Torild Skrivarhaug

• Mattila, Markus; Tapia, German; Størdal, Ketil; Brantsæter, Anne Lise; Virtanen, Suvi M. & Lund-Blix, Nicolai Andre [Vis alle 133 forfattere av denne artikkelen] (2026). Maternal Intake of Vitamins A, C, D, and E During Pregnancy and Risk of Type 1 Diabetes in the Child: The Norwegian Mother, Father, and Child Cohort Study. American Journal of Clinical Nutrition. ISSN 0002-9165. 124(3). doi: 10.1016/j.ajcnut.2026.101431. Fulltekst i vitenarkiv
• Pavithram, Aishwarya; Johansson, Bente Berg; Tjora, Erling; Svalastoga, Pernille; Mohamed, Khadra Aabdi & Koløen, Ingvild [Vis alle 17 forfattere av denne artikkelen] (2026). HNF1B-MODY in the Norwegian MODY Registry and the Norwegian Childhood Diabetes Registry: Clinical Insights and Prevalence Informed by Genetic and Functional Evaluation. International Journal of Molecular Sciences. ISSN 1661-6596. 27(11). doi: 10.3390/ijms27115067. Fulltekst i vitenarkiv
• Haugvik, Severina; Hennekes, Mareille H.C.L.; Wit, Maartje de; Toschi, Elena; Desjardins, Christopher D. & Skrivarhaug, Torild [Vis alle 9 forfattere av denne artikkelen] (2026). Can the Diabetes Eating Problem Survey-Revised (DEPS-R) reliably identify eating disorder diagnosis in women with type 1 diabetes? Diabetic Medicine. ISSN 0742-3071. 43(5). doi: 10.1111/dme.70207. Fulltekst i vitenarkiv Vis sammendrag

  Aims The objective of this study was to evaluate the Diabetes Eating Problems Survey-Revised (DEPS-R) against the Eating Disorder Diagnostic Interview (EDDI). Specific aims were to (1) assess the ability of the DEPS-R to identify Diagnostic and Statistical Manual-5 (DSM-5) eating disorders, including sensitivity and specificity of the current DEPS-R cutoff ≥20 and (2) report the correlation of each item to the presence of any eating disorder. Methods Baseline data from 293 women (14–35 years) with type 1 diabetes (T1D) and body image concerns enrolled in a multinational randomized controlled trial were examined. Receiver operating characteristic (ROC) analysis, univariate logistic regression and two-sample t-test were performed. Results The ROC analysis demonstrated good accuracy of the DEPS-R with an area under the curve (AUC) of 0.82 (95% CI 0.79–0.94). The cutoff of ≥20 yielded a sensitivity of 87.5% (95% CI 83.6%–91.3%) and a specificity of 60.4% (95% CI 54.8%–66.0%). Univariate logistic regression identified 12 items as significantly correlated with the presence of any eating disorder. The highest odds ratios (OR) were observed for items 9 (OR = 3.64), 8 (OR = 2.85), 13 (OR = 2.36), 14 (OR = 2.23), 15 (OR = 1.99) and 5 (OR = 1.99). Conclusions This is the first study to investigate the ability of the DEPS-R to identify DSM-5 eating disorder diagnosis established via a diagnostic interview using a ROC-analysis. DEPS-R cutoff ≥20 correctly identified most cases with eating disorders but showed moderate specificity, considered acceptable as an initial screening tool for disordered eating. In clinical care, specific DEPS-R items may be emphasized to explore the presence of disordered eating behaviours and eating disorders.

• Bakke, Kristin Andersen; Brunborg, Cathrine; Egil, Midtlyng; Helverschou, Aud Sissel Berge & Skrivarhaug, Torild (2025). Comorbidity of Type 1 Diabetes and ADHD: A Longitudinal Cohort Study in Males and Females From the Norwegian Childhood Diabetes Registry. Pediatric Diabetes. ISSN 1399-543X. 2025. doi: 10.1155/pedi/9574797. Fulltekst i vitenarkiv Vis sammendrag

  Aims This study of interactions between attention-deficit hyperactivity disorder (ADHD) and type 1 diabetes has two aims. First, compare the prevalence of prescribed ADHD medications in individuals with type 1 diabetes to the general paediatric population in Norway. Second, study trajectories in mean glycated haemoglobin (HbA1c) in individuals with comorbid ADHD in comparison to individuals with type 1 diabetes only. Methods Part 1 uses data from the Norwegian Prescription Database and register linkage between the Norwegian Childhood Diabetes Registry (NCDR) and the Norwegian Prescribed Drug Registry to obtain yearly prevalence in the general population and NCDR between 2005 and 2019. Part 2 uses data from annual controls in NCDR between 2005 and 2022. Linear mixed-effects models adjusted for age and diabetes duration were used to compare mean HbA1c in 365 individuals (66% males) with comorbid ADHD to 5,888 individuals (54% males) with type 1 diabetes only. Results Part 1: Yearly prevalence (2009–2019) ranged from 0.02 to 0.52 percentage points higher in NCDR than in the general population. The difference was significant only for 2017. Part 2: Mean national HbA1c decreased from 2012 to 2022 but was higher in individuals with comorbid ADHD. This difference was significant from 2016 (67.6 mmol/mol [8.3%] vs. 64.5 mmol/mol [8.1%]) to 2022 (57.5 mmol/mol [7.4%] vs. 54.7 mmol/mol [7.2%]). When grouped by sex, these differences continued to be significant in males (except in 2018), but not in females. Individuals with ADHD were more likely to have experienced at least one episode of diabetic ketoacidosis (odds ratio [OR] = 1.39, 95% confidence interval [CI] [1.04, 1.86]; males: OR = 1.65, 95% CI [1.15, 2.36]; females: OR = 1.10, 95% CI [0.658, 1.83]). Conclusion Mean national HbA1c decreased in Norway during the last decade, but continued to be higher in individuals with comorbid ADHD than in individuals with type 1 diabetes only.

• Haugvik, Severina; Harel, Shiraz; Shaw, Heather; Wit, Maartje de; Toschi, Elena & Hennekes, Mareille H.C.L. [Vis alle 10 forfattere av denne artikkelen] (2025). Diabetes body project eating disorder prevention program—Descriptive content analysis of participant and facilitator feedback in a multinational randomized controlled trial. Diabetic Medicine. ISSN 0742-3071. 42(10). doi: 10.1111/dme.70108. Fulltekst i vitenarkiv Vis sammendrag

  Aims To examine and describe feedback after participation in a novel eating disorder prevention program for young women with type 1 diabetes (Diabetes Body Project) in a multinational randomised controlled trial. Methods Written feedback from participants (N = 109) and facilitators (N = 19) at four sites (Europe and US) was analysed using descriptive, manifest content analysis. Open-ended questions included motivation for participation, most/less valuable aspects of the program and suggestions for improvement. Results “Community” was the most important motivator and most valued aspect, reported by one-third of participants. When asked about less valued aspects of the program, participants and facilitators most frequently reported “none/not sure/everything was valuable” and “nothing” respectively. Suggestions to improve the program common for participants and facilitators were “more creative exercises”, specific for participants after “none” was “limit homework/obligations” and specific for facilitators was “more flexibility to move away from the script”. The three most frequently perceived barriers for participation reported by participants and facilitators were “requiring personal vulnerability”, “time and energy constraints” and the “group setting”. Conclusions Participants and facilitators expressed overall high satisfaction with the program, specifically the value of T1D community. Additionally, they suggested incorporating more creative exercises. Future research should aim at widespread implementation and addressing barriers to participation.

• Hennekes, Mareille H. C. L.; Haugvik, Severina; Wit, Maartje de; Toschi, Elena; Desjardins, Christopher D. & Skrivarhaug, Torild [Vis alle 9 forfattere av denne artikkelen] (2025). Diabetes Body Project: Acute Effects of an Eating Disorder Prevention Program for Young Women With Type 1 Diabetes. A Multinational Randomized Controlled Trial. Diabetes Care. ISSN 0149-5992. 48(2), s. 221–225. doi: 10.2337/dc24-1599. Fulltekst i vitenarkiv
• Hatle, Håvard; Skrivarhaug, Torild; Bjørgaas, Marit Ragnhild Rokne; Åsvold, Bjørn Olav & Rø, Torstein Baade (2024). Prevalence and associations of impaired awareness of hypoglycemia in a pediatric type 1 diabetes population – The Norwegian Childhood Diabetes Registry. Diabetes Research and Clinical Practice. ISSN 0168-8227. 209. doi: 10.1016/j.diabres.2024.111093. Fulltekst i vitenarkiv Vis sammendrag

  Aims To determine the prevalence and associations of impaired awareness of hypoglycemia (IAH) in pediatric type 1 diabetes. Methods Nationwide, population-based cross-sectional study with 51 % participation. Participants (n = 1329; 53 % males) aged 2–19 years (median 13.3) with type 1 diabetes ≥ 6 months (median 4.6 years) self-assessed hypoglycemia awareness with a validated questionnaire (‘Clarke’). Parents responded for children aged < 9 years (n = 235). We estimated associations between IAH and clinical data in the Norwegian Childhood Diabetes Registry. Results The overall prevalence of IAH was 22 %, but gradually decreased from 53 % in preschoolers to 12 % in adolescents aged ≥ 16 years. IAH was associated (adjusted OR; 95 %CI) with episodes of severe hypoglycemia (6.0; 3.04, 11.8) and diabetic ketoacidosis (3.45; 1.37, 8.68) the preceding year, increased fear of hypoglycemia (highest quartile vs. lowest: 2.27; 1.51, 3.40), female sex (1.41; 1.05, 1.90), and HbA1c ≥ 8.5 % (69 mmol/mol) vs. 7.5–8.4 % (58–68 mmol/mol) (1.48; 1.01, 2.18), but not with disease duration, use of insulin pump or continuous glucose monitoring, or HbA1c < 7.5 % (58 mmol/mol). Conclusions IAH is prevalent in pediatric diabetes and more likely reported in young children. IAH is associated with severe hypoglycemia and fear of hypoglycemia, but good metabolic control seems achievable without increased risk of IAH.

• Lund-Blix, Nicolai Andre; Bjerregaard, Anne A.; Tapia, German; Størdal, Ketil; Brantsæter, Anne Lise & Strøm, Marin [Vis alle 14 forfattere av denne artikkelen] (2024). No association between long-chain n-3 fatty acid intake during pregnancy and risk of type 1 diabetes in offspring in two large Scandinavian pregnancy cohorts. Diabetologia. ISSN 0012-186X. 67, s. 1023–1028. doi: 10.1007/s00125-024-06125-4. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims/hypothesis The aim of this study was to investigate whether higher dietary intake of marine n-3 fatty acids during pregnancy is associated with a lower risk of type 1 diabetes in children. Methods The Danish National Birth Cohort (DNBC) and the Norwegian Mother, Father and Child Cohort Study (MoBa) together include 153,843 mother–child pairs with prospectively collected data on eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake during pregnancy from validated food frequency questionnaires. Type 1 diabetes diagnosis in children (n=634) was ascertained from national diabetes registries. Results There was no association between the sum of EPA and DHA intake during pregnancy and risk of type 1 diabetes in offspring (pooled HR per g/day of intake: 1.00, 95% CI 0.88, 1.14), with consistent results for both the MoBa and the DNBC. Robustness analyses gave very similar results. Conclusions/interpretation Initiation of a trial of EPA and DHA during pregnancy to prevent type 1 diabetes in of

• Ruiz, Paz Lopez-Doriga; Tapia, German; Bakken, Inger Johanne Landsjøåsen; Håberg, Siri Eldevik; Gulseth, Hanne Løvdal & Skrivarhaug, Torild [Vis alle 8 forfattere av denne artikkelen] (2024). Parental education and occupation in relation to childhood type 1 diabetes: Nationwide cohort study. Journal of Epidemiology and Community Health. ISSN 0143-005X. 78(5), s. 319–325. doi: 10.1136/jech-2023-220693. Fulltekst i vitenarkiv Vis sammendrag

  Background Socioeconomic status in the risk of developing type 1 diabetes seems inconsistent. We investigated whether risk of childhood-onset type 1 diabetes differed by parental education or occupation in a nationwide cohort. Methods This cohort study included all children born in Norway from 1974 to 2013. In individually linked data from nationwide population registries following children born in Norway up to 15 years of age, we identified 4647 with newly diagnosed type 1 diabetes during 15 381 923 person-years of follow-up. Results Children of mothers with a master’s degree had lower risk of type 1 diabetes than children of mothers with completed upper secondary education only (adjusted incidence rate ratio, aIRR=0.82 95% CI: 0.70 to 0.95). There was no difference between upper secondary and lower secondary maternal education (aIRR=0.98, 95% CI: 0.89 to 1.08). Paternal education was not significantly associated with type 1 diabetes, lower secondary compared with upper secondary aIRR 0.96 (0.88–1.05) and master compared with upper secondary aIRR 0.93 (0.83–1.05). While maternal elementary occupation was associated with a lower risk of type 1 diabetes, specific maternal or paternal occupations were not. Conclusions Our results suggested inverse U-shaped associations between maternal socioeconomic status and risk of type 1 diabetes. Non-linear associations may be part of the reason why previous literature has been inconsistent.

