREFUL which is a control group of 185 subjects without diabetes. The investigation included a standard medical history including data on diabetes duration and on-going medication. Anthropometric data were recorded and both office and ambulatory blood pressure were measured. The patients filled out a detailed questionnaire and physical activity was measured by using waist-mounted pedometers. Pedometer-determined physical activity was classified in four groups: Group 1: <5000 steps/day (‘sedentary’); Group 2: 5000-7499 steps/day (‘low active’); Group 3: 7500-9999 steps/day (‘somewhat active’); Group 4: and ≥10 000 steps/day (‘active’). Blood samples were drawn for routine analyses and also frozen for later analyses. The investigations at the departments of physiology included echocardiography, measurements of the carotid intima-media thickness, applanation tonometry and measurements of  sagittal abdominal diameter. Results Paper 1: Patients with a non-dipping systolic blood pressure pattern showed higher left ventricular mass index and pulse wave velocity (PWV) compared with patients with ≥10% decline in nocturnal systolic blood pressure. Patients with <10% decline in nocturnal systolic blood pressure had higher BMI and sagittal abdominal diameter, lower GFR and higher albumin:creatinine ratio and also higher levels of NT-proBNP than patients with a dipping pattern of the nocturnal blood pressure. Paper 2: The number of steps/day were inversely significantly associated with BMI, waist circumference and sagittal abdominal diameter, levels of CRP, levels of interleukin-6 and PWV. Paper 3: At the 4-year follow-up the change in PWV (ΔPWV) from baseline was calculated. The group with the lowest steps/day had a significantly higher increase in ΔPWV compared with the group with the highest steps/day. The associations between baseline steps/day and ΔPWV remained after further adjustment in a multivariate linear regression statistically significant (p=0.005). 23% of the variation in the study could be explained by our model. Every 1000 extra steps at baseline reduced the change in ΔPWV by 0.103 m/s between baseline and follow-up. Paper 4: Low vitamin D levels were associated with significantly increased risk for premature mortality in men with type 2 diabetes. High levels of parathyroid hormone were associated with significantly increased risk for premature mortality in women with type 2 diabetes. These relationships were still statistically significant also when two other well-established risk markers for mortality, PWV and carotid intima-media thickness, were added to the analyses. Conclusions Ambulatory blood pressure recording can by addressing the issue of diurnal blood pressure variation, explore early cardiovascular organ damage and microvascular complications that goes beyond effects of standardised office blood pressure measurements. Pedometer-determined physical activity may serve as a surrogate marker for inflammation and subclinical organ damage in patients with type 2 diabetes. There is novel support for the durable vascular protective role of a high level of daily physical activity, which is independent of BMI and systolic blood pressure. The use of pedometers is feasible in clinical practice and provides objective information not only about physical activity but also the future risk for subclinical organ damage in middle-aged people with type 2 diabetes. Our results indicate that low vitamin D levels in men or high parathyroid hormone levels in women give independent prognostic information of an increased risk for total mortality.

Unilateral cortisol producing adenoma (CPA) is the most common cause of ACTH-independent Cushing’s syndrome and is surgically curable. On the other hand, adrenocortical carcinomas (ACCs) are rare and aggressive tumours. Although the overall survival of the patients with ACC is very poor, the outcome can be heterogeneous and vary significantly between the patients. This thesis comprises studies showing genetic and genomic events occurring in CPAs and ACCs, their functional impact and clinical correlations. The Wnt/β-catenin and cAMP/PKA signalling pathways are crucial in adrenal homeostasis and frequent mutations in members of these pathways (CTNNB1, GNAS, and PRKACA) are found in CPAs. Mutational analysis revealed that ~60% of the CPAs harboured mutations in either of these genes. Transcriptome signature exhibited increased expression of genes involved in steroidogenesis in PRKACA/GNAS mutated (Cluster1) tumours in comparison to CTNNB1 mutated /wildtype (Cluster2) tumours. In addition we have also observed that gain of chromosome arm 9q was the most frequent arm level copy number variation (CNV) occurring in CPAs and were exclusively present in Cluster2 tumours. We also discovered novel PRKACA mutations occurring in ACCs, causing activation of cAMP/signalling pathway.    Comprehensive analysis of Wnt/β-catenin signalling pathway in ACCs revealed novel interstitial deletions occurring in CTNNB1 leading to deletion of the N-terminus of β-catenin. This is a novel and yet another frequent event leading to activated Wnt/β-catenin signalling and downstream targets in ACCs. Both, mutations occurring in CTNNB1 and nuclear expression of its protein were associated with poor overall survival. Through multiregional sampling approach we discovered intra-tumour heterogeneity in ACC tumours. Although all the multiregions within a tumour showed presence of shared basal CNVs, they encompassed private CNVs, different ploidy levels and private mutations in known driver genes. We found intra-tumour heterogeneity in CTNNB1, PRKACA, TERT promoter and TP53 mutations as well as ZNRF3 and CDKN2A/2B homozygous deletions.

