Yes / Type 2 diabetes is a progressive condition that may require the combination of three oral treatments to achieve optimal glycemic management to prevent microvascular and macrovascular complications whilst minimizing the risk of acute complications and side effects or adverse reactions to treatments. With the widening availability of treatment options and increasing importance of individualized treatment pathways, including personalized HbA1c targets, this article will explore the mode of action of currently available oral treatments, factors to consider when individualizing HbA1c targets, the relevance of estimated glomerular filtration rate assessment, and the importance of reviewing the clinical impact of all treatment decisions.

Bakgrund Diabetes typ 2 är en av världens vanligaste dödsorsaker och medför stora samhällskostnader. I västvärlden förutspås diabetes typ 2 att fortsätta öka. Diabetes typ 2 kan delvis härledas till livsstilsfaktorer och behandlingen går ut på att uppnå ett så normalt plasmaglukosvärde som möjligt genom egenvård. Sjuksköterskan har här en viktig handledande funktion. I takt med den ökade digitaliseringen har mobila applikationer som stöd för egenvården vid diabetes typ 2 blivit allt vanligare. Syfte Syftet var att undersöka effekterna av mobila applikationer som egenvårdsstöd hos personer med diabetes typ 2. Metod En icke-systematisk litteraturöversikt som innefattade 17 kvantitativa originalartiklar. Artiklarna är publicerade de senaste fem åren och har kvalitetsgranskats enligt Sophiahemmets högskolas bedömningsunderlag. Artikelsökningarna gjordes i CINAHL och PubMed. Resultat För att lättare analysera effekterna i de valda artiklarna skapades två teman och ett antal subteman. Det första temat var effekter på glukosvärden med subtema HbA1c och fasteglukos. Det andra temat var egenvårdsbeteenden med subtema motionsvanor, kostvanor, frekvens av egenmätning av blodsocker, fotvård, läkemedelsföljsamhet och rökvanor. Från detta kunde utläsas att användandet av mobila applikationer kan kopplas till lägre fasteglukos, lägre HbA1c, bättre egenvårdsbeteende främst i form av nyttigare kostintag, mer frekvent mätande av glukosvärden samt bättre följsamhet till läkemedelsanvändning. Slutsats Resultatet av litteraturstudien tyder på att mobila applikationer kan vara ett värdefullt stöd för att förbättra egenvården vid diabetes typ 2. Studien visade att deltagarna åt nyttigare, fick bättre följsamhet till läkemedelsanvändningen samt testade sitt blodsocker mer frekvent. Fasteglukosvärden och HbA1c förbättrades. Följsamheten för användning av dessa mobila applikationer ser dock ut att minska med tiden. Det är viktigt att sjuksköterskan har kunskap om dessa mobila applikationer, så att de kan ge patienterna det stöd de efterfrågar i användandet av applikationerna. / Background Type 2 diabetes is one of the most common causes of death in the world and leads to large social costs. In the western world type 2 diabetes is predicted to continue to increase. Type 2 diabetes can partly be explained by lifestyle factors and the treatment is to achieve a plasma glucose level as close to normal as possible throughout self-care. The nurse has an important guiding function. Along with the digitalization growth, mobile applications to support self-care in type 2 diabetes has become more common. Aim The aim was to investigate the effects of mobile applications as self-care support for people with type 2 diabetes. Method A non-systematic literature review that included 17 quantitative original articles. The articles have been published in the last five years and have been quality reviewed according to Sophiahemmet University's assessment data. The article searches were done in CINAHL and PubMed. Resultat To more easily analyze the effects in the selected articles, two themes and a number of sub-themes were created. The first theme was effects on glucose values with the subtheme HbA1c and fasting glucose. The second theme was self-care behaviors with sub-themes: exercise habits, dietary habits, frequency of self-measurement of blood sugar, foot care, drug compliance and smoking habits. From this it could be deduced that the use of mobile applications can explain a lower fasting glucose, lower HbA1c, better self-care behavior mainly in the form of healthier dietary intake, more frequent measurement of glucose values and better drug compliance. Conclusion The results of the literature study suggest that mobile applications can be a valuable support for improving self-care in type 2 diabetes. The study showed that the participants ate healthier, gained better adherence to drug use and tested their blood sugar more frequently. Both fasting glucose values and HbA1c improved. However, compliance with the use of these mobile applications appears to be declining over time. It is important that the nurse has knowledge of these mobile applications, so that they can give the patients the support that they require in the use of the applications.

