Tore Julsrud Berg

• Stalheim, Astrid Melteig; Nilsen, Roy Miodini; Vangen, Siri; Vik, Eline Skirnisdottir; Alnæs-Katjavivi, Patji Haakon & Iversen, Marjolein M. [Show all 8 contributors for this article] (2026). Adverse pregnancy outcomes in women with type 1 diabetes: A nationwide, population-based study, 1999–2021. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. p. 1–13. doi: 10.1111/aogs.70215. Full text in Research Archive Show summary

  Introduction For the total population and for groups of non-immigrant and immigrant women, we examined the associations of maternal type 1 diabetes with adverse pregnancy outcomes among women who gave birth in Norway from 1999 to 2021. Further, we examined the associations between the two time periods 1999–2014 and 2015–2021 and adverse pregnancy outcomes, and whether these associations differed in women with or without type 1 diabetes. Material and Methods In this nationwide population-based observational study, with data from the Medical Birth Registry of Norway and Statistics Norway 1999–2021, we used logistic regression to examine the associations between type 1 diabetes and adverse pregnancy outcomes. Moreover, differences in ORs for adverse pregnancy outcomes between those with and without type 1 diabetes were compared for the two time periods 1999–2014 and 2015–2021 using interaction analyses. Analyses were performed for the overall population, as well as separately for non-immigrant (n = 964 542) and immigrant women (n = 257 409). Results Women with type 1 diabetes (non-immigrant women n = 5067 and immigrant women n = 619) had higher ORs for almost all adverse pregnancy outcomes (OR 1.41–11.04) compared to women without diabetes in the period 1999–2021. In the time period 2015–2021, compared to 1999–2014, women with type 1 diabetes had a notably reduced OR of congenital malformations compared to those without diabetes (p interaction: 0.006). Immigrant women with type 1 diabetes had a higher OR in 2015–2021 vs. 1999–2014 of having large for gestational age infants (p interaction: 0.003). Conclusions Women with type 1 diabetes had higher odds of most of the examined adverse pregnancy outcomes, though improvements were observed from 2015 to 2021 compared to 1999–2014, particularly a reduction in congenital malformations. In contrast, immigrants had higher odds of large for gestational age. These findings highlight the continued need for targeted interventions to reduce the burden of adverse outcomes in all women with type 1 diabetes.

• Bjarkø, Vera Vik; Wolford, Brooke N.; Haug, Eirin Beate; Stene, Lars Christian Mørch; Carlsson, Sofia & Langhammer, Arnulf [Show all 13 contributors for this article] (2026). Temporal changes and genetic susceptibility to type 2 diabetes (1984-2019; HUNT): a longitudinal, population-based study. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 14(3), p. 223–232. doi: 10.1016/S2213-8587(25)00322-5. Full text in Research Archive
• Braffett, Barbara H.; Berg, Tore Julsrud; Zimmerman, Malin; Olesen, Kasper; Gregersen, Søren & Krogsgaard, Michael R. [Show all 8 contributors for this article] (2025). Upper-Limb Complications in Diabetes: A Narrative Review. Diabetes Care. ISSN 0149-5992. 48(11), p. 1865–1874. doi: 10.2337/dci25-0012. Full text in Research Archive
• Özgümüs, Türküler; Sulaieva, Oksana; Begum, Most Champa; Ekström, Ola; Jain, Ruchi & Nilsson, Peter [Show all 9 contributors for this article] (2025). DNA repair and inflammatory response genes play a central role in protecting patients with long-standing type 1 diabetes from vascular complications. Journal of Diabetes and its Complications (JDC). ISSN 1056-8727. 39(9). doi: 10.1016/j.jdiacomp.2025.109112. Full text in Research Archive
• Tibelles, Hatuia Bø; Kirkebøen, Lars Johannessen; Jenum, Anne Karen; Straand, Jørund; Berg, Tore Julsrud & Buhl, Esben Selmer (2025). Young-onset type 2 diabetes and associations with high disability rate, low educational level and immigrant background: A study from Norwegian general practice. BMJ Open. 15(9). doi: 10.1136/bmjopen-2024-096521. Full text in Research Archive
• Narum, Marte; Christensen, Jacob J.; Holven, Kirsten Bjørklund; Berg, Tore Julsrud & Sveen, Kari Anne (2025). Low LDL particle levels associate with coronary arteries free from atherosclerosis in long-term type 1 diabetes: the Dialong study. Cardiovascular Diabetology. 24. doi: 10.1186/s12933-025-02844-z. Full text in Research Archive Show summary

  Background The risk of developing coronary artery disease (CAD) is increased in type 1 diabetes, due to accelerated atherosclerosis. The molecular mechanisms are yet to be unraveled, but potential functional and quantitative abnormalities in lipoproteins are suggested to be involved. Some individuals have coronary arteries free from atherosclerosis even after living with type 1 diabetes for many decades. We therefore aimed to investigate the associations between a set of lipoproteins and metabolites and the presence of coronary arteries free from atherosclerosis in individuals with long-term type 1 diabetes. Methods Cross-sectional, controlled study of 102 participants with type 1 diabetes and 61 control subjects. We used a high-throughput nuclear magnetic resonance (NMR) spectroscopy platform to quantify circulating lipids and metabolites in serum. In participants without previously established coronary heart disease (CHD) we performed computed tomography coronary angiography (CTCA). Results In the diabetes group, mean age was 62 (7) [mean (standard deviation, SD)] year and diabetes duration 50.6 (4.9) years. Lower particle concentration of all LDL subclass particles associated significantly with higher odds of having coronary arteries free from atherosclerosis (p < 0.05). Low particle concentration of all LDL subclasses also associated significantly with normal Coronary Artery Calcium (CAC) score (p < 0.05 for all), after adjustment for age, sex, BMI, eGFR and statin treatment. The whole diabetes group, independent of presence of CAD, had significantly lower particle concentration of IDL and all LDL and VLDL subclass particles compared to the control group (p < 0.05 for all). Conclusions In this cohort of long-term survivors of type 1 diabetes, lower levels of all types of LDL particles associated significantly with higher odds of having coronary arteries free from atherosclerosis, after adjustment for statin treatment. These results emphasize the importance of early treatment start and lipid management in the development of CAD in type 1 diabetes and suggest a subgroup of long-term survivors of type 1 diabetes to may hold environmental or genetic protective beneficial traits, independent of statin use. More research on the role of lipoproteins in the development of atherosclerosis in patients with type 1 diabetes is needed.

• Simeunovic, Aida; Brunborg, Cathrine; Heier, Martin; Berg, Tore Julsrud; Dahl-Jørgensen, Knut & MARGEIRSDOTTIR, HANNA DIS (2025). Early increase in carotid intima-media thickness in women with childhood-onset type 1 diabetes compared with healthy peers: the Norwegian Atherosclerosis and Childhood Diabetes study. BMJ Open Diabetes Research & Care. 13(1). doi: 10.1136/bmjdrc-2024-004505. Full text in Research Archive Show summary

  Introduction The risk of cardiovascular disease is increased in individuals with type 1 diabetes, despite good glycemic control. This study aims to evaluate early signs of atherosclerosis and predisposing factors in individuals with childhood-onset type 1 diabetes compared with healthy controls. Research design and methods The Atherosclerosis and Childhood Diabetes study is a prospective population-based cohort study with follow-up every fifth year. The cohort consists of 329 subjects with type 1 diabetes and 173 controls. Carotid intima-media thickness (cIMT) was measured at baseline and 5 and 10 years of follow-up. Data from the Norwegian Childhood Diabetes Registry were used in assessment of traditional risk factors. Results Mean cIMT in young women with type 1 diabetes increased significantly over a 10-year period compared with healthy controls (∆0.019 mm (0.001–0.035), p=0.035). At the 10-year follow-up the group with type 1 diabetes had a mean age of 24.2±2.9 years (13.7±2.8 years at baseline), diabetes duration of 15.6±3.4 years (5.4±3.3 years at baseline) and HbA1c of 8.2±3.6% (66±16 mmol/mol) (8.4±3.4% (68±13 mmol/mol) at baseline). Women with type 1 diabetes had significantly higher mean weight, body mass index, waist circumference, diastolic blood pressure (DBP), serum low-density lipoprotein (LDL)-cholesterol and apolipoprotein B, while men with type 1 diabetes had significantly higher mean DBP and urinary albumin-creatinine ratio compared with the control group. Mean cIMT change over time was not associated with long-term HbA1c or LDL-cholesterol burden in childhood and adolescence. Conclusion Young women with childhood-onset type 1 diabetes of relatively short diabetes duration had a higher mean cIMT over a 10-year period compared with their healthy female controls, with values similar to males.

• Tibelles, Hatuia Bø; Jenum, Anne Karen; Kirkebøen, Lars Johannessen; Berg, Tore Julsrud; Claudi, Tor & Cooper, John [Show all 10 contributors for this article] (2024). High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice. BMJ Open Diabetes Research & Care. 12(1). doi: 10.1136/bmjdrc-2023-003624. Full text in Research Archive Show summary

  Introduction People with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD among adults with type 2 diabetes (T2D) in Norwegian general practice and explore associations between age at diabetes diagnosis and retinopathy overall and in men and women. Research design and methods We collected cross-sectional data from general practice electronic medical records of 10 241 adults with T2D in 2014, and repeated measurements of hemoglobin A1c (HbA1c) from 2012 to 2014. Using multivariate logistic regression, we assessed associations between YOD and later-onset T2D, sex and retinopathy. Results Of all individuals with T2D, 10% were diagnosed before 40 years of age in both sexes. Compared with later-onset T2D, HbA1c increased faster in YOD, and at the time of diagnosis HbA1c was higher in men, particularly in YOD. Retinopathy was found in 25% with YOD, twice as frequently as in later onset. After adjustments for confounders (age, country of origin, education, body mass index), OR of retinopathy was increased in both men with YOD (OR 2.6 (95% CI 2.0 to 3.5)) and women with YOD (OR 2.2 (1.5 to 3.0)). After further adjustments for potential mediators (diabetes duration and HbA1c), the higher OR persisted in men with YOD (OR 1.8 (1.3 to 2.4)) but was attenuated and no longer significant for women with YOD. Conclusions Retinopathy prevalence was more than twice as high in YOD as in later-onset T2D. The increased likelihood of retinopathy in YOD was partly mediated by higher HbA1c and longer T2D duration, but after accounting for these factors it remained higher in men with YOD.

