Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by loss of insulin-producing beta cells resulting in life-long insulin deficiency. Beta cell destruction by autoreactive CD8+ effector T-cells is thought to be the main cause of loss of insulin output. Autoreactive T-cells are similarly to autoantibodies, which have been established as markers of risk and progression of the disease, directed towards autoantigens of T1D. These are most notably, insulin, 65 kDa glutamic acid decarboxylase (GAD65, also known as GAD2), insulinoma-associated protein 2 (IA­2, also known as PTPRN or ICA512) or zinc transporter 8 (ZNT8). Most of the known T1D autoantigens are components of insulin secretory granules (SGs). T1D arises from an interplay of genetic and environmental factors, which are thought to act as triggers in susceptible individuals. Predisposing alleles in genetic loci for human leukocyte antigen (HLA) account for by far the highest contribution to the risk of disease development, followed by an array of polymorphisms thought to play a role in either immune cells or beta cells. Of environmental factors that potentially add to the risk of disease progression, the most evidence-supported are Enteroviruses (EVs). Most notably, their genome and viral proteins, as well as higher expression of cellular proteins involved in viral response were detected more often in blood and pancreata of patients with T1D than in healthy population. In addition, recent evidence from a large long-term observational study has implicated prolonged shedding of specifically species Enterovirus B in the stools of children as a risk factor in development of beta cell autoimmunity in children with high genetic risk of T1D. For these reasons, many researchers have studied the potential mechanisms of EV involvement in T1D pathogenesis. In our laboratory, we have investigated the effects of coxsackievirus B5 (CVB5) infection on murine insulinoma MIN6 cells. Previously, we have reported that glucose-stimulated translation of SG proteins can be carried out in a cap-independent manner and is not shut down as part of the early effects of CVB5 infection on MIN6 cells. We have also observed that mature forms of SG proteins are being degraded during viral infection. As intracellular protein degradation is one of the major pathways to supply peptides for presentation on HLA I for immune recognition, we hypothesized that concomitant production and degradation of SG proteins upon viral infection could lead to altered presentation of mainly peptides derived from insulin SG component proteins and potentially drive the response of autoreactive T-cells. To address this hypothesis, we aimed to identify appropriate conditions to study the impact of EV infection on antigen presentation of ECN90 cells. To that end, we established a panel of markers examined by SDS-PAGE and immunoblotting. Stage of viral infection was assessed based on the detection of the viral protein VP1 and cleavage of cellular factors such as eukaryotic translation initiation factor 4 G (eIF4G), poly(A)-binding protein (PABP1), polypyrimidine tract-binding protein 1 (PTBP1), poly (ADP-ribose) polymerase (PARP) and caspase 3, which is mediated by viral proteases. Furthermore, we assessed the levels of ICA512 and chromogranin A and their pro-forms to estimate the size of insulin SG stores, and the expression of HLA I and β2 microglobulin to confirm sufficient antigen presentation. Peptides presented on both HLA I and II were isolated by immunoaffinity purification and identified by liquid chromatography-tandem mass spectrometry analysis. About 500 unique HLA I-presented peptides were found on average per replicate and condition with purity of 89% (peptides predicted to bind HLA alleles expressed by ECN90 cells). The distribution of unique peptides presented by infected ECN90 cells significantly differed from those presented by control cells as 54 unique peptides were present only in all infected samples and none of uninfected and 13 peptides were only found in uninfected cells. In total, we identified 26 unique peptides from known T1D autoantigens associated with SGs (e.g. insulin, chromogranin A, ICA512) in both conditions. The majority of them were predicted to bind HLA I alleles B*40:01 and A*02:01, while two identified viral peptides were found to bind B*40:01 and A*03:01 alleles. Both of the viral peptides and almost half of the peptides originating from known T1D autoantigens have not been described before. In addition, on average 300 unique HLA II peptides were found per replicate and condition. Similarly to HLA I peptides, the distribution of unique peptides across infected and control cells differed as well, showing that antigen presentation was altered in infected cells. We identified two viral HLA II-eluted peptides and peptides originating from only two known T1D autoantigens, 35 originated from insulin and 157 from chromogranin A. As most of the newly identified HLA I peptides originating from T1D autoantigens and one peptide from viral proteins were restricted by the allele HLA-B*40:01, our further efforts were invested in the development of a recombinant disulfide-stabilized biotinylated peptide-receptive HLA molecule of this allele. This technology has been extensively validated, and will allow us to test the wide array of novel peptides identified by us for the ability to bind this allele, as well as asses frequencies and responses of specific T-cells in subject populations relevant for T1D.