• Zimmermann, Anthony; Lanzinger, Stefanie; Kummernes, Siv Janne; Lund-Blix, Nicolai Andre; Holl, Reinhard W. & Fröhlich-Reiterer, Elke [Vis alle 27 forfattere av denne artikkelen] (2024). Treatment regimens and glycaemic outcomes in more than 100 000 children with type 1 diabetes (2013–22): a longitudinal analysis of data from paediatric diabetes registries. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 13(1), s. 47–56. doi: 10.1016/S2213-8587(24)00279-1. Fulltekst i vitenarkiv
• Wisting, Line; Haugvik, Severina; Wennersberg, Anne Louise; Hage, Trine Wiig; Stice, Eric & Olmsted, Marion P. [Vis alle 11 forfattere av denne artikkelen] (2024). A pilot study of a virtually delivered dissonance-based eating disorder prevention program for young women with type 1 diabetes: within-subject changes over 6-month follow-up. Eating Disorders. ISSN 1064-0266. doi: 10.1080/10640266.2024.2331391. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. Methods: Young women with T1D aged 16–35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. Results: Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen’s ds ranged from .34 to 1.70). Conclusion: The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.

• Bratke, Heiko Holger Karl-Ernst; Biringer, Eva Aaker; Ushakova, Anastasia; MARGEIRSDOTTIR, HANNA DIS; Kummernes, Siv Janne & Njølstad, Pål Rasmus [Vis alle 7 forfattere av denne artikkelen] (2024). Ten Years of Improving Glycemic Control in Pediatric Diabetes Care: Data From the Norwegian Childhood Diabetes Registry. Diabetes Care. ISSN 0149-5992. 47(7), s. 1122–1130. doi: 10.2337/dc24-0086. Fulltekst i vitenarkiv
• Svalastoga, Pernille; Kaci, Alba; Molnes, Janne; Solheim, Marie Holm; Johansson, Bente Berg & Krogvold, Lars [Vis alle 16 forfattere av denne artikkelen] (2023). Characterisation of HNF1A variants in paediatric diabetes in Norway using functional and clinical investigations to unmask phenotype and monogenic diabetes. Diabetologia. ISSN 0012-186X. 66, s. 2226–2237. doi: 10.1007/s00125-023-06012-4. Fulltekst i vitenarkiv Vis sammendrag

  Aims/hypothesis Correctly diagnosing MODY is important, as individuals with this diagnosis can discontinue insulin injections; however, many people are misdiagnosed. We aimed to develop a robust approach for determining the pathogenicity of variants of uncertain significance in hepatocyte nuclear factor-1 alpha (HNF1A)-MODY and to obtain an accurate estimate of the prevalence of HNF1A-MODY in paediatric cases of diabetes. Methods We extended our previous screening of the Norwegian Childhood Diabetes Registry by 830 additional samples and comprehensively genotyped HNF1A variants in autoantibody-negative participants using next-generation sequencing. Carriers of pathogenic variants were treated by local healthcare providers, and participants with novel likely pathogenic variants and variants of uncertain significance were enrolled in an investigator-initiated, non-randomised, open-label pilot study (ClinicalTrials.gov registration no. NCT04239586). To identify variants associated with HNF1A-MODY, we functionally characterised their pathogenicity and assessed the carriers’ phenotype and treatment response to sulfonylurea. Results In total, 615 autoantibody-negative participants among 4712 cases of paediatric diabetes underwent genetic sequencing, revealing 19 with HNF1A variants. We identified nine carriers with novel variants classified as variants of uncertain significance or likely to be pathogenic, while the remaining ten participants carried five pathogenic variants previously reported. Of the nine carriers with novel variants, six responded favourably to sulfonylurea. Functional investigations revealed their variants to be dysfunctional and demonstrated a correlation with the resulting phenotype, providing evidence for reclassifying these variants as pathogenic. Conclusions/interpretation Based on this robust classification, we estimate that the prevalence of HNF1A-MODY is 0.3% in paediatric diabetes. Clinical phenotyping is challenging and functional investigations provide a strong complementary line of evidence. We demonstrate here that combining clinical phenotyping with functional protein studies provides a powerful tool to obtain a precise diagnosis of HNF1A-MODY.

• Hodnekvam, Kristin; Iversen, Hilde H.; Gani, Osman; Brunborg, Cathrine & Skrivarhaug, Torild (2023). Do adolescents and emerging adults receive the diabetes care they truly need? A nationwide study of the quality of diabetes health care during the transition from paediatric to adult care. Diabetic Medicine. ISSN 0742-3071. 40(7). doi: 10.1111/dme.15091. Fulltekst i vitenarkiv
• Bratke, Heiko; Biringer, Eva; Margeirsdottir, Hanna Dis; Njølstad, Pål Rasmus & Skrivarhaug, Torild (2022). Relation of health-related quality of life with glycemic control and use of diabetes technology in children and adolescents with type 1 diabetes: Results from a national population based study. Journal of Diabetes Research. ISSN 2314-6745. 2022:8401328, s. 1–14. doi: 10.1155/2022/8401328. Fulltekst i vitenarkiv Vis sammendrag

  Objective: The primary aim was to analyse the association between diabetes-specific health-related quality of life (HRQOL) and HbA1c in children and adolescents with type 1 diabetes. The secondary aims were to evaluate the associations between diabetes-specific HRQOL and age, sex, diabetes duration, and the use of diabetes technology in diabetes treatment. Research Design and Methods: Children with type 1 diabetes (10-17 years, N =1,019) and parents (children <10 years, N =371; 10-17 years, N =1,070) completed the DISABKIDS diabetes-specific questionnaire (DDM-10) as part of the 2017 data collection for the Norwegian Childhood Diabetes Registry. The DDM-10 consists of two subscales—‘impact’ and ‘treatment’—with six and four items, respectively. In the linear regression models, the items and subscales were outcome variables, while HbA1c, age, sex, diabetes duration, insulin pump use, and continuous glucose monitoring (CGM) system use were predictor variables. Results: Lower HbA1c measurements and male sex were associated with higher HRQOL scores on both DDM-10 scales in the age group 10-17 years, but not in children under 10 years. Parents gave lower HRQOL scores than children in the 10-17 age group. Insulin pump and CGM use were not significantly associated with HRQOL on the impact and treatment scale. Conclusions: Low HbA1c and male sex are significantly associated with high HRQOL in children aged 10-17 with type 1 diabetes, but the use of diabetes technology is not positively associated with HRQOL. Differences in child- and parent-reported scores imply that parents might both over- and underestimate their child’s HRQOL.

• Lanzinger, Stefanie; Zimmermann, Anthony; Ranjan, Ajenthen G.; Gani, A B S M Osman; Perez, Saira Pons & Akesson, Karin [Vis alle 21 forfattere av denne artikkelen] (2022). A collaborative comparison of international pediatric diabetes registries. Pediatric Diabetes. ISSN 1399-543X. 23(6), s. 627–640. doi: 10.1111/pedi.13362. Fulltekst i vitenarkiv Vis sammendrag

  Background An estimated 1.1 million children and adolescents aged under 20 years have type 1 diabetes worldwide. Principal investigators from seven well-established longitudinal pediatric diabetes registries and the SWEET initiative have come together to provide an international collaborative perspective and comparison of the registries. Work Flow Information and data including registry characteristics, pediatric participant clinical characteristics, data availability and data completeness from the Australasian Diabetes Data Network (ADDN), Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids), Diabetes prospective follow-up registry (DPV), Norwegian Childhood Diabetes Registry (NCDR), National Paediatric Diabetes Audit (NPDA), Swedish Childhood Diabetes Registry (Swediabkids), T1D Exchange Quality Improvement Collaborative (T1DX-QI), and the SWEET initiative was extracted up until 31 December 2020. Registry Objectives and Outcomes The seven diabetes registries and the SWEET initiative collectively show data of more than 900 centers and around 100,000 pediatric patients, the majority with type 1 diabetes. All share the common objectives of monitoring treatment and longitudinal outcomes, promoting quality improvement and equality in diabetes care and enabling clinical research. All generate regular benchmark reports. Main differences were observed in the definition of the pediatric population, the inclusion of adults, documentation of CGM metrics and collection of raw data files as well as linkage to other data sources. The open benchmarking and access to regularly updated data may prove to be the most important contribution from registries. This study describes aspects of the registries to enable future collaborations and to encourage the development of new registries where they do not exist.

• Svensson, J.; Ibfelt, E.H.; Carstensen, B.; Neu, A.; Cinek, O. & Skrivarhaug, Torild [Vis alle 20 forfattere av denne artikkelen] (2022). Age-period-cohort modelling of type 1 diabetes incidence rates among children included in the EURODIAB 25-year follow-up study. Acta Diabetologica. ISSN 0940-5429. 60, s. 73–82. doi: 10.1007/s00592-022-01977-x. Fulltekst i vitenarkiv
• Birkebaek, Niels H; Kamrath, Clemens; Grimsmann, Julia M; Aakesson, Karin; Cherubini, Valentino & Dovc, Klemen [Vis alle 26 forfattere av denne artikkelen] (2022). Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 10(11), s. 786–794. doi: 10.1016/S2213-8587(22)00246-7. Fulltekst i vitenarkiv
• Saeed, Maryam; Stene, Lars Christian Mørch; Ariansen, Inger Kristine Holtermann; Tell, Grethe S.; Tapia, German & Joner, Geir [Vis alle 7 forfattere av denne artikkelen] (2022). Nine-fold higher risk of acute myocardial infarction in subjects with type 1 diabetes compared to controls in Norway 1973–2017. Cardiovascular Diabetology. 21, s. 1–8. doi: 10.1186/s12933-022-01498-5. Fulltekst i vitenarkiv Vis sammendrag

  Background We aimed to study the cumulative incidence and risk factors (sex, age, calendar year of diabetes onset, country of origin and educational level) of acute myocardial infarction (AMI) in subjects with type 1 diabetes and matched controls. Methods A nationwide cohort of subjects with type 1 diabetes diagnosed at age < 15 years in Norway during 1973–2000 was followed until the first AMI event, emigration, death or 31st of December 2017. The Norwegian Childhood Diabetes Registry was linked to five nationwide registries, and up to ten sex- and age-matched controls per case were included. Results Among 7086 subjects with type 1 diabetes, 170 (2.4%) were identified with incident AMI, compared to 193 (0.3%) of 69,356 controls. Mean age and diabetes duration at first AMI was 40.8 years and 30.6 years, respectively. The probability of AMI after 40 years of follow-up was 8.0% in subjects with type 1 diabetes and 1.1% in controls, aHR 9.05 (95% CI 7.18–11.41). In type 1 diabetes, male sex (aHR 1.45), higher age at onset of diabetes and lower education (higher compared to lower, aHR 0.38) were significantly associated with higher risk of AMI. There was no significant time trend in AMI by calendar year of diabetes onset. Conclusions We found nine-fold excess risk of AMI in subjects with type 1 diabetes, and three-fold higher risk in subjects with low versus high education. These results highlight a strengthened focus on prevention of cardiovascular disease, and diabetes education tailored to the subjects’ educational background.

• Saeed, Maryam; Stene, Lars Christian Mørch; Reisæter, Anna Varberg; Jenssen, Trond Geir; Tell, Grethe S. & Tapia, German [Vis alle 8 forfattere av denne artikkelen] (2022). End-stage renal disease: incidence and prediction by coronary heart disease, and educational level. Follow-up from diagnosis of childhood-onset type 1 diabetes throughout Norway 1973–2017. Annals of Epidemiology. ISSN 1047-2797. 76, s. 181–187. doi: 10.1016/j.annepidem.2022.03.015. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To investigate incidence of end-stage renal disease (ESRD), and the association of education and coronary heart disease (CHD) with ESRD, in subjects throughout Norway followed from the diagnosis of childhood-onset type 1 diabetes. Methods All new onset cases of type 1 diabetes 1973–2016 were followed for CHD and ESRD in nation-wide registries through 2017. Ten matched controls per case were selected from the National Population Register. Cox regression was used to estimate hazard ratios, and probabilities were estimated by the cumulative incidence function accounting for competing risk. Results Among 9311 patients with type 1 diabetes, 130 developed ESRD with a probability of ESRD after 40 years of 5.5%. The rate was 35-fold higher than in controls (aHR = 35.5, 95% CI 23.1 – 54.6). Higher education was associated with lower risk of ESRD compared to low education (aHR = 0.14, 95% CI 0.07 – 0.27). Diagnosed CHD was associated with 14-fold increased rate of ESRD (aHR = 14.3, 95% CI 9.2 – 22.2). Conclusions The hazard rate of ESRD was 35-fold higher in cases compared to controls. CHD was associated with a 14-fold increased rate of subsequent ESRD, while higher education was associated with substantially lower rate of ESRD.