• Narum, Marte; Seljeflot, Ingebjørg; Bratset, Vibeke; Berg, Tore Julsrud & Sveen, Kari Anne (2024). Intestinal fatty acid binding protein is associated with coronary artery disease in long-term type 1 diabetes—the Dialong study. Cardiovascular Diabetology. 23(1). doi: 10.1186/s12933-024-02509-3. Full text in Research Archive Show summary

  Background Individuals with type 1 diabetes are at increased risk of accelerated atherosclerosis, causing coronary artery disease (CAD). The underlying mechanisms remain unclear, but new theories proposed are damage of gut mucosa causing leakage and translocation of gut microbiota products into the circulation, leading to inflammatory responses and atherosclerosis. We therefore aimed to study the associations between gut related inflammatory biomarkers and coronary atherosclerosis in individuals with long-term type 1 diabetes. Methods In this cross-sectional, controlled study of 102 participants with type 1 diabetes and 63 control subjects, we measured circulating levels of intestinal fatty acid binding protein (I-FABP), soluble cluster of differentiation 14 (sCD14), lipopolysaccharide binding protein (LBP) and interleukin 18 (IL-18) by enzyme-linked immunosorbent assay (ELISA), and further gene expression of CD14 and toll-like receptor 4 (TLR4) by real time PCR in circulating leukocytes and peripheral blood mononuclear cells (PBMCs). The participants had either established coronary heart disease (CHD) or underwent computed tomography coronary angiography (CTCA) to assess for coronary atherosclerosis, including total, calcified and soft/mixed plaque volumes. Results In the diabetes group, the levels of I-FABP were significantly higher in participants with established CHD or significant stenosis on CTCA compared to the participants with normal arteries or non-significant stenosis, with median 1.67 ng/ml (interquartile range [IQR] 1.02–2.32) vs. median 1.09 ng/ml (IQR 0.82–1.58), p = 0.003. I-FABP was associated with significant coronary artery stenosis by CTCA (> 50%) or previously established CHD in the adjusted analysis (odds ratio [OR] = 2.32, 95% confidence interval [CI]: 1.09–4.95; p = 0.029). The levels of I-FABP correlated also to total coronary plaque volume (r = 0.22, p < 0.05). This association remained significant after adjusting for age, sex, persistent albuminuria, eGFR, statin treatment, diabetes duration and mean time-weighted variables; HbA1c, LDL-cholesterol and systolic blood pressure (OR = 1.97, 95% CI: 1.28–3.01; p = 0.002). Conclusions In this cohort of individuals with long-term type 1 diabetes I-FABP associated significantly with coronary artery stenosis, suggesting a potential role of gut mucosa damage in the process of atherosclerosis in type 1 diabetes.

• Igland, Jannicke; Forster, Rachel Bedenis; Jenum, Anne Karen; Strandberg, Ragnhild Bjarkøy; Berg, Tore Julsrud & Røssberg, Jan Ivar [Show all 8 contributors for this article] (2024). How valid is a prescription-based multimorbidity index (Rx-risk) in predicting mortality in the Outcomes and Multimorbidity In Type 2 diabetes (OMIT) study? A nation-wide registry-based cohort study from Norway. BMJ Open. 14(3). doi: 10.1136/bmjopen-2023-077027. Full text in Research Archive Show summary

  Objective: The prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes. Design: Registry-based study. Setting: Adults with type 2 diabetes in Norway identified within the ‘Outcomes and Multimorbidity In Type 2 diabetes’ cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry. Participants: We defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950–2013, and a temporal validation sample of 7085 adults diagnosed 2014–2016 to evaluate the index validity over time Primary outcome measure: All-cause mortality Methods: For the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots. Results: In the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84). Conclusions: The Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.

• Hatlen, Kristine Vaage; Lensnes, Therese Margrethe Lysell; Henriksen, Christine; Berg, Tore Julsrud; Nermoen, Ingrid & Lundin, Knut (2024). Suboptimal adherence to a gluten-free diet in adults with both type 1 diabetes and celiac disease using urinary gluten immunogenic peptide measurement. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 60(1), p. 28–36. doi: 10.1080/00365521.2024.2442688. Full text in Research Archive Show summary

  Objectives Concurrent type 1 diabetes (T1D) and celiac disease (CeD) pose challenges in insulin dosage adjustments and gluten-free dietary adherence. Urine testing for gluten immunogenic peptides (GIP) is a new method to detect gluten exposure within the last 3–12 h. Our aims were to compare gluten-free dietary adherence between T1D + CeD and CeD individuals and evaluate urinary GIP testing in an outpatient setting. Materials and methods This observational cross-sectional study included three adult groups: (1) T1D and CeD, (2) CeD only, and (3) T1D only. T1D participants were recruited from outpatient clinics, the CeD group via social media. One urine sample (12 pm–7 pm) was analyzed using a qualitative immunographic GIP test. CeD participants completed ‘Celiac Dietary Adherence Test’ (CDAT) and ‘Celiac Symptom Index’ (CSI) questionnaires. IgA anti-transglutaminase 2 (IgA-TG2) and IgG anti-deamidated gliadin (IgG-DGP) serology were also analyzed. Results 197 participants, mean (SD) age 43 (15) years, were included. Female percentages were: CeD: 90%, T1D + CeD: 64%, and T1D: 47%. Positive urinary GIP was found in 15% (14/96) of T1D + CeD and 0% (0/50) of CeD (p = 0.002). As expected, most T1D only participants had positive urinary GIP (86%, 44/51). CDAT and CSI scores did not differ between T1D + CeD and CeD groups. Positive IgA-TG2 and/or IgG-DGP levels were found in 12% of T1D + CeD and 6% of CeD participants (p = 0.38). Conclusions A single GIP urine test revealed higher gluten exposure in T1D + CeD versus CeD only, questioning dietary adherence in this population. Urinary GIP tests can be useful for clinical follow-up.

• Bjarkø, Vera Vik; Haug, Eirin Beate; Langhammer, Arnulf; Ruiz, Paz Lopez-Doriga; Carlsson, Sofia & Birkeland, Kåre Inge [Show all 10 contributors for this article] (2024). Clinical utility of novel diabetes subgroups in predicting vascular complications and mortality: up to 25 years of follow-up of the HUNT Study. BMJ Open Diabetes Research & Care. 12(6). doi: 10.1136/bmjdrc-2024-004493. Full text in Research Archive Show summary

  Introduction Cluster analysis has previously revealed five reproducible subgroups of diabetes, differing in risks of diabetic complications. We aimed to examine the clusters’ predictive ability for vascular complications as compared with established risk factors in a general adult diabetes population. Research design and methods Participants from the second (HUNT2, 1995–1997) and third (HUNT3, 2006–2008) surveys of the Norwegian population-based Trøndelag Health Study (HUNT Study) with adult-onset diabetes were included (n=1899). To identify diabetes subgroups, we used the same variables (age at diagnosis, body mass index, HbA1c, homeostasis model assessment estimates of beta cell function and insulin resistance, and glutamic acid decarboxylase antibodies) and the same data-driven clustering technique as in previous studies. We used Cox proportional hazards models to investigate associations between clusters and risks of vascular complications and mortality. We estimated the C-index and R2 to compare predictive abilities of the clusters to those of established risk factors as continuous variables. All models included adjustment for age, sex, diabetes duration and time of inclusion. Results We reproduced five subgroups with similar key characteristics as identified in previous studies. During median follow-up of 9–13 years (differing between outcomes), the clusters were associated with different risks of vascular complications and all-cause mortality. However, in prediction models, individual established risk factors were at least as good predictors as cluster assignment for all outcomes. For example, for retinopathy, the C-index for the model including clusters (0.65 (95% CI 0.63 to 0.68)) was similar to that of HbA1c (0.65 (95% CI 0.63 to 0.68)) or fasting C-peptide (0.66 (95% CI 0.63 to 0.68)) alone. For chronic kidney disease, the C-index for clusters (0.74 (95% CI 0.72 to 0.76)) was similar to that of triglyceride/high-density lipoprotein ratio (0.74 (95% CI 0.71 to 0.76)) or fasting C-peptide (0.74 (95% CI 0.72 to 0.76)), and baseline estimated glomerular filtration rate yielded a C-index of 0.76 (95% CI 0.74 to 0.78). Conclusions Cluster assignment did not provide better prediction of vascular complications or all-cause mortality compared with established risk factors.

• Nøkleby, Kjersti; Jenum, Anne Karen; Buhl, Esben Selmer; Claudi, Tor; Cooper, John & Flottorp, Signe Agnes [Show all 9 contributors for this article] (2024). Effects on HbA1c of referral of type 2 diabetes patients to secondary care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. p. 1–11. doi: 10.1080/02813432.2024.2433107. Full text in Research Archive Show summary

  Aim: To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs. Methods: We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership. Results: Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up. Conclusions: Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC.

• Mdala, Ibrahimu; Nøkleby, Kjersti; Berg, Tore Julsrud; Cooper, John; Sandberg, Sverre & Løvaas, Karianne Fjeld [Show all 9 contributors for this article] (2023). Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1). doi: 10.1080/02813432.2023.2296118. Full text in Research Archive Show summary

  Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were ‘timely basal insulin-initiation’ (primary) and ‘attainment of HbA1c<7%’ after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin naïve patients with ‘timely’ (N = 294), ‘postponed’ (N = 219) or ‘no need of’ (N = 3,781) basal insulin-initiation, respectively. Results: HbA1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA1c to 7.3 (6.8–8.1) % by which only 35% of the subjects reached HbA1c <7%. Adjusted risk of ‘timely basal insulin-initiation’ was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome. Conclusion: In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up.

• Bjarkø, Vera Vik; Haug, Eirin Beate; Sørgjerd, Elin Pettersen; Stene, Lars Christian Mørch; Ruiz, Paz Lopez-Doriga & Birkeland, Kåre Inge [Show all 11 contributors for this article] (2022). Undiagnosed diabetes: Prevalence and cardiovascular risk profile in a population-based study of 52,856 individuals. The HUNT Study, Norway. Diabetic Medicine. ISSN 0742-3071. 39(6). doi: 10.1111/dme.14829. Full text in Research Archive Show summary

  Aims We investigated the current extent of undiagnosed diabetes and prediabetes and their associated cardiovascular risk profile in a population-based study. Methods All residents aged ≥20 years in the Nord-Trøndelag region, Norway, were invited to the HUNT4 Survey in 2017–2019, and 54% attended. Diagnosed diabetes was self-reported, and in those reporting no diabetes HbA1c was used to classify undiagnosed diabetes (≥48 mmol/mol [6.5%]) and prediabetes (39–47 mmol/mol [5.7%–6.4%]). We estimated the age- and sex-standardized prevalence of these conditions and their age- and sex-adjusted associations with other cardiovascular risk factors. Results Among 52,856 participants, the prevalence of diabetes was 6.0% (95% CI 5.8, 6.2), of which 11.1% were previously undiagnosed (95% CI 10.1, 12.2). The prevalence of prediabetes was 6.4% (95% CI 6.2, 6.6). Among participants with undiagnosed diabetes, 58% had HbA1c of 48–53 mmol/mol (6.5%–7.0%), and only 14% (i.e., 0.1% of the total study population) had HbA1c >64 mmol/mol (8.0%). Compared with normoglycaemic participants, those with undiagnosed diabetes or prediabetes had higher body mass index, waist circumference, systolic blood pressure, triglycerides and C-reactive protein but lower low-density lipoprotein cholesterol (all p < 0.001). Participants with undiagnosed diabetes had less favourable values for every measured risk factor compared with those with diagnosed diabetes. Conclusions The low prevalence of undiagnosed diabetes suggests that the current case-finding-based diagnostic practice is well-functioning. Few participants with undiagnosed diabetes had very high HbA1c levels indicating severe hyperglycaemia. Nonetheless, participants with undiagnosed diabetes had a poorer cardiovascular risk profile compared with participants with known or no diabetes.