Bakgrund: Den snabba utvecklingen av avancerad diabetesteknik kräver god kunskap från diabetesteamet. Diabetessjuksköterskan ansvarar för utbildningen av ny teknologi med krav på säker och personcentrerad vård. Vid start av en hybrid closed loop insulinpumpbehandling inkluderar diabetessjuksköterskan generellt en representant från det företag som ansvarar för den avancerade insulinpumpen så att mottagaren ska få all teknisk information korrekt.  Syfte: Syftet med studien var att beskriva hur vuxna personer med diabetes typ 1 (T1D) upplever utbildningen utifrån säker och personcentrerad vård vid övergång till en hybrid closed loop insulinpumpbehandling. Metod: Kvalitativ intervjustudie med en induktiv ansats med semistrukturerade frågor genomfördes med åtta personer med T1D som har startat med en hybrid closed loop insulinpumpbehandling under åren 2020–2021. Intervjuerna hölls via zoom och de spelades in, transkriberades ordagrant och analyserades med en kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier och åtta underkategorier. Huvudkategorierna var: Tekniken och livet, Tekniken och utbildningen samt Tekniken och det professionella stödet. Det förekom tre olika typer av utbildningar; halvdag, tre dagar och distansuppstart, där majoriteten av deltagarna upplevde att de mottagit den utbildning de behöver för att känna sig trygg med behandlingen, men där vikten av snar uppföljning betonas. Insulinpumpföretagets support och diabetesteamets stöd är väsentliga för upplevelsen av trygghet. Slutsats: Den avancerade teknik som finns att tillgå idag förbättrar livskvaliteten och leder till ökad trygghet och frihet men kräver praktisk övning och snar uppföljning hos diabetessjuksköterska för att vara förenad med säker och personcentrerad vård. / Background: The rapid development of advanced diabetes technology requires great knowledge from the diabetes team. The diabetes nurse specialist is responsible for the education of new technology with demands for safe and person-centered care. When starting a hybrid closed loop insulin pump treatment, the diabetes nurse generally includes a specialist from the current company that is responsible for the advanced item, so that the receiver of the insulin pump is ensured to get all technical information correctly. Aim: The aim of this study was to describe how adult persons with diabetes type 1 (T1D) experience the education from the intention of safe and person-centered care in connection with transmission to a hybrid closed loop insulin pump treatment.  Method: Qualitative interview study with an inductive approach with semi structured interview questions were conducted with eight persons with T1D who have started with a closed loop insulin pump treatment during the years of 2020 and 2021. The interviews took place via zoom and were recorded, transcribed verbatim and analyzed using a qualitative content analysis. Results: The analysis resulted in three main categories and eight subcategories. The main categories were: Technique and life, Technique and education, Technique and the professional support. The result showed that there were three different kinds of education; half day, three days and distance start, where the majority of the participants experienced that they had received the education they needed to feel safe with the treatment, but where a close follow-up visit to the diabetes nurse specialist is crucial. Conclusion: The advanced technology that is available today, increases quality of life and leads to a sense of safety and freedom but demands practical training and a close follow-up visit to the diabetes nurse to be associated with safe and person-centered care.