Abstract   Aims and objectives. To examine whether an intervention with carbohydrate- counting at onset of type 1 diabetes in children, has had any effect on metabolic indicators such as HbA1c , BMI-sds and total daily insulin / kg, 2 months and 1 year after onset by age and gender .Background. The pediatric department at the university hospital of Norrland in Umeå (NUS), has since several years a higher average HbA1c among children 0-17 years, compare with pediatric departments in the rest of Sweden.  Therefore, in autumn 2011, an intervention was made to teach children with diabetes and their parents to count carbohydrates from the onset of diabetes. Using this method they can regulate their insulin doses depending on the amount of carbohydrates they are eating. Design. This is an empirical registry study done on the basis of a quantitative method. It is retrospective controlled non- randomized with comparison group .Methods. The study included 46 children aged 0-17 years diagnosed with type 1 diabetes. Those who fell ill in 2009 (n=22) did not learn to use carbohydrate counting and served as a control group. The intervention group were diagnosed 2011-2012, (n=24), began using carbohydrate counting at the onset of diabetes.Results. The study shows with significant security that carbohydrate counting lowers HbA1c two months and one year after onset of type 1 diabetes. No significant difference was found in BMI-sds. The study shows no significant difference in HbA1c between the sexes.Conclusion.  Carbohydrate-counting from onset of diabetes gives a significant reduction of HbA1c without affecting BMI-sds significantly.Relevance to clinical practice. It is important that health professionals continue to teach and support families in carbohydrate counting from the onset of diabetes.Keywords. children, HbA1c, BMI- sds , type 1 diabetes , carbohydrate counting

Aims: The intravenous application of the chlorite-based drug solution WF10 is known to improve wound healing in patients with diabetic foot syndrome. In this retrospective study, we addressed the question, which effects are caused by this drug in patients with diabetic foot ulcers on the hemoglobin A1c value. Methods: Patients received five consecutive daily infusions of WF10. Three patients received a second cycle of WF10, and one patient a third cycle. Results: On a group of twelve patients with diabetic foot syndrome, WF10 gradually reduced the HbA1c values from a high-risk range (9.1 ± 1.6% (76 ± 13 mmol/mol)) into a low-risk range in all patients but one. These values remain low over at least 8 to 12 weeks after the administration of WF10. This drug improved also considerably wound healing processes in eleven patients. Conclusions: The chlorite component of WF10 is known to inactivate efficiently free cytotoxic hemoglobin forms that might accumulate in peripheral blood after hemolysis and induces the removal of predamaged red blood cells from circulation. By these mechanisms WF10 diminished toxic effects of hemolysis, improved microcirculation and glucose consumption in affected tissues, and prevented, thus, below knee amputation.