• Molvær, Anne Karin; Iversen, Marjolein M.; Igland, Jannicke; Peyrot, Mark; Tell, Grethe S. & Holte, Kristine Bech [Show all 9 contributors for this article] (2022). Metabolic predictors of pain, fatigue, depression and quality of life in people with long-term type 1 diabetes—the Dialong study. Diabetic Medicine. ISSN 0742-3071. 40, p. 1–12. doi: 10.1111/dme.15009. Full text in Research Archive Show summary

  Aim To examine associations of metabolic parameters (mean 30 years' time-weighted HbA1c and low-density lipoprotein-cholesterol [LDL-c], current methionine sulfoxide [MetSO], advanced glycation end products [AGEs], inflammatory markers and hypoglycaemia) with pain, fatigue, depression and quality of life (QoL) in people with long-term type 1 diabetes. Methods A total of 104 persons with type 1 diabetes ≥45 years duration were included. Participants completed questionnaires measuring bodily pain (RAND-36 bodily pain domain with lower scores indicate higher levels of bodily pain), fatigue (Fatigue Questionnaire), depression (Patient Health Questionnaire), overall QoL (World Health Organization Quality of Life—BREF) and diabetes-related QoL (Audit of Diabetes-Dependent Quality of Life). In this observational study, mean time-weighted HbA1c and LDL-c were calculated based on longitudinal measures obtained from medical records of up to 34 years, while current HbA1c, LDL-c and inflammatory markers were analysed in blood samples and collagen MetSO and AGEs in skin biopsies. History of hypoglycaemia was self reported. Associations between metabolic parameters and questionnaire scores were analysed using linear regression analyses and are reported as standardized regression coefficients (beta). Results Of the metabolic variables, higher mean time-weighted HbA1c was associated with higher levels of bodily pain and total fatigue (beta [p-value]) −0.3 (<0.001) and 0.2 (0.001). Conclusions Long-term chronic hyperglycaemia may have a negative influence on pain and fatigue in people with type 1 diabetes. These results may assist health care workers in emphasizing the importance of strict glycaemic control in people with diabetes and identifying and treating type 1 diabetes-related pain and fatigue.

• Aukrust, Sverre Grøver; Holte, Kristine Bech; Opstad, Trine Baur; Seljeflot, Ingebjørg; Berg, Tore Julsrud & Helseth, Ragnhild (2022). NETosis in Long-Term Type 1 Diabetes Mellitus and Its Link to Coronary Artery Disease. Frontiers in Immunology. 12, p. 1–9. doi: 10.3389/fimmu.2021.799539. Full text in Research Archive Show summary

  Background Neutrophil extracellular traps NETs have been linked to glucose and the pathogenesis of type 1 diabetes mellitus (T1DM). NETs also play a role in vascular inflammation and the development of coronary artery disease (CAD). The role of NETs in CAD progression in patients with long-term T1DM is unclear. We aimed to 1) investigate whether levels of circulating NETs markers were elevated in long-term T1DM subjects compared to controls, and 2) explore whether levels of NETs were related to the presence of CAD. Material and Methods 102 patients with &amp;gt; 45 years of T1DM and 75 age-matched controls were enrolled in a cross-sectional study. Median age was 62 years. Computed tomography coronary angiography (CTCA) was performed in 148 subjects without established coronary heart disease. For the current study, CAD was defined as a coronary artery stenosis &amp;gt;50%. Double-stranded deoxyribonucleic acid (dsDNA) was measured by a nucleic acid stain, myeloperoxidase-DNA (MPO-DNA), citrullinated histone 3 (H3Cit) and peptidylarginine deiminase 4 (PAD4) by ELISAs, while gene expression of PAD4 was measured in leukocytes from PAXgene tubes. Results Circulating MPO-DNA levels were significantly lower in patients with T1DM than in controls (0.17 vs 0.29 OD, p&amp;lt;0.001), while dsDNA, H3Cit, PAD4 and gene expression of PAD4 did not differ with respect to the presence of T1DM. There were no significant associations between NETs markers and HbA1c in the T1DM group. None of the NETs markers differed according to the presence of CAD in patients with T1DM. While all circulating NETs markers correlated significantly with circulating neutrophils in the control group (r=0.292-393, p&amp;lt;0.014), only H3Cit and PAD4 correlated with neutrophils in the T1DM group (r= 0.330-0.449, p ≤ 0.001). Conclusions In this cross-sectional study of patients with long-term T1DM and age-matched controls, circulating NETs levels were not consistently associated with the presence of T1DM or glycemic status, and did not differ according to the presence of CAD in patients with T1DM. Our results entail the possibility of altered neutrophil function and reduced NETosis in T1DM. This warrants further investigation.

• Bjerkreim, Betty Ann; Hammerstad, Sara Salehi; Gulseth, Hanne Løvdal; Berg, Tore Julsrud; Lee-Ødegård, Sindre & Eriksen, Erik Fink (2022). Thyroid Signaling Biomarkers in Female Symptomatic Hypothyroid Patients on Liothyronine versus Levothyroxine Monotherapy: A Randomized Crossover Trial. Journal of Thyroid Research. ISSN 2090-8067. 2022. doi: 10.1155/2022/6423023. Full text in Research Archive Show summary

  Background. Levels of thyroid-stimulating hormone (TSH) are believed to reflect degree of disease in patients with hypothyroidism, and normalization of levels is the treatment goal. However, despite adequate levels of TSH after starting levothyroxine (LT4) therapy, 5–10% of hypothyroid patients complain of persisting symptoms with a significant negative impact on quality of life. This indicates that TSH is not an optimal indicator of intracellular thyroid hormone effects in all patients. Our aim was to investigate different effects of LT3 and LT4 monotherapy on other biomarkers of the thyroid signaling pathway, in addition to adverse effects, in patients with residual hypothyroid symptoms. Methods. Fifty-nine female hypothyroid patients, with residual symptoms on LT4 monotherapy or LT4/liothyronine (LT3) combination therapy, were randomly assigned in a non-blinded crossover study and received LT4 or LT3 monotherapy for 12 weeks each. Measurements, including serum analysis of a number of biochemical and hormonal parameters, were obtained at the baseline visit and after both treatment periods. Results. Free thyroxine (FT4) was higher in the LT4 group, while free triiodothyronine (FT3) was higher in the LT3 group. The levels of reverse triiodothyronine (rT3) decreased after LT3 treatment compared with LT4 treatment. Both low-density lipoprotein (LDL) and total cholesterol levels were reduced, while sex hormone-binding globulin (SHBG) increased after LT3 treatment compared with LT4 treatment. The median TSH levels for both treatment groups were within the reference range, however, lower in the LT4 group than in the LT3 group. We did not find any differences in pro-B-type natriuretic peptide (NT pro-BNP), handgrip strength, bone turnover markers, or adverse events between the two treatment groups. Conclusion. We have demonstrated that FT4, FT3, rT3, cholesterol, and SHBG show significantly different values on LT4 treatment compared with LT3 treatment in women with hypothyroidism and residual symptoms despite normal TSH levels. No differences in general or bone-specific adverse effects were demonstrated. This trial is registered with NCT03627611 in May 2018.

• Forster, Rachel Bedenis; Strandberg, Ragnhild Bjarkøy; Tibballs, Katrina Louise Bø; Nøkleby, Kjersti; Berg, Tore Julsrud & Iversen, Tor [Show all 15 contributors for this article] (2022). Cohort profile: Outcomes & Multi-morbidity In Type 2 diabetes (OMIT) - a national registry-based observational cohort with focus on care and treatment of key high-risk groups in Norway. BMJ Open. 12(5). doi: 10.1136/bmjopen-2021-054840. Full text in Research Archive Show summary

  Purpose The ‘Outcomes & Multi-morbidity in Type 2 Diabetes’ (OMIT) is an observational registry-based cohort of Norwegian patients with type 2 diabetes (T2D) established to study high-risk groups often omitted from randomised clinical trials. Participants The OMIT cohort includes 57 572 patients with T2D identified via linkage of Norwegian Diabetes Register for Adults and the Rogaland-Oslo-Salten-Akershus-Hordaland study, both offering data on clinical patient characteristics and drug prescriptions. Subsequently these data are further linked to the Norwegian Prescription Database for dispensed medications, the Norwegian Population Register for data on death and migration, Statistics Norway for data on socioeconomic factors and ethnicity and the Norwegian Directorate of Health for data on the general practices and clinical procedures involved in the care of cohort patients. OMIT offers large samples for key high-risk patient groups: (1) young-onset diabetes (T2D at age <40 years) (n=6510), (2) elderly (age >75 years) (n=15 540), (3) non-Western ethnic minorities (n=9000) and (4) low socioeconomic status (n=20 500). Findings to date On average, patient age and diabetes duration is 67.4±13.2 and 12.3±8.3 years, respectively, and mean HbA1c for the whole cohort through the study period is 7.6%±1.5% (59.4±16.3 mmol/mol), mean body mass index (BMI) and blood pressure is 30.2±5.9 kg/m2 and 135±16.1/78±9.8 mm Hg, respectively. Prevalence of retinopathy, coronary heart disease and stroke is 10.1%, 21% and 6.7%, respectively. Future plans The OMIT cohort features 5784 subjects with T2D in 2006, a number that has grown to 57 527 in 2019 and is expected to grow further via repeated linkages performed every third to fifth year. At the next wave of data collection, additional linkages to Norwegian Patient Registry and Norwegian Cause of Death Registry for data on registered diagnoses and causes of death, respectively, will be performed.

• Tronstad, Christian; Pabst, Oliver; Amini, Maryam; Kleggetveit, Inge Petter; Elvebakk, Ole & Martinsen, Ørjan Grøttem [Show all 10 contributors for this article] (2022). Development of a prototype toe sensor for detection of diabetic peripheral small fiber neuropathy. Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). doi: 10.1109/EMBC48229.2022.9871101. Full text in Research Archive
• Kyte, Karoline Holsen; Stensrud, Trine; Berg, Tore Julsrud; Seljeflot, Ingebjørg & Hisdal, Jonny (2022). Vascular Function in Norwegian Female Elite Runners: A Cross-Sectional, Controlled Study. Sports. 10(3). doi: 10.3390/sports10030037. Full text in Research Archive Show summary

  In general, aerobic exercise has a positive impact on the vascular system, but the syndrome of relative energy-deficiency in sports (RED-S) makes this impact less clear for the athlete. The present cross-sectional controlled study aimed to investigate the vascular function in female elite long-distance runners, compared to inactive women. Sixteen female elite long-distance runners and seventeen healthy controls were recruited. Assessments of vascular function and morphology included endothelial function, evaluated by flow-mediated dilatation (FMD), vascular stiffness, evaluated with pulse wave velocity (PWV), carotid artery reactivity (CAR %), and carotid intima-media thickness (cIMT). Blood samples included hormone analyses, metabolic parameters, lipids, and biomarkers reflecting endothelial activation. RED-S risk was assessed through the low energy availability in female questionnaire (LEAF-Q), and body composition was measured by dual-energy X-ray absorptiometry (DXA). We found no significant differences in brachial FMD, PWV, CAR %, cIMT, or biomarkers reflecting endothelial activation between the two groups. Forty-four percent of the runners had a LEAF-Q score consistent with being at risk of RED-S. Runners showed significantly higher HDL-cholesterol and insulin sensitivity compared to controls. In conclusion, Norwegian female elite runners had an as good vascular function and morphology as inactive women of the same age.

