Onset of coupled atmosphere-ocean oxygenation 2.3 billion years ago.

The initial rise of molecular oxygen (O2) shortly after the Archaean-Proterozoic transition 2.5 billion years ago was more complex than the single step-change once envisioned. Sulfur mass-independent fractionation records suggest that the rise of atmospheric O2 was oscillatory, with multiple returns to an anoxic state until perhaps 2.2 billion years ago1-3. Yet few constraints exist for contemporaneous marine oxygenation dynamics, precluding a holistic understanding of planetary oxygenation. Here we report thallium (Tl) isotope ratio and redox-sensitive element data for marine shales from the Transvaal Supergroup, South Africa. Synchronous with sulfur isotope evidence of atmospheric oxygenation in the same shales3, we found lower authigenic 205Tl/203Tl ratios indicative of widespread manganese oxide burial on an oxygenated seafloor and higher redox-sensitive element abundances consistent with expanded oxygenated waters. Both signatures disappear when the sulfur isotope data indicate a brief return to an anoxic atmospheric state. Our data connect recently identified atmospheric O2 dynamics on early Earth with the marine realm, marking an important turning point in Earth's redox history away from heterogeneous and highly localized 'oasis'-style oxygenation.

The impact of upper extremity impairments on work and everyday life of people with type 1 diabetes-A nationwide controlled study.

AIMS: The study objective was to explore how upper extremity impairments (UEIs) affect the everyday life and work-life of people with type 1 diabetes (T1D) and to compare them to a control group without T1D to determine if there are diabetes-specific consequences of UEIs. METHODS: In a controlled cross-sectional study, a survey was distributed across all regions of Denmark. A total of 2174 people with T1D and 827 controls were included in the study population. The survey addressed UEI symptoms, employment status, functional disability, mental well-being and diabetes distress. Data were analysed using multivariable logistic and linear regression. RESULTS: Upper extremity impairments were associated with a higher rate of work absence and modification, but no more so for people with T1D than for the control group. Among people with T1D, UEIs were significantly associated with worse mental well-being and diabetes distress, and across all outcomes including functional disability, additive effects were found with an increasing number of coexisting impairments. The impact of UEIs on functional disability was more severe for the T1D group than the control group, but this was primarily due to differences in the number of coexisting impairments. CONCLUSIONS: Upper extremity impairments have significant negative implications for the work-life and everyday life of people with T1D, and interventions to reduce UEIs and their impact among this group are highly relevant.

Copenhagen Diabetes Consensus (CODIAC) 2021: User involvement in diabetes care, prevention and research.

AIMS: User involvement is pivotal for health development, but there are significant gaps in our understanding of the concept. The Copenhagen Diabetes Consensus on User Involvement in Diabetes Care, Prevention and Research (CODIAC) was established to address these gaps, share knowledge and develop best practices. METHODS: A literature review of user involvement was undertaken in diabetes care, prevention and research. Moreover, a Group Concept Mapping (GCM) survey synthesized the knowledge and opinions of researchers, healthcare professionals and people with diabetes and their carers to identify gaps between what is important for user involvement and what is being done in practice. Finally, a consensus conference discussed the main gaps in knowledge and practice while developing plans to address the shortcomings. RESULTS: The literature review demonstrated that user involvement is an effective strategy for diabetes care, prevention and research, given the right support and conditions, but gaps and key challenges regarding the value and impact of user involvement approaches were found. The GCM process identified 11 major gaps, where important issues were not being sufficiently practised. The conference considered these gaps and opportunities to develop new collaborative initiatives under eight overall themes. CONCLUSIONS: User involvement is effective and adds value to diabetes care, prevention and research when used under the right circumstances. CODIAC developed new learning about the way in which academic and research knowledge can be transferred to more practice-oriented knowledge and concrete collaborative initiatives. This approach may be a potential new framework for initiatives in which coherence of process can lead to coherent outputs.

Social inequalities in the self-management of type 1 diabetes: A serial multiple mediation analysis.