Bakgrund: Äldre patienter med typ 1-diabetes påträffas allt oftare i hemsjukvård då patienterna behöver hjälpinsatser. Vården för typ 1-diabetes har under flera år utvecklats vilket har resulterat i mindre komplikationer och längre överlevnad. Viktigt inom diabetesvården är patientens egenvård, men när andra sjukdomstillstånd tillkommer kan det vara svår att upprätthålla denna själv. Syfte: Syftet är att beskriva specialistsjuksköterskors erfarenheter av att möta äldre patienter med typ 1-diabetes i hemsjukvård där förmågan till egenvård har försämrats. Metod: En kvalitativ intervjustudie med induktiv ansats gjordes. Åtta specialistsjuksköterskor som arbetade inom hemsjukvård intervjuades med semistrukturerade frågor. Datamaterialet analyserades med en kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier; Att se skillnaden mellan typ 1- och typ 2-diabetes hos patienten, Att kommunicera kunskap mellan sjukvårdspersonal och Att ta över ansvaret av patientens egenvård. Fynden i studien visade att det fanns skillnader att behandla patienter med typ 1- och typ 2-diabetes. Kunskap saknades om typ 1-diabetes och därmed var det svårt att förmedla information till omvårdnadspersonal. Att ta över ansvaret av patients egenvård beskrevs som en viktig, men svår del för att patienten ska känna sig trygg i relation med omvårdnadspersonal. Slutsats: Specialistsjuksköterskorna upplever en svårighet att ta över patientens egenvård när de inte längre har förmågan att själva utföra den. Utbildning inom diabetesvård är viktigt då specialistsjuksköterskan har som arbetsuppgift att utbilda, handleda och delegera omvårdnadspersonal. Typ 1-diabetes är en sjukdom som kommer att öka inom den äldre populationen, vilket innebär att patienterna kommer att ha ett behov av hemsjukvård i likhet med övrig befolkning. / Background: Elderly patients with type 1-diabetes are increasingly found in home healthcare as patients need assistance. Care for type 1-diabetes has developed over several years, which has resulted in fewer complications and longer survival. Important in diabetes care is the patient's self-care, but when other disease states arise, it can be difficult to maintain this yourself. Aim: The aim is to describe specialist nurses' experiences of meeting elderly patients with type1- diabetes in home care where the ability to self-care has deteriorated. Method: A qualitative interview study with inductive approach was performed. Eight specialist nurses who worked in home care were interviewed with semi-structured questions. The data material was analyzed using a qualitative content analysis. Results: The analysis resulted in three categories; To see the difference between type 1- and type 2-diabetes in the patient, To communicate knowledge between nursing staff and To take over the responsibility of self-care. The findings of the study showed that there were differences in treating patients with type 1- and type 2-diabetes. Knowledge of type 1 -diabetes was lacking and thus it was difficult to convey information to nursing staff. Taking over the patient's responsibility for self-care was described as an important, but hard part to make the patient feel safe in relation to nursing staff. Conclusion: The specialist nurses experience a difficulty in taking over the patient's self-care when the patients no longer are able. Diabetes care training is crucial as the specialist nurse's task is to train, supervise and delegate nursing staff. Type 1 diabetes is a disease that is estimated to increase in the elderly population, which means that patients will have a need for home care similar to the rest of the population.

Background: Type 1 diabetes in young children is a heavy parental burden. As part of pilot phase of the KIDSAP01 study, we conducted a baseline assessment in parents to study the association between hypoglycemia fear, parental well-being and child behavior. Methods: All parents were invited to fill in baseline questionnaires: hypoglycemia fear survey (HFS), WHO-5, Epworth Sleepiness Scale and Strength and Difficulties Questionnaire (SDQ). Results: 24 children (median age: 5-year, range 1-7 years, 63% male, mean diabetes duration: 3 ± 1.7 years) participated. 23/24 parents filled out the questionnaires. We found a higher score for the hypoglycemia fear behavior 33.9 ± 5.6 compared to hypoglycemia worry 34.6 ± 12.2. Median WHO-5 score was 16 (8 - 22) with poor well-being in two parents. Median daytime sleepiness score was high in five parents (>10). For six children a high total behavioral difficulty score (>16) was reported. Pro social behavior score was lower than normal in six children (<6). Parental well-being was negatively associated with HFS total (r = - 0.50, p <.05) and subscale scores (r = - 0.44, p <.05 for HFS-Worry and HFS-Behavior), child behavior (r = - 0.45, p = .05) and positively with child age and diabetes duration (r = 0.58, p <.01, r = 0.6, p <.01). HFS, parental well-being nor daytime sleepiness are associated with the HbA1c. Conclusion: Regular screening of parental well-being, hypoglycemia fear and child behavior should be part of routine care to target early intervention.