Bakgrund: År 2040 beräknas det finnas 642 miljoner diabetespatienter i världen. Sjukdomen leder till många komplikationer som kan bli allvarliga och har en negativ effekt på livskvalitén hos diabetespatienterna. Den mest förekommande av alla diabetesformer är diabetes typ 2. Diabetes typ 2 är en sjukdomstillstånd där kroppen inte producerar tillräckligt med insulin eller reagerar inte kroppens vävnader på insulinet (insulinresistens), vilket medför till att det blir en förhöjd glukoshalt i blodet. Insulin är ett peptidhormon som gör att glukos kan transporteras in i en cell och ifall inte insulinet fungerar kommer ingen glukos in i cellen och kroppen får då ingen energi. Symtom som kan uppstå är trötthet, urinering och dimsyn. Riskfaktorer som kan leda till diabetes typ 2 är stillasittande livsstil, högt blodtryck och fetma. En av metoderna som används vid diagnos av diabetes är kontroll av HbA1c-värdet. HbA1c är en mätmetod som kontrollerar blodsockervärdet under längre tid. Det är andelen glukos som fastnar på hemoglobinet som HbA1c mäter. Skulle HbA1c-värdet vara ≥ 48mmol/mol har patienten diabetes. Eftersom detta är en allt vanligare sjukdom och det inte finns något läkemedel som botar diabetes finns det ett stort behov för nya effektivare läkemedel och det är ett stort forskningsområde. ”Dualpeptider” har visat positiva resultat i djurstudier, både vad gäller glykemisk kontroll samt viktminskning hos möss. Dualpeptiderna är en kombination av två inkretinhormoner: GLP-1R (glukagonliknande peptid-1-receptor) och GIP (glukosberoende insulinotrop peptid) agonister. De nya dualpeptiderna som undersöks kallas för: ‘’LY3298176’’ och ‘’RG7697’’. Syftet med litteraturstudien var att undersöka framtida behandlingsalternativ för patienter med diabetes typ 2. Metod: I denna litteraturstudie användes PubMed för att söka efter publicerade studier. Fyra studier uppfyllde de uppställda kriterierna och undersökte effekten av nya kombinationspeptider vid behandling av diabetes typ 2. Resultat: Dualpeptiderna RG7697 och LY3298176 visade kroppsviktreducering och minskade även HbA1c-värdet. Trots den korta studietiden och en liten studiepopulation sågs signifikanta skillnader. Den glykemiska kontrollen ökade vid behandling med dualpeptiderna jämfört med placebo. Slutsats: Båda dualpeptiderna visade på glykemisk kontroll och viktminskning för patienter med diabetes typ 2 och var effektiva i fas 2 studier. Inga allvarliga biverkningar förekom i någon av studierna. Dualpeptiderna anses kunna vara mer effektiva än metformin och GLP-1 agonisterna dulaglutid (Trulicity®) och liraglutid (Victoza®). / Background: By 2040, it is estimated that there will be 642 million diabetic patients worldwide. The disease leads to many complications that may have negative effects on the quality of life of patients with diabetes. The most common of all forms of diabetes is diabetes type 2. Diabetes type 2 is a disease state where the body doesn’t produce enough insulin or the body’s tissues don’t react to the insulin (insulinresistance), this leads to an elevated level of glucose in blood. Insulin is a peptide hormone that allows glucose to be transported into a cell. If this process does not work, glucose does not enter the cell and the cell will lack a source of energy. Symptoms that may occur are fatigue, urination and blurred vision. Risk factors that can lead to type 2 diabetes are sedentary lifestyle, high blood pressure and obesity. Measuring the HbA1c is one of the methods used in diagnosing diabetes. HbA1c is a measurement method that controlls the blood sugar level for a longer period of time. It is the percentage of glucose that sticks to the hemoglobin that HbA1c measures. The patient has diabetes type 2 if the HbA1c value is ≥ 48 mmol/mol. Since there is still no treatment that can cure diabetes and the number of patients increase, there is on-going research to discover new drugs to treat diabetes in the future. ‘’Dualpeptides’’ have shown positive results in animal studies. Dualpeptides increase glycemic control and weight loss in mice. The dualpeptides are a combination of two incretin hormones: GLP-1R (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic peptide). Both are receptor agonists. The new dual peptides being studied are called: ‘’LY3298176’’ and ‘’RG7697’’. Objective: The purpose of this literature study was to investigate the future treatment alternatives for patients with diabetes type 2. Method: In this literature study PubMed was used to search for published studies. Four studies met the set criteria and were examined. The effect of new dualpeptides in the treatment of type 2 diabetes was assessed. Results: The dual peptides RG7697 and LY3298176 showed a reduction in body weight and also reduced the HbA1c value. Despite the short study-time and a small study populations, significant differences were reported. Glycemic control increased during treatment with dualpeptides compared with placebo. Conclusion: Based on the results the following can be concluded, both dualpeptides showed glycemic control and weight loss in patients with type 2 diabetes, and were effective in phase 2 studies. No serious side effects were observed in any of the studies. The dualpeptides are considered to be more effective than metformin and the GLP-1 agonists dulaglutide (Trulicity®) and liraglutide (Victoza®).