• Slåtsve, Kristina Barbara; Claudi, Tor; Lappegård, Knut Tore; Jenum, Anne Karen; Larsen, Marthe & Nøkleby, Kjersti [Show all 12 contributors for this article] (2022). Level of education is associated with coronary heart disease and chronic kidney disease in individuals with type 2 diabetes: a population-based study. BMJ Open Diabetes Research & Care. 10(5). doi: 10.1136/bmjdrc-2022-002867. Full text in Research Archive Show summary

  Introduction - To study the relationship between education level and vascular complications in individuals with type 2 diabetes in Norway.<p> <p>Research design and methods - Multiregional population-based cross-sectional study of individuals with type 2 diabetes in primary care. Data were extracted from electronic medical records in the period 2012–2014. Information on education level was obtained from Statistics Norway. Using multivariable multilevel regression analyses on imputed data we analyzed the association between education level and vascular complications. We adjusted for age, sex, HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, smoking and diabetes duration. Results are presented as ORs and 95% CIs.<p> <p>Results - Of 8192 individuals with type 2 diabetes included, 34.0% had completed compulsory education, 49.0% upper secondary education and 16.9% higher education. The prevalence of vascular complications in the three education groups was: coronary heart disease 25.9%, 23.0% and 16.9%; stroke 9.6%, 7.4% and 6.6%; chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) 23.9%, 16.8% and 12.6%; and retinopathy 13.9%, 11.5% and 11.7%, respectively. Higher education was associated with lower odds for coronary heart disease (OR 0.59; 95% CI 0.49 to 0.71) and chronic kidney disease (OR 0.75; 95% CI 0.60 to 0.93) compared with compulsory education when adjusting for age, sex, HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, smoking and diabetes duration.<p> <p>Conclusions - In a country with equal access to healthcare, high education level was associated with lower odds for coronary heart disease and chronic kidney disease in individuals with type 2 diabetes.

• Sveen, Kari Anne; Holte, Kristine Bech; Svanteson, Mona; Hanssen, Kristian F.; Nilsson, Jan-Åke & Bengtsson, Eva [Show all 7 contributors for this article] (2021). Autoantibodies against methylglyoxal-modified apolipoprotein B100 and apob100 peptide are associated with less coronary artery atherosclerosis and retinopathy in long-term type 1 diabetes. Diabetes Care. ISSN 0149-5992. 44(6), p. 1402–1409. doi: 10.2337/dc20-2089. Full text in Research Archive
• Slåtsve, Kristina Barbara; Claudi, Tor; Lappegård, Knut Tore; Jenum, Anne Karen; Larsen, Marthe & Nøkleby, Kjersti [Show all 9 contributors for this article] (2021). Factors associated with treatment in primary versus specialist care: A population-based study of people with type 2 and type 1 diabetes. Diabetic Medicine. ISSN 0742-3071. 38(7). doi: 10.1111/dme.14580. Full text in Research Archive Show summary

  Aims The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care. Methods Population-based cross-sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed-effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables. Results Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA1c, use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners’ use of a structured form and a diabetes nurse were negatively associated with specialist care. Conclusions Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow-up in primary care.

• Bjerkreim, Betty Ann; Hammerstad, Sara Salehi; Gulseth, Hanne Løvdal; Berg, Tore Julsrud; Lee-Ødegård, Sindre & Rangberg, Anbjørg [Show all 12 contributors for this article] (2021). Effect of Liothyronine Treatment on Quality of Life in Female Hypothyroid Patients With Residual Symptoms on Levothyroxine Therapy: A Randomized Crossover Study. Frontiers in Endocrinology. 13, p. 1–11. doi: 10.3389/fendo.2022.816566. Full text in Research Archive
• Nøkleby, Kjersti; Berg, Tore Julsrud; Mdala, Ibrahimu; Buhl, Esben Selmer; Claudi, Tor & Cooper, John [Show all 9 contributors for this article] (2021). High adherence to recommended diabetes follow-up procedures by general practitioners is associated with lower estimated cardiovascular risk. Diabetic Medicine. ISSN 0742-3071. 38(8), p. 1–11. doi: 10.1111/dme.14586. Full text in Research Archive Show summary

  Aims To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. Methods A cross-sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP’s average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10-year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables. Results The mean total and modifiable estimated 10-year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest-performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest-performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile. Conclusions We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.

• Opstad, Trine Baur; Berg, Tore Julsrud; Holte, Kristine Bech; Arnesen, Harald; Solheim, Svein & Seljeflot, Ingebjørg (2020). Reduced leukocyte telomere lengths and sirtuin 1 gene expression in long-term survivors of type 1 diabetes: A Dialong substudy. Journal of Diabetes Investigation. ISSN 2040-1116. p. 1–10. doi: 10.1111/jdi.13470. Full text in Research Archive Show summary

  Aims/Introduction The shortening of leukocyte telomere length with age has been associated with coronary disease, whereas the association with type 1 diabetes is unclear. We aimed to explore telomere lengths in diabetes patients with regard to coronary artery disease, compared with healthy controls. The longevity factors sirtuin 1 and growth‐differentiating factor 11 were investigated accordingly. Materials and Methods We carried out a cross‐sectional study of 102 participants with long‐term type 1 diabetes and 75 controls (mean age 62 and 63 years, respectively), where 88 cases and 60 controls without diagnosed coronary artery disease completed computed tomography coronary angiography. Telomere lengths and gene expression of sirtuin 1 and growth‐differentiating factor 11 were quantified in leukocytes. Results Telomere lengths and sirtuin 1 were reduced in diabetes patients versus controls, medians (25th to 75th percentiles): 0.97 (0.82–1.15) versus 1.08 (0.85–1.29) and 0.88 (0.65–1.14) vs 1.01 (0.78–1.36), respectively, adjusted P < 0.05, both. Previous coronary artery disease in diabetes patients (n = 15) was associated with lower sirtuin 1 and growth‐differentiating factor 11 messenger ribonucleic acid expression (adjusted P < 0.03, both). In the combined diabetes and control group, previous artery coronary disease (n = 18) presented with significantly shorter telomeres (adjusted P = 0.038). Newly diagnosed obstructive coronary artery disease, defined as >50% stenosis, was not associated with the investigated variables. Conclusions Long‐term type 1 diabetes presented with reduced telomeres and sirtuin 1 expression, with additional reduction in diabetes patients with previous coronary artery disease, showing their importance for cardiovascular disease development with potential as novel biomarkers in diabetes and coronary artery disease.

• Nøkleby, Kjersti; Berg, Tore Julsrud; Mdala, Ibrahimu; Tran, Anh Thi; Bakke, Åsne & Gjelsvik, Bjørn E. [Show all 12 contributors for this article] (2020). Variation between general practitioners in type 2 diabetes processes of care. Primary Care Diabetes. ISSN 1751-9918. 15(3), p. 1–7. doi: 10.1016/j.pcd.2020.11.018. Full text in Research Archive Show summary

  Aims To explore variation in general practitioners’ (GPs’) performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. Methods Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. Results We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37–65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37–4.92). GPs’ age >60 years and heavier workload were associated with poorer performance. Conclusion We found large variations in GPs’ performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.

• Opstad, Trine Baur; Kalstad, Are; Holte, Kristine Bech; Berg, Tore Julsrud; Solheim, Svein & Arnesen, Harald [Show all 7 contributors for this article] (2020). Shorter leukocyte telomer length in healthy relatives of patients with coronary heart disease. Rejuvenation Research. ISSN 1549-1684. doi: 10.1089/rej.2019.2258. Full text in Research Archive
• Holte, Kristine Bech; Svanteson, Mona; Hanssen, Kristian Folkvord; Sveen, Kari Anne; Seljeflot, Ingebjørg & Solheim, Svein [Show all 9 contributors for this article] (2020). Collagen methionine sulfoxide and glucuronidine/LW-1 are markers of coronary artery disease in long-term survivors with type 1 diabetes. The Dialong study. PLOS ONE. doi: 10.1371/journal.pone.0233174. Full text in Research Archive Show summary

  Objectives Type 1 diabetes is a risk factor for coronary heart disease. The underlying mechanism behind the accelerated atherosclerosis formation is not fully understood but may be related to the formation of oxidation products and advanced glycation end-products (AGEs). We aimed to examine the associations between the collagen oxidation product methionine sulfoxide; the collagen AGEs methylglyoxal hydroimidazolone (MG-H1), glucosepane, pentosidine, glucuronidine/LW-1; and serum receptors for AGE (RAGE) with measures of coronary artery disease in patients with long-term type 1 diabetes. Methods In this cross-sectional study, 99 participants with type 1 diabetes of ≥ 45-year duration and 63 controls without diabetes had either established coronary heart disease (CHD) or underwent Computed Tomography Coronary Angiography (CTCA) measuring total, calcified and soft/mixed plaque volume. Skin collagen methionine sulfoxide and AGEs were measured by liquid chromatography-mass spectrometry and serum sRAGE/esRAGE by ELISA. Results In the diabetes group, low levels of methionine sulfoxide (adjusted for age, sex and mean HbA1c) were associated with normal coronary arteries, OR 0.48 (95% CI 0.27–0.88). Glucuronidine/LW-1 was associated with established CHD, OR 2.0 (1.16–3.49). MG-H1 and glucuronidine/LW-1 correlated with calcified plaque volume (r = 0.23–0.28, p<0.05), while pentosidine correlated with soft/mixed plaque volume (r = 0.29, p = 0.008), also in the adjusted analysis. Conclusions Low levels of collagen-bound methionine sulfoxide were associated with normal coronary arteries while glucuronidine/LW-1 was positively associated with established CHD in long-term type 1 diabetes, suggesting a role for metabolic and oxidative stress in the formation of atherosclerosis in diabetes.

• Tran, Anh Thi; Berg, Tore Julsrud; Mdala, Ibrahimu; Gjelsvik, Bjørn E.; Cooper, John & Sandberg, Sverre [Show all 8 contributors for this article] (2020). Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA<inf>1c</inf> in type 2 diabetes in norwegian general practice. Diabetic Medicine. ISSN 0742-3071. doi: 10.1111/dme.14500. Full text in Research Archive Show summary

  Aims To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured. Methods A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations. Results Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs’ use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed. Conclusion Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.

• Keindl, Magdalena; Fedotkina, Olena; Plessis, Elsa du; Jain, Ruchi; Bergum, Brith & Jensen, Troels Mygind [Show all 19 contributors for this article] (2020). Increased Plasma Soluble Interleukin-2 Receptor Alpha Levels in Patients With Long-Term Type 1 Diabetes With Vascular Complications Associated With IL2RA and PTPN2 Gene Polymorphisms. Frontiers in Endocrinology. 11:575469, p. 1–13. doi: 10.3389/fendo.2020.575469. Full text in Research Archive Show summary

  Type 1 diabetes (T1D) is largely considered an autoimmune disease leading to the destruction of insulin-producing pancreatic β cells. Further, patients with T1D have 3–4-fold increased risk of developing micro- and macrovascular complications. However, the contribution of immune-related factors contributing to these diabetes complications are poorly understood. Individuals with long-term T1D who do not progress to vascular complications offer a great potential to evaluate end-organ protection. The aim of the present study was to investigate the association of inflammatory protein levels with vascular complications (retinopathy, nephropathy, cardiovascular disease) in individuals with long-term T1D compared to individuals who rapidly progressed to complications. We studied a panel of inflammatory markers in plasma of patients with long-term T1D with (n = 81 and 26) and without (n = 313 and 25) vascular complications from two cross-sectional Scandinavian cohorts (PROLONG and DIALONG) using Luminex technology. A subset of PROLONG individuals (n = 61) was screened for circulating immune cells using multicolor flow cytometry. We found that elevated plasma levels of soluble interleukin-2 receptor alpha (sIL-2R) were positively associated with the complication phenotype. Risk carriers of polymorphisms in the IL2RA and PTPN2 gene region had elevated plasma levels of sIL-2R. In addition, cell surface marker analysis revealed a shift from naïve to effector T cells in T1D individuals with vascular complications as compared to those without. In contrast, no difference between the groups was observed either in IL-2R cell surface expression or in regulatory T cell population size. In conclusion, our data indicates that IL2RA and PTPN2 gene variants might increase the risk of developing vascular complications in people with T1D, by affecting sIL-2R plasma levels and potentially lowering T cell responsiveness. Thus, elevated sIL-2R plasma levels may serve as a biomarker in monitoring the risk for developing diabetic complications and thereby improve patient care.