Bakgrund: I Sverige är det cirka 50 000 personer som lever med diabetes mellitus typ 1. Det är en kronisk komplex sjukdom som kräver livslång behandling.  Sampel med vården krävs under hela sjukdomsförloppet där en god vårdrelation blir betydande. Självkännedom och god självkänsla underlättar för egenvården eftersom det handlar om att kunna se de egna styrkorna för en god hanteringsförmåga av sjukdomen. Syfte: Syftet var att beskriva erfarenheter av egenvård hos unga vuxna med diabetes mellitus typ 1.  Metod: En kvalitativ litteraturöversikt med induktiv ansats har gjorts. Resultatet baseras på 12 vetenskapliga artiklar. Resultat:  Två huvudteman framkom i resultatet och ett av de var utmaningar med fyra underteman: rädsla och oro, begränsningar, övergång till vuxen livet och hur vardagen kan påverka egenvården. Andra huvudtemat var socialt stöd med tre underteman: stöd från familj och vänner, vårdpersonalens betydelse och okunskap från omgivningen påverkar egenvården. Slutsatser: Stöd från familj och vänner var av stor betydelse när det gällde hur de unga vuxna med diabetes mellitus typ 1 skötte egenvården. Vårdpersonal hade ett stort ansvar i att stötta och vägleda personer till egenvård. Utomståendes okunskap kunde leda till försämrad egenvård för personerna. / Background: In Sweden there are about 50 000 people living with diabetes mellitus type 1. It is a chronic complex disease and demands a lifelong treatment. Teamwork with the healthcare is required throughout the course of the disease and a good relationship with the health care providers becomes significant. Self-awareness and good self-esteem facilitate self-care when it comes to being able to see one’s own strengths for a good management ability of the disease. Aim: The aim was to describe experiences of self-care among young adults with diabetes mellitus type 1. Method: A qualitative literature research that has an inductive design has been done. The results are based on twelve different scientific articles. Results:  Two main themes have emerged in results and one of them was challenge with four sub themes: fear and anxiety, limitations, transitions to adult life and how daily life can affect self-care. The other main theme was social support with three sub themes: support from family and friends, the importance of healthcare professionals and lack of knowledge by others that affects self-care. Conclusion:  Social support from family and friends was important when it comes to how young adults with diabetes mellitus type 1 managed self-care. Healthcare professionals have a big responsibility in supporting and guiding people to self-care. Lack of knowledge from others could lead to mismanagement of self-care.