AIMS: Diabetes requires complex self-management. Due to this complexity, social disparities exist in the self-management of type 1 diabetes. Various pathways to describe associations between socio-economic factors and health outcomes have been suggested. We sought to elucidate the potential of health literacy and social support to reduce social disparities in diabetes self-management. METHODS: Questionnaire responses were linked to data from electronic medical records, yielding a study population of 1186 people with type 1 diabetes. Mediation analyses using adjusted linear regressions were used to establish pathways between self-reported educational attainment, social support, functional health literacy and clinically obtained measures of glycaemic control. RESULTS: We found evidence of an association between education and glycated haemoglobin, partially mediated by functional health literacy and social support. However, the direct association between social support and glycaemic control was not statistically significant. CONCLUSIONS: Whilst both functional health literacy and social support play a role in glycaemic control, our findings did not explain the main impact of social disparities on glycaemic control. Interventions to reduce disparities in glycaemic control related to educational attainment should focus beyond functional health literacy and social support.

Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention.

To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.

Diabetes stigma and its association with diabetes outcomes: a cross-sectional study of adults with type 1 diabetes.

Aims: The aim of this study was to investigate the relationship between diabetes stigma as experienced by adults with type 1 diabetes and diabetes outcomes using the novel, validated measure of the Type 1 Diabetes Stigma Assessment Scale. Methods: A total of 1594 adults with type 1 diabetes completed a questionnaire on socio-economic factors, psychosocial health, and diabetes stigma and these self-reported data were linked with data from electronic clinical records on glycaemic control, diabetes duration, age, and diabetes-related complications. Bivariate analyses and multivariate linear regressions were performed to assess the relationship between diabetes stigma as measured by three subscales, Identity concern, Blame and judgement, and Treated differently on the one hand, and patient characteristics and diabetes outcomes on the other. Results: Endorsement of the stigma statements ranged from 3.6-78.3% of respondents. Higher stigma scores in relation to Identity concern and Blame and judgement were significantly associated with being female, of lower age, lower diabetes duration, and having at least one complication. Those who reported higher levels of perceived stigma reported significantly higher levels of diabetes distress (ß = 0.37 (95% CI: 0.33-0.40), 0.35 (95% CI: 0.30-0.39), 0.41 (95% CI: 0.35-0.46)), and HbA1c levels (ß = 0.11 (95% CI: 0.02-0.21), 0.28 (95% CI: 0.16-0.40), 0.26 (95% CI: 0.14-0.42) for Identity concern, Blame and judgement, and Treated differently, respectively). Conclusions: The findings demonstrated that diabetes stigma is negatively associated with both diabetes distress and glycaemic control and should be considered part of the psychosocial burden of adults with type 1 diabetes.

Willingness to pay for flexibility at the workplace for people with diabetes and chronic disease: a discrete choice experiment in a population of workers in Denmark.

BACKGROUND: The number of people of working age suffering from chronic disease is increasing. Chronic diseases such as diabetes can cause negative work-related consequences in the form of early retirement or absenteeism. Providing flexible workplace accommodations may enable the person with diabetes to retain their position in the labor market. However, the successfulness of such accommodations depends largely on the perceptions of those not suffering from diabetes. The purpose of this study was to examine preferences of a population of workers in Denmark for flexibility at the workplace, for people with diabetes and for people with chronic disease in general, measured as their willingness to pay (WTP). METHODS: Respondents were drawn from online panels and randomized to answer an online survey regarding flexibility at the workplace for people with diabetes or chronic disease in general. One thousand one hundred and three respondents were included in the analysis. Based on discrete choice experiments included in the survey, we analyzed WTP for five flexibility attributes: part-time, customizing job description, additional break with pay and time off for medical visits with and without pay. We further examined perceptions of the employer's responsibility to ensure workplace flexibility for five different specific chronic diseases including diabetes. Finally, we analyzed differences in WTP for flexibility across subgroups. RESULTS: Respondents' WTP was significantly higher for chronic disease in general compared to diabetes for the possibility of part-time (81€/month vs. 47€/month, p < 0.001) and customizing job description (58€/month vs. 41€/month, p = 0.018) attributes, as well as for the overall average (49€/month vs. 36€/month, p = 0.008). Ensuring workplace flexibility for patients with a specific chronic disease other than diabetes (cancer, heart disease, arthritis and COPD) was to a higher degree considered a responsibility of the employer. Average WTP for flexibility varied across subgroups, consistently yielding a larger amount for chronic disease in general. CONCLUSIONS: The population examined in this study are willing to pay less for flexibility at the workplace for people with diabetes compared to people with chronic disease in general. This finding was evident in terms of specific flexibility attributes and on average across subgroups.

Leg power, pelvic movement and physical activity after periacetabular osteotomy. A prospective cohort study.