• Wisting, Line Norøm; Haugvik, Severina; Wennersberg, Anne Louise; Stice, Eric; Hage, Trine Wiig & Olmsted, Marion P. [Vis alle 11 forfattere av denne artikkelen] (2021). Feasibility of a virtually delivered eating disorder preventionprogram for young females with type 1 diabetes. International Journal of Eating Disorders. ISSN 0276-3478. s. 1–11. doi: 10.1002/eat.23578. Fulltekst i vitenarkiv Vis sammendrag

  Objective This study aimed to develop a virtual diabetes-specific version of the eating disorder (ED) prevention program the Body Project, and to assess feasibility and preliminary efficacy of this program for young females with type 1 diabetes. Method Young females with type 1 diabetes aged 16–35 years were invited to participate in the study. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks) and completed pretest assessments; 26 participants completed all sessions and posttest assessments (<7 days after last meeting). Primary measures included ED risk factors and symptoms, and secondary outcomes included diabetes-specific constructs previously found to be associated with ED psychopathology (e.g., diabetes distress and illness perceptions). Results The ease of recruitment, timely conduct of five groups, moderate drop-out rate and appreciation of the intervention by participants indicated that the Diabetes Body Project is feasible. Meaningful reductions occurred on the primary outcomes (i.e., ED psychopathology, body dissatisfaction, and thin ideal internalization) and on internalization of appearance ideals and appearance pressures at posttest (Cohen's d ranging from .63 to .83, which are medium to large effects). Small to medium effect sizes were found for diabetes illness perceptions and distress (.41 and .48, respectively). Discussion The virtual Diabetes Body Project is a promising and much-needed intervention, worthy of more rigorous evaluation. A randomized controlled trial is warranted to determine its effectiveness compared with a control condition.

• Saeed, Maryam; Tapia, German; Ariansen, Inger Kristine Holtermann; Stene, Lars Christian Mørch; Seljeflot, Ingebjørg & Tell, Grethe Seppola [Vis alle 8 forfattere av denne artikkelen] (2021). Serum galectin-3 and subsequent risk of coronary heart disease in subjects with childhood-onset type 1 diabetes: A cohort study. Diabetes Care. ISSN 0149-5992. 44(3), s. 810–816. doi: 10.2337/dc20-1712. Fulltekst i vitenarkiv
• Tapia, German; Suvitaival, Tommi; Ahonen, Linda; Lund-Blix, Nicolai Andre; Njølstad, Pål Rasmus & Joner, Geir [Vis alle 10 forfattere av denne artikkelen] (2021). Prediction of type 1 diabetes at birth: Cord blood metabolites vs genetic risk score in the Norwegian mother, father, and child cohort. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 106(10), s. E4062–E4071. doi: 10.1210/clinem/dgab400. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim: Genetic markers are established as predictive of type 1 diabetes, but unknown early life environment is believed to be involved. Umbilical cord blood may reflect perinatal metabolism and exposures. We studied whether selected polar metabolites in cord blood contribute to prediction of type 1 diabetes. Methods: Using a targeted UHPLC-QQQ-MS platform, we quantified 27 low-molecular-weight metabolites (including amino acids, small organic acids, and bile acids) in 166 children, who later developed type 1 diabetes, and 177 random control children in the Norwegian Mother, Father, and Child cohort. We analyzed the data using logistic regression (estimating odds ratios per SD [adjusted odds ratio (aOR)]), area under the receiver operating characteristic curve (AUC), and k-means clustering. Metabolites were compared to a genetic risk score based on 51 established non-HLA single-nucleotide polymorphisms, and a 4-category HLA risk group. Results: The strongest associations for metabolites were aminoadipic acid (aOR = 1.23; 95% CI, 0.97-1.55), indoxyl sulfate (aOR = 1.15; 95% CI, 0.87-1.51), and tryptophan (aOR = 0.84; 95% CI, 0.65-1.10), with other aORs close to 1.0, and none significantly associated with type 1 diabetes. K-means clustering identified 6 clusters, none of which were associated with type 1 diabetes. Cross-validated AUC showed no predictive value of metabolites (AUC 0.49), whereas the non-HLA genetic risk score AUC was 0.56 and the HLA risk group AUC was 0.78. Conclusions: In this large study, we found no support of a predictive role of cord blood concentrations of selected bile acids and other small polar metabolites in the development of type 1 diabetes.

• Bratke, Heiko; Margeirsdottir, Hanna D.; Assmus, Jörg; Njølstad, Pål Rasmus & Skrivarhaug, Torild (2021). Does Current Diabetes Technology Improve Metabolic Control? A Cross-Sectional Study on the Use of Insulin Pumps and Continuous Glucose Monitoring Devices in a Nationwide Pediatric Population. Diabetes Therapy. 12, s. 2571–2583. doi: 10.1007/s13300-021-01127-6. Fulltekst i vitenarkiv Vis sammendrag

  Objective To examine the use of multiple daily injections (MDI), insulin pumps, self-measured blood glucose (SMBG), and continuous glucose monitoring (CGM) systems, and their association with glycated hemoglobin (HbA1c), diabetic ketoacidosis (DKA), and severe hypoglycemia. Methods In a pediatric population-based nationwide cross-sectional study, we analyzed data from 2623 participants up to 18 years of age with type 1 diabetes, using 2017 annual data from the Norwegian Childhood Diabetes Registry. HbA1c was adjusted for age, gender, and diabetes duration. Using a linear mixed-effects model, we assessed HbA1c and the incidence of DKA and severe hypoglycemia according to the use of MDI, insulin pumps, SMBG, and CGM. Results We observed that 74.7% of participants were using an insulin pump and 52.6% were using a CGM system. Mean HbA1c was 7.8% (62 mmol/mol). The HbA1c of pump users was 0.14 percentage points (pp) higher than that of MDI users. Fewer pump users than MDI users achieved an HbA1c of < 7.5% (38.3 vs. 41.6%). CGM users had a 0.18 pp lower HbA1c than SMBG users, with 40.5 and 38.0%, respectively, achieving an HbA1c of < 7.5%. The incidence of severe hypoglycemia or hospitalization due to DKA was not different in pump and CGM users compared with nonusers. Compared with other insulin pumps, patch pump use was associated with a significantly lower odds ratio for DKA. Conclusions Despite the broad use of diabetes technology, as many as 61% of our pediatric cohort did not reach the HbA1c target recommended by the International Society for Pediatric and Adolescent Diabetes (ISPAD). Lower HbA1c was associated with CGM use but not with insulin pump use. Acute complications were not less frequent in the groups using insulin pumps or CGM compared with those using MDI and SMBG. Further research is required to explore the lower incidence of DKA among patch pump users.

• Lund-Blix, Nicolai Andre; Tapia, German; Mårild, Karl Staffan; Brantsæter, Anne Lise; Njølstad, Pål Rasmus & Joner, Geir [Vis alle 9 forfattere av denne artikkelen] (2020). Maternal and child gluten intake and association with type 1 diabetes: The Norwegian Mother and Child Cohort Study. PLoS Medicine. ISSN 1549-1277. 17(3), s. 1–15. doi: 10.1371/journal.pmed.1003032. Fulltekst i vitenarkiv Vis sammendrag

  Background The relationship between maternal gluten intake in pregnancy, offspring intake in childhood, and offspring risk of type 1 diabetes has not been examined jointly in any studies. Our aim was to study the relationship between maternal and child intake of gluten and risk of type 1 diabetes in children. Methods and findings We included 86,306 children in an observational nationwide cohort study, the Norwegian Mother and Child Cohort Study (MoBa), with recruitment from 1999 to 2008 and with follow-up time to April 15, 2018. We used registration of type 1 diabetes in the Norwegian childhood diabetes registry as the outcome. We used Cox proportional hazard regression to estimate hazard ratios (HRs) for the mother’s intake of gluten up to week 22 of pregnancy and offspring gluten intake when the child was 18 months old. The average time followed was 12.3 years (0.70–16.0). A total of 346 children (0.4%) children were diagnosed with type 1 diabetes, resulting in an incidence rate of 32.6/100,000 person-years. Mean gluten intake per day was 13.6 g for mothers and 8.8 g for children. There was no association between the mother’s intake of gluten in pregnancy and offspring type 1 diabetes, with an adjusted HR (aHR) of 1.02 (95% confidence interval [CI] 0.73–1.43, p = 0.91) for each 10-g-per-day increment. There was an association between offspring intake of gluten and a higher risk of type 1 diabetes, with an aHR of 1.46 (95% CI 1.06–2.01, p = 0.02) for each 10-g-per-day increment. Among the limitations are the likely imprecision in estimation of gluten intake and that we only had information regarding gluten intake at 2 time points in early life. Conclusions Our results show that, while the mother’s intake of gluten in pregnancy was not associated with type 1 diabetes, a higher intake of gluten by the child at an early age may give a higher risk of type 1 diabetes.

• Cherubini, Valentino; Grimsmann, Julia M.; Åkesson, Karin; Birkebæk, Niels H.; Cinek, Ondrej & Dovč, Klemen [Vis alle 24 forfattere av denne artikkelen] (2020). Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. ISSN 0012-186X. 63(8), s. 1530–1541. doi: 10.1007/s00125-020-05152-1. Fulltekst i vitenarkiv Vis sammendrag

  Aims/hypothesis The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. Methods An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status. Results During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0 years [5.5–11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia. Conclusions/interpretation DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups.

• Wisting, Line Norøm; Siegwarth, Cecilie; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2020). The impact of psychological aspects, age, and BMI on eating disorder psychopathology among adult males and females with type 1 diabetes. Health Psychology Open (HPO). 7(2). doi: 10.1177/2055102920975969. Fulltekst i vitenarkiv Vis sammendrag

  This study investigated correlates of eating disorder (ED) psychopathology among adults with type 1 diabetes (T1D). A total of 282 males (n = 112) and females (n = 170) with T1D (18–79 years) participated. Overall, psychological aspects (i.e. illness perceptions, coping strategies, insulin beliefs, anxiety, and depression) were associated with ED psychopathology. Associations were generally stronger among females than males. In a regression model, age, BMI, personal control, and anxiety explained 51% of the variance in ED psychopathology among females, whereas BMI, personal control, and anxiety explained 47% of the variance among males. Greater clinical awareness of health psychological aspects may contribute to reduce the risk of developing ED.

• Svensson, Jannet; Sildorf, Stine Møller; Bøjstrup, Julie; Kreiner, Svend; Skrivarhaug, Torild & Hanberger, Lena [Vis alle 10 forfattere av denne artikkelen] (2020). The DISABKIDS generic and diabetes-specific modules are valid but not directly comparable between Denmark, Sweden, and Norway. Pediatric Diabetes. ISSN 1399-543X. 21(5), s. 900–908. doi: 10.1111/pedi.13036. Fulltekst i vitenarkiv Vis sammendrag

  Background: Type 1 Diabetes (T1D) has a negative impact on psychological and overall well-being. Screening for Health-related Quality of Life (HrQoL) and addressing HrQoL issues in the clinic leads to improved well-being and metabolic outcomes. The aim of this study was to translate the generic and diabetes-specific validated multinational DISABKIDS® questionnaires into Danish, and then determine their validity and reliability. Methods: The questionnaires were translated using a validated translation procedure and completed by 99 children and adolescents from our diabetes-department; all diagnosed with T1D and were aged between 8 and 18 years old. The Rasch and the graphical log linear Rasch model (GLLRM) were used to determine validity. Monte Carlo methods and Cronbach's α were used to confirm reliability. Results: The data did not fit a pure Rasch model but did fit a GLLRM when item six in the independence scale is excluded. The six subscales measure different aspects of HrQoL indicating that all the subscales are necessary. The questionnaire shows local dependency between items and differential item functioning (DIF). Therefore age, gender, and glycated hemoglobin (HbA1c) levels must be taken into account when comparing HrQoL between groups. Conclusions: The Danish versions of the DISABKIDS® chronic-generic and diabetes-specific modules provide valid and objective measurements with adequate reliability. These Danish versions are useful tools for evaluating HrQoL in Danish patients with T1D. However, guidelines on how to manage DIF and local independence will be required, and item six should be rephrased. Keywords: Adolescents; Children; Chronic condition; DISABKIDS; Diabetes type 1; HrQoL; Rasch.

