Jacob Andreas Winther

• Spildo, Ingeborg; Holmen, Heidi; Jensen, Annesofie Lunde; Hagen, Milada; Singstad, Tone & Winther, Jacob Andreas [Vis alle 8 forfattere av denne artikkelen] (2026). Digital Outpatient Care for Patients With Type 1 Diabetes (DigiDiaS): Pragmatic Observational Pre-Post Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 28, s. 1–21. doi: 10.2196/94782. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patient-reported outcomes in digital health solutions can offer patients with type 1 diabetes an opportunity to voice their needs in outpatient care, enabling clinicians to tailor support. Evidence on long-term health impact and routine integration of such digital solutions outside controlled settings is limited. Objective: This study aimed to compare a flexible digital supplement to outpatient care for type 1 diabetes (DigiDiaS) with usual care over 1 year, with self-management as the primary outcome and glycemic control and well-being as secondary outcomes. Methods: This longitudinal real-world observational pre-post study was conducted at the Endocrinology Department of Akershus University Hospital in Norway. Adults with type 1 diabetes were recruited consecutively from October 2022 to October 2023 and could choose either the digital mobile health (mHealth)–based outpatient care model—“DigiDiaS” care—or usual care. DigiDiaS care is delivered via a smartphone app and includes a messaging service; patient-reported outcome–based preconsultation questionnaires; video, telephone, and in-person consultations; and an individually tailored information section. Outcome data comprised self-reported measures, clinical data extracted from electronic medical records, the national diabetes registry, and the digital platform. Data were collected at baseline and at the 1-year follow-up. Change in self-management (Patient Activation Measure short version [PAM-13]; primary outcome) and the secondary outcomes well-being (Five Well-Being Index [WHO-5]) and glycemic control (glycated hemoglobin [HbA1c]) were analyzed using a generalized linear model. Utilization of the digital solution and health care services was also explored. Results: We included 237 patients, with 185 (78%) opting for DigiDiaS care and 52 (22%) for usual care. At the follow-up, most participants (145/178, 81%) in the DigiDiaS care group used the digital solution. The messaging service was the most utilized feature with 592 messages sent collectively (median 1, min-max 0-57). There were no statistically significant between-group differences in change from baseline to follow-up in self-management (mean difference 1.18, 95% CI –5.2 to 7.6; P=.72), glycemic control (HbA1c mean difference –2.1, 95% CI –6.6 to 2.4; P=.36), or well-being (mean difference 1.9, 95% CI –3.1 to 6.9; P=.46). Health care utilization did not differ between the groups, including participation in one or more individual consultations during the 1-year follow-up (DigiDiaS care: 159/178, 89%; usual care: 42/50, 84%; P=.30) or appointment cancellations (DigiDiaS care: 64/91, 70%; usual care: 13/18, 72%; P=.20). Conclusions: This real-world pragmatic observational comparison under routine conditions demonstrates that reorganizing outpatient care for patients with type 1 diabetes into a flexible digital model, DigiDiaS care, did not result in statistically significant between-group differences in health outcomes, including self-management, glycemic control, and well-being, compared with usual care. Over 80% of participants in DigiDiaS care utilized the digital solution, with patient-initiated asynchronous messaging as the most frequently used feature.

• Hjertaas, Tonje Holm; Hjelle, Tone Reinholdtsen; Singstad, Tone; Winther, Jacob Andreas & Ranjbar, Arian (2025). Impact of Telehealth in Diabetes Care: A Pragmatic Study. Studies in Health Technology and Informatics. ISSN 0926-9630. 327. doi: 10.3233/shti250533. Fulltekst i vitenarkiv Vis sammendrag

  This paper presents a pragmatic single center study at a large-scale tertiary hospital. The initial results include 1292 participants already included in a remote monitoring telehealth pathway and show a decreasing trend, however, only 243 patients have been enrolled for more than 2.5 years and additional data is needed to ensure statistical significance.