To investigate changes in leg power, pelvic movement and patient-reported outcome in patients with hip dysplasia one year after periacetabular osteotomy. Forty-one patients (7 males) with a mean age of 28.8 years scheduled for periacetabular osteotomy were tested before surgery, and 4 and 12 months after. Leg power, pelvic range of motion and the Hip and Groin Outcome Score (HAGOS) was collected. One year after surgery, power in the operated leg had improved (p = 0.004) and there was no significant difference between power in the operated leg and contralateral leg (p = 0.22). In the frontal plane, pelvic range of motion decreased significant during stair-climbing and stepping down. The same pattern was seen in the sagittal plane but the changes were non-significant. All subscales on the HAGOS improved significantly over time (p < 0.001). Leg power and pelvic range of motion in patients with symptomatic hip dysplasia improved 12 months after periacetabular.

Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees.

PURPOSE: Little is known about the anterolateral ligament's (ALL) influence on knee laxity. The purpose of this study was to investigate rotational knee laxity against a pure axial rotational stress using radiostereometric analysis (RSA) after cutting and reconstructing both the anterior cruciate ligament (ACL) and the ALL. METHODS: Eight human donor legs were positioned and stereoradiographically recorded at 0°, 30° and 60° of knee flexion using a motorised fixture, while an internally rotating force of 4 Nm was applied to the foot. Anterior-posterior and rotational laxity were investigated for knees with intact ligaments and compared with those observed after successive ACL and ALL resection and reconstruction. RESULTS: After cutting the ALL in ACL-deficient knees, the internal rotation was increased in all three knee flexion angles, 0° (p = 0.04), 30° (p = 0.03) and 60° (p < 0.01) by 1.0°, 1.6° and 2.5°, respectively. However, no decrease in laxity was found after reconstructing the ALL in ACL-reconstructed knees. CONCLUSIONS: The ALL was confirmed as a stabiliser of internal rotation in ACL-deficient knees. However, reconstructing the ALL using a gracilis autograft tendon did not decrease the internal rotation laxity in the ACL-reconstructed knee. Based on the results of this study, we do not recommend reconstructing the ALL in ACL-reconstructed knees to decrease internal knee laxity.

Does retirement reduce the risk of mental disorders? A national registry-linkage study of treatment for mental disorders before and after retirement of 245,082 Danish residents.

OBJECTIVES: The effect of retirement on mental health is not well understood. We examined the prevalence of hospital treatment for depression and purchase of antidepressant medication before, during and after retirement in a Danish population sample. We hypothesised that retirement was followed by reduced prevalence of hospital treatment for depression and antidepressant purchase. METHODS: Participants were 245,082 Danish workers who retired between 2000 and 2006. Information on retirement, hospital treatment and antidepressant purchases were obtained from Danish national registers. The yearly prevalence of hospital treatment for depression and antidepressant purchases was estimated in relation to the year of retirement from 5 years prior to the retirement year to 5 years after retirement. Using logistic regressions with generalised estimating equations we analysed the trends in prevalence before, during and after the retirement. RESULTS: Two of 1000 participants were hospitalised with depression in the year of their retirement and 63 of 1000 purchased antidepressant medication during the retirement year. The prevalence of hospital treatment for depression increased before and around retirement, followed by a slight decline from 2 years after retirement with the prevalence of hospitalisation dropping from 0.21%(retirement +2 years) to 0.16% (retirement +5 years). For antidepressants, we observed a steady increase in purchases before retirement (retirement -2 years). This increase levelled off in the years around retirement, but continued after retirement (retirement +2 years). CONCLUSIONS: Overall, this study did not confirm the hypothesis that retirement is beneficial for mental health measured by hospitalisation with depression and treatment with antidepressants. Although the temporary levelling off of the increase in antidepressant treatment around time of retirement might indicate a beneficial effect, this possible effect was only short-term.

The association between health and sickness absence among Danish and non-Western immigrant cleaners in Denmark.