• Anderzén, Johan; Hermann, Julia M.; Samuelsson, Ulf; Charalampopoulos, Dimitrios; Svensson, Jannet & Skrivarhaug, Torild [Vis alle 27 forfattere av denne artikkelen] (2020). International benchmarking in type 1 diabetes: Large difference in childhood HbA1c between eight high-income countries but similar rise during adolescence—A quality registry study. Pediatric Diabetes. ISSN 1399-543X. 21(4), s. 621–627. doi: 10.1111/pedi.13014. Fulltekst i vitenarkiv
• Hodnekvam, Kristin; Iversen, Hilde Karin Hestad; Brunborg, Cathrine & Skrivarhaug, Torild (2020). Development and validation of a questionnaire to assess young patients' experiences with diabetes care and transition. Acta Paediatrica. ISSN 0803-5253. 109(10), s. 2057–2066. doi: 10.1111/apa.15205. Fulltekst i vitenarkiv Vis sammendrag

  To describe the development and validation of a questionnaire in a national Norwegian population-based cohort study designed to assess the experiences of young people with type 1 diabetes who had made the transition from paediatric to adult diabetes care. The questionnaire was developed by the authors based on literature searches, focus group interviews, discussions with experts and cognitive interviews. We included 776 individuals with type 1 diabetes who were last registered in the Norwegian Childhood Diabetes Registry between 2009-2012 and had been receiving adult health care for at least two years. The data quality was analysed, factor analysis were performed and the internal reliability, test-retest reliability and construct validity were determined. The response rate was 321 patients (41.4%); 57.6% were female, and the average age at recruitment was 22.9 ± 1.2 years. Seven factors were identified. Satisfactory evidence was provided for the internal consistency, reliability and construct validity of the questionnaire. All scales met the criterion of Cronbach's alpha above 0.4. The test-retest correlations ranged from 0.64-0.92. The thorough validation of the questionnaire proved satisfactory and indicated that it may be of value for further studies measuring patients' experiences with diabetes care and transition.

• Wisting, Line Norøm; Rø, Astrid Valborg; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2019). Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control. Journal of Health Psychology. ISSN 1359-1053. s. 1–13. doi: 10.1177/1359105319840688. Fulltekst i vitenarkiv Vis sammendrag

  This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes (n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females (β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c (β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.

• Tapia, German; Mortimer, Georgina; Ye, Jody; Gillard, Benjamin Thomas; Chipper-Keating, Saranna & Mårild, Karl Staffan [Vis alle 14 forfattere av denne artikkelen] (2019). Maternal microchimerism in cord blood and risk of childhood-onset type 1 diabetes. Pediatric Diabetes. ISSN 1399-543X. 20(6), s. 728–735. doi: 10.1111/pedi.12875. Fulltekst i vitenarkiv Vis sammendrag

  Background: Maternal microchimerism (MMc), the transmission of small quantities of maternal cells to the fetus, is relatively common and persistent. MMc has been detected with increased frequency in the circulation and pancreas of type 1 diabetes (T1D) patients. We investigated for the first time whether MMc levels at birth predict future T1D risk. We also tested whether cord blood MMc predicted MMc in samples taken at T1D diagnosis. Methods: Participants in the Norwegian Mother and Child Cohort study were human leukocyte antigen (HLA) class II typed to determine non‐inherited, non‐shared maternal alleles (NIMA). Droplet digital (dd) polymerase chain reaction (PCR) assays specific for common HLA class II NIMA (HLADQB1*03:01, *04:02, and *06:02/03) were developed and validated. MMc was estimated as maternal DNA quantity in the fetal circulation, by NIMA specific ddPCR, measured in cord blood DNA from 71 children who later developed T1D and 126 controls within the cohort. Results: We found detectable quantities of MMc in 34/71 future T1D cases (48%) and 53/126 controls (42%) (adjusted odds ratio [aOR] 1.27, 95% confidence interval (CI) 0.68‐2.36), and no significant difference in ranks of MMc quantities between cases and controls (Mann‐Whitney P = .46). There was a possible association in the NIMA HLA‐DQB1*03:01subgroup with later T1D (aOR 3.89, 95%CI 1.05‐14.4). MMc in cord blood was not significantly associated with MMc at T1D diagnosis. Conclusions: Our findings did not support the hypothesis that the degree of MMc in cord blood predict T1D risk. The potential subgroup association with T1D risk should be replicated in a larger cohort.

• Samuelsson, Ulf; Westerberg, Lars; Aakesson, Karin; Birkebæk, Niels H.; Bjarnason, Ragnar & Drivvoll, Ann Kristin [Vis alle 10 forfattere av denne artikkelen] (2019). Geographical variation in the incidence of type 1 diabetes in the Nordic countries: A study within NordicDiabKids. Pediatric Diabetes. ISSN 1399-543X. 21(2), s. 259–265. doi: 10.1111/pedi.12943. Fulltekst i vitenarkiv Vis sammendrag

  Background The incidence of type 1 diabetes (T1D) is high in the Nordic countries with geographic differences between as well as within countries. Objective To describe the geographical distribution of the incidence of T1D among children in four Nordic countries, an area where the population is considered genetically similar. Methods Data on children 0 to 14 years of age and diagnosed with T1D 2006 to 2011 was collected from four Nordic national pediatric quality diabetes registries. Data included year of diagnosis (2006‐2011), sex, and age at diagnosis. Figures for number of children at risk during 2006 to 2011—as well as total population, proportion with foreign background and size of populated areas of geographic regions—were collected from official statistics. Results The total incidence during the study period for all four countries was 35.7/100 000 person years but differed between the countries (range 18.2‐44.1; P  < .001). The incidence difference between the countries was most obvious in the highest age group, 10 to 14 years of age, whereas there was no difference in the youngest age group 0 to 5 years of age. Iceland had similar incidence in the entire country, whereas the other countries had areas with different incidence. Densely populated areas, such as major cities, had the lowest incidence. Conclusion The incidence of T1D differed between the Nordic countries and also between the neighboring countries and generally decreased with population density. This indicates that environmental factors may contribute to the level of incidence of T1D.

• Hatle, Håvard; Bjørgaas, Marit Ragnhild Rokne; Skrivarhaug, Torild; Åsvold, Bjørn Olav; Graveling, Alex & Frier, Brian [Vis alle 7 forfattere av denne artikkelen] (2019). Assessing awareness of hypoglycemia in children and adolescents with type 1 diabetes: Evaluation of established questionnaires. Pediatric Diabetes. ISSN 1399-543X. s. 1–10. doi: 10.1111/pedi.12951. Fulltekst i vitenarkiv Vis sammendrag

  Objective To evaluate the use of two questionnaires assessing awareness of hypoglycemia, in a pediatric type 1 diabetes (T1D) population. Methods Prospective observational study with children (aged 9‐18 years) and parents (for children aged 2‐11 years) answering the Gold and Clarke questionnaires assessing awareness of hypoglycemia. Psychometric properties of the questionnaires were evaluated, and the most appropriate cut‐off score to classify participants as having normal vs impaired awareness of hypoglycemia (IAH) was determined by ability to recognize subsequent hypoglycemia and hypoglycemia severity, documented in a 4‐week blood glucose diary. Questionnaires were readministered at follow‐up assessment approximately 1.5 years later. Results In total, 112 participants (51% male) with median (IQR) age 13.7 (11.1‐15.8) years, T1D duration 4.7 (2.2‐7.8) years, and HbA1c 62 (57‐73) mmol/mol (7.8%) were included. Both questionnaires demonstrated acceptable psychometric properties. Using score ≥3 to classify IAH gave a prevalence of IAH of 41% (Gold) and 22% (Clarke). When classified using the Gold questionnaire, IAH participants had higher incidences of mild asymptomatic hypoglycemia, whereas with the Clarke questionnaire, they had higher incidences of clinically significant and severe hypoglycemia. Subgroup analyses confirmed these associations only in participants aged ≥9 years. Follow‐up was completed in 90% of the participants, and a change of awareness status was observed in 22% to 36%. Conclusions The Gold and Clarke questionnaires may be used to assess awareness of hypoglycemia in pediatric T1D in those ≥9 years of age, but the more detailed Clarke questionnaire has higher specificity and is superior in predicting risk of clinically significant hypoglycemia.

• Wisting, Line Norøm; Wonderlich, Joseph; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2019). Psychometric properties and factor structure of the diabetes eating problem survey - revised (DEPS-R) among adult males and females with type 1 diabetes. Journal of Eating Disorders. 7:2, s. 1–7. doi: 10.1186/s40337-018-0232-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Although an increasing amount of research has now established good psychometric properties and a three-component factor structure of the Diabetes Eating Problem Survey – Revised (DEPS-R) in pediatric samples with type 1 diabetes (T1D), research using adult samples has been limited and divergent. This study therefore aimed to investigate psychometric properties and test a three-factor model of the DEPS-R among adults with T1D. Methods A total of 282 adults with T1D aged 18–79 years participated in the study. Measures included the DEPS-R, the Eating Disorder Examination Questionnaire (EDE-Q), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. Results The DEPS-R total mean score (SD) for the total sample, males, and females were 13.8 (9.2), 11.2 (7.8), and 15.6 (9.6) respectively. Good fit indices for the confirmatory factor analysis were found. The Cronbach’s alpha of the DEPS-R was .84, suggesting good internal consistency. The DEPS-R correlated significantly with the EDE-Q among both males (.52, p < .01) and females (.68, p < .001). Also, the DEPS-R correlated significantly with BMI in both genders (.33, p < .001 in females and .35, p < .001 in males). HbA1c correlated significantly with the DEPS-R in females (.27, p < .01), but not in males. Conclusions Good fit for a three-factor structure of the DEPS-R was confirmed. Further, the DEPS-R demonstrated good psychometric properties among adults with T1D, and can be recommended for clinical use for this patient group.

• Iversen, Hilde Karin Hestad; Bjertnæs, Øyvind Andresen & Skrivarhaug, Torild (2019). Associations between adolescent experiences, parent experiences and HbA1c: results following two surveys based on the Norwegian Childhood Diabetes Registry (NCDR). BMJ Open. 9(11), s. 1–8. doi: 10.1136/bmjopen-2019-032201. Fulltekst i vitenarkiv Vis sammendrag

  The aim of the current study was to determine the association between the experiences of adolescents and their parents with paediatric diabetes care at hospital outpatient departments and the association between these experiences and the Hemoglobin A1c (HbA1c) levels of adolescents.Cross-sectional survey.Paediatric diabetes care at hospital outpatient departments in Norway.Parents of all outpatients registered in the Norwegian Childhood Diabetes Registry and patients in the same registry aged 12–17 years.1399 parents participated in a national pilot survey and 335 patients aged 12–17 years from the four largest paediatric outpatient departments in Norway responded in another pilot study. 181 paired parental and patient questionnaires were analysed.Main outcome measuresThe correlations between single items, indicator scores and overall scores were explored, as was that between indicator scores and HbA1c levels.There was a moderate but significant correlation between the responses of the patients and parents. For 40 of the 42 associations the correlations were significant, ranging from 0.16 to 0.42. A weak but significant negative correlation was found between the indicator scores of parents and the HbA1c levels of the adolescents. The strongest correlations were between HbA1c level and nurse contact and organisation, both with a correlation coefficient of 0.21 (p&lt;0.01). There was no significant correlation between HbA1c level and patient indicator scores.These results highlight the need to obtain information from both parents and adolescents, and indicate that the views of adolescents are not always mirrored by their parents. Three of the seven parent experience indicators were significantly related to the HbA1c levels of adolescents, but replication in future research with larger sample sizes is warranted.

• Iversen, Hilde Karin Hestad; Bjertnæs, Øyvind Andresen; Helland, Ylva & Skrivarhaug, Torild (2019). The Adolescent Patient Experiences of Diabetes Care Questionnaire (APEQ-DC): Reliability and Validity in a Study Based on Data from the Norwegian Childhood Diabetes Registry. Patient Related Outcome Measures. 10, s. 405–416. doi: 10.2147/PROM.S232166. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Patient-reported experiences are a key source of information on quality in health care. Most patient experience surveys only include adults’ assessments including parent or proxy surveys in child health care settings. The aim of this study was to determine the psychometric properties of the Adolescent Patient Experiences of Diabetes Care Questionnaire, a new instrument developed to measure adolescent experiences of paediatric diabetes care at hospital outpatient departments in Norway. Patients and Methods: The questionnaire was developed based on a literature review, qualitative interviews with adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The pilot study involved adolescents aged 12–17 years with type 1 diabetes, sampled from the four largest paediatric outpatient departments in Norway. We assessed the levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity. Results: The pilot study included responses from 335 (54%) patients. Low proportions of missing or “not applicable” responses were found for 17 of the 19 items, and 14 of these 19 items were below the ceiling-effect criterion. Five indicators were identified: consultation, information on food and physical activity/exercise, nurse contact, doctor contact and outcome. All except one indicator met the criterion of 0.7 for Cronbach’s alpha. Each of the single items had a stronger correlation with its hypothesized indicator than with any of the other indicators. The construct validity of the instrument was supported by 38 out of 45 significant associations. Conclusion: The content validity of the instrument was secured by a rigorous development process. Psychometric testing produced good evidence for data quality, internal consistency and construct validity. Further research is needed to assess the usefulness of the Adolescent Patient Experiences of Diabetes Care Questionnaire as a basis for quality indicators.