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ABSTRAKT Bakgrund: Typ 1-diabetes (T1D) hos barn ökar. T1D är en kronisk sjukdom som barnet kommer behöva leva med hela livet vilket kan medföra att fler föräldrar behöver ta ansvar för barnets behandling med T1D. Sjukdomen har visat sig ha stor påverkan på föräldrarnas och hela familjens vardag. Syfte: Syftet med litteraturstudien var att belysa påverkan på vardagen hos föräldrar som vårdar ett barn med typ 1-diabetes. Metod: En litteraturstudie baserad på tio kvalitativa studier. Studierna granskades, analyserades och sammanställdes. Resultat: Upplevelsen av att behöva anpassa sig till sjukdomen framkom som ett genomgående tema i resultatet. Resultatet presenteras i följande kategorier; Att behöva rätta sig efter sjukdomen, Att uppleva att relationer förändras samt Att uppleva stöd och brist på stöd från andra. Konklusion: Föräldrarna uppskattade när stödet de fick från vården var individuellt anpassat och när vårdpersonalen kände till hela familjens omständigheter. En förändring hos en familjemedlem påverkar hela familjen. Med kunskap om detta kan sjuksköterskan bättre förstå behovet av familjefokuserad vård. Det behövs mer forskning om föräldrars och familjers behov av familjefokuserad vård. Även forskning om könsskillnader inom föräldraskapet behövs. Nyckelord: Typ 1-diabetes, föräldrar, vardag, modell för omvårdnad, familjefokuserad omvårdnad / ABSTRACT Background: Type 1 Diabetes (T1D) among children increases. This may lead to more parents who need to take responsibility for their child’s treatment. The disease has been shown to have a major impact on everyday life for parents and the whole family.   Aim: The aim of this study was to illuminate the impact on everyday life among parents that care for a child with Type 1 Diabetes. Methods: A literature study based on ten qualitative studies. The studies were reviewed, analyzed and compiled. Results: The experience of having to adapt to the disease emerged as a recurrent theme in the outcome. The results is presented in three categories; Having to comply with the disease, To experience that relationships change and To experience support and lack of support from others. Conclusion: Parents appreciated when the healthcare support was adjusted to the whole family’s circumstances. A change in one family member affects the entire family. With knowledge of this the nurse could better understand the need for family-focused care. There should be more research on parents’ and families’ need for family-focused care and also on gender differences in parenting.  Keywords: Type 1 Diabetes, parents, everyday life, model for nursing, family-focused care

Bakgrund Diabetes mellitus är ett samlingsnamn för olika diabetessjukdomar, däribland typ 1 diabetes och typ 2 diabetes. Typ 1 diabetes och typ 2 diabetes är kroniska sjukdomar där insulinproduktionen helt har upphört eller inte är tillräckligt för att täcka kroppens behov. Den tekniska utvecklingen inom hälso-och sjukvård har blivit alltmer digitaliserad och skapat förutsättningar för en ny typ av stöd med mobila applikationer. Egenvård är en viktig del av diabetesbehandlingen och mobila applikationer kan vara ett hjälpmedel för personer med diabetes. Sjuksköterskans roll behöver anpassas för att möta kraven inom en mer digitaliserat hälso-och sjukvårds miljö. Avsikten var att ge patienten adekvat information och utbildning av mobila applikationer för att stärka patientens egenvårdsförmåga. Syfte Syftet är att belysa patienters upplevelser och erfarenheter av mobila applikationer som stöd för egenvård med diabetes typ 1 och typ 2. Metod Studien genomfördes som en icke-systematisk litteraturöversikt som inkluderade 14 vetenskapliga artiklar från databaserna PubMed och CINAHL. De vetenskapliga artiklarna var publicerade från de fem senaste åren och var av både kvalitativ och kvantitativ ansats. Vidare hade studien en systematisk struktur där samtliga artiklarna hade kvalitetsgranskat i enlighet med Sophiahemmets bedömningsunderlag. Resultatet erhölls genom en integrerad dataanalys. Resultat Personernas upplevelser och erfarenheter sammanställdes i tre huvudkategorier och flera underkategorier. Av de 14 utvalda artiklarna var sex kvalitativa, fem kvantitativa och tre utav en mixad metod. Resultaten visar på en övervägande positiv respons mot mobila applikationer, där de bidrar till förbättrad egenvård och engagemang. Trots detta kvarstår frågor om användarvänlighet och tekniska begränsningar. Slutsats Mobila applikationer har stor potential