Objetivos: Avaliar os níveis de mieloperoxidase do fluido gengival (MPO) e de peroxidase salivar (SPO) de pacientes portadores de diabetes mellitus tipo 2 com periodontite crônica generalizada (DMDP) antes e após o tratamento periodontal. Material e Métodos: Participaram do estudo 31 indivíduos com DMDP, 31 controle com DM 2 (DM), 31 com periodontite crônica generalizada sem diabetes (DP) e 31 Controles(C) saudáveis periodontalmente e sistemicamente. Foram coletados dados de parâmetros clínicos como profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), sangramento à sondagem (SS), índice de placa (IP) e amostras de sangue para hemoglobina glicada, saliva e fluido gengival (FG) de todos os pacientes antes e 30 dias após o tratamento periodontal (TP). A atividade das enzimas foi determinada pela técnica de espectrofotometria. Os dados clínicos e enzimáticos foram analisados por métodos estatísticos não-paramétricos. Resultados: No baseline, a atividade da MPO estava maior no grupo DMDP: 1893,27 comparado ao grupo DM: 1202,73 (p0,015) e ao grupo C: 6,46 (p0,001). Também se mostrou mais elevada no grupo DP: 2196,10 em relação ao grupo C: 6,46 (p0,007). O tratamento periodontal se mostrou efetivo na redução de MPO nos grupos DMDP e DP (p0,004). A atividade da SPO estava mais elevada na comparação entre os grupos DMDP: 138859,10 e grupo C: 26927,453 (p0,001) e DMDP com o grupo DP: 59115,99(p<0,02). O tratamento periodontal se mostrou eficiente para a redução dos níveis de SPO nos grupos DMDP e DP, mas apenas foi significante para o grupo DP (p<0,005). Conclusão: A SPO apresentou níveis mais elevados nos grupos DMDP comparado ao grupo DP e ao grupo C. A MPO apresentou níveis mais elevados no grupo DMDP comparados aos grupos DM e C. E o grupo DP mostrou maiores níveis de MPO em comparação ao grupo C. O tratamento periodontal foi efetivo na melhora dos parâmetros clínicos periodontais, no volume do FG nos grupos DMDP e DP que se refletiu na redução dos níveis de SPO no grupo DP e de MPO nos grupos DMDP e DP. Após o tratamento periodontal, os níveis de MPO se mostraram maiores para o grupo DMDP comparados aos níveis observados no grupo DP. / Objectives: To evaluate the levels of gingival crevicular fluid (GCF) myeloperoxidase (MPO) and salivary peroxidase (TSP) in type 2 diabetes mellitus patients with generalized chronic periodontitis (DMDP) before and after the nonsurgical periodontal treatment (PT). Material and Methods Thirty-one individuals were included in each group: DMDP, DM, chronic periodontitis (DP), control (C). Plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL), blood, saliva and GCF of all patients were collected at baseline and 30 days after PT. The enzyme activity was determined by spectrophotometer. Clinical and enzymatic data were analyzed by non-parametric statistical methods. Results: At baseline, the MPO activity was significantly higher in the DMDP: 1893.27 compared to the DM group: 1202.73 (p ) and to C group: 6.46 (p ). Results also showed significantly higher levels in the DP group: 2196.10 compared to the C group: 6.46 (p 0.007). PT reduced MPO levels in DP and DMDP groups (p 0.004). TPS activity was significantly higher in DMDP: 138859.10 and C: 26927.453 groups (p when compared with DMDP and DP: 59115.99 groups (p<0.02). PT effectively reduced TPS levels of DMDP and DP groups, but achieved statistical significance for the PD group (p <0005). Conclusion: TPS showed higher levels for DMDP groups compared to PD and C group. MPO showed higher levels for DMDP group compared to DM and C. PD group showed higher levels of MPO compared to C group. Periodontal treatment resulted in significant improvement of clinical parameters and FG volume for both groups DP and DMDP. That was reflected in the low levels of TPS in DP group and the low levels of MPO in DP and DMDP groups. After periodontal therapy, MPO levels were higher for DMDP group compared to the levels observed in PD group.