• Jain, Ruchi; Özgümüs, Türküler; Jensen, Troels Mygind; Plessis, Elsa du; Keindl, Magdalena & Møller, Cathrine Laustrup [Show all 26 contributors for this article] (2020). Liver nucleotide biosynthesis is linked to protection from vascular complications in individuals with long-term type 1 diabetes. Scientific Reports. 10:11561, p. 1–12. doi: 10.1038/s41598-020-68130-y. Full text in Research Archive Show summary

  Identification of biomarkers associated with protection from developing diabetic complications is a prerequisite for an effective prevention and treatment. The aim of the present study was to identify clinical and plasma metabolite markers associated with freedom from vascular complications in people with very long duration of type 1 diabetes (T1D). Individuals with T1D, who despite having longer than 30 years of diabetes duration never developed major macro- or microvascular complications (non-progressors; NP) were compared with those who developed vascular complications within 25 years from diabetes onset (rapid progressors; RP) in the Scandinavian PROLONG (n = 385) and DIALONG (n = 71) cohorts. The DIALONG study also included 75 healthy controls. Plasma metabolites were measured using gas and/or liquid chromatography coupled to mass spectrometry. Lower hepatic fatty liver indices were significant common feature characterized NPs in both studies. Higher insulin sensitivity and residual ß-cell function (C-peptide) were also associated with NPs in PROLONG. Protection from diabetic complications was associated with lower levels of the glycolytic metabolite pyruvate and APOCIII in PROLONG, and with lower levels of thiamine monophosphate and erythritol, a cofactor and intermediate product in the pentose phosphate pathway as well as higher phenylalanine, glycine and serine in DIALONG. Furthermore, T1D individuals showed elevated levels of picolinic acid as compared to the healthy individuals. The present findings suggest a potential beneficial shunting of glycolytic substrates towards the pentose phosphate and one carbon metabolism pathways to promote nucleotide biosynthesis in the liver. These processes might be linked to higher insulin sensitivity and lower liver fat content, and might represent a mechanism for protection from vascular complications in individuals with long-term T1D.

• Slåtsve, Kristina Barbara; Claudi, Tor; Lappegård, Knut Tore; Jenum, Anne Karen; Larsen, Marthe & Cooper, John [Show all 8 contributors for this article] (2020). The total prevalence of diagnosed diabetes and the quality of diabetes care for the adult population in Salten, Norway. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–11. doi: 10.1177/1403494820951004. Full text in Research Archive Show summary

  Objective: To assess the total prevalence of types 1 and 2 diabetes and to describe and compare cardiovascular risk factors, vascular complications and the quality of diabetes care in adults with types 1 and 2 diabetes in Salten, Norway. Research design and methods: Cross-sectional study including all patients with diagnosed diabetes in primary and specialist care in Salten, 2014 (population 80,338). Differences in cardiovascular risk factors, prevalence of vascular complications and attained treatment targets between diabetes types were assessed using regression analyses. Results: We identified 3091 cases of diabetes, giving a total prevalence in all age groups of 3.8%, 3.4% and 0.45% for types 2 and 1 diabetes, respectively. In the age group 30–89 years the prevalence of type 2 diabetes was 5.3%. Among 3027 adults aged 18 years and older with diabetes, 2713 (89.6%) had type 2 and 304 (10.0%) type 1 diabetes. The treatment target for haemoglobin A1c (⩽7.0%/53 mmol/mol) was reached in 61.1% and 22.5% of types 2 and 1 diabetes patients, respectively. After adjusting for age, sex and diabetes duration we found differences between patients with types 2 and 1 diabetes in mean haemoglobin A1c (7.1% vs. 7.5%, P<0.001), blood pressure (136/78 mmHg vs. 131/74 mmHg, P<0.001) and prevalence of coronary heart disease (23.1% vs. 15.8%, P<0.001). Conclusions: The prevalence of diagnosed type 2 diabetes was slightly lower than anticipated. Glycaemic control was not satisfactory in the majority of patients with type 1 diabetes. Coronary heart disease was more prevalent in patients with type 2 diabetes.

• Tollånes, Mette Christophersen; Jenum, Anne Karen; Berg, Tore Julsrud; Løvaas, Karianne Fjeld; Cooper, John & Sandberg, Sverre (2020). Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes. Clinical Chemistry and Laboratory Medicine. ISSN 1434-6621. 58(8), p. 1349–1356. doi: 10.1515/cclm-2020-0026. Full text in Research Archive Show summary

  Background: It is not clear if point-of-care (POC) testing for hemoglobin A1c (HbA1c) is associated with glycemic control in type 2 diabetes. Methods: In this cross-sectional study, we linked general practitioner (GP) data on 22,778 Norwegian type 2 diabetes patients to data from the Norwegian Organization for Quality Improvement of Laboratory Examinations. We used general and generalized linear mixed models to investigate if GP offices’ availability (yes/no) and analytical quality of HbA1c POC testing (average yearly “trueness score”, 0–4), as well as frequency of participation in HbA1c external quality assurance (EQA) surveys, were associated with patients’ HbA1c levels during 2014–2017. Results: Twenty-eight out of 393 GP offices (7%) did not perform HbA1c POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA1c levels (95% confidence interval (0.04–0.27) (1.7 mmol/mol [0.5–2.9]). GP offices participating in one or two yearly HbA1c EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA1c levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices’ HbA1c POC analytical trueness score, the patients’ HbA1c levels were lower by 0.04% HbA1c (−0.09, −0.001) (−0.5 mmol/mol [−1.0, −0.01]). Conclusions: Novel use of validated patient data in combination with laboratory EQA data showed that patients consulting GPs in offices that perform HbA1c POC testing, participate in HbA1c EQA surveys, and maintain good analytical quality have lower HbA1c levels. Accurate HbA1c POC results, available during consultations, may improve diabetes care.

• Molvær, Anne Karin; Iversen, Marjolein M.; Igland, Jannicke; Peyrot, Mark; Tell, Grethe S. & Holte, Kristine Bech [Show all 7 contributors for this article] (2020). Higher levels of bodily pain in people with long-term type 1 diabetes: associations with quality of life, depressive symptoms, fatigue and glycaemic control – the Dialong study. Diabetic Medicine. ISSN 0742-3071. 37(9), p. 1569–1577. doi: 10.1111/dme.14331. Full text in Research Archive Show summary

  Aims To compare reported level of bodily pain, overall and health‐related quality of life (QoL), depression and fatigue in people with long‐term type 1 diabetes vs. a comparison group without diabetes. Further, to examine the associations of total bodily pain with QoL, depression, fatigue and glycaemic control in the diabetes group. Methods Cross‐sectional study of 104 (76% of eligible) people with type 1 diabetes of ≥ 45 years’ duration attending the Norwegian Diabetes Centre and 75 persons without diabetes who completed questionnaires measuring bodily pain (RAND‐36 bodily pain domain), shoulder pain (Shoulder Pain and Disability Index), hand pain (Australian/Canadian Osteoarthritis Hand Index), overall QoL (World Health Organization Quality of Life – BREF), health‐related QoL (RAND‐36), diabetes‐specific QoL (Audit of Diabetes‐Dependent Quality of Life; only diabetes group), depression (Patient Health Questionnaire) and fatigue (Fatigue questionnaire). For people with type 1 diabetes, possible associations between the bodily pain domain (lower scores indicate higher levels of bodily pain) and other questionnaire scores, were measured with regression coefficients (B) per 10‐unit increase in bodily pain score from linear regression. Results The diabetes group reported higher levels of bodily (P = 0.003), shoulder and hand pain (P < 0.001) than the comparison group. In the diabetes group, bodily pain was associated with lower overall and diabetes‐specific QoL [B (95% confidence intervals)]: 0.2 (0.1, 0.2) and 0.2 (0.1, 0.3); higher levels of depression −1.0 (−1.3, −0.7) and total fatigue −1.5 (−1.9, −1.2); and worse glycaemic control HbA1c (mmol/mol; %) −0.8 (−1.5, −0.1); −0.1 (−0.1, −0.01). Conclusions People with long‐term type 1 diabetes experience a high level of bodily pain compared with a comparison group. Total bodily pain was associated with worse QoL and glycaemic control.

• Tran, Anh Thi; Berg, Tore Julsrud; Gjelsvik, Bjørn E.; Mdala, Ibrahimu; Thue, Geir & Cooper, John [Show all 11 contributors for this article] (2019). Ethnic and gender differences in the management of type 2 diabetes: a cross-sectional study from Norwegian general practice. BMC Health Services Research. 19:903, p. 1–11. doi: 10.1186/s12913-019-4557-4. Full text in Research Archive Show summary

  Background: Ethnic minority groups from Asia and Africa living in Western countries have a higher prevalence of type 2 diabetes (T2DM) than the general population. We aimed to assess ethnic differences in diabetes care by gender. Methods: Population-based, cross-sectional study identified 10,161 individuals with T2DM cared for by 282 General Practitioners (GP) in Norway. Ethnicity was based on country of birth. Multilevel regression models adjusted for individual and GP factors were applied to evaluate ethnic differences by gender. Results: Diabetes was diagnosed at a younger mean age in all other ethnic groups compared with Westerners (men: 45.9–51.6 years vs. 56.4 years, women: 44.9–53.8 years vs. 59.1 years). Among Westerners mean age at diagnosis was 2.7 years higher in women compared with men, while no gender difference in age at diagnosis was found in any minority group. Daily smoking was most common among Eastern European, South Asian and Middle East/North African men. In both genders, we found no ethnic differences in processes of care (GPs’ measurement of HbA1c, blood pressure, LDL-cholesterol, creatinine). The proportion who achieved the HbA1c treatment target was higher in Westerners (men: 62.3%; women: 66.1%), than in ethnic minorities (men 48.2%; women 53.5%). Compared with Western men, the odds ratio (OR) for achieving the target was 0.45 (95% CI 0.27 to 0.73) in Eastern European; 0.67 (0.51 to 0.87) in South Asian and 0.62 (0.43 to 0.88) in Middle Eastern/North African men. Compared with Western women, OR was 0.49 (0.28 to 0.87) in Eastern European and 0.64 (0.47 to 0.86) South Asian women. Compared with Westerners, the blood pressure target was more often achieved in South Asians and Middle Easterners/North Africans in both genders. Small ethnic differences in achieving the LDL-cholesterol treatment target by gender were found. Conclusion: Diabetes was diagnosed at a considerably earlier age in both minority men and minority women compared with Westerners. Several minority groups had worse glycaemic control compared with Westerners in both genders, which implies that it is necessary to improve glucose lowering treatment for the minority groups. Smoking cessation advice should particularly be offered to men in most minority groups.