att förbättra diabetesvården genom att stärka patienters egenvård och erhålla viktig information om sjukdomen till vårdgivaren. Framtidens forskning bör fokusera på att förbättra design och funktionalitet samt att adressera användares frustation och stress. / Background Diabetes mellitus is an umbrella term for various diabetes diseases, including type 1 diabetes and type 2 diabetes. Type 1 and type 2 diabetes are chronic conditions where insulin production has completely ceased or is insufficient to meet the body's requirements. The technological advancements in healthcare have gradually become more digitalized and created opportunities for a new type of support through mobile applications. Self-care is a crucial component of diabetes treatment, and mobile applications can serve as a tool for patients with diabetes. The nurse’s role needs to be adapted to meet the demands of a more digitized healthcare environment. This is to provide patients with adequate information and education on mobile applications to strengthen the patient's self-care ability. Aim The purpose is to shed light on patients' experiences and perceptions of mobile applications as support for self-care in type 1 and type 2 diabetes. Method The study was conducted as a non-systematic literature review, which included 14 scientific articles retrieved from the databases PubMed and CINAHL. These articles were published within the last five years and encompassed both qualitative and quantitative approaches. Furthermore, the study followed a systematic structure where all articles were quality-assessed according to Sophiahemmet's evaluation criteria. The results were obtained through an integrated data analysis. Results The individuals' experiences and perceptions were compiled into three main categories and several subcategories. Out of the 14 selected articles, six were qualitative, five were quantitative, and three utilized a mixed methods approach. The results indicate a predominantly positive response towards mobile applications, as they contribute to improved self-care and engagement. However, questions regarding usability and technical limitations remain. Conclusions Mobile applications have significant potential to enhance diabetes care by empowering patients in self-management and providing important disease-related information to healthcare providers. Future research should focus on improving design and functionality, as well as addressing users' concerns regarding frustration and stress.

[ES] La regulación de los niveles de glucosa en el cuerpo humano es el resultado de la secreción coordinada de hormonas. La Diabetes Tipo 1 (DT1) es una enfermedad crónica que provoca la destrucción de las células responsables de la producción de insulina, uno de los principales agentes en la regulación de glucosa. Por tanto, las personas con DT1 dependen de la administración exógena de insulina. No obstante, la gestión de la terapia no es sencilla y está sujeta a una gran variabilidad. Los sistemas de Páncreas Artificial se diseñaron con el objetivo de simplificar la gestión de la enfermedad, administrando insulina de manera automática a través de una bomba de insulina, en base a la lógica de un algoritmo de control que emplea información de un monitor continuo de glucosa. Sin embargo, la acción de la insulina es unidireccional (disminuye el valor de la glucosa), y a veces resulta insuficiente para mantener unos niveles seguros de glucosa en sangre. Por eso, en ocasiones se administran otras hormonas, con efectos opuestos (como el glucagón), o complementarios (como la pramlintida) a la insulina. Para que los sistemas automáticos se beneficien de estas acciones de control, es necesario estudiar y conocer sus dinámicas para poder simular su comportamiento, diseñar controladores que los tengan en cuenta y realizar experimentos in silico previos a utilizar los sistemas en pacientes. El uso del glucagón ya cuenta con una larga trayectoria y ha sido utilizado en varios sistemas automáticos. Sin embargo, existe mucha heterogeneidad en las formulaciones de modelos del efecto del glucagón, sobre todo en relación con su interacción con la insulina, y es necesario profundizar en el desarrollo de modelos que reflejen mejor la fisiología subyacente. Por otra parte, los modelos de pramlintida apenas se han estudiado. El objetivo principal de esta tesis es contribuir a mejorar simuladores para validar sistemas de páncreas artificial. En concreto, se realiza un análisis detallado del estado del arte para conocer las propuestas de