PURPOSE: The aim of the study is to investigate the association between health and sickness absence among Danish and non-Western immigrant cleaners in Denmark. METHODS: This study is based on a cross-sectional analysis of baseline data from 2007 to 2008. The study population includes 276 cleaners, 144 Danish and 132 non-Western immigrant cleaners. Cumulative sickness absences during a 6-month period from administrative records were subdivided into no sickness absence (0 days), low occurrence of sickness absence (1-10 days) and high occurrence of sickness absence (over 10 days). Measures of health consisted of self-report and objective assessments. The relationship between sickness absence and health was analyzed through multinomial logistic regression, stratified by immigrant status. RESULTS: For both Danish and non-Western immigrant cleaners, poor self-reported health was significantly related to high occurrence of sickness absence. Among Danish cleaners, high blood pressure was related to high occurrence of sickness absence. Among non-Western immigrant cleaners, total body pain and having one or more diagnosed chronic disease were related to high occurrence of sickness absence. No association between health and low occurrence of sickness absence was found. CONCLUSIONS: The findings confirm the importance of health for high occurrence of sickness absence, in both ethnic groups. Moreover, low occurrence of sickness absence was not related to the health conditions investigated.

Does health literacy predict cardiometabolic marker trajectories among people with diabetes? A longitudinal mixed-effect analysis.

AIMS: To assess trajectories in cardiometabolic markers among people with type 1 and type 2 diabetes with varying health literacy levels. METHODS: Survey data assessing self-reported health literacy among 1401 people with type 1 diabetes and 910 people with type 2 diabetes were linked to prospective clinical data. Mixed effects modelling was used to identify the impact of three health literacy domains on trajectories of systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin (HbA1c). RESULTS: High health literacy scores in some domains were associated with attenuated HbA1c trajectories, while associations with LDL-C and SBP were weak or absent, particularly among participants with type 2 diabetes. The domain "Ability to Actively Manage Health" had the strongest association with HbA1c (P < 0.001). Exponential changes over time were not observed. Differences in the estimated progression of cardiometabolic markers by health literacy levels did not reach statistical significance. CONCLUSION: Low health literacy was associated with suboptimal glycaemic levels in type 1 and type 2 diabetes. There was inconclusive evidence of associations between health literacy, BP, and LDL-C. Development in cardiometabolic markers did not indicate faster diabetes progression among people with low health literacy.

Upper-Extremity Impairments in Type 1 Diabetes: Results From a Controlled Nationwide Study.

OBJECTIVE: This study aimed to identify current and lifetime prevalence of upper-extremity impairments (UEIs) among individuals with type 1 diabetes and explore factors associated with UEIs. RESEARCH DESIGN AND METHODS: In a Danish cross-sectional nationwide case-control study, data on UEIs and health behavior were paired with data on sociodemographics and clinical factors from national registers. Participants included individuals with type 1 diabetes (n = 2,245) and a control group (n = 841). Differences between groups were assessed using binomial proportions and multivariable logistic regression. RESULTS: Compared with controls, individuals with type 1 diabetes were significantly (P < 0.05) more likely to experience frozen shoulder (odds ratio [OR] 3.5), carpal tunnel syndrome (OR 3.5), trigger finger (OR 5.0), and Dupuytren contracture (OR 4.3). They were also more likely to have several coexisting impairments than the control group (P < 0.01). Diabetes duration was associated with all four impairments. CONCLUSIONS: UEIs are common, particularly among individuals with type 1 diabetes.

A Short-Form Measure of Diabetes Distress Among Adults With Type 1 Diabetes for Use in Clinical Practice: Development and Validation of the T1-DDS-7.

OBJECTIVE: Valid and reliable diabetes distress assessment is essential for identifying adults with elevated levels of concern and to guide targeted support. However, assessing diabetes distress must also be feasible in time-limited settings. We aimed to identify a short-form measure of the 28-item Type 1 Diabetes Distress Scale (T1-DDS-28) representing seven sources of type 1 diabetes distress that would be convenient for use in clinical practice. RESEARCH DESIGN AND METHODS: Based on the evaluation of influence and importance by 14 experts in diabetes care and research, we identified the best-performing item within each of seven sources of diabetes distress included in the T1-DDS-28. To further validate the proposed short-form measure, we used survey data from 2,016 adults living with type 1 diabetes. Validity was examined by exploratory factor analysis, Cronbach's α, test-retest reliability analysis, and correlations with other psychosocial measures. RESULTS: We identified a short-form measure of the T1-DDS-28 consisting of seven items, each representing a source of diabetes distress. These items showed satisfactory reliability (factor loadings > 0.45; α = 0.82; test-retest correlation, r = 0.90) and validity (correlation with T1-DDS-28, r = 0.95; area under the curve = 0.91; sensitivity 93%; specificity 89%) when combined in the short-form scale (T1-DDS-7). CONCLUSIONS: We propose the T1-DDS-7 as a valid and reliable measure for routine screening of diabetes distress among adults with type 1 diabetes. In case of elevated levels of diabetes distress, we recommend that a full-scale assessment and open dialogue follow the short-form measure before determining further treatment.