• Tapia, German; Mårild, Karl Staffan; Dahl, Sandra Rinne; Lund-Blix, Nicolai Andre; Viken, Marte K & Lie, Benedicte Alexandra [Vis alle 12 forfattere av denne artikkelen] (2019). Maternal and Newborn Vitamin D-Binding Protein, Vitamin D Levels, Vitamin D Receptor Genotype, and Childhood Type 1 Diabetes. Diabetes Care. ISSN 0149-5992. 42(4), s. 553–559. doi: 10.2337/dc18-2176. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVE Circumstantial evidence links 25-hydroxy vitamin D [25(OH)D], vitamin D–binding protein (DBP), vitamin D–associated genes, and type 1 diabetes (T1D), but no studies have jointly analyzed these. We aimed to investigate whether DBP levels during pregnancy or at birth were associated with offspring T1D and whether vitamin D pathway genetic variants modified associations between DBP, 25(OH)D, and T1D. RESEARCH DESIGN AND METHODS From a cohort of >100,000 mother/child pairs, we analyzed 189 pairs where the child later developed T1D and 576 random control pairs. We measured 25(OH)D using liquid chromatography–tandem mass spectrometry, and DBP using polyclonal radioimmunoassay, in cord blood and maternal plasma samples collected at delivery and midpregnancy. We genotyped mother and child for variants in or near genes involved in vitamin D metabolism (GC, DHCR7, CYP2R1, CYP24A1, CYP27B1, and VDR). Logistic regression was used to estimate odds ratios (ORs) adjusted for potential confounders. RESULTS Higher maternal DBP levels at delivery, but not in other samples, were associated with lower offspring T1D risk (OR 0.86 [95% CI 0.74–0.98] per μmol/L increase). Higher cord blood 25(OH)D levels were associated with lower T1D risk (OR = 0.87 [95% CI 0.77–0.98] per 10 nmol/L increase) in children carrying the VDR rs11568820 G/G genotype (Pinteraction = 0.01 between 25(OH)D level and rs11568820). We did not detect other gene-environment interactions. CONCLUSIONS Higher maternal DBP level at delivery may decrease offspring T1D risk. Increased 25(OH)D levels at birth may decrease T1D risk, depending on VDR genotype. These findings should be replicated in other studies. Future studies of vitamin D and T1D should include VDR genotype and DBP levels.

• Patterson, Christopher C.; Harjutsalo, Valma; Rosenbauer, Joachim; Neu, Andreas; Cinek, Ondrej & Skrivarhaug, Torild [Vis alle 27 forfattere av denne artikkelen] (2018). Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989?2013: a multicentre prospective registration study. Diabetologia. ISSN 0012-186X. 62(3), s. 408–417. doi: 10.1007/s00125-018-4763-3. Fulltekst i vitenarkiv Vis sammendrag

  Aims/hypothesis: Against a background of a near-universally increasing incidence of childhood type 1 diabetes, recent reports from some countries suggest a slowing in this increase. Occasional reports also describe cyclical variations in incidence, with periodicities of between 4 and 6 years. Methods: Age/sex-standardised incidence rates for the 0- to 14-year-old age group are reported for 26 European centres (representing 22 countries) that have registered newly diagnosed individuals in geographically defined regions for up to 25 years during the period 1989–2013. Poisson regression was used to estimate rates of increase and test for cyclical patterns. Joinpoint regression software was used to fit segmented log-linear relationships to incidence trends. Results: Significant increases in incidence were noted in all but two small centres, with a maximum rate of increase of 6.6% per annum in a Polish centre. Several centres in high-incidence countries showed reducing rates of increase in more recent years. Despite this, a pooled analysis across all centres revealed a 3.4% (95% CI 2.8%, 3.9%) per annum increase in incidence rate, although there was some suggestion of a reduced rate of increase in the 2004–2008 period. Rates of increase were similar in boys and girls in the 0- to 4-year-old age group (3.7% and 3.7% per annum, respectively) and in the 5- to 9-year-old age group (3.4% and 3.7% per annum, respectively), but were higher in boys than girls in the 10- to 14-year-old age group (3.3% and 2.6% per annum, respectively). Significant 4 year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012. Conclusions/interpretation: Despite reductions in the rate of increase in some high-risk countries, the pooled estimate across centres continues to show a 3.4% increase per annum in incidence rate, suggesting a doubling in incidence rate within approximately 20 years in Europe. Although four centres showed support for a cyclical pattern of incidence with a 4 year periodicity, no plausible explanation for this can be given.

• Thorsen, Steffen U.; Mårild, Karl Staffan; Olsen, Sjurdur Frodi; Holst, Klaus; Tapia, German & Granström, Charlotta [Vis alle 17 forfattere av denne artikkelen] (2018). Lack of Association between Maternal or Neonatal Vitamin D Status and Risk of Childhood Type 1 Diabetes: A Scandinavian Case-Cohort Study. American Journal of Epidemiology. ISSN 0002-9262. 187(6), s. 1174–1181. doi: 10.1093/aje/kwx361. Fulltekst i vitenarkiv Vis sammendrag

  Studies on vitamin D status during pregnancy and risk of type 1 diabetes mellitus (T1D) lack consistency and are limited by small sample sizes or single measures of 25-hydroxyvitamin D (25(OH)D). We investigated whether average maternal 25(OH)D plasma concentrations during pregnancy are associated with risk of childhood T1D. In a case-cohort design, we identified 459 children with T1D and a random sample (n = 1,561) from the Danish National Birth Cohort (n = 97,127) and Norwegian Mother and Child Cohort Study (n = 113,053). Participants were born between 1996 and 2009. The primary exposure was the estimated average 25(OH)D concentration, based on serial samples from the first trimester until delivery and on umbilical cord plasma. We estimated hazard ratios using weighted Cox regression adjusting for multiple confounders. The adjusted hazard ratio for T1D per 10-nmol/L increase in the estimated average 25(OH)D concentration was 1.00 (95% confidence interval: 0.90, 1.10). Results were consistent in both cohorts, in multiple sensitivity analyses, and when we analyzed mid-pregnancy or cord blood separately. In conclusion, our large study demonstrated that normal variation in maternal or neonatal 25(OH)D is unlikely to have a clinically important effect on risk of childhood T1D. This is a pre-copyedited, author-produced version of an article accepted for publication following peer review.

• Størdal, Ketil; McArdle, Harry J.; Hayes, Helen; Tapia, German; Viken, Marte K & Lund-Blix, Nicolai Andre [Vis alle 17 forfattere av denne artikkelen] (2018). Prenatal iron exposure and childhood type 1 diabetes. Scientific Reports. 8. doi: 10.1038/s41598-018-27391-4. Fulltekst i vitenarkiv Vis sammendrag

  Iron overload due to environmental or genetic causes have been associated diabetes. We hypothesized that prenatal iron exposure is associated with higher risk of childhood type 1 diabetes. In the Norwegian Mother and Child cohort study (n = 94,209 pregnancies, n = 373 developed type 1 diabetes) the incidence of type 1 diabetes was higher in children exposed to maternal iron supplementation than unexposed (36.8/100,000/year compared to 28.6/100,000/year, adjusted hazard ratio 1.33, 95%CI: 1.06–1.67). Cord plasma biomarkers of high iron status were non-significantly associated with higher risk of type 1 diabetes (ferritin OR = 1.05 [95%CI: 0.99–1.13] per 50 mg/L increase; soluble transferrin receptor: OR = 0.91 [95%CI: 0.81–1.01] per 0.5 mg/L increase). Maternal but not fetal HFE genotypes causing high/intermediate iron stores were associated with offspring diabetes (odds ratio: 1.45, 95%CI: 1.04, 2.02). Maternal anaemia or non-iron dietary supplements did not significantly predict type 1 diabetes. Perinatal iron exposures were not associated with cord blood DNA genome-wide methylation, but fetal HFE genotype was associated with differential fetal methylation near HFE. Maternal cytokines in mid-pregnancy of the pro-inflammatory M1 pathway differed by maternal iron supplements and HFE genotype. Our results suggest that exposure to iron during pregnancy may be a risk factor for type 1 diabetes in the offspring.

• Charalampopoulos, Dimitrios; Hermann, Julia M.; Svensson, Jannet; Skrivarhaug, Torild; Maahs, David M. & Åkesson, Karin [Vis alle 24 forfattere av denne artikkelen] (2018). Exploring variation in glycemic control across and within eight high-income countries: A cross sectional analysis of 64,666 children and adolescents with type 1 diabetes. Diabetes Care. ISSN 0149-5992. 41(6), s. 1180–1187. doi: 10.2337/dc17-2271. Fulltekst i vitenarkiv
• Tapia, German; Størdal, Ketil; Mårild, Karl Staffan; Kahrs, Christian Riddervold; Skrivarhaug, Torild & Njølstad, Pål Rasmus [Vis alle 8 forfattere av denne artikkelen] (2018). Antibiotics, acetaminophen and infections during prenatal and early life in relation to type 1 diabetes. International Journal of Epidemiology. ISSN 0300-5771. 47(5), s. 1538–1548. doi: 10.1093/ije/dyy092. Fulltekst i vitenarkiv Vis sammendrag

  Background Infections in early life have been linked to type 1 diabetes (T1D) risk, but no previous study has comprehensively analysed exposure to antibiotics, acetaminophen and infections during pregnancy and early childhood in relation to offspring risk of T1D. Methods Participants in the Norwegian Mother and Child Cohort Study (n = 114 215 children, of whom 403 children were diagnosed with T1D) reported infections and medication use through repeated questionnaires from pregnancy until the children were 18 months old. Adjusted hazard ratios (aHR) for offspring T1D were estimated through Cox regression adjusted for child’s sex, maternal age and parity, maternal T1D, smoking in pregnancy, education level, pre-pregnancy body mass index (BMI) and birthweight. Antibiotic use was also analysed in a population-based register cohort of 541 036 children of whom 836 developed T1D. Results Hospitalization for gastroenteritis during the first 18 months of life was associated with increased risk (aHR 2.27, 95% CI 1.21 − 4.29, P = 0.01) of T1D. Childhood infections not requiring hospitalization, or any kind of maternal infection during pregnancy, did not predict offspring risk of T1D. Antibiotic or acetaminophen use in pregnancy, or child`s use in early childhood, was not associated with risk of T1D. Conclusions Our study, which is population-based and the largest of its kind, did not find support for general early life infections, infection frequency or use of antibiotics or acetaminophen to play a major role in childhood T1D. Hospital admission for gastroenteritis was associated with T1D risk, but must be interpreted cautiously due to scarcity of cases.

• Wisting, Line Norøm; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2018). Prevalence of disturbed eating behavior and associated symptoms of anxiety and depression among adult males and females with type 1 diabetes. Journal of Eating Disorders. 6(28), s. 1–10. doi: 10.1186/s40337-018-0209-z. Fulltekst i vitenarkiv Vis sammendrag

  Background The increased prevalence of disturbed eating behaviors (DEB), depression, and anxiety in type 1 diabetes (T1D) is generally well established; however the majority of existing research to date has focused on female adolescents and young adults. Data on males and older females is scarce. The aim of this study was to assess prevalence of DEB and symptoms of depression and anxiety among adult males and females with type 1 diabetes, to investigate differences between individuals scoring below and above the cut-off on psychopathology, and to examine patterns of eating disorder psychopathology by age and weight. Methods A total of 282 adults with type 1 diabetes aged 18–79 years participated in the study. Measures included the Diabetes Eating Problem Survey – Revised (DEPS-R), the Hospital Anxiety and Depression Scale (HADS), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. Results A total of 20.3% of the whole sample (13.3% among males and 24.8% among females) scored above the DEPS-R cut-off score for DEB. As for depression and anxiety, the prevalence in the whole sample was 6.2% and 19.0%, respectively. The prevalence was generally higher in females than males across all psychopathology measures. HbA1c was significantly associated with the DEPS-R total score (p < .01) among females, but not with depression and anxiety. Mean DEPS-R score decreased with increasing age, and when our previous reported data from children and adolescents are included, a peak prevalence in DEB in adolescence and young adult age is demonstrated. Conclusions The results of this study point to the need for increased awareness of psychological comorbidity among adults with type 1 diabetes, in particular young adult females. Screening is recommended to secure early detection and subsequent intervention for these individuals.

• Birkebaek, Niels Holtum; Kahlert, Johnny; Bjarnason, Ragnar; Drivvoll, Ann Kristin; Johansen, Anders Straarup & Konradsdottir, Elisabet [Vis alle 10 forfattere av denne artikkelen] (2018). Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA1c and other predictors of increasing BMISDS. Pediatric Diabetes. ISSN 1399-543X. 19(7), s. 1198–1205. doi: 10.1111/pedi.12693. Fulltekst i vitenarkiv
• Magnus, Maria Christine; Tapia, German; Olsen, Sjurdur Frodi; Granström, Charlotta; Mårild, Karl Staffan & Ueland, Per Magne [Vis alle 14 forfattere av denne artikkelen] (2018). Parental smoking and risk of childhood-onset type 1 diabetes. Epidemiology. ISSN 1044-3983. 29(6), s. 848–856. doi: 10.1097/EDE.0000000000000911. Fulltekst i vitenarkiv Vis sammendrag

  Background: A few prospective studies suggest an association between maternal smoking during pregnancy and lower risk of type 1 diabetes. However, the role of unmeasured confounding and misclassification remains unclear. Methods: We comprehensively evaluated whether maternal smoking in pregnancy predicts lower risk of childhood-onset type 1 diabetes in two Scandinavian pregnancy cohorts (185,076 children; 689 cases) and a Norwegian register-based cohort (434,627 children; 692 cases). We measured cord blood cotinine as an objective marker of nicotine exposure during late pregnancy in 154 cases and 476 controls. We also examined paternal smoking during pregnancy, in addition to environmental tobacco smoke exposure the first 6 months of life, to clarify the role of characteristics of smokers in general. Results: In the pregnancy cohorts, maternal smoking beyond gestational week 12 was inversely associated with type 1 diabetes, pooled adjusted hazard ratio (aHR) 0.66 (95% CI = 0.51, 0.85). Similarly, in the Norwegian register-based cohort, children of mothers who still smoked at the end of pregnancy had lower risk of type 1 diabetes, aHR 0.65 (95% CI = 0.47, 0.89). Cord blood cotinine ≥30 nmol/L was also associated with reduced risk of type 1 diabetes, adjusted odds ratio 0.42 (95% CI = 0.17, 1.0). We observed no associations of paternal smoking during pregnancy, or environmental tobacco smoke exposure, with childhood-onset type 1 diabetes. Conclusion: Maternal sustained smoking during pregnancy is associated with lower risk of type 1 diabetes in children. This sheds new light on the potential intrauterine environmental origins of the disease.