• Holte, Kristine Bech; Svanteson, Mona; Hanssen, Kristian Folkvord; Haig, Ylva; Solheim, Svein & Berg, Tore Julsrud (2019). Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study. Journal of Diabetes and its Complications (JDC). ISSN 1056-8727. 33(5), p. 383–389. doi: 10.1016/j.jdiacomp.2019.01.006. Full text in Research Archive Show summary

  Aims We studied the total prevalence of obstructive coronary artery disease (CAD), undiagnosed CAD and absent CAD in persons with ≥45-year duration of type 1 diabetes (T1D) versus controls, and associations with mean HbA1c, LDL-cholesterol and blood pressure over 2–3 decades. Methods We included 76% (n = 103) of all persons with T1D diagnosed ≤1970 attending a diabetes center and 63 controls without diabetes. We collected 20–30 years of HbA1c, LDL-cholesterol and blood pressure measurements. Participants without previously diagnosed coronary heart disease (CHD) underwent Computed Tomography Coronary Angiography (CTCA). Undiagnosed obstructive CAD was defined as any coronary stenosis >50% on CTCA, absent CAD as no detected plaque, and total obstructive CAD as either obstructive CAD on CTCA or previous CHD diagnosis. Results The prevalence of undiagnosed, absent and obstructive CAD was 24% (21/88), 16% (14/88) and 35% (36/103) in T1D versus 10% (6/60), 50% (30/60) and 14% (9/63) in controls (all p < 0.05). Mean HbA1c was associated with undiagnosed obstructive CAD (OR 2.30 95% C.I. 1.13–4.69), while mean LDL-cholesterol was inversely associated with absent CAD (0.12, 0.04–0.43). Conclusions The prevalence of undiagnosed obstructive CAD was high (24%) in this cohort of long-term survivors with T1D. Mean LDL-cholesterol and HbA1c were associated with CAD.

• Gjelsvik, Bjørn E.; Tran, Anh Thi; Berg, Tore Julsrud; Bakke, Åsne; Mdala, Ibrahimu & Nøkleby, Kjersti [Show all 12 contributors for this article] (2019). Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients. British Journal of General Practice Open. doi: 10.3399/bjgpopen18X101636. Full text in Research Archive Show summary

  Background: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. Aim: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. Design & setting: A cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations. Method: Summary statistics with adjustments and binary logistic regression models were used. Results: In total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l). Conclusion: The diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.

• Bakke, Åsne; Dalen, Ingvild; Thue, Geir; Cooper, John; Skeie, Svein & Berg, Tore Julsrud [Show all 10 contributors for this article] (2019). Variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control. Diabetic Medicine. ISSN 0742-3071. p. 1–11. doi: 10.1111/dme.14159. Full text in Research Archive Show summary

  Aims To identify population, general practitioner, and practice characteristics associated with the achievement of HbA1c, blood pressure and LDL cholesterol targets, and to describe variation in the achievement of risk factor control. Methods We conducted a cross‐sectional survey of 9342 people with type 2 diabetes, 281 general practitioners and 77 general practices in Norway. Missing values (7.4%) were imputed using multiple imputation by chained equations. We used three‐level logistic regression with the achievement of HbA1c, blood pressure and LDL cholesterol targets as dependent variables, and factors related to population, general practitioners, and practices as independent variables. Results Treatment targets were achieved for HbA1c in 64%, blood pressure in 50%, and LDL cholesterol in 52% of people with type 2 diabetes, and 17% met all three targets. There was substantial heterogeneity in target achievement among general practitioners and among practices; the estimated proportion of a GPs diabetes population at target was 55–73% (10–90 percentiles) for HbA1c, 36–63% for blood pressure, and 47–57% for LDL cholesterol targets. The models explained 11%, 5% and 14%, respectively, of the total variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets. Use among general practitioners of a structured diabetes form was associated with 23% higher odds of achieving the HbA1c target (odds ratio 1.23, 95% confidence interval (CI) 1.02–1.47) and 17% higher odds of achieving the LDL cholesterol target (odds ratio 1.17, 95% CI 1.01–1.35). Conclusions Clinical diabetes management is difficult, and few people meet all three risk factor control targets. The proportion of people reaching target varied among general practitioners and practices. Several population, general practitioner and practice characteristics only explained a small part of the total variation. The use of a structured diabetes form is recommended.

• Svanteson, Mona; Holte, Kristine Bech; HAIG, YLVA; Kløw, Nils-Einar & Berg, Tore Julsrud (2019). Coronary plaque characteristics and epicardial fat tissue in long term survivors of type 1 diabetes identified by coronary computed tomography angiography. Cardiovascular Diabetology. 18(58), p. 1–9. doi: 10.1186/s12933-019-0861-x. Full text in Research Archive Show summary

  Objectives The aim was to assess coronary atherosclerosis, plaque morphology and associations to cardiovascular risk factors and epicardial adipose tissue (EAT) in patients with long duration of type 1 diabetes mellitus (T1DM). Materials and methods Eighty-eight patients with ≥ 45 year T1DM duration and 60 controls underwent coronary CT angiography (CCTA) for evaluation of coronary artery plaque volume (total, calcified or mixed/soft), coronary artery calcification score (CAC) and EAT. Results Plaques were detected in 75 (85%) T1DM patients and 28 (47%) controls, p < 0.01. Median (interquartile range) plaque volume (mm3) in T1DM vs. controls was: 21.0 (1.0–66.0) vs. 0.2 (0.0–7.1), p < 0.01 for calcified, 0.0 (0.0–8.7) vs. 0.0 (0.0–0.0), p < 0.01 for soft/mixed and 29.5 (3.9–95.8) vs. 0.4 (0.0–7.4), p < 0.01 for total plaque volume. Median CAC was 128 (13–671) vs. 1 (0.0–39.0), p < 0.01 in T1DM vs. controls. Median EAT volume did not differ between the groups; 52.3 (36.1–65.5) cm3 vs. 55 (38.3–79.6), p = 0.20. No association between CAC or plaque volumes and EAT were observed. Low time-weighted LDL-cholesterol and HbA1c for 30 years were associated with having plaque volume < 25th percentile, OR (95% CI) 0.18 (0.05–0.70), p = 0.01 and 0.45 (0.20–1.00), p < 0.05, respectively. Time-weighted LDL-c was linearly associated with CAC (beta 0.82 (95% CI 0.03–1.62), p = 0.04) and total plaque volume (beta 0.77 (95% CI 0.19–1.36), p = 0.01). Conclusion Long-term survivors of T1DM have a higher prevalence of coronary atherosclerosis compared to controls. Low LDL-cholesterol and HbA1c over time have a protective effect on coronary atherosclerosis. EAT volume was not associated with coronary atherosclerosis in T1DM patients.

• Juel, Niels Gunnar; Brox, Jens Ivar; Hellund, Johan Castberg; Merckoll, Else; Holte, Kristine Bech & Berg, Tore Julsrud (2018). Radiological glenohumeral osteoarthritis in long-term type 1 diabetes. Prevalence and reliability of three classification systems. The Dialong shoulder study. Skeletal Radiology. ISSN 0364-2348. 47(9), p. 1245–1251. doi: 10.1007/s00256-018-2923-7. Full text in Research Archive
• Bakke, Åsne; Tran, Anh Thi; Dalen, Ingvild; Cooper, John; Løvaas, Karianne Fjeld & Jenum, Anne Karen [Show all 15 contributors for this article] (2018). Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway. Diabetic Medicine. ISSN 0742-3071. p. 1–13. doi: 10.1111/dme.13842. Full text in Research Archive
• Tran, Anh Thi; Bakke, Åsne; Berg, Tore Julsrud; Gjelsvik, Bjørn E.; Mdala, Ibrahimu & Nøkleby, Kjersti [Show all 13 contributors for this article] (2018). Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 36(2), p. 170–179. doi: 10.1080/02813432.2018.1459238. Full text in Research Archive Show summary

  Objective: To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM). Design: Cross-sectional survey. Setting and subjects: The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified. Main outcome measures: Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics. Result: Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p < 0.01), a larger proportion of their patients achieved good glycaemic control (HbA1c = 6.0%–7.0%) (49.1% vs. 44.4%, p = 0.018) and lower mean systolic blood pressure (133.0 mmHg vs. 134.7 mmHg, p < 0.01) compared with non-specialists. GPs who graduated in Western Europe achieved lower diastolic blood pressure than their counterparts (76.6 mmHg vs. 77.8 mmHg, p < 0.01). Conclusion: Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice.

• Juel, Niels Gunnar; Brox, Jens Ivar; Hellund, Johan Castberg; Holte, Kristine Bech & Berg, Tore Julsrud (2017). The prevalence of radiological glenohumeral osteoarthritis in long-term type 1 diabetes: the Dialong shoulder study. Scandinavian Journal of Rheumatology. ISSN 0300-9742. 47(4), p. 325–330. doi: 10.1080/03009742.2017.1397189. Full text in Research Archive
• Magnusson, Karin; Holte, Kristine Bech; Juel, Niels Gunnar; Brox, Jens Ivar; Hagen, Kåre Birger & Haugen, Ida Kristin [Show all 7 contributors for this article] (2017). Long term type 1 diabetes is associated with hand pain, disability and stiffness but not with structural hand osteoarthritis features - The Dialong hand study. PLOS ONE. 12:e0177118(5), p. 1–13. doi: 10.1371/journal.pone.0177118. Full text in Research Archive Show summary

  Objective: To explore whether having long-term type 1 diabetes (>45 years) is associated with a higher prevalence of radiographic hand OA, erosive hand OA and increased hand pain, disability and stiffness. Methods: In total N = 96 persons with type 1 diabetes diagnosed before 1970 were included (mean [SD] age: 62.2 [7.4], mean [SD] HbA1c: 7.43 [0.80] and N = 49 [51%] men). Regular measurements of their HbA1c were obtained till 2015. We included N = 69 healthy controls without any diabetes (mean [SD] age: 63.0 [7.0], mean [SD] HbA1c: 5.41 [0.32], N = 29 [42%] men). The groups were compared for radiographic hand OA (Kellgren-Lawrence grade ≥2 in ≥1 joint) and erosive hand OA (central erosions in ≥1 joint), Australian/Canadian index (AUSCAN) for hand pain, disability and stiffness using regression analyses adjusted for age, sex, educational level and waist circumference. Results: We found no associations between having long term type 1 diabetes and more prevalent radiographic hand OA (OR = 0.83, 95% CI = 0.38–1.81). We found a trend towards higher prevalence of erosive hand OA in diabetes patients (OR = 2.96, 95% CI = 0.82–10.64). Strong and consistent associations were observed between long term type 1 diabetes and increased hand pain (B = 2.78, 95% CI = 1.65–3.91), disability (B = 5.30, 95% CI = 3.48–7.12) and stiffness (B = 2.00, 95% CI = 1.33–2.67). These associations were particularly strong for women and participants below the median age of 61 years. Conclusion: Long-term type 1 diabetes was not associated with radiographic hand OA, but was strongly associated with hand pain, disability and stiffness. The association between diabetes and erosive hand OA warrants further investigation.

• Bakke, Åsne; Cooper, John; Thue, Geir; Skeie, Svein; Carlsen, Siri & Dalen, Ingvild [Show all 15 contributors for this article] (2017). Type 2 diabetes in general practice in Norway 2005-2015: moderate improvements in risk factor control, but still major gaps in complication screening. BMJ Open Diabetes Research & Care. 5(1). doi: 10.1136/bmjdrc-2017-000459. Full text in Research Archive Show summary

  Objective: To assess the status of type 2 diabetes care in general practice and changes in the quality of care between 2005 and 2014, and to identify areas of diabetes care requiring improvement. Research design and methods: Two cross-sectional surveys were performed that included patients with type 2 diabetes in selected areas (n=9464 in 2014, n=5463 in 2005). Quality of care was assessed based on key recommendations in national guidelines. Differences in clinical performance between 2005 and 2014 were assessed in regression models adjusting for age, sex, counties and clustering within general practices. Results: Treatment targets were achieved in a higher proportion of patients in 2014 compared with 2005: hemoglobin A1c ≤7.0% (≤53 mmol/mol) in 62.8% vs 54.3%, blood pressure ≤135/80 mm Hg in 44.9% vs 36.6%, and total cholesterol ≤4.5 mmol/L in 49.9% vs 33.5% (all adjusted P≤0.001). Regarding screening procedures for microvascular complications, fewer patients had recorded an eye examination (61.0% vs 71.5%, adjusted P<0.001), whereas more patients underwent monofilament test (25.9% vs 18.7%, adjusted P<0.001). Testing for albuminuria remained low (30.3%) in 2014. A still high percentage were current smokers (22.7%). Conclusions: We found moderate improvements in risk factor control for patients with type 2 diabetes in general practice during the last decade, which are similar to improvements reported in other countries. We report major gaps in the performance of recommended screening procedures to detect microvascular complications. The proportion of daily smokers remains high. We suggest incentives to promote further improvements in diabetes care in Norway.