Psychosocial work environment among immigrant and Danish cleaners.

INTRODUCTION: Non-Western cleaners have been shown to have poorer health than their Danish colleagues. One reason could be a poorer psychosocial work environment. However, it is unknown if differences in self-reported psychosocial work environment exist between non-Western and Danish workers within the same social class. The aim of this study was to investigate such differences among cleaners with the hypothesis that the non-Western compared with Danish cleaners would report a generally poorer psychosocial work environment. METHODS: Two hundred and eighty-five cleaners (148 Danes and 137 non-Western immigrants) from 9 workplaces in Denmark participated in this cross-sectional study. The cleaners' immigrant status was tested for association with psychosocial work environment scales from the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ) using ordinal logistic regression. RESULTS: Models adjusted for age, sex, BMI, smoking, workplace, and perceived physical work exertion showed that non-Western cleaners compared with Danish cleaners reported significantly higher scores with regard to Predictability (OR = 3.97), Recognition (OR = 1.92), Quality of Leadership (OR = 1.81), Trust Regarding Management (OR = 1.72), and Justice (OR = 2.14). CONCLUSIONS: This study showed that non-Western immigrant cleaners reported a statistically significantly better psychosocial work environment than Danish cleaners on a number of scales. Therefore, the hypothesis of non-Western immigrants reporting worse psychosocial work environment than their Danish colleagues was not supported.

Associations between psychosocial work environment and hypertension among non-Western immigrant and Danish cleaners.

INTRODUCTION: Non-Western cleaners have reported better psychosocial work environment but worse health compared with their Danish colleagues. The aim of this study was to compare the association between psychosocial work environment and hypertension among non-Western immigrant cleaners and Danish cleaners. METHODS: Two hundred and eighty-five cleaners from nine workplaces in Denmark participated in this cross-sectional study. The cleaners were identified as non-Western immigrants (n = 137) or Danes (n = 148). Blood pressure was measured in a seated position, and psychosocial work environment was assessed by the Copenhagen Psychosocial Questionnaire (COPSOQ). In each population, multivariate logistic regressions were applied testing for an association between each of the COPSOQ scales and hypertension. RESULTS: Models adjusted for age, sex, BMI, smoking, workplace and physical work exertion showed that high Trust regarding management (OR = 0.50) and high Predictability (OR = 0.63) were statistically significantly associated with low prevalence of hypertension in the Danish population. In the immigrant population, no significant associations were found. Analyses on interaction effects showed that associations between Meaning of work and hypertension were significantly different among the two populations (p < 0.05). CONCLUSIONS: Psychosocial work factors were associated with hypertension among Danes, but not among non-Western immigrants. This divergent association between psychosocial work environment and hypertension between Danes and non-Western immigrant cleaners may be explained by different perceptions of psychosocial work environment.

Participation of Danish and immigrant cleaners in a 1-year worksite intervention preventing physical deterioration.

Worksite health promotion is seldom offered to workers who are low-educated and multi-ethnic, possibly due to an assumption that they are more reluctant to participate. Furthermore, little has been done to promote health at female-dominated workplaces. The main aim of this study was to investigate differences in participation among immigrant and Danish cleaners throughout a 1-year randomised controlled study tailored to cleaners and carried out in predominantly female workplaces. No significant differences in ethnicity were found in consent and participation throughout the 1-year intervention. Dropout was equally distributed among Danish and immigrant cleaners. This study indicates that a worksite health promotion intervention among a female-dominated, high-risk occupation such as cleaning can be equally appealing for Danes and immigrants. PRACTITIONER SUMMARY: This study provides insight about participation of Danish and immigrant cleaners in a worksite health promotion intervention in a predominantly female occupation. For attaining high participation and low dropout in future worksite health promotion interventions among cleaners, the intervention ought to not only target the ethnic background of the workers, but also to be specifically tailored to the job group.

Cultural adaption and psychometric validation of the Danish Illness Identity Questionnaire (IIQ-DK) in adolescents and emerging adults with type 1 diabetes.