• Bowman, Pamela; Sulen, Åsta Nordsveen; Barbetti, Fabrizio; Beltrand, Jacques; Svalastoga, Pernille & Codner, Ethel [Vis alle 21 forfattere av denne artikkelen] (2018). Effectiveness and safety of long-term treatment with sulfonylureas in patients with neonatal diabetes due to KCNJ11 mutations: an international cohort study. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 6(8), s. 637–646. doi: 10.1016/S2213-8587(18)30106-2. Fulltekst i vitenarkiv
• Iversen, Hilde Karin Hestad; Helland, Ylva; Bjertnæs, Øyvind Andresen & Skrivarhaug, Torild (2018). Parent experiences of diabetes care questionnaire (PEQ-DC): reliability and validity following a national survey in Norway. BMC Health Services Research. 18(1). doi: 10.1186/s12913-018-3591-y. Fulltekst i vitenarkiv Vis sammendrag

  Background Patient experiences are acknowledged as an important aspect of health care quality but no validated instruments have been identified for the measurement of either parent or patient experiences with outpatient paediatric diabetes care. The aim of the current study was to assess the psychometric properties of a new instrument developed to measure parent experiences of paediatric diabetes care at hospital outpatient departments in Norway. Methods The development of the questionnaire was based on a literature review of existing questionnaires, qualitative interviews with both parents and children/adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The national pilot study included parents of 2606 children/adolescents aged 0–17 years with Type 1 Diabetes registered in The Norwegian Childhood Diabetes Registry, a nationwide, population-based registry. Levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity were assessed. Results A total of 2606 patients were included in the survey, but 80 were excluded due to incorrect addresses. 1399 (55%) parents responded to the questionnaire. Low levels of missing or “not applicable” responses were found for 31 of the 35 items (< 10%), and 27 of 35 items were below the ceiling-effect criterion. Psychometric testing and theoretical considerations identified six scales: Consultation (six items), organisation (five items), equipment (three items), nurse contact (four items), doctor contact (four items) and outcome (five items). All six scales met the 0.7 criterion for Cronbach’s alpha (range: 0.71–0.90). As expected, each item had a higher correlation with its hypothesised scale than with any of the other five scales. The construct validity of the Parent Experiences of Diabetes Care Questionnaire (PEQ-DC) was supported by 17 out of 18 associations with variables expected to be related to parent experiences. Conclusion The psychometric testing of the PEQ-DC showed good evidence for data quality, internal consistency and construct validity. The instrument includes important aspects of diabetes care at paediatric outpatient departments from the perspective of the parent. The content validity of the PEQ-DC was secured by a rigorous development process, and the instrument was tested following a national survey in Norway, securing generalisability across Norway.

• Bjertnæs, Øyvind Andresen; Iversen, Hilde Karin Hestad & Skrivarhaug, Torild (2018). A randomized comparison of three data collection models for the measurement of parent experiences with diabetes outpatient care. BMC Medical Research Methodology. 18(95). doi: 10.1186/s12874-018-0557-z. Fulltekst i vitenarkiv
• Magnus, Maria Christine; Olsen, Sjurdur Frodi; Granström, Charlotta; Lund-Blix, Nicolai Andre; Svensson, Jannet & Johannesen, Jesper [Vis alle 12 forfattere av denne artikkelen] (2018). Paternal and maternal obesity but not gestational weight gain is associated with type 1 diabetes. International Journal of Epidemiology. ISSN 0300-5771. 47(2), s. 417–426. doi: 10.1093/IJE/DYX266. Fulltekst i vitenarkiv Vis sammendrag

  Background Our objective was to examine the associations of parental body mass index (BMI) and maternal gestational weight gain with childhood-onset type 1 diabetes. Comparing the associations of maternal and paternal BMI with type 1 diabetes in the offspring will provide further insight into the role of unmeasured confounding by characteristics linked to BMI in both parents. Methods We studied 132 331 children participating in the Norwegian Mother and Child Cohort Study (MoBa) and the Danish National Birth Cohort (DNBC) who were born between February 1998 and July 2009. Exposures of interest included parental BMI and maternal gestational weight gain obtained by maternal report. We used Cox-proportional hazards regression to examine the risk of type 1 diabetes (n=499 cases), which was ascertained by national childhood diabetes registers. Results The incidence of type 1 diabetes was 32.7 per 100 000 person-years in MoBa and 28.5 per 100 000 person-years in DNBC. Both maternal pre-pregnancy obesity, adjusted hazard ratio (HR) 1.41 [95% confidence interval (CI): 1.06, 1.89] and paternal obesity, adjusted HR 1.51 (95% CI: 1.11, 2.04), were associated with childhood-onset type 1 diabetes. The associations were similar after mutual adjustment. In contrast, maternal total gestational weight gain was not associated with childhood-onset type 1 diabetes, adjusted HR 1.00 (95% CI: 0.99, 1.02) per kilogram increase. Conclusions Our study suggests that the association between maternal obesity and childhood-onset type 1 diabetes is not likely explained by intrauterine mechanisms, but possibly rather by unknown environmental factors influencing BMI in the family.

• Gagnum, Vibeke; Saeed, Maryam; Stene, Lars Christian Mørch; Leivestad, Torbjørn; Joner, Geir & Skrivarhaug, Torild (2018). Low Incidence of End-Stage Renal Disease in Childhood-Onset Type 1 Diabetes Followed for Up to 42 Years. Diabetes Care. ISSN 0149-5992. 41(3), s. 420–425. doi: 10.2337/dc17-0906. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Reas, Deborah; Bang, Lasse; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2017). Eating patterns in adolescents with type 1 diabetes: Associations with metabolic control, insulin omission, and eating disorder pathology. Appetite. ISSN 0195-6663. 114, s. 226–231. doi: 10.1016/j.appet.2017.03.035. Fulltekst i vitenarkiv Vis sammendrag

  Objective: The purpose of this study was to investigate eating patterns among male and female adolescents with type 1 diabetes (T1D), and the associations with age, zBMI, eating disorder (ED) pathology, intentional insulin omission, and metabolic control. Method: The sample consisted of 104 adolescents (58.6% females) with child-onset T1D, mean age of 15.7 years (SD 1.8) and mean zBMI of 0.4 (SD 0.8). The Child Eating Disorder Examination (ChEDE) assessed meal/snack frequency and ED pathology. T1D clinical data was obtained from the Norwegian Childhood Diabetes Registry. Results: A significantly lower proportion of females than males (73.8% vs 97.7%) consumed breakfast on a daily basis. Approximately 50% of both genders ate lunch and 90% ate dinner daily. Among females, skipping breakfast was significantly associated with higher global ED psychopathology, shape concerns, self-induced vomiting, binge eating, insulin omission due to shape/weight concerns, and poorer metabolic control. Less frequent lunch consumption was significantly associated with poorer metabolic control. Skipping dinner was significantly associated with older age, higher dietary restraint, eating concerns, self-induced vomiting, and insulin omission. Among males, less frequent consumption of lunch and evening snacks was associated with attitudinal features of ED, including shape/weight concerns and dietary restraint. Discussion: Among adolescents with T1D, irregular or infrequent meal consumption appears to signal potential ED pathology, as well as being associated with poorer metabolic control. These findings suggest the importance of routinely assessing eating patterns in adolescents with T1D to improve detection of ED pathology and to facilitate improved metabolic control and the associated risk of somatic complications.