A web installation that uses blood glucose levels uploaded by diabetics to create music. Available at https://radiodiabetes.eu / En webbinstallation som låter diabetiker ladda upp sina blodsockervärden och skapar musik av dessa. Tillgänglig på https://radiodiabetes.eu

Titel: Att leva med diabetes mellitus typ 2.  Bakgrund: Diabetes mellitus typ 2 (DMT2) är ett globalt problem och fler personer insjuknar årligen. Egenvård är en central del av behandlingen för dessa personer. Att förstå livsstilsförändringar, behandlingar och egenvården hos dessa personer bidrar till ökad kunskap inom hälso- och sjukvården.   Syfte: Att beskriva personers erfarenheter av att leva med diabetes mellitus typ 2.   Metod: Litteraturöversikt med artiklar av kvalitativ design baserad på 12 vetenskapliga artiklar från databaserna Cinahl och MedLine.   Resultat: Resultatet presenteras i två huvudteman egenvård och information vid diabetes mellitus typ 2 och påverkan av diabetes mellitus typ 2 i livet med respektive underkategorier. Det fanns erfarenhet av bristande och otillräcklig information av hälso- och sjukvården. Erfarenheter fanns av att närstående gav bra information och under gruppbaserad utbildning reflekterades erfarenheter av att leva med DMT2. Resultatet visade att egenvården innefattade en del svårigheter som ändrade kostvanor, fysisk aktivitet, kulturella aspekter och förändrad livsstil.   Slutsats: DMT2 är en global och livslång sjukdom där livsstilsförändringar bör genomföras. Erfarenheter av att det var svårt att genomföra livsstilsförändringar där kostvanor visade sig vara det svårast att anpassa sin DMT2 till. Vidare forskning kring erfarenheter hos personer med DMT2 bidrar till ökad kunskap för sjuksköterskan men även allmänheten. Vidare forskning av personer med DMT2 och hur kultur påverkar egenvården kan ge ökad kunskap till sjuksköterskan och allmänheten.   Nyckelord: Diabetes mellitus typ 2, diabetes typ 2, livsstil, patienters erfarenheter, egenvård. / Title: Living with diabetes mellitus type 2.    Background: Type 2 diabetes mellitus (DMT2) is a global problem and more people are getting sick every year. Self-care is a central part of the treatment for these people. Understanding the lifestyle changes, treatments and self-care of these people contributes to increased knowledge in health care.  Aim: Describing people's experiences of living with type 2 diabetes mellitus.  Method: A qualitative literature review. Based on 12 scientific articles collected from Cinahl and MedLine.    Results: The results are presented in two main themes of self-care and information in diabetes mellitus type 2 and the impact of diabetes mellitus type 2 in life with the respective subcategories. There was experience of inadequate and insufficient information from the health service. There was experience that close relatives provided good information and during group-based training, experiences of living with DMT2 were reflected. The results showed that self-care included some difficulties such as changing dietary habits, physical activity, cultural aspects and changing lifestyles.  Conclusion: DMT2 is a global and lifelong disease where lifestyle changes should be implemented. Experiences that it was difficult to implement lifestyle changes where dietary habits proved to be the most difficult to adapt your DMT2 to. Further research on the experiences of people with DMT2 contributes to increased knowledge for the nurse but also the public. Further research of people with DMT2 and how culture affects self-care can provide increased knowledge to the nurse and the public.   Keywords: Diabetes mellitus type 2, diabetes type 2, lifestyle, patient experience, self care.

Bakgrund: Diabetes mellitus typ-2 är en av de vanligaste folksjukdomar världen över, i Sverige uppskattas det till att ca 300 000 människor lider av sjukdomen. En stor del av behandlingen för människor med diabetes typ-2 är att ändra sina matvanor, fysisk aktivitet och att medicinera sig själva, detta kallas för egenvård. En stor del av sjuksköterskors arbete med diabetes typ-2 patienter är att motivera och ge stöd till patienterna så att de efterlever de livsstilsråd som ges i den mån det går. Hur patienterna upplever sin egenvård ser olika ut, några menade att eftersom sjukdomen är genetisk är det inget som kunde styras medan andra menade att egenvården och sjukdomen kunde vara svår att hantera och att stödet från sjukvården är viktigt.  Syfte: Syftet med studien var att beskriva sjuksköterskans erfarenheter av egenvård hosdiabetes mellitus typ-2 patienter  Metod: En litteraturstudie med beskrivande design som totalt innefattar 10 artiklar av kvalitativ ansats från databasen Pubmed. Huvudresultat: Resultatet visade att sjuksköterskorna ofta upplevde sina patienter som omotiverade i deras egenvård och att de hade svårt att efterfölja de livsstilsråd som gavs, detta var ett vanligt förekommande tema. Sjuksköterskorna använde sig av olika metoder till att förbättra egenvården och motivationen hos deras patienter. Det framkom även i resultatet att sjuksköterskorna upplevde stress och minskad arbetsglädje relaterat till att de inte kunde ge den bra diabetesvård de ville då de kände att de inte fick något gehör från patientens sida.  Slutsats: Föreliggande litteraturstudie visade att sjuksköterskor kunde behöva stöd och verktyg till att ge rätt egenvårdsstöd till deras patienter. Detta kunde därmed leda till att sjuksköterskor kan känna sig mer nöjda med det arbete de åstadkommit och därmed även främja arbetsglädjen. / Background: Diabetes mellitus type-2 is one of the most common public diseases worldwide, in Sweden it is estimated that about 300,000 people suffer from the disease. A large part of the treatment for people with type 2 diabetes is to change their eating habits, physical activity and to medicate themselves, this is called self-care. A large part of nurses' work with type 2 diabetes patients is to motivate and provide support to the patients so that they comply with the lifestyle advice given as far as possible. How patients experience their self-care looks different, some believe that because the disease is genetic it is not something that could be controlled while others thought that self-care and the disease could be difficult to manage and that support from health care is important.   Aim: The aim of the study was to describe the nurse's experiences of self-care in diabetes mellitus type-2 patients   Method: A literature study with descriptive design that includes a total of 10 articles of qualitative approach from the database Pubmed.   Results:  The results showed that nurses often perceived their patients as unjustified in their self-care and that they had difficulty following the lifestyle advice given, this was a common theme. Nurses used various methods to improve the self-care and motivation of their patients. It also emerged from the results that the nurses experienced stress and reduced job satisfaction, related to the fact that they could not provide the good diabetes care they wanted as they felt that they did not get any hearing from the patient.   Conclusion: The present literature study shows that nurses may need support and tools to provide the right self-care support to their patients. This can thus lead to the nurses feeling more satisfied with the work they have accomplished and thus also promote job satisfaction.