• Mollestad, Maria Aadland; Jensen, Annesofie Lunde; Holmen, Heidi; Singstad, Tone; Årsand, Eirik & Winther, Jacob Andreas [Vis alle 7 forfattere av denne artikkelen] (2025). Exploring Clinicians’ and Patients’ Acceptance and Utilization of a Digital Solution to Support Individualized Care in Diabetes Specialist Outpatient Care (DigiDiaS): Qualitative Study. JMIR Human Factors. 12. doi: 10.2196/70301. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background With the increasing prevalence of type 1 diabetes alongside limited health care resources, the need for more sustainable health care services is apparent. Central to ensuring the standard of diabetes care while simultaneously optimizing resource utilization is improved patient-clinician communication and the provision of individualized care. Digital outpatient solutions incorporating patient-reported outcome measures (PROMs) have been introduced in diabetes outpatient care over recent years; however, features and delivery methods differ, and existing studies on their use and perceived clinical value are limited. Furthermore, clinicians’ acceptance has been suggested as a key factor in the sustainability of digital solutions. Thus, to support the implementation of digital outpatient solutions perceived as valuable by clinicians and patients, we need more knowledge about how they are accepted and utilized in clinical practice. Objective This study investigates how clinicians and patients with type 1 diabetes accept and utilize a digital outpatient solution to support individualized care in the context of full-scale implementation at a diabetes specialist outpatient clinic. Furthermore, we aim to explore the synchronous interaction between patients and clinicians when they are allowed to prepare through the filling and reviewing of asynchronous PROMs before consultations. Methods This qualitative study uses interpretive description as a methodological approach. The digital outpatient solution features various components, including PROM questionnaires, asynchronous chat, remote consultations, e-learning, and information distribution. Data were collected through semistructured interviews with 10 clinicians and 20 patients with type 1 diabetes and observations of consultations. The data from the patient and clinician interviews (267 A4 pages) were analyzed separately before being jointly analyzed in the context of the findings from the observations (40 A4 pages). Results Our analysis resulted in the following three main themes that describe the interplay between clinicians’ and patients’ acceptance, utilization, and perceived clinical value of a digital outpatient solution: (1) clinicians’ acceptance of the digital outpatient solution influences patients’ acceptance, (2) variations in the use of different features influence the extent of individualized care, and (3) clinicians’ and patients’ utilization influences perceived care efficiency and quality. Those who demonstrated higher acceptance and more extensive utilization reported that the solution was more valuable in enhancing individualized care efficiency and quality. Conclusions This study highlights the interplay between clinicians’ and patients’ acceptance, utilization, and perceived clinical value of a digital outpatient solution in diabetes specialist outpatient care. Our findings suggest that when clinicians and patients understand why and how digital solutions are used, such solutions can enhance care efficiency and quality, contributing to sustainable health care. Future research should aim to gain an in-depth understanding of clinicians’ and patients’ acceptance, as well as the effectiveness of change management strategies when implementing digital outpatient solutions in diabetes specialist outpatient care.

• Spildo, Ingeborg; Holmen, Heidi; Jensen, Annesofie Lunde; Hagen, Milada; Singstad, Tone & Winther, Jacob Andreas [Vis alle 8 forfattere av denne artikkelen] (2025). Examining Patient Characteristics Associated With Digital Outpatient Care for Type 1 Diabetes (DigiDiaS): Cross-Sectional Study. JMIR Human Factors. 12. doi: 10.2196/73708. Fulltekst i vitenarkiv Vis sammendrag