Le taux du diabète de type 2 (DT2) est en augmentation partout dans le monde, y compris dans les régions du monde où le trait drépanocytaire (TD) est très prévalent. Le TD, la forme hétérozygote de la drépanocytose, est généralement considéré comme bénin. Cependant, une dysfonction vasculaire plus importante a été récemment observée chez les patients DT2 porteurs du TD (DT2-TD) par rapport à des patients DT2 non-porteurs du TD. En outre, certaines études démontrent que le TD pourrait rendre le dépistage du DT2 plus complexe. De ce fait, les deux objectifs principaux de ma thèse étaient d’étudier les difficultés liées au dépistage et le suivi du DT2 chez les porteurs du TD, et d’évaluer les mécanismes et conséquences de la dysfonction vasculaire amplifiée chez les porteurs du TD. La 1ère étude a comparé deux mesures typiques (l’HbA1c et la glycémie à jeun) et une mesure atypique (fructosamine) de la glycémie chez des adultes sénégalais avec et sans le TD. Cette étude a démontré une disparité entre ces mesures qui étaient plus marquées chez des porteurs du TD. La 2ème étude a observé que les prévalences d’hypertension, de rétinopathie, et de néphropathie étaient plus élevées chez les sujets DT2-TD que chez les sujets diabétiques. La dysfonction vasculaire à l’origine de ces complications plus fréquentes semble impliquer les produits de glycation avancés. Les études 3 et 4 étaient réalisées dans un modèle murin du DT2-TD. L’étude 3 a montré une vasodilatation endothélium-dépendante significativement réduite chez des souris DT2-TD. Enfin, l’étude 4 a montré que la vasodilatation in-vivo induite par acétylcholine était augmentée chez la souris DT2-TD via un mécanisme dépendant de la cyclooxygenase-2. Ce travail de thèse a permis de mieux comprendre les difficultés liées au dépistage du DT2 chez les porteurs du TD, de montrer que le TD est un facteur de risque de complications vasculaire dans le DT2 et d’explorer les mécanismes à l’origine de cette dysfonction vasculaire plus marquée / Rates of type 2 diabetes (T2D) are rapidly increasing worldwide, including in regions, and among populations, of the globe where sickle cell trait (SCT) is prevalent. SCT, the heterozygote form of sickle cell disease, is generally considered a benign condition. However, evidence shows that vascular function is more severely impaired in people with combined T2D and SCT (T2D-SCT) than in those with T2D only. Furthermore, evidence suggests that SCT could complicate screening for T2D, thereby increasing the risk of delayed diagnosis of T2D. In light of this information, the main objectives of this thesis were to study the challenges related to diagnosing and monitoring T2D in individuals with SCT, and to evaluate the mechanisms and consequences of the amplified vascular dysfunction observed in T2D-SCT. Study 1 compared the agreement between two standard measures of glycemia, HbA1c and fasting glucose, and one alternative measure of glycemia, fructosamine, in Senegalese adults with and without SCT. The findings revealed substantial disparities between the markers of glycemia, and these differences were exaggerated in individuals with SCT. Study 2 illustrated that SCT could potentially augment the risk of developing retinopathy, nephropathy, and hypertension in T2D, and demonstrated that AGEs are likely implicated in the vascular dysfunction observed in T2D-SCT. Studies 3 and 4 studied microvascular function in a mouse model of T2D-SCT. Study 3 showed that T2D-SCT mice had significantly impaired endothelium-dependent vasodilation in-vivo. Study 4 revealed that ACH-mediated vasodilation in-vivo was significantly elevated in the microvasculature of mice with combined T2D and SCT due to cyclooxygenase-2 dependent mechanisms. Overall these findings deepen our understanding about the complexities related to diagnosing and managing T2D in individuals with SCT