• Birkebæk, NH; Drivvoll, Ann Kristin; Aakeson, K.; Bjarnason, Ragnar; Johansen, A. & Samuelsson, U. [Vis alle 9 forfattere av denne artikkelen] (2017). Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008–2012: association with hemoglobin A 1c and treatment modality. BMJ Open Diabetes Research & Care. 5(1). doi: 10.1136/bmjdrc-2016-000377. Fulltekst i vitenarkiv
• Vistnes, Maria; Tapia, German; Mårild, Karl Staffan; Midttun, Øivind; Ueland, Per Magne & Viken, Marte K [Vis alle 14 forfattere av denne artikkelen] (2017). Plasma immunological markers in pregnancy and cord blood: A possible link between macrophage chemo-attractants and risk of childhood type 1 diabetes. American journal of reproductive immunology. ISSN 1046-7408. 79(3). doi: 10.1111/aji.12802. Fulltekst i vitenarkiv
• Johansson, Bente Berg; Irgens, Henrik Underthun; Molnes, Janne; Sztromwasser, Pawel Szymon; Aukrust, Ingvild & Juliusson, Petur Benedikt [Vis alle 13 forfattere av denne artikkelen] (2017). Targeted next-generation sequencing reveals MODY in up to 6.5% of antibody-negative diabetes cases listed in the Norwegian Childhood Diabetes Registry. Diabetologia. ISSN 0012-186X. 60(4), s. 625–635. doi: 10.1007/s00125-016-4167-1. Fulltekst i vitenarkiv
• Gagnum, Vibeke; Stene, Lars Christian; Leivestad, Torbjørn; Joner, Geir & Skrivarhaug, Torild (2017). Long-term Mortality and End-Stage Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15-29 Years in Norway. Diabetes Care. ISSN 0149-5992. 40(1), s. 38–45. doi: 10.2337/dc16-1213. Fulltekst i vitenarkiv
• Carlsen, Siri; Skrivarhaug, Torild; Thue, Geir; Cooper, John; Gøransson, Lasse & Løvaas, Karianne Fjeld [Vis alle 7 forfattere av denne artikkelen] (2017). Glycemic control and complications in patients with type 1 diabetes – a registry-based longitudinal study of adolescents and young adults. Pediatric Diabetes. ISSN 1399-543X. 18(3), s. 188–195. doi: 10.1111/pedi.12372. Fulltekst i vitenarkiv
• Gagnum, Vibeke; Stene, Lars Christian; Jenssen, Trond Geir; Berteussen, Line Marie; Sandvik, Leiv & Joner, Geir [Vis alle 8 forfattere av denne artikkelen] (2017). Causes of death in childhood-onset Type 1 diabetes: long-term follow-up. Diabetic Medicine. ISSN 0742-3071. 34(1), s. 56–63. doi: 10.1111/dme.13114. Fulltekst i vitenarkiv
• Viken, Marte K; Flåm, Siri Tennebø; Skrivarhaug, Torild; Amundsen, Silja Svanstrøm; Sollid, Ludvig Magne & Drivvoll, Ann Kristin [Vis alle 9 forfattere av denne artikkelen] (2017). HLA class II alleles in Norwegian patients with coexisting type 1 diabetes and celiac disease. HLA. ISSN 2059-2302. 89(5), s. 278–284. doi: 10.1111/tan.12986. Fulltekst i vitenarkiv
• Lund-Blix, Nicolai Andre; Sander, Stine Dydensborg; Størdal, Ketil; Andersen, Anne-Marie Nybo; Rønningen, Kjersti Skjold & Joner, Geir [Vis alle 10 forfattere av denne artikkelen] (2017). Infant feeding and risk of type 1 diabetes in two large scandinavian birth cohorts. Diabetes Care. ISSN 0149-5992. 40(7), s. 920–927. doi: 10.2337/dc17-0016. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Bang, Lasse; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2016). Psychological barriers to optimal insulin therapy: More concerns in adolescent females than males. BMJ Open Diabetes Research & Care. 4(1). doi: 10.1136/bmjdrc-2016-000203. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Bang, Lasse; Natvig, Henrik; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Lask, Bryan [Vis alle 7 forfattere av denne artikkelen] (2016). Metabolic Control and Illness Perceptions in Adolescents with Type 1 Diabetes. Journal of Diabetes Research. ISSN 2314-6745. 2016. doi: 10.1155/2016/3486094. Fulltekst i vitenarkiv
• Ddidzonu, Daniel; Skrivarhaug, Torild; Joner, Geir & Moger, Tron Anders (2016). Ethnic differences in the incidence of type 1 diabetes in Norway: a register-based study using data from the period 2002-2009. Pediatric Diabetes. ISSN 1399-543X. 17(5), s. 337–341. doi: 10.1111/pedi.12294. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Bang, Lasse; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2015). Adolescents with type 1 diabetes - The impact of gender, age, and health-related functioning on eating disorder psychopathology. PLOS ONE. 10(11). doi: 10.1371/journal.pone.0141386. Fulltekst i vitenarkiv
• Gagnum, Vibeke; Stene, Lars Christian; Sandvik, Leiv; Fagerland, Morten; Njølstad, Pål Rasmus & Joner, Geir [Vis alle 7 forfattere av denne artikkelen] (2015). All-cause mortality in a nationwide cohort of childhood-onset diabetes in Norway 1973–2013. Diabetologia. ISSN 0012-186X. 58(8), s. 1779–1786. doi: 10.1007/s00125-015-3623-7. Fulltekst i vitenarkiv
• Magnus, Maria Christine; Olsen, Sjurdur Frodi; Granström, Charlotta; Joner, Geir; Skrivarhaug, Torild & Svensson, Jannet [Vis alle 11 forfattere av denne artikkelen] (2015). Infant growth and risk of childhood-onset type 1 diabetes in children from 2 scandinavian birth cohorts. JAMA pediatrics. ISSN 2168-6203. 169(12), s. 1–8. doi: 10.1001/jamapediatrics.2015.3759. Fulltekst i vitenarkiv
• Fredheim, Siri; Ahmed, Delli; Rida, Heba; Drivvoll, Ann Kristin; Skrivarhaug, Torild & Bjarnason, Ragnar [Vis alle 9 forfattere av denne artikkelen] (2014). Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes. Pediatric Diabetes. ISSN 1399-543X. 15(7), s. 519–527. doi: 10.1111/pedi.12157. Fulltekst i vitenarkiv
• Hanberger, Lena; Birkebæk, Niels; Bjarnason, Ragnar; Drivvoll, Ann Kristin; Johansen, Anders & Skrivarhaug, Torild [Vis alle 8 forfattere av denne artikkelen] (2014). Childhood diabetes in the Nordic countries: A comparison of quality registries. Journal of Diabetes Science and Technology. 8(4), s. 738–744. doi: 10.1177/1932296814531479. Fulltekst i vitenarkiv
• Skrivarhaug, Torild; Stene, Lars Christian; Drivvoll, Ann Kristin; Strøm, Hanne & Joner, Geir (2014). Incidence of type 1 diabetes in Norway among children aged 0-14 years between 1989 and 2012: has the incidence stopped rising? Results from the Norwegian Childhood Diabetes Registry. Diabetologia. ISSN 0012-186X. 57(1), s. 57–62. doi: 10.1007/s00125-013-3090-y. Fulltekst i vitenarkiv
• Irgens, Henrik Underthun; Molnes, Janne; Johansson, Bente Berg; Ringdal, Monika; Skrivarhaug, Torild & Undlien, Dag Erik [Vis alle 10 forfattere av denne artikkelen] (2013). Prevalence of monogenic diabetes in the population-based Norwegian Childhood Diabetes Registry. Diabetologia. ISSN 0012-186X. 56(7), s. 1512–1519. doi: 10.1007/s00125-013-2916-y. Fulltekst i vitenarkiv
• Frøisland, Dag Helge; Graue, Marit; Markestad, Trond; Skrivarhaug, Torild; Wentzel-Larsen, Tore & Dahl-Jørgensen, Knut (2013). Health-related quality of life among Norwegian children and adolescents with type 1 diabetes on intensive insulin treatment: a population-based study. Acta Paediatrica. ISSN 0803-5253. 102(9), s. 889–895. doi: 10.1111/apa.12312. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Frøisland, Dag Helge; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2013). Disturbed Eating Behavior and Omission of Insulin in Adolescents Receiving Intensified Insulin Treatment A nationwide population-based study. Diabetes Care. ISSN 0149-5992. 36(11), s. 3382–3387. doi: 10.2337/dc13-0431. Fulltekst i vitenarkiv
• Skrivarhaug, Torild (2013). Mortality in childhood-onset type 1 diabetes : nationwide population based data from Norway. Norsk Epidemiologi. ISSN 0803-2491. 23(1), s. 89–93. doi: 10.5324/nje.v23i1.1607. Fulltekst i vitenarkiv
• Skrivarhaug, Torild (2013). Norwegian Childhood Diabetes Registry: Childhood onset diabetes in Norway 1973-2012. Norsk Epidemiologi. ISSN 0803-2491. 23(1), s. 23–27. doi: 10.5324/nje.v23i1.1598. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Frøisland, Dag Helge; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Rø, Øyvind (2013). Psychometric Properties, Norms, and Factor Structure of the Diabetes Eating Problem Survey - Revised in a Large Sample of Children and Adolescents With Type 1 Diabetes. Diabetes Care. ISSN 0149-5992. 36(8), s. 2198–2202. doi: 10.2337/dc12-2282. Fulltekst i vitenarkiv
• Jenum, Anne Karen; Mørkrid, Kjersti; Sletner, Line; Vangen, Siri; Torper, Johan & Nakstad, Britt [Vis alle 15 forfattere av denne artikkelen] (2012). Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. European Journal of Endocrinology (EJE). ISSN 0804-4643. 166(2), s. 317–324. doi: 10.1530/EJE-11-0866. Fulltekst i vitenarkiv Vis sammendrag

  Objective The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. Methods This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l. Results OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact. Conclusion GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweight

• Frøisland, Dag Helge; Markestad, Trond; Wentzel-Larsen, Tore; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Graue, Marit (2012). Reliability and validity of the Norwegian child and parent versions of the DISABKIDS Chronic Generic Module (DCGM-37) and Diabetes-Specific Module (DSM-10). Health and Quality of Life Outcomes. 10. doi: 10.1186/1477-7525-10-19. Fulltekst i vitenarkiv Vis sammendrag

  Background International guidelines on type 1 diabetes advocate routine screening of health-related quality of life (HRQOL). DISABKIDS questionnaires are the first instruments developed across cultures and nations to provide age-appropriate measures of HRQOL in children with chronic diseases. DISABKIDS includes a Chronic Generic Module 37 (DCGM-37) and disease-specific modules. The purpose of this study was to examine reliability and validity of the Norwegian versions of the DISABKIDS questionnaires in children and adolescents with type 1 diabetes. Methods The DCGM-37 and the Diabetes Specific Module-10 (DDM-10) were translated into Norwegian using standard forward-backward translation. Eight to 19 year old children and adolescents with type 1 diabetes scheduled for routine follow-up at three diabetic clinics in Norway and one of their parents were invited to complete the DCGM-37 and the DDM-10. Internal consistency was determined using Cronbach's alpha. Results were compared with those of the Child Health Questionnaire Children Form-87 (CHQ-CF87) and Child Health Questionnaire Parent Form-50 which are established generic questionnaires. DISABKIDS results were related to age, gender, duration of diabetes, mode of insulin delivery and metabolic control. Clinical data were obtained from the Norwegian Childhood Diabetes Registry. Results Of 198 eligible child-parent dyads, 103 (52%) completed the questionnaires. Mean age was 13.6 (2.6), range 8-19 yrs, 52% were boys. Cronbach's alpha was > 0.70 for all the DISABKIDS sub-scales except two (physical ability and social inclusion). There were moderate to high correlations (0.65-0.81) between the DISABKIDS scales and mental/emotional sub-scales of CHQ-CF87. Increasing age and higher HbA1c were significantly associated with reduced HRQOL scores. Parents tended to score their child's HRQOL lower than the children/adolescents themselves. Conclusions The study shows that the DISABKIDS instruments are applicable to a Norwegian childhood diabetes population. They seem to be a relevant supplement to other clinical indicators in medical practice and research

• Berg, Jens Petter; Hanssen, Kristian Folkvord; Bjerve, Kristian S; Claudi, Tor; Dahl-Jørgensen, Knut & Rustad, Pål [Vis alle 8 forfattere av denne artikkelen] (2011). Standardisert hemoglobin A1C til diagnostisk bruk? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 131(6), s. 565–6. doi: 10.4045/tidsskr.10.1160. Fulltekst i vitenarkiv

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• Helverschou, Aud Sissel Berge; Skrivarhaug, Torild; Houge, Sofia Douzgou & Stray-Pedersen, Asbjørg (2023). Persontilpasset medisin ved utviklingsforstyrrelser. 143(13). doi: 10.4045/tidsskr.23.0351. Fulltekst i vitenarkiv
• Bakke, Kristin Andersen; Helverschou, Sissel Berge; Skrivarhaug, Torild; Houge, Sofia Douzgou & Stray-Pedersen, Asbjørg (2023). Persontilpasset medisin ved utviklingsforstyrrelser. 143(13), s. 1130–1132. doi: 10.4045/tidsskr.23.0351. Fulltekst i vitenarkiv
• Bakke, Kristin Andersen; Midtlyng, Egil; Kummernes, Siv Janne & Skrivarhaug, Torild (2019). ADHD and Type 1 Diabetes; the comorbidity increases behavioural challenges and may affect metabolic control. Fulltekst i vitenarkiv
• Birkebaek, Niels Holtum; Hermann, Julia M.; Hanberger, Lena; Charalampopoulos, Dimitrios; Holl, Reinhard W. & Skrivarhaug, Torild [Vis alle 24 forfattere av denne artikkelen] (2019). Center size and glycemic control: An international study with 504 centers from seven countries. Diabetes Care. ISSN 0149-5992. 42(3), s. E37–E39. doi: 10.2337/dc18-1253. Fulltekst i vitenarkiv
• Skrivarhaug, Torild; Størdal, Ketil & Stene, Lars Christian Mørch (2018). Hva kan gjøres for å forebygge forsinket diagnostikk av diabetes type 1 hos barn? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(6), s. 521–523. doi: 10.4045/tidsskr.17.0935. Fulltekst i vitenarkiv
• Hatle, Håvard; Bjørgaas, Marit Ragnhild Rokne; Skrivarhaug, Torild; Åsvold, Bjørn Olav & Rø, Torstein Baade (2018). Prevalence and Predictors of Impaired Awareness of Hypoglycemia in a contemporary pediatric Type 1 diabetes population - The Norwegian Childhood Diabetes Registry (NCDR). Fulltekst i vitenarkiv
• Frøisland, Dag Helge; Graue, Marit; Markestad, Trond; Wentzel-Larsen, Tore; Skrivarhaug, Torild & Dahl-Jørgensen, Knut (2017). Norwegian adolescents with Type 1 diabetes undergoing intensive insulin treatment generally report levels of diabetes-related emotional distress. Furthermore, the short version of the Problem Areas in diabetes (PAID5)questionnaire functions as a valid and practical instrument for routine clinical avaluations. Fulltekst i vitenarkiv Vis sammendrag

  https://diabetesjournals.org/diabetes/issue/66/Supplement_1 Norwegian Adolescents score low on diabetes-related distress measured with PAID. A small group have a high score on PAID associated with low score on WHO-5. We suggest PAID-5 as a useful short screening tool among adolescents with type 1 diabetes in order to reveal those with elevated diabetes-related emotional distress.