  Background People with type 1 diabetes require ongoing self-management and frequent follow-up care. Digital care models might offer flexible solutions and increased sustainability, and while the clinical opportunities of these care models have been explored, the characteristics of patients inclined to opt for digital care remain unclear. Objective This study aimed to investigate which selected sociodemographic and disease-related patient characteristics are associated with opting for digital outpatient care among patients with type 1 diabetes. Methods This cross-sectional study was conducted at the endocrinology department of Akershus University Hospital in Norway, as part of a larger longitudinal study. Adult patients with type 1 diabetes were eligible to participate and were recruited consecutively. Patients could choose either a novel, mobile health–based, digital, tailored, outpatient care model (DigiDiaS care) or continuation of usual care. DigiDiaS care is delivered via an app comprising a message service; preconsultation questionnaires; options for physical, video, or telephone consultations; an information page; and an e-learning course. Sociodemographic and clinical data were collected from the participants’ medical records and the national diabetes registry. Self-reported data comprised self-management measured using the Patient Activation Measure 13 (PAM-13), diabetes distress (20-item Problem Areas in Diabetes; PAID-20), well-being (World Health Organization-Five Well-Being Index; WHO-5), and health literacy (12-item short version of the European Health Literacy Survey Questionnaire; HLS-19 Q12) questionnaires. We explored group differences and conducted logistic regression to identify factors associated with opting for DigiDiaS care versus usual care. Results A total of 237 patients consented to participate in the study, with 185 (78.1%) opting for DigiDiaS care and 52 (21.9%) opting for usual care. The DigiDiaS care group had a statistically significantly shorter duration of diabetes (median 19, range 0-51 years) compared with the usual care group (median 29, range 3-58 years; P<.001); higher proportions of users of insulin pumps than insulin pens for insulin delivery (DigiDiaS care: 74/185, 40%; usual care: 12/185, 23.1%; P=.007), and a lower median well-being care score (DigiDiaS care: median score 60, range 4-96; usual care: median score 68, range 16-100; P=.04). The DigiDiaS care and usual care groups did not differ in sociodemographic variables, presence of late complications from diabetes or comorbidities, self-management, diabetes distress, or health literacy. Conclusions This study reveals that most patients with type 1 diabetes choose digital outpatient care when it is offered. Our study suggests that those opting for DigiDiaS care are already familiar with using diabetes-related technology, have a shorter diabetes duration, and have lower well-being. It is essential to understand the characteristics of patients who opt for usual care to ensure high-quality health care services. Further studies should also focus on how the implementation of digital solutions in outpatient care can affect how and if patients use them. International Registered Report Identifier (IRRID) RR2-10.2196/52766

• Bechensteen, Brit; Sithiravel, Cindhya; Strøm-Roum, Ellen Marie; Ruud, Heidi Kathrine; Kravdal, Gunnhild & Winther, Jacob Andreas [Vis alle 7 forfattere av denne artikkelen] (2024). Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study. BMC Pregnancy and Childbirth. 24(1). doi: 10.1186/s12884-024-06407-0. Fulltekst i vitenarkiv
• Berge, Kristian; Lyngbakken, Magnus; Einvik, Gunnar; Winther, Jacob Andreas; Brynildsen, Jon & Røysland, Ragnhild [Vis alle 11 forfattere av denne artikkelen] (2018). Diagnostic and prognostic properties of procalcitonin in patients with acute dyspnea: Data from the ACE 2 Study. Clinical Biochemistry. ISSN 0009-9120. 59, s. 62–68. doi: 10.1016/j.clinbiochem.2018.07.006. Fulltekst i vitenarkiv
• Pervez, Mohammad Osman; Winther, Jacob Andreas; Brynildsen, Jon; Strand, Heidi; Christensen, Geir Arve & Høiseth, Arne Didrik [Vis alle 11 forfattere av denne artikkelen] (2018). Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study. Biomarkers. ISSN 1354-750X. s. 1–11. doi: 10.1080/1354750X.2018.1474258. Fulltekst i vitenarkiv
• Winther, Jacob Andreas; Brynildsen, Jon; Høiseth, Arne Didrik; Strand, Heidi; Følling, Ivar & Christensen, Geir Arve [Vis alle 9 forfattere av denne artikkelen] (2017). Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: Data from the ACE 2 study. Respiratory Research. ISSN 1465-9921. 18(184). doi: 10.1186/s12931-017-0665-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Copeptin is a novel biomarker that predicts mortality in lower respiratory tract infections and heart failure (HF), but the diagnostic value of copeptin in acute dyspnea and the prognostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not clear. Method We determined copeptin and NT-proBNP concentrations at hospital admission in 314 patients with acute dyspnea who were categorized by diagnosis. Survival was registered after a median follow-up of 816 days, and the prognostic and diagnostic properties of copeptin and NT-proBNP were analyzed in acute HF (n = 143) and AECOPD (n = 84) separately. Results The median concentration of copeptin at admission was lower in AECOPD compared to acute HF (8.8 [5.2–19.7] vs. 22.2 [10.2–47.9]) pmol/L, p < 0.001), but NT-proBNP discriminated acute HF from non-HF related dyspnea more accurately than copeptin (ROC-AUC 0.85 [0.81–0.89] vs. 0.71 [0.66–0.77], p < 0.0001). Adjusted for basic risk factors, increased copeptin concentrations predicted mortality in AECOPD (HR per log (ln) unit 1.72 [95% CI 1.21–2.45], p = 0.003) and acute HF (1.61 [1.25–2.09], p < 0.001), whereas NT-proBNP concentrations predicted mortality only in acute HF (1.62 [1.27–2.06], p < 0.001). On top of a basic model copeptin reclassified a significant proportion of patients into a more accurate risk strata in AECOPD (NRI 0.60 [0.19–1.02], p = 0.004) and acute HF (0.39 [0.06–0.71], p = 0.020). Conclusion Copeptin is a strong prognostic marker in both AECOPD and acute HF, while NT-proBNP concentrations predict mortality only in patients with acute HF. NT-proBNP levels are superior to copeptin levels to diagnose acute HF in patients with acute dyspnea.