Objetivos: Avaliar os níveis de mieloperoxidase do fluido gengival (MPO) e de peroxidase salivar (SPO) de pacientes portadores de diabetes mellitus tipo 2 com periodontite crônica generalizada (DMDP) antes e após o tratamento periodontal. Material e Métodos: Participaram do estudo 31 indivíduos com DMDP, 31 controle com DM 2 (DM), 31 com periodontite crônica generalizada sem diabetes (DP) e 31 Controles(C) saudáveis periodontalmente e sistemicamente. Foram coletados dados de parâmetros clínicos como profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), sangramento à sondagem (SS), índice de placa (IP) e amostras de sangue para hemoglobina glicada, saliva e fluido gengival (FG) de todos os pacientes antes e 30 dias após o tratamento periodontal (TP). A atividade das enzimas foi determinada pela técnica de espectrofotometria. Os dados clínicos e enzimáticos foram analisados por métodos estatísticos não-paramétricos. Resultados: No baseline, a atividade da MPO estava maior no grupo DMDP: 1893,27 comparado ao grupo DM: 1202,73 (p0,015) e ao grupo C: 6,46 (p0,001). Também se mostrou mais elevada no grupo DP: 2196,10 em relação ao grupo C: 6,46 (p0,007). O tratamento periodontal se mostrou efetivo na redução de MPO nos grupos DMDP e DP (p0,004). A atividade da SPO estava mais elevada na comparação entre os grupos DMDP: 138859,10 e grupo C: 26927,453 (p0,001) e DMDP com o grupo DP: 59115,99(p<0,02). O tratamento periodontal se mostrou eficiente para a redução dos níveis de SPO nos grupos DMDP e DP, mas apenas foi significante para o grupo DP (p<0,005). Conclusão: A SPO apresentou níveis mais elevados nos grupos DMDP comparado ao grupo DP e ao grupo C. A MPO apresentou níveis mais elevados no grupo DMDP comparados aos grupos DM e C. E o grupo DP mostrou maiores níveis de MPO em comparação ao grupo C. O tratamento periodontal foi efetivo na melhora dos parâmetros clínicos periodontais, no volume do FG nos grupos DMDP e DP que se refletiu na redução dos níveis de SPO no grupo DP e de MPO nos grupos DMDP e DP. Após o tratamento periodontal, os níveis de MPO se mostraram maiores para o grupo DMDP comparados aos níveis observados no grupo DP. / Objectives: To evaluate the levels of gingival crevicular fluid (GCF) myeloperoxidase (MPO) and salivary peroxidase (TSP) in type 2 diabetes mellitus patients with generalized chronic periodontitis (DMDP) before and after the nonsurgical periodontal treatment (PT). Material and Methods Thirty-one individuals were included in each group: DMDP, DM, chronic periodontitis (DP), control (C). Plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL), blood, saliva and GCF of all patients were collected at baseline and 30 days after PT. The enzyme activity was determined by spectrophotometer. Clinical and enzymatic data were analyzed by non-parametric statistical methods. Results: At baseline, the MPO activity was significantly higher in the DMDP: 1893.27 compared to the DM group: 1202.73 (p ) and to C group: 6.46 (p ). Results also showed significantly higher levels in the DP group: 2196.10 compared to the C group: 6.46 (p 0.007). PT reduced MPO levels in DP and DMDP groups (p 0.004). TPS activity was significantly higher in DMDP: 138859.10 and C: 26927.453 groups (p when compared with DMDP and DP: 59115.99 groups (p<0.02). PT effectively reduced TPS levels of DMDP and DP groups, but achieved statistical significance for the PD group (p <0005). Conclusion: TPS showed higher levels for DMDP groups compared to PD and C group. MPO showed higher levels for DMDP group compared to DM and C. PD group showed higher levels of MPO compared to C group. Periodontal treatment resulted in significant improvement of clinical parameters and FG volume for both groups DP and DMDP. That was reflected in the low levels of TPS in DP group and the low levels of MPO in DP and DMDP groups. After periodontal therapy, MPO levels were higher for DMDP group compared to the levels observed in PD group.