• Gagnum, Vibeke; Stene, Lars Christian Mørch; Leivestad, Torbjørn; Joner, Geir & Skrivarhaug, Torild (2017). Response to Comment on Gagnum et al. Long-term mortality and end-stage renal disease in a type 1 diabetes population diagnosed at age 15-29 years in Norway. Diabetes Care. ISSN 0149-5992. 40(9), s. e125–e125. doi: 10.2337/dci17-0018. Fulltekst i vitenarkiv
• Gagnum, Vibeke; Stene, Lars Christian; Sandvik, L; Njølstad, Pål Rasmus; Joner, Geir & Skrivarhaug, Torild (2015). Causes of dealth in a cohort of childhood-onset type 1 diabetes diagnosed during 1973-2012. A Nationwide population-based study in Norway. Fulltekst i vitenarkiv
• Borkamo, Hildegunn Styve; Drivvoll, Ann Kristin; Kummernes, Siv Janne; Dahl-Jørgensen, Knut & Skrivarhaug, Torild (2015). Reduced incidence of severe hypoglycemia and changing trends in treatment of Type 1 diabetes (T1D) in children the last 12 years in Norway - a Nationwide study. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Frøisland, Dag Helge; Skrivarhaug, Torild; Dahl-Jørgensen, Knut; Bang, Lasse & Natvig, Henrik [Vis alle 8 forfattere av denne artikkelen] (2015). Type 1 diabetes and Disturbed Eating Behaviors - Comorbidity, Prevalence, Psychological Correlates and Metabolic Control. Fulltekst i vitenarkiv
• Birkebæk, Niels; Drivvoll, Ann Kristin; Aakeson, K.; Bjarnason, Ragnar; Johansen, A & Samuelsson, Ulf [Vis alle 9 forfattere av denne artikkelen] (2015). Incidence of severe hypoglycemia in children With type 1 diabetes in the Nordic countries in the period 2008-12. Influence of HbA1c and treatment modality. Fulltekst i vitenarkiv
• Kummernes, Siv Janne; Fredriksen, S.T. Dreyer & Skrivarhaug, Torild (2015). Diabetes nurses have an important role in preparing families for pubertal Challenges during transition through adolescence in type 1 diabetes. Fulltekst i vitenarkiv
• Hatle, Håvard; Bjørgaas, Marit Ragnhild Rokne; Skrivarhaug, Torild; Graveling, Alex; Frier, Brian & Rø, Torstein Baade (2015). Evaluation of questionnaires to classify awareness of hypoglycemia in children and adolescents with type 1 diabetes. Fulltekst i vitenarkiv
• Wisting, Line Norøm; Frøisland, Dag Helge; Skrivarhaug, Torild; Dahl-Jørgensen, Knut; Bang, Lasse & Natvig, Henrik [Vis alle 8 forfattere av denne artikkelen] (2015). Comorbid type 1 diabetes and disturbed eating behaviors - assessment, prevalence, psychological correlates and metabolic Control. Fulltekst i vitenarkiv
• Frøisland, Dag Helge; Graue, Marit; Markestad, Trond; Wenzel-Larsen, Tore; Drivvoll, A. K. & Skrivarhaug, Torild (2012). Health Related Quality of Life Among Norwegian Children and Adolescents with Type 1 Diabetes on Intensive Insulin Treatment. A Population Based Study. Fulltekst i vitenarkiv
• Viken, Marte K; Flåm, Siri Tennebø; Sollid, Ludvig Magne; Skrivarhaug, Torild; Dahl-Jørgensen, Knut & Lie, Benedicte Alexandra (2012). STUDY OF THE HLA-DRB1 AND-DQB1 GENES IN PATIENTS WITH COEXISTING TYPE 1 DIABETES AND CELIAC DISEASE. Tissue Antigens. ISSN 0001-2815. 79(6), s. 584–584. Fulltekst i vitenarkiv
• Haugvik, Severina; Wisting, Line; Skrivarhaug, Torild & Dahl-Jørgensen, Knut (2026). Diabetes Body Project. Contributing to the Development of an Evidence-Based Clinical Toolkit for Eating Disorder Prevention Among Young Women with Type 1 Diabetes. Universitetet i Oslo. ISSN 9788234808715. Fulltekst i vitenarkiv Vis sammendrag

  This doctoral thesis is situated at the intersection of diabetes care, eating disorder research, and preventive health. Young women with type 1 diabetes face an increased risk of disordered eating behaviors and eating disorders, which are associated with diabetes-related complications and higher mortality. Yet effective prevention strategies remain limited. This doctoral thesis, including three papers, addresses this important clinical gap through research focusing on identification and targeted prevention, drawing on both quantitative and qualitative methods. Paper I focused on identification through a cross-sectional validation study of the widely recommended screening questionnaire, the Diabetes Eating Problem Survey – Revised (DEPS-R). The questionnaire demonstrated good discriminative ability for identifying individuals with and without eating disorders, and the current cut-off showed high sensitivity, supporting its use as a screening tool in clinical practice. Papers II and III focused on the Diabetes Body Project, a virtual, diabetes-specific adaptation of an evidence-based eating disorder prevention program for young women with type 1 diabetes. The intervention was evaluated in a multinational randomized controlled trial and complemented by a qualitative analysis of written feedback from participants and facilitators. Compared with the control condition, participants showed significantly larger short-term improvements in eating disorder risk factors, symptoms, and psychological correlates, while qualitative findings indicated high user satisfaction and highlighted the value of peer support within a type 1 diabetes-specific community. Collectively, findings in this doctoral thesis may contribute to the development of an evidence-based clinical toolkit for eating disorder prevention, ultimately supporting improved long-term health outcomes in young women with type 1 diabetes.

• Bratke, Heiko; Skrivarhaug, Torild; Margeirsdottir, Hanna Dis; Biringer, Eva & Njølstad, Pål Rasmus (2025). Pediatric Diabetes Care in Norway : Glycemic Results and Health-Related Quality of Life. Universitetet i Bergen. ISSN 9788230860380. Fulltekst i vitenarkiv Vis sammendrag

  Background In Norway, a variety of efforts have been made to improve pediatric diabetes care and to support children with diabetes in the best possible way. Aside from the early adoption of new diabetes technology, Norwegian pediatric diabetes care has also focused on standardized patient education starting from the onset of diabetes, precise insulin dose calculation, systematic quality improvement and clearly defined treatment targets. Children and adolescents with type 1 diabetes in Norway routinely receive diabetes care from diagnosis and until the age of 18 years solely at the pediatric departments within the Norwegian public health care system. Thus, the pediatric departments annually deliver comprehensive data, including relevant treatment outcomes, of the children and adolescents with diabetes under follow-up to the Norwegian Childhood Diabetes Registry (NCDR), with a data completeness of ≥98%. Aims The overall aims of this thesis were to study the glycemic status, characterized by glycated hemoglobin A1c (HbA1c), and the incidence of diabetic ketoacidosis (DKA) and severe hypoglycemia (SH), and the diabetes-specific health-related quality of life (HRQOL) of children and adolescents with type 1 diabetes in Norway. We also aimed to identify factors associated with better glycemic control and diabetes-specific HRQOL in the last decade. Material and methods This thesis is based on data collected for the NCDR from 2013 to 2022, including 27,214 annual registrations of 6,775 children and adolescents (0-17 years) with type 1 diabetes and HbA1c levels analyzed at the same DCCT reference laboratory. In addition, we used the results of a survey on diabetes-specific HRQOL conducted as part of the 2017 annual NCDR data collection. In Paper I, we included the 2017 NCDR cohort (N=2,623) in a cross-sectional study and used linear mixed-effects regression analysis to assess the association of diabetes technology use and HbA1c. Logistic regression analysis was used to assess the association between diabetes technology use and the incidence of DKA and SH. Paper II was a cross-sectional study based on the DISABKIDS diabetes-specific module (DDM 10). Children 10 years and older, and parents of all children regardless their age were invited to complete the questionnaire as part of the NCDR’s 2017 annual data collection. Of 2,059 children 10 years or older, 1,059 children (50%) completed the questionnaire. Of the 2,725 parents, 1,441 (53%) participated. We analyzed potential associations between diabetes-specific HRQOL and HbA1c, age, sex, diabetes duration and the use of diabetes technology. For Paper III, we analyzed longitudinal registry data from 2013 to 2022. Using linear mixed-effects regression analysis, we assessed longitudinal associations of glycemic outcomes (HbA1c, DKA and SH), and the use of diabetes technology and carbohydrate counting for meal bolus calculation, separately for boys and girls. Further, we compared the glycemic outcomes of the 9 pediatric departments in the NCDR that participated in a national quality improvement project (IQ Norway) from 2017 to 2019 with the glycemic outcomes of the 17 nonparticipating departments. Results In 2017, 75% of children in the NCDR used an insulin pump, and 53% used continuous glucose monitoring (CGM). Cross-sectional analyses of the 2017 annual NCDR cohort showed that insulin pump use was associated with a higher HbA1c compared to insulin pen use, whereas CGM use was associated with a lower HbA1c compared to not using CGM. DKA and SH were not associated with insulin pump or CGM use. However, the use of patch pumps was associated with a notably lower odds ratio for DKA compared to other pump types. Diabetes-specific HRQOL in children with type 1 diabetes was generally high. Parents assessed diabetes specific HRQOL as lower than the children themselves. There was no cross-sectional association between diabetes-specific HRQOL and the use of diabetes technology. Higher diabetes-specific HRQOL was associated with lower HbA1c and male sex in children 10 years and older, but not in younger children. From 2013 to 2022, mean HbA1c in children and adolescents with type 1 diabetes in Norway decreased steadily from 66.6 mmol/mol to 55.4 mmol/mol. The proportion of children reaching an HbA1c of under 53.0 mmol/mol increased from 13% to 43%. The incidence of acute complications declined from 4.8% to 1.0% (DKA) and 4.9% to 2.1% (SH). The use of diabetes technology increased continuously over the study period, resulting in 91% of children using an insulin pump and 97% using CGM in 2022. Insulin pump and CGM use as well as carbohydrate counting were associated with better glycemic results in this longitudinal study. The 9 pediatric departments that participated in the quality improvement project enhanced their average institutional HbA1c more than the 17 nonparticipating departments. This difference in HbA1c remained stable over the following three years after the completion of ‘IQ Norway’. At all annual registrations, female sex was associated with higher HbA1c during this 10-year period. We found unexpected differences between boys and girls regarding HbA1c, the use of diabetes technology and carbohydrate counting. Conclusions and consequences This thesis identified important factors that likely contributed to the considerably improving glycemic outcomes seen in the Norwegian pediatric population from 2013 to 2022. We showed sex specific differences regarding HbA1c and diabetes-specific HRQOL that advocate for a more personalized approach for boys and girls in diabetes care. Diabetes technology use was not associated with better diabetes-specific HRQOL in 2017, but due to the enormous development in diabetes technology since 2017, the potential association of such technology with HRQOL may be more positive in future assessments. As shown in the present thesis, the NCDR was very useful in the identification of factors contributing to improved diabetes care and monitoring of glycemic outcomes over time at a national level. The results of this thesis can be inspiring and relevant for the future development of pediatric diabetes care in Norway and guide health care efforts in other populations, aiming for better glycemic results and HRQOL. For this purpose, the establishment of a diabetes registry to monitor treatment outcome measures and HRQOL, benchmark the pediatric departments, and identify factors that contribute to the improvement of diabetes care at a national or local level, in combination with universal access to diabetes technology and specialized diabetes care, might be important cornerstones.

• Hatle, Håvard; Rø, Torstein Baade; Bjørgaas, Marit Ragnhild Rokne & Skrivarhaug, Torild (2023). Awareness of hypoglycemia in type 1 diabetes - On the assessment, prevalence, and clinical associations of impaired awareness of hypoglycemia in children and adults. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232675135. Fulltekst i vitenarkiv Vis sammendrag

  Over one hundred years after the first doses of insulin were given as treatment for type 1 diabetes (TlD), hypoglycemia is still the main factor limiting optimal blood glucose control. Episodes of hypoglycemia are by itself one of the causes of reduced defense mechanisms towards hypoglycemia and the clinical syndrome of'impaired awareness of hypoglycemia' (IAH), defined as diminished or absent ability to recognize impending hypoglycemia. The syndrome is characterized by hypoglycemia being asymptomatic or that symptoms arise too late. A vicious circle with increased risk of severe hypoglycemia (SH) with loss of consciousness and need for help from others may then arise. Experiencing such episodes may lead to fear of hypoglycemia (FOH) with behaviors to keep blood glucose higher than recommended to avoid long-term complications of diabetes. The aim of this thesis of increased knowledge about IAH, also in children and adolescents, may as such contribute to better care, quality of life and health for those with diabetes. In a cross-sectional study among adults with TlD in Central Norway, 445 (70% of those who were invited) responded to questionnaires about hypoglycemia. As expected, we found episodes of SH the previous year to be associated with increased FOH, but also that FOH to greater extent was associated with having IAH. In our second study, we investigated whether two questionnaires often used to assess IAH in adults could be used also in children and adolescents. Children from two to nineteen years of age with TlD could participate, and 112 of those followed at the Children's Clinic at St. Olavs hospital in Trondheim completed these questionnaires (parents in children aged <9 years). They then kept a blood glucose diary for four weeks documenting details of all episodes of hypoglycemia. We found that the questionnaires possessed the most important measurement properties needed, and that those having IAH experienced more episodes of severe as well as clinically significant hypoglycemia, and more episodes without symptoms and where they did not recognize the hypoglycemia themselves. This is characteristic of the syndrome of IAH and we concluded that the questionnaires could be used in children and adolescents. In the third study, we used these questionnaires in a nationwide survey to learn how prevalent IAH is in children and adolescents with TlD, and how those with IAH differ from those with normal hypoglycemia awareness. To investigate this we used data collected at annual controls registered in the Norwegian Childhood Diabetes Registry. Most clinics participated and we analyzed data from 1,329 participants, which is over half of the children and adolescents with TlD in Norway. We found that more than one out of five reported to have IAH, and this was more common the younger the child. Furthermore, it was more common in those who had experienced SH or DKA the previous year, in those with high FOH, in females and in those with the worst glycernic control. The thesis concludes from these three studies that IAH, as assessed by these commonly used questionnaires, is prevalent also in children and adolescents with diabetes. Our fmdings further indicate that it is important to have knowledge of and assess IAH as it involves increased risk of SH and is related to FOH in both children and adults.

• Iversen, Hilde Karin Hestad; Helland, Ylva & Skrivarhaug, Torild (2018). Utvikling av metode for å måle pårørende- og pasienterfaringer med polikliniske konsultasjoner for barn med diabetes type 1. Folkehelseinstituttet. Fulltekst i vitenarkiv
• Iversen, Hilde Karin Hestad; Holmboe, Olaf & Skrivarhaug, Torild (2018). Pårørendes erfaringer med polikliniske konsultasjoner for barn med diabetes type 1. Nasjonale resultater. Folkehelseinstituttet. Fulltekst i vitenarkiv

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