• Juel, Niels Gunnar; Brox, Jens Ivar; Brunborg, Cathrine; Holte, Kristine Bech & Berg, Tore Julsrud (2017). Very high prevalence of frozen shoulder in patients with type 1 diabetes of ≥45 years' duration: The Dialong Shoulder Study. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 98(8), p. 1551–1559. doi: 10.1016/j.apmr.2017.01.020. Full text in Research Archive
• Holte, Kristine Bech; Juel, Niels Gunnar; Brox, Jens Ivar; Hanssen, Kristian Folkvord; Fosmark, Dag Sigurd & Sell, David R. [Show all 8 contributors for this article] (2017). Hand, shoulder and back stiffness in long-term type 1 diabetes; cross-sectional association with skin collagen advanced glycation end-products. The Dialong study. Journal of Diabetes and its Complications (JDC). ISSN 1056-8727. 31(9), p. 1408–1414. doi: 10.1016/j.jdiacomp.2017.06.007. Full text in Research Archive
• Robberstad, Mari; Bentsen, Signe Berit; Berg, Tore Julsrud & Iversen, Marjolein M. (2017). Diabetiske fotsårteam i norske sykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(17). doi: 10.4045/tidsskr.16.1001. Full text in Research Archive
• Qvigstad, Elisabeth; Gulseth, Hanne Løvdal; Risstad, Hilde; Roux, Carel W. le; Berg, Tore Julsrud & Mala, Tom [Show all 7 contributors for this article] (2016). A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report. International Journal of Surgery Case Reports (IJSCR). 21, p. 91–94. doi: 10.1016/j.ijscr.2016.02.033. Full text in Research Archive
• Sørensen, Monica; Arneberg, F.; Line, T.M. & Berg, Tore Julsrud (2016). Cost of diabetes in Norway 2011. Diabetes Research and Clinical Practice. ISSN 0168-8227. 122, p. 124–132. doi: 10.1016/j.diabres.2016.10.012. Full text in Research Archive
• Vikøren, Thea Berge; Berg, Jens Petter & Berg, Tore Julsrud (2014). Feilkilder ved bruk av hemoglobin A1C. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(4), p. 417–421. doi: 10.4045/tidsskr.13.0938. Full text in Research Archive
• Strøm, Hanne; Selmer, Randi; Birkeland, Kåre I.; Schirmer, Henrik; Berg, Tore Julsrud & Jenum, Anne Karen [Show all 9 contributors for this article] (2014). No increase in new users of blood glucose-lowering drugs in Norway 2006-2011: a nationwide prescription database study. BMC Public Health. 14:520. doi: 10.1186/1471-2458-14-520. Full text in Research Archive Show summary

  Background: National estimates for the occurrence of diabetes are difficult to obtain, particularly time trends in incidence. The aim was to describe time trends in prevalent and incident use of blood glucose-lowering drugs by age group and gender in Norway during 2005–2011. Methods: Data were obtained from the nationwide Norwegian Prescription Database. We defined prevalent users of “insulins only” as individuals having no oral antidiabetic drugs (OAD) dispensed from a pharmacy during the previous 24 months or in the subsequent 12 months. Incident users had no blood glucose-lowering drugs dispensed in the previous 24 months; incident “insulins only” users also had no OAD in the subsequent 12 months. Results: In 2011, 3.2% of the population had blood glucose-lowering drugs dispensed, and the incidence rate was 313 per 100,000 person years. The prevalence of OAD use increased from 1.8% in 2005 to 2.4% in 2011; however a decreasing trend in incidence of OAD use was observed, particularly in those aged 70 years and older. In 2010, 0.64% of the population had insulins only dispensed, with an overall incidence rate in the total population of 33 per 100,000 person years which was stable over time. Conclusions: In this nationwide study, we found that although the prevalent use of OAD had increased in recent years, incident use was stable or had decreased. This may indicate that the increase in diabetes occurrence in Norway is levelling off, at least temporarily.

• Sakhi, Amrit Kaur; Berg, Jens Petter & Berg, Tore Julsrud (2013). Glyoxalase 1 enzyme activity in erythrocytes and Ala111Glu polymorphism in type 1-diabetes patients. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 73(2), p. 175–181. doi: 10.3109/00365513.2013.765028. Full text in Research Archive
• Sakhi, Amrit Kaur & Berg, Tore Julsrud (2011). Reduced glutathione concentrations are not decreased in red blood cells of patients with long term type 1-diabetes. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 71(2), p. 108–111. doi: 10.3109/00365513.2010.536851. Full text in Research Archive
• Sakhi, Amrit Kaur & Berg, Tore Julsrud (2010). Reduced glutathione concentrations are not decreased in red blood cells of patients with long term type 1-diabetes. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. doi: 10.3109/00365513.2010.536851. Full text in Research Archive
• Bangstad, Hans J; Seljeflot, Ingebjørg; Berg, Tore Julsrud & Hanssen, Kristian Folkvord (2009). Renal tubulointerstitial expansion is associated with endothelial dysfunction and inflammation in type-1 diabetes. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 69(1), p. 138–144. doi: 10.1080/00365510802444080. Full text in Research Archive
• Erichsen, Martina Moter; Erichsen, Martina M; Løvås, Kristian; Skinningsrud, Beate; Wolff, Anette & Undlien, Dag E [Show all 16 contributors for this article] (2009). Clinical, Immunological, and Genetic Features of Autoimmune Primary Adrenal Insufficiency: Observations from a Norwegian Registry. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 94(12), p. 4882–4890. doi: 10.1210/jc.2009-1368. Full text in Research Archive
• Bangstad, Hans J; Seljeflot, Ingebjørg; Berg, Tore Julsrud & Hanssen, Kristian Folkvord (2008). Renal tubulointerstitial expansion is associated with endothelial dysfunction and inflammation in type 1 diabetes. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 10, p. 1–7. doi: 10.1080/00365510802444080. Full text in Research Archive
• Omsland, Tone Kristin; Bangstad, Hans-Jacob; Berg, Tore Julsrud & Kolset, Svein Olav (2006). Avanserte glykerte endeprodukter og hyperglykemi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126(2), p. 155–158. Full text in Research Archive
• Kilhovd, Bente K.; Juutilainen, A.; Lehto, S.; Rönnemaa, T.; Torjesen, Peter A. & Birkeland, Kåre I. [Show all 9 contributors for this article] (2005). High Serum Levels of Advanced Glycation End Products Predict Increased Coronary Heart Disease Mortality in Nondiabetic Women but not in Nondiabetic Men. A population-Based 18- Year Follow-Up Study. Arteriosclerosis, Thrombosis and Vascular Biology. ISSN 1079-5642. 25(4), p. 815–20. Full text in Research Archive
• Larsen, Jakob; Sjøholm, Hans; Berg, Tore Julsrud; Sandvik, Leiv; Brekke, Magne & Hanssen, Kristian Folkvord [Show all 7 contributors for this article] (2004). Eighteen Years of Fair Glycemic Control Preserves Cardiac Autonomic Function in Type 1 Diabetes. Diabetes Care. ISSN 0149-5992. 27(4), p. 963–6. Full text in Research Archive
• Kilhovd, Bente K.; Giardino, I.; Torjesen, Peter A.; Birkeland, Kåre I.; Berg, Tore Julsrud & Thornalley, P.J. [Show all 8 contributors for this article] (2003). Increased serum levels of the specific AGE-compound methylglyoxal derived hydroimidazolone in patients with type 2 diabetes. Metabolism: Clinical and Experimental. ISSN 0026-0495. 52(2), p. 163–7. Full text in Research Archive
• Larsen, Jakob R.; Sjøholm, H.; Hanssen, Kristian Folkvord; Sandvik, Leiv; Berg, T Julsrud & Dahl-Jørgensen, Knut (2003). Optimal blood glucose control during 18 years preserves peripheral nerve function in patients with 30 years' duration of type 1 diabetes. Diabetes Care. ISSN 0149-5992. 26(8), p. 2400–4. Full text in Research Archive
• Svistounov, Dmitri; Berg, Tore J.; McCourt, Peter Anthony; Zykova, Svetlana; Elvevold, Kjetil Helge & Nagai, Ryoji [Show all 8 contributors for this article] (2003). Lack of recognition of N-epsilon-(carboxymethyl)lysine by the mouse liver reticulo-endothelial system: implications for pathophysiology. Biochemical and Biophysical Research Communications - BBRC. ISSN 0006-291X. 309, p. 786–791. Full text in Research Archive
• Borrebæk, Jørgen; Prydz, Kristian; Fjeldstad, Katja; Vuong, Tram Thu; Berg, Tore Julsrud & Holkov, Charlotte [Show all 7 contributors for this article] (2001). The AGE product N-epsilon-(carboxymethyl)lysine serum albumine is a modulator of proteoglycan expression in polarised cultured kidney epithelial cells. Diabetologia. ISSN 0012-186X. 44, p. 488–494. Full text in Research Archive
• Kilhovd, Bente K.; Berg, Tore Julsrud; Birkeland, Kåre I.; Thorsby, Per & Hanssen, Kristian Folkvord (1999). Serum Levels of Advanced Glycation End Products are Increased in Patients With Type 2 Diabetes and Coronary Heart Disease. Diabetes Care. ISSN 0149-5992. 22, p. 1543–1548. Full text in Research Archive
• Bangstad, Hans-Jacob; Østerby, Ruth; Berg, Tore Julsrud; Hartmann, Anders & Hanssen, Kristian Folkvord (1999). The severity of glomerulopathy predicts long-term urinary albumin excretion rate in patients with IDDM and microalbuminuria. Diabetes Care. ISSN 0149-5992. 22, p. 314–319. Full text in Research Archive
• Berg, T Julsrud; Nourooz-Zadeh, J.; Wolff, S.P.; Tritschler, H.; Bangstad, Hans-Jacob & Hanssen, Kristian Folkvord (1998). Hydroperoxides in plasma are reduced by intensified insulin treatment. A randomized controlled study of IDDM patients with microalbuminuria. Diabetes Care. ISSN 0149-5992. 21, p. 1295–1300. Full text in Research Archive
• Berg, Tore Julsrud; Nourooz-Zadeh, J.; Wolff, S.P.; Trictschler, H.J.; Bangstad, Hans-Jacob & Hanssen, Kristian Folkvord (1998). Hyperperoxides in plasma are reduced by intensified insulin treatment. Diabetes Care. ISSN 0149-5992. 21, p. 1295–1300. Full text in Research Archive
• Berg, Tore Julsrud; Clausen, J.T.; Torjesen, Peter A.; Dahl-Jørgensen, Knut; Bangstad, Hans-Jacob & Hanssen, Kristian Folkvord (1998). The advanced glycation end product N(carboxymethyl)lysine is increased in serum from children and adolescents with type 1 diabetes. Diabetes Care. ISSN 0149-5992. 21(11), p. 1997–2002. Full text in Research Archive
• Berg, T Julsrud; Clausen, J.T.; Torjesen, Peter A.; Dahl-Jørgensen, Knut; Bangstad, Hans-Jacob & Hanssen, Kristian Folkvord (1998). The advanced glycation end product Nepsilon-(carboxymethyl)lysine is increased in serum from children and adolescents with type 1 diabetes. Diabetes Care. ISSN 0149-5992. 21, p. 1997–2002. Full text in Research Archive
• Landmark, Knud Holck & Berg, T Julsrud (1997). Lokale lønnsforhandlinger for ansatte ved Universitetet i Oslo. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 117, p. 1362–1362. Full text in Research Archive
• Berg, Tore Julsrud; Torjesen, Peter A.; Dahl-Jørgensen, Knut & Hanssen, Kristian Folkvord (1997). Increased serum levels of advanced glycation end products (AGEs) in children and adolescent with IDDM. Diabetes Care. ISSN 0149-5992. 20, p. 1006–1008. Full text in Research Archive
• Berg, Tore Julsrud; Dahl-Jørgensen, Knut; Torjesen, Peter A. & Hanssen, Kristian Folkvord (1997). Increased serum levels of advanced glycation endproducts (AGE) in children and adolescents with IDDM. Diabetes Care. ISSN 0149-5992. 20, p. 1006–1008. Full text in Research Archive
• Berg, Tore Julsrud; Bangstad, Hans-Jacob; Torjesen, Peter A.; Østerby, Ruth; Bucala, Richard & Hanssen, Kristian Folkvord (1997). Advanced glycation end products in serum predict changes in the kidney morphology of patients with insulin-dependent diabetes mellitus. Metabolism: Clinical and Experimental. ISSN 0026-0495. 46, p. 661–665. Full text in Research Archive