modelos fisiológicos en la literatura, para luego centrarse en la descripción del efecto de glucagón en la producción endógena de glucosa y la farmacocinética y farmacodinámica de la pramlintida. El trabajo incluye la propuesta de nuevos modelos para glucagón y pramlintida basados en la fisiología, validados con datos clínicos individuales en el caso del glucagón y con datos poblacionales de la literatura en el caso de la pramlintida, mejorando en ambos casos los resultados previamente existentes. / [CA] La regulació dels nivells de glucosa en el cos humà és el resultat de la secreció coordinada d'hormones. La Diabetis Tipus 1 (DT1) és una malaltia crònica que provoca la destrucció de les cèl·lules responsables de la producció d'insulina, un dels principals agents en la regulació de glucosa. Per tant, les persones amb DT1 depenen de l'administració exògena d'insulina. No obstant això, la gestió de la teràpia no és senzilla i està subjecta a una gran variabilitat. Els sistemes de Pàncrees Artificial es van dissenyar amb l'objectiu de simplificar la gestió de la malaltia, administrant insulina de manera automàtica a través d'una bomba d'insulina, en funció de la lògica d'un algorisme de control que empra informació d'un monitor continu de glucosa. No obstant això, l'acció de la insulina és unidireccional (disminueix el valor de la glucosa), i de vegades resulta insuficient per a mantindre uns nivells segurs de glucosa en sang. Per això, ocasionalment s'administren altres hormones, amb efectes oposats (com el glucagó), o complementaris (com la pramlintida) a la insulina. Perquè els sistemes automàtics es beneficien d'aquestes accions de control, és necessari estudiar i conéixer les seues dinàmiques per a poder simular el seu comportament, dissenyar controladors que els tinguen en compte i realitzar experiments in silico previs a utilitzar els sistemes en pacients. L'ús del glucagó ja compta amb una llarga trajectòria i ha sigut utilitzat en diversos sistemes automàtics. No obstant això, existeix molta heterogeneïtat en les formulacions de models de l'efecte del glucagó, sobretot en relació amb la seua interacció amb la insulina, i és necessari aprofundir en el desenvolupament de models que reflectisquen millor la fisiologia subjacent. D'altra banda, els models de pramlintida a penes s'han estudiat. L'objectiu principal d'aquesta tesi és contribuir a millorar simuladors per a validar sistemes de pàncrees artificial. En concret, es fa una anàlisi detallada de l'estat de l'art per a conéixer les propostes de models fisiològics en la literatura, per a després centrar-se en la descripció de l'efecte de glucagó en la producció endògena de glucosa i la farmacocinètica i farmacodinàmica de la pramlintida. El treball inclou la proposta de nous models per a glucagó i pramlintida basats en la fisiologia, validats amb dades clíniques individuals en el cas del glucagó i amb dades poblacionals de la literatura en el cas de la pramlintida, millorant en tots dos casos els resultats prèviament existents. / [EN] Glucose regulation in the human body results from the coordinated secretion of hormones. Type 1 Diabetes (T1D) is a chronic disease that destroys insulin-producing cells, one of the main agents in the glucose regulation process. Consequently, people with T1D depend on exogenous insulin administration. However, therapy management is not an easy task, and it faces great variability. Artificial Pancreas systems were designed to ease the disease management, administering insulin automatically through an insulin pump based on the logic of a control algorithm that reads information from a continuous glucose monitor. Nevertheless, insulin action is uni-directional (lowering glucose values), and sometimes, it is insufficient to maintain safe plasma glucose levels. That is why, occasionally, other hormones are also administered, with opposite (like glucagon) or complementary effects (like pramlintide) to insulin. For automatic systems to benefit from these control actions, it is necessary to study and know their dynamics to simulate their behavior, design aware controllers, and carry out in silico experiments before using the system with patients. Glucagon use in T1D has a long trajectory; and has been used in automatic systems. However, there exists a wide heterogeneity in the definitions of glucagon effect, especially related to its interaction with insulin, and it is necessary to develop models that are more physiologically accurate. On the other hand, pramlintide models have barely been studied. This