Bakgrund: Diabetes Mellitus typ 2 är ett stort folkhälsoproblem som påverkar personers fysiska och psykiska hälsa. För att kunna leva med en kronisk sjukdom som typ 2-diabetes måste personer hantera sjukdomen genom att anpassa sitt dagliga liv och tillämpa egenvårdsaktiviteter för att uppnå god hälsa. Sjuksköterskan kan stötta i att hantera denna förändring och uppnå en god egenvård genom utbildning och motiverande samtal. Syfte: Syftet var att beskriva erfarenheter kring barriärer och möjliggörande faktorer för egenvård vid typ 2-diabetes. Metod: Denna studie är en kvalitativ litteraturöversikt. De femton artiklar som omfattas i studien hittades i två olika databaser, CINAHL och PubMed. Innehållsanalys tillämpades för att analysera data. Resultat: Två kategorier beskriver erfarenheterna av egenvårdsförmågan vid typ 2-diabetes; 1) Lyckad egenvård med subkategorier: att erhålla stöd från närstående, att erhålla stöd från sjukvårdspersonal, kunskapens betydelse för livsstilsförändringar och bedömning om hälsorisker samt motivation som verktyg. 2) Utmaningar med egenvård med subkategorier: behov av stöd från närstående, behov av ökad kunskap, utmaningar i möte med sjukvårdspersonal samt utmaningar i det dagliga livet. Slutsats: Typ 2-diabetes är en utmanande sjukdom för personen att både leva med och hantera. Nya och strikta egenvårdsaktiviteter måste implementeras i det dagliga livet för att upprätthålla en god hälsa. Stöd från närstående och sjukvårdspersonal, kunskap om förändringar kring livsstil samt motivation som ett redskap för uppfyllelse av egenvårdsbehov är betydelsefullt för att personen ska lyckas med egenvården. Sjuksköterskan är av stor vikt vid förbättringen av personers egenvårdsförmåga, då handledning och förmedling av kunskap är aktuellt. / Background: Type 2 Diabetes Mellitus is a major public health problem that affects a person's physical and psychological health. To be able to live with a chronic disease such as type 2 diabetes, people must manage the disease by adapting their daily lives and applying self care activities to achieve good health. The nurse can support in dealing with this change and achieve good self care through training and motivational conversations. Aim: The aim was to describe experiences about barriers and enabling factors for self care in type 2 diabetes. Method: This study is a qualitative literature review. The fifteen articles covered in the study were found in two different databases, CINAHL and PubMed. Content analysis was applied to analyze data. Results: Two categories describe the experiences of the self care ability in type 2 diabetes; 1) Successful self care with subcategories: to receive support from close ones, to receive support from healthcare professionals, the importance of knowledge for lifestyle changes and assessment of health risks and motivation as a tool. 2) Challenges with self care with subcategories: need for support from relatives, need for increased knowledge, challenges in meeting healthcare professionals and challenges in daily life. Conclusion: Type 2 diabetes is a challenging disease for the person to both live with and manage. New and strict self care activities must be implemented in daily life in order to maintain good health. Support from relatives and healthcare professionals, knowledge of lifestyle changes and motivation as a tool for meeting self care needs is important for the person to succeed with self care. The nurse is of great importance in improving people's self care ability, as supervision and dissemination of knowledge is relevant.