Hintergrund und Ziel: Der hausärztliche Bereich ist von zentraler Bedeutung für die Betreuung von Patienten mit Diabetes mellitus. Die Autoren untersuchten a) die Prävalenz von Diabetes mellitus Typ 1 und Typ 2, b) die Art und Häufigkeit von nichtmedikamentösen und medikamentösen Behandlungen und deren Zusammenhang mit dem Vorliegen von diabetestypischen Komplikationen sowie c) die Qualität der Stoffwechseleinstellung anhand des HbA1c. Methodik: Auf der Grundlage einer bundesweiten Zufallsstichprobe von 3 188 Arztpraxen („response rate“ [RR] 50,6%) wurden 55 518 Patienten (RR 93,5%) im September 2003 in einer prospektiven Querschnittsstudie standardisiert mit Fragebögen, Arztgespräch und Labormessungen untersucht. Neben Diabetes mellitus wurden 28 weitere Erkrankungen explizit erfasst, darunter auch die typischen makrovaskulären (koronare Herzkrankheit, zerebrovaskuläre Erkrankungen, periphere arterielle Verschlusskrankheit) und mikrovaskulären Komplikationen (Neuropathie, Nephropathie, Retinopathie, diabetischer Fuß). Ergebnisse: Es wurde eine Prävalenz des Diabetes mellitus von 0,5% (Typ 1) bzw. 14,7% (Typ 2) dokumentiert. 49,5% (Typ 1) bzw. 50,2% (Typ 2) der Patienten hatten bereits mikro- oder makrovaskuläre Folge- bzw. Begleiterkrankungen. 6,8% der Patienten erhielten keine Therapie, 13,5% wurden nur mit Diät/Bewegung behandelt, und 75,3% erhielten orale Antidiabetika und/oder Insulin, davon 26,6% eine Kombinationstherapie mit verschiedenen Antidiabetika. Die Behandlungsintensität war im Vergleich zu Diabetikern ohne Komplikationen bei Patienten mit mikrovaskulären Kom- plikationen deutlich höher (Odds-Ratio [OR] 3,02) als bei denen mit makrovaskulären Komplikationen (OR 0,98). Ein HbA1c-Wert ≥ 7,0% fand sich bei 39,6% der Patienten. Schlussfolgerung: Im Vergleich zu früheren Untersuchungen im hausärztlichen Bereich hat die Rate der medikamentös behandelten Diabetiker zugenommen. Eine Kombinationstherapie wird häufiger eingesetzt. Die Qualität der Einstellung scheint sich ebenfalls verbessert zu haben. / Background and Purpose: The primary care sector is of key importance for the management of patients with diabetes mellitus. The authors investigated (a) the prevalence of diabetes mellitus type 1 and type 2, (b) the type and frequency of non-drug and drug treatment and its association with the presence of diabetic complications, and (c) the quality of metabolic control by HbA1c. Method: Using a nationwide probability sample of 3,188 general practices (response rate [RR] 50.6%), a total of 55,518 (RR 93.5%) patients were assessed in a prospective cross-sectional study by their physicians in September 2003 in a standardized manner using questionnaires, physician interview, and laboratory assessments. In addition to diabetes mellitus, 28 diseases were explicitly screened for, among them typical macrovascular (coronary heart disease, cerebrovascular disease, peripheral arterial disease) and microvascular disease (neuropathy, nephropathy, retinopathy, diabetic foot) complications. Results: The prevalence of diabetes mellitus was 0.5% (type 1) and 14.7% (type 2), respectively. 49.5% (type 1) and 50.2% (type 2) of patients had micro- or macrovascular complications. 6.8% did not receive any treatment, 13.5% received non-drug treatment, and 75.3% received oral antidiabetic drugs and/or insulin (26.6% a combination of two or more). Compared to diabetics without any complications, treatment intensity was significantly higher in patients with microvascular complications (odds ratio [OR] 3.02), but not in those with macrovascular complications only (OR 0.98). An HbA1c value ≥ 7.0% was recorded in 39.6% of patients. Conclusion: Compared to previous studies in this setting, the proportion of diabetics with drug treatment has increased. More patients receive antidiabetic drug combinations. Quality of blood sugar control appears to have improved as well.