thesis' main objective is to improve T1D simulators to validate artificial pancreas systems. Specifically, a detailed analysis of the state of the art is carried out to know the physiological model proposals in the literature. Then, the focus moves to describing the glucagon effect on endogenous glucose production and the pharmacokinetics and pharmacodynamics of pramlintide. This work includes the proposal of new physiology-based models for glucagon and pramlintide. The glucagon model was validated with individual clinical data, and the pramlintide model was validated with populational data. Both proposals improved previously existing results. / This work was supported by grant FPU17/03404, grant EST19/00740, and project PID2019-107722RB-C21, funded by MCIN/AEI/10.13039/501100011033. / Furió Novejarque, C. (2024). Contributions to Glucagon and Pramlintide Pharmacokinetics and Pharmacodynamics Modeling for Multi-Hormone Artificial Pancreas Systems [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/202872

Bakgrund: Glykemisk kontroll hos personer med typ 1 diabetes kräver stöd och utbildning av vårdpersonal inom diabetesvården. För att förbättra behandlingsresultat och livskvalitet samt minska risken för komplikationer kan intensiva behandlingsstrategier användas för att sträva efter optimal glykemisk kontroll och hälsa. Syfte: Syftet är att beskriva hur intensivbehandling påverkar HbA1c och hälsa hos personer med diabetes typ 1. Metod: En retrospektiv studie, deskriptiv design med kvantitativ ansats. Urvalet skedde från en diabetesmottagning och utgick från redan insamlade data från ett intensivbehandlingsprojekt. 42 patienter med diabetes typ 1 och HbA1c ≥70 mmol/mol inkluderades i intensivbehandlingsprojektet. De variabler som undersöktes var HbA1c och EQ-VAS, för att undersöka sambandet mellan glykemiskkontroll och skattad hälsa. Huvudresultat: Resultatet visade ett svagt samband mellan sjunkande HbA1c och stigande EQ-VAS vid uppföljningen. Det starkaste signifikanta sambandet sågs i kategorin kontakt med dietist, kopplat till HbA1c och EQ-VAS. I kategorierna patienter med flerdosbehandling av insulinpenna, behandling med insulinpump samt utebliven kontakt med dietist visade inget signifikant samband kopplat till sjunkande HbA1c och stigande EQ-VAS.  Slutsats: Studien visar betydande förbättringar i både HbA1c och EQ-VAS hos patienter med diabetes typ 1 efter intensivbehandling. Positiva samband observerades mellan insulinpumpbehandling och högre EQ-VAS, samt dietistkontakt och minskat HbA1c. Fynden tyder på att intensivbehandlingen, särskilt med dietistrådgivning, effektivt förbättrar glykemisk kontroll och livskvalitet. Ytterligare forskning behövs för att bekräfta dessa resultat. / Background: Glycemic control in individuals with type 1 diabetes requires support and education from diabetes care professionals. To improve treatment outcomes and quality of life while reducing the risk of complications, intensive treatment strategies can be employed to achieve optimal glycemic control and health. Purpose: The purpose is to describe how intensive treatment affects HbA1c and health in individuals with type 1 diabetes. Method: A retrospective study with a descriptive design using a quantitative approach. The sample was selected from a diabetes clinic and relied on previously reported data from an intensive treatment project. 42 patients with type 1 diabetes and HbA1c ≥70 mmol/mol were included in the intensive treatment project. Data were analyzed using Spearman's rank correlation analysis to identify relationships between HbA1c and health. Main Results: The results showed a weak correlation between decreasing HbA1c and increasing EQ-VAS scores at follow-up. The strongest significant correlation was observed in the category of contact with a dietitian, linked to HbA1c and EQ-VAS. In the categories of patients using multiple daily injections with insulin pens, insulin pump therapy, and lack of contact with a dietitian, no significant correlation was found related to decreasing HbA1c and increasing EQ-VAS. Conclusion: The study shows significant improvements in both HbA1c and EQ-VAS in patients with type 1 diabetes after intensive treatment. Positive correlations were observed between insulin pump therapy and higher EQ-VAS scores, as well as between dietitian contact and reduced HbA1c. The findings suggest that intensive treatment, especially with dietitian counseling, effectively enhances glycemic control and quality of life. Further research is needed to confirm these results.