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• Iversen, Marjolein M.; Hernar, Ingvild; Landbakk, Tilla; Haugstvedt, Anne; Berg, Tore Julsrud & Krohne, Kariann (2023). Fagprosedyre for diabetes i kommunale helse- og omsorgstjenester. Nasjonal kompetansetjeneste for aldring og helse. ISBN 9788280619464. 51 p. Full text in Research Archive

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• Hewitt, Stephen I; Hofsø, Dag; Qvigstad, Elisabeth; Berg, Tore Julsrud; Chahal-Kummen, Monica & Kristinsson, Jon Adalsteinn [Show all 7 contributors for this article] (2025). Hypoglykemi etter fedmekirurgi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(6). doi: 10.4045/tidsskr.24.0396. Full text in Research Archive Show summary

  Omfanget av fedmekirurgi har økt vår erkjennelse av hypoglykemi som en komplikasjon, og forekomsten synes høyere enn tidligere anslått. Pasientene har oftest milde til moderate symptomer, og de fleste har god effekt av kostholdstilpasninger. Et fåtall får kramper, synkoperer eller klarer ikke ta vare på seg selv. Hypoglykemien knyttes til både vektavhengige og vektuavhengige mekanismer, med både bedret insulinsensitivitet og økt frigjøring av inkretinhormoner, som glukagonlignende peptid 1. Hovedprinsippet i behandlingen er å begrense svingninger i nivåene av blodglukose og insulin etter måltider. Enkelte medikamenter kan avhjelpe tilstanden, men brukes lite. I denne kliniske oversikten oppsummeres noen viktige hensyn for leger som møter disse pasientene.

• Berg, Tore Julsrud (2024). Digital Technology for Diabetes. New England Journal of Medicine. ISSN 0028-4793. 390(10), p. 963–963. doi: 10.1056/NEJMc2315000. Full text in Research Archive
• Buhl, Esben Selmer; Igland, Jannicke; Forster, Rachel Bedenis; Jenum, Anne Karen; Strandberg, Ragnhild Bjarkøy & Berg, Tore Julsrud [Show all 8 contributors for this article] (2023). Prediction of mortality and validation of the ATC-code based Rx-risk comorbidity index in the “Outcomes & Multi-Morbidity In Type 2 diabetes” (OMIT) cohort. Full text in Research Archive
• Igland, Jannicke; Forster, Rachel Bedenis; Jenum, Anne Karen; Strandberg, Ragnhild Bjarkøy; Berg, Tore Julsrud & Røssberg, Jan Ivar [Show all 8 contributors for this article] (2022). The validity of the Rx-risk comorbidity index among adults in the Outcomes & Multimorbidity in Type 2 diabetes cohort (OMIT). Full text in Research Archive
• Berg, Tore Julsrud & Iversen, Marjolein M. (2019). En enkel undersøkelse kan redde tær, føtter og liv for de med diabetes. Full text in Research Archive
• Tran, Anh Thi; Gjelsvik, Bjørn E.; Berg, Tore Julsrud; Nøkleby, Kjersti; Cooper, John & Bakke, Åsne [Show all 10 contributors for this article] (2018). The influences of ethnicity on the quality of type 2 diabetes care in Norwegian general practice. Full text in Research Archive
• Bakke, Åsne; Cooper, John; Thue, Geir; Skeie, Svein; Carlsen, Siri & Dalen, Ingvild [Show all 14 contributors for this article] (2017). Type 2 diabetes in General Practice in Norway 2005-2014: Moderate improvements in risk Control but still major gaps in complication screening. Full text in Research Archive
• Bakke, Åsne; Cooper, John; Thue, Geir; Skeie, Svein; Carlsen, Siri & Dalen, Ingvild [Show all 15 contributors for this article] (2017). Type 2 Diabetes in General Practice in Norway 2005-2014: Moderate improvements in risk factor control but still major gaps in complication screening. Full text in Research Archive
• Berg, Tore Julsrud (2013). National diabetes strategy and diabetes epidemiology in Norway :. Norsk Epidemiologi. ISSN 0803-2491. 23(1), p. 3–4. Full text in Research Archive
• Kilhovd, Bente K.; Hjerkinn, Elsa M.; Seljeflot, Ingebjørg; Berg, T Julsrud & Reikvam, Åsmund (2001). Serum levels of advanced glycation endproducts in high risk patients with coronary artery disease are modified by the ACE inhibitor ramipril. Full text in Research Archive
• Kilhovd, Bente K.; Hjerkinn, Elsa M.; Seljeflot, Ingebjørg; Berg, T Julsrud & Reikvam, Åsmund (2001). Serum levels of advanced glycation endproducts (AGEs) in high risk coronary artery disease patients are modifies by the ACE inhibitor ramipril. Full text in Research Archive
• Hanssen, Kristian Folkvord & Berg, Tore Julsrud (2000). Diabetesbehandling i forandring. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 120, p. 2377–2377. Full text in Research Archive
• Bangstad, Hans-Jacob; Østerby, Ruth; Dahl-Jørgensen, Knut; Berg, Tore Julsrud; Hartmann, Anders & Hanssen, Kristian Folkvord (1997). The degree of glumerulopathy predicts urinary albumin excretion rate six years later in patients with IDDM and microalbuminuria. Full text in Research Archive
• Bangstad, Hans-Jacob; Østerby, Ruth; Hartmann, Anders; Berg, Tore Julsrud; Dahl-Jørgensen, Knut & Hanssen, Kristian Folkvord (1997). Renal morphological changes predict urinary albumin excretion rate 6 years later in patients with IDDM and microalbuminuria. Full text in Research Archive
• Bangstad, Hans-Jacob; Osterby, R.; Hartmann, K A.; Berg, Tore Julsrud; Dahl-Jørgensen, Knut & Hanssen, Kristian Folkvord (1997). Renal morphological changes predict urinary albumin excretion rate 6 years later in patients with IDDM and microalbuminuria. Diabetologia. ISSN 0012-186X. 40. Full text in Research Archive
• Berg, Tore Julsrud; Bergersen, K.; Jensen, Petter & Løken, Kirsti (1997). Uholdbare forhold for stipendiater ved Det medisinske fakultet i Oslo. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. p. 1338–1338. Full text in Research Archive
• Berg, T Julsrud; Holmberg, K.M.; Allgot, B.; Moum, Torbjørn & Jervell, Jakob Anton (1997). Summer camps for children and adolescents with IDDM; methods, results and impact. Full text in Research Archive
• Berg, Tore Julsrud; Torjesen, Peter A.; Dahl-Jørgensen, Knut; Bangstad, Hans-Jacob; Vogt, H. & Hanssen, Kristian Folkvord [Show all 7 contributors for this article] (1997). Carboxymethyllysine (CML) is increased in serum of children and adolescents with IDDM. Full text in Research Archive
• Hanssen, Kristian Folkvord; Kilhovd, Bente K. & Berg, Tore Julsrud (1996). Advanced Glycosylation Endproducts (AGEs). The link between micro- and macrovascular complications? Full text in Research Archive
• Bangstad, Hans-Jacob; Østerby, Ruth; Dahl-Jørgensen, Knut; Hartmann, Anders; Berg, Tore Julsrud & Hanssen, Kristian Folkvord (1996). The natural course of albumin excretion in low grade microalbuminuric IDDM-subjects with distinctive morphological changes in the kidneys. Full text in Research Archive
• Berg, Tore Julsrud; Dahl-Jørgensen, Knut; Torjesen, Peter A.; Bucala, Richard & Hanssen, Kristian Folkvord (1996). Increased serum levels of Advanced glycosylation end products (AGEs) in children and adolescents with IDDM. Full text in Research Archive Show summary

  Increased Serum levels of Advanced Glycosylation End products (AGE's) in Children and Adolescents with IDDM. TORE J. BERG, KNUT DAHL-JØRGENSEN*, PETER A. TORJESEN, RICK BUCALA*4, KRISTIAN F. HANSSEN, Oslo, Norway and Manhasset, NY.We have developed a sandwich fluoremetric-immunoassay for measuring AGE's in serum utilizing polyclonal antibodies made from rabbit immunized with AGE-RNase. Using this assay we have earlier shown that AGE's in serum predict the progression of morphological pathology in the kidney of diabetic patients with microalbuminuria. In the present study we aimed to investigate whether the serum levels of AGE's in a cohort of diabetic adolescent patients were different from normal subjects. IDDM patients (n=69) were compared with healthy non-diabetic control subjects (n=24). Age was 12.7±4.3 (mean, ±SD) years in the diabetic group and 12.5±2.2 years in the control group; sex distribution (male/female) was 36/33 and 14/10, respectively; Tanner stage (pubic hair) (I/II-V) was 24/42 vs. 14/10. HbA1c was 8.4±2.2 vs. 4.9±0.7 % and blood glucose 13.1±6.3 and 5.1±1.0 mmol/l, respectively. Diabetes duration was 5.2 ±3.7 years. The serum levels of AGE¿s were significantly elevated in the diabetic group when compared to controls(14±3.4 vs. 11.5±2.8 U/ml, p<0.0005. A significant correlation (r=0.25, p<0.04) was found between the levels of AGE¿s and HbA1c in the diabetic group but not in controls. No significant correlation was found between AGE¿s in serum and diabetes duration in the diabetic group or serum AGE¿s and blood glucose or age in either of the groups. There were no differences in levels of AGE¿s between males and females or between prepubertal or pubertal diabetic patients or controls. We conclude that AGE¿s are increased in young patients with diabetes already after a short duration of diabetes. Since AGE¿s are linked to the pathogenesis of vascular complications, this finding might indicate that the pathological processes leading to diabetic late complications start even before puberty.

• Berg, Tore Julsrud; Torjesen, Peter A.; Bangstad, Hans-Jacob; Bucala, Richard; Østerby, Ruth & Hanssen, Kristian Folkvord (1996). Serum levels of advanced glycosylation end products (AGEs) predict changes in kidney morphology in type 1 diabetic patients with microalbuminuria. Full text in Research Archive

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