• Winther, Jacob Andreas; Brynildsen, Jon; Høiseth, Arne Didrik; Følling, Ivar; Brekke, Pål Haugar & Christensen, Geir Arve [Vis alle 10 forfattere av denne artikkelen] (2016). Prevalence and prognostic significance of hyponatremia in patients with acute exacerbation of chronic obstructive pulmonary disease: Data from the akershus cardiac examination (ACE) 2 study. PLOS ONE. 11:e0161232(8). doi: 10.1371/journal.pone.0161232. Fulltekst i vitenarkiv Vis sammendrag

  Background Hyponatremia is prevalent and associated with mortality in patients with heart failure (HF). The prevalence and prognostic implications of hyponatremia in acute exacerbation of chronic obstructive pulmonary (AECOPD) have not been established. Method We included 313 unselected patients with acute dyspnea who were categorized by etiology of dyspnea according to established guidelines (derivation cohort). Serum Na+ was determined on hospital admission and corrected for hyperglycemia, and hyponatremia was defined as [Na+]<137 mmol/L. Survival was ascertained after a median follow-up of 816 days and outcome was analyzed in acute HF (n = 143) and AECOPD (n = 83) separately. Results were confirmed in an independent AECOPD validation cohort (n = 99). Results In the derivation cohort, median serum Na+ was lower in AECOPD vs. acute HF (138.5 [135.9–140.5] vs. 139.2 [136.7–141.3] mmol/L, p = 0.02), while prevalence of hyponatremia (27% [22/83] vs. 20% [29/143], p = 0.28) and mortality rate (42% [35/83] vs. 46% [66/143], p = 0.56) were similar. By univariate Cox regression analysis, hyponatremia was associated with increased mortality in acute HF (HR 1.85 [95% CI 1.08, 3.16], p = 0.02), but not in AECOPD (HR 1.00 [0.47, 2.15], p = 1.00). Analogous to the results of the derivation cohort, hyponatremia was prevalent also in the AECOPD validation cohort (25% [25/99]), but not associated with mortality. The diverging effect of hyponatremia on outcome between AECOPD and acute HF was statistically significant (p = 0.04). Conclusion Hyponatremia is prevalent in patients with acute HF and AECOPD, but is associated with mortality in patients with acute HF only.

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• Gundersen, Julia Kristine; Holmøy, Anne Katrin; Eide, Per Kristian & Winther, Jacob Andreas (2025). Arginine vasopressin deficiency after surgical ligation of an unruptured anterior communicating artery aneurysm – a case report and literature review. doi: 10.3389/fendo.2025.1662205. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Plasma osmolality is maintained within a narrow range by secretion of arginine vasopressin (AVP). AVP deficiency (formerly known as central diabetes insipidus) is a rare complication of surgery in the hypothalamic and pituitary region. Case description: A 50-year-old male patient developed postoperative dehydration, polyuria and cognitive impairment following surgical clip ligation of an unruptured anterior communicating artery (ACOM) aneurysm. Endocrine tests revealed moderate hypernatremia, plasma hyperosmolality and urine hypoosmolality. Magnetic resonance imaging of the brain uncovered delayed cerebral infarctions in genu rostrum of corpus callosum and bilateral oedema of fornix anterior columns. All clinical findings supported the diagnosis of central AVP deficiency, likely involving the anterior hypothalamic nuclei. Follow-up 2 months postoperatively confirmed persisting AVP deficiency and cognitive impairment. Conclusion: AVP deficiency without associated haemorrhage is exceedingly rare, with only seven cases identified in our literature review. This case highlights that postoperative AVP deficiency may present with mild or unspecific symptoms. Importantly, concurrent cognitive impairment may occur, further complicating compliance to treatment. Therefore, close postoperative monitoring is crucial for correct diagnosis and bed-side management.

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