Glykerat hemoglobin, HbA1c, är en indikation på genomsnittligt glukosvärde. HbA1c används vid diagnostisering av diabetes men också uppföljning av diagnostiserade diabetiker. Uppföljningen visar hur väl diabetiker förhåller sig till kost men också medicinering. Informationen av patientens HbA1c värde spelar en stor roll i vidare behandlingar. Analysmetoden HbA1c är inte helt standardiserad vilket har medfört att flera analysmetoder utvecklats för HbA1c. Syftet med denna studie var att undersöka om en enzymatisk, Direct enzymatic HbA1c eller immunologisk analysmetod, Hemoglobin A1c kan lösa problemet med hemoglobin-variationer vid analys av HbA1c som idag analyseras med HPLC som rutin på klinisk kemi-laboratorium i Västerås. Genomförandet gjordes på två instrument, TOSOH G7 och AU 680. TOSOH:s värden (HPLC) användes vid jämförelse av de två analysmetoderna på AU680. Förberedelse och behandling, såsom hemolysering, skedde innan proven sattes i instrumentet AU680. Resultatet (n=134) visade att analysmetoden Hemoglobin A1c förhöll sig väl till HPLC analysmetod (R 2=0,98) jämfört med vad analysmetoden Direct enzymatic HbA1c gjorde (R2=0,86). Likartade resultat kunde observeras för Hemoglobin A1c (R2=0,98) och Direct enzymatic Hba1c (R2=0,95) då bara patientprov med hemoglobin-varianter analyserades (n=10). Mann-Whitney’s U-test vid analys av hemoglobin varianter med Hemoglobin A1c visade en tendens till signifikant skillnad gentemot HPLC analysen (p=0,051; n=34). Fel reagens erhölls från reagenstillverkaren gällande Direct enzymatic, Detta kan förklara det erhållna resultatet och kräver fler analyser med korrekta reagens. Hemoglobin A1c bör även undersökas vidare med mer omfattande provmaterial för möjlig standardisering i rutin hos KKTM i Västerås. / Glycated hemoglobin, HbA1c, is an indication of average long-term glucose. HbA1c is used as a diagnostic method for diabetes but also as a follow-up for diagnosed diabetics. Follow-ups shows how well a diabetic relates to diet but also medication. The information of the patient's HbA1c value plays an important factor in further treatments. The analysis method for HbA1c is not standardized, which has resulted in several analysis methods developed for HbA1c. The purposes of this study were to investigate whether an enzymatic, Direct enzymatic HbA1c or immunological assay method, Hemoglobin A1c, can solve the problem of hemoglobin variations in the analysis of HbA1c, which is currently analyzed by HPLC as a routine at the clinical chemistry laboratory in Västerås The implementation was performed on two instruments, TOSOH G7 and AU 680. The values from TOSOH (HPLC) were used for comparison of the two analysis methods applied on the AU680. Preparation and treatment, such as hemolysis, occurred before putting the samples into the AU680 instrument. The result showed that the Hemoglobin A1c assay method was well-matched with HPLC assay (R2 = 0.98) in comparison to that of the Direct enzymatic HbA1c assay method (R2 = 0.86). Similar results could be observed for Hemoglobin A1c (R2 = 0.98) and Direct Enzyme HbA1c (R2 = 0.95) when only samples from patients with hemoglobin variants were analyzed (n=10). Solely analysis of hemoglobin variants with Hemoglobin A1c showed a boundary case for a significant difference compared to HPLC analysis (P = 0.051; n=134). Incorrect reagents were obtained from the reagent manufacturer in the case of Direct enzymatic. This can explain the results obtained. Hemoglobin A1c should also be investigated with more extensive test materials for possible standardization in the routine of KKTM in Västerås.