Purpose: The Illness Identity Questionnaire (IIQ) captures the ways in which individuals integrate chronic illness into their identity. The objectives were to linguistically validate and culturally adapt a Danish language version of the IIQ, and to evaluate the psychometric properties of this Danish version. Methods: IIQ was adapted through a forward-backward translation process, content validity assessment, and cognitive interviews (n = 5). Data for psychometric analysis were collected through an online Danish version of the IIQ (IIQ-DK). Data quality, internal consistency, and item correlations were assessed. Confirmatory factor analyses (CFA) were conducted. Results: Cognitive interviews resulted in re-wordings of two items. 1176 adolescents and emerging adults (15-26 years) with type 1 diabetes completed the IIQ-DK. Floor and ceiling effects were demonstrated for most items. Analysis showed good internal consistency of scales, as well as internal and discriminant item validity. CFA fit statistics after including correlated residuals were good for all scales. CFA showed acceptably high factor loadings for all items except one. Conclusion: Results demonstrated good reliability and psychometric properties of the IIQ-DK, which may be forwarded to use in research and clinical practice as a robust instrument to measure illness identity in adolescents and emerging adults with type 1 diabetes.

How has the COVID-19 Pandemic Affected Diabetes Self-Management in People With Diabetes? - A One-Year Follow-Up Study.

Background and Aim: In Denmark, the COVID-19 pandemic resulted in two lockdowns, one from March to May 2020 and another from December 2020 to April 2021, which had severe impact on everyday life. The aim of this study was to explore changes in diabetes self-management behaviors during the pandemic and to examine how specific population characteristics were associated with changes in diabetes management. Methods and Participants: In a cohort study from March 2020 to April 2021, two online questionnaires were collected from a total of 760 people with diabetes. Descriptive statistics were used to assess the proportion of participants experiencing improvements, deterioration, and status quo in diabetes self-management during the pandemic. Using logistic regressions, baseline characteristics were explored as potential predictors of change. Results: Approximately half of the participants reported that they experienced lower physical activity in April 2021 compared to before the pandemic, approximately one fifth reported diabetes self-management to be more difficult than prior to the pandemic, and one fifth reported eating more unhealthily than before the pandemic. Some participants reported higher frequency of high blood glucose levels (28%), low blood glucose levels (13%) and more frequent blood glucose variability (33%) compared to before. Easier diabetes self-management was reported by relatively few participants, however, 15% reported eating more healthily, and 20% reported being more physically active. We were largely unable to identify predictors of change in exercise activities. The few baseline characteristics identified as predictors of difficulties in diabetes self-management and adverse blood glucose levels due to the pandemic were sub-optimal psychological health, including high diabetes distress levels. Conclusion: Findings indicate that many people with diabetes changed diabetes self-management behaviors during the pandemic, mostly in a negative direction. Particularly high diabetes distress levels in the beginning of the pandemic was a predictor of both positive and negative change in diabetes self-management, indicating that people with high diabetes distress levels could potentially benefit from increased support in diabetes care during a period of crisis.

Staff experiences of diabetes care in residential care facilities for people with severe disabilities in Denmark: a mixed-methods assessment of access to screening for diabetes complications.

OBJECTIVES: To identify the prevalence of diabetes among adults (>18 years) living in residential care facilities in Denmark and to identify the structural, practical, and individual barriers and drivers related to their participation in screening programmes. DESIGN: SETTING: The register-based study included all residents living in residential care facilities in Denmark. The survey and qualitative analysis were carried out exclusively in the Capital Region of Denmark. PARTICIPANTS: For the register-based study, we identified 11 620 residents of care facilities in Denmark (>18 years) and identified the number of residents with diagnosis codes of type 1 or type 2 diabetes or dispensed prescriptions of blood glucose-lowering medication. Staff from 102 psychiatric facilities housing adults with severe psychiatric disabilities were invited to participate in the survey. Of these, 56 facilities participated with one responder each, of which n=16 also participated in follow-up qualitative interviews. RESULTS: Register-based study: of the residents at the facilities, 954 (8%) were diagnosed with diabetes. Descriptive statistics of responses and results from content analysis of interviews were summarised in five themes that illuminated how a screening programme could be tailored to the care facilities: (1) characteristics of residents and care facilities, (2) the care needs of residents, (3) the way care was organised, (4) the specific barriers and drivers for participating in programmes, (5) number of hours and settings for screening programmes. CONCLUSION: To increase the participation of people living in psychiatric care facilities in screening programmes, future programmes should be tailored to the identified needs and barriers experienced by the residential care staff.