Photo: Mauricio Pavez DiaBEST Research Group Research for Best Practice in Diabetes ANNUAL REPORT 2014 1 ANNUAL REPORT
Table of contents 1. Research for Best Practice in Diabetes 2. Overall aims and intermediate objectives 3. Activities in 2014 4. Research projects 5. Research group management 6. Scientific publications and dissemination of results APPENDIX A Scientific members of DiaBEST research group APPENDIX B Aims and objectives (2015-2016) APPENDIX C Publications and presentations 2014 2 ANNUAL REPORT
ANNUAL REPORT 3 1. Research for Best Practice in Diabetes RESEARCH FOR BEST PRACTICE IN DIABETES Diabetes is one of the major chronic conditions of our time. An estimated 382 million people worldwide are living with diabetes, and the prevalence is expected to reach 592 million by 2035 (IDF Global Atlas, 2013). Diabetes is one of the major diseases of our time. An estimated 382 million In Norway, about 350,000 people have diabetes, of which The group collaborates with researchers and clinicians people worldwide are living with diabetes, and the prevalence is expected to approximately half are undiagnosed. Despite the growing from specialist and primary health care in Western Health knowledge reach 592 about million what might by improve 2035 (IDF glycemic Global control, Atlas, 2013). Norway, and national and international researchers from the many persons do not meet the recommended treatment Nordic countries (Iceland, Denmark and Sweden), Europe goals. DiaBEST Psychosocial research problems group is one might of four complicate research the groups required in the Centre (the Netherlands for Evidence-Based and United Practice Kingdom), at Bergen Australia, University and USA self-management College (HiB). The of projects the disease, in DiaBEST and impede are anchored people with in the strategical (see page plans 8-14). of HiB, and are directly related to the college s diabetes Strategic to Research use their Program individual in resources Evidence-Based to self-manage Practice. The research group consists of senior staff and PhD candidates In an international perspective, research in DiaBEST intends the from condition Bergen and University attain treatment College, the goals. University Maintaining of Stavanger, an University of Bergen and University of Oslo (see Appendix A). to expand the evidence-based decision base for innovation appropriate glycemic control is important to prevent late in patient self-management competencies and to advocate complications The group collaborates of diabetes. with Many researchers people with and diabetes clinicians have from specialist and primary health care in Western Health Norway, renewing health care providers professional delivery of complex and national and compound and international needs, researchers and both competence from the Nordic levels countries (Iceland, Denmark and Sweden), Europe (the diabetes care and management. More knowledge is needed of Netherlands health-care and personnel United and Kingdom), organizational Australia, relationships and Northern America (Canada and the US) (see page 4-7). on researching complex interventions. According to the have Projects implications in the DiaBEST for quality research of care. group aim to contribute to research Medical for Research best practice Council in Complex diabetes Interventions health care and Research the DiaBEST implementation research of group evidence-based is one of four practice research in diabetes groups in health Framework care services. (MRC Health framework) care intervention (Fig 1) complex studies interventions are considered the complex. Centre According for Evidence-Based to the Medical Practice Research at Bergen Council University Complex contain Interventions multiple Research components Framework with the (MRC potential framework) for College (Fig 2) (HiB). complex The interventions projects DiaBEST contain multiple are anchored components in with interaction, the potential which for can interaction, influence which their effects can influence (Craig their et al. the effects strategical (Craig plans et al. 2008). of HiB, Mixed and are methods directly approaches related to the are needed 2008). to explore Mixed methods processes approaches and outcomes are needed in designing to explore and college s modelling Strategic new studies, Research feasibility Program testing Evidence-Based and piloting interventions, processes providing and outcomes new knowledge in designing on barriers and modelling and facilitators Practice. to adopting The new research strategies group in scientific health care, members and understanding consist change new studies, processes feasibility identifying testing multiple and piloting components interventions, which of can senior influence staff and the PhD effects. candidates Components from with Bergen potential University for interaction providing have new to be knowledge investigated on barriers systematically and facilitators in all phases to College, of an intervention. the University of Stavanger, University of Bergen adopting new strategies in health care, and understanding and University of Oslo (see Appendix A). change processes. Components with potential for interaction have to be investigated systematically in all phases of an intervention. FEASIBILITY AND PILOTING Testing procedures. Estimating recruitment and retention. Determining sample size. DEVELOPMENT Identifying the evidence base. Identifying or developing theory. Modelling process and outcomes. EVALUATION Assessing effectiveness. Understanding changeprocess. Assessing cost effectiveness. IMPLEMTATION Dissemination. Surveillance and monitoring. Long term follow-up. Fig 1. 1. Craig Medical P, Dieppe Research P, Macintyre Council Complex S, Michie Interventions S, Nazareth I, Research Petticrew Framework M (2008). Developing and evaluating complex interventions: 3 ANNUAL REPORT the new Medical Research Council guidance. British Medical Journal 337: a1655.
2. Overall aims and intermediate objectives Projects in the DiaBEST research group aim to contribute to research for best practice in diabetes health care and the implementation of evidence-based practice in diabetes health care services. The overall aims of the DiaBEST research group are: 1. To develop high quality research within the field of diabetes psychosocial health, with specific focus on promoting patient competence and motivation to self-manage their condition. 2. To develop new knowledge of factors promoting high quality diabetes care and enhanced patient and professional competencies in diabetes care and management. A specific focus is on the challenges of coordination between specialist and primary health care services. 3. To contribute to a solid epidemiological knowledge base within the field of diabetes with a specific focus on challenges related to risk for complications and comorbidity. For intermediate objectives (see Appendix B). In connection with the World Diabetes Day November 14th, the DiaBEST research group held a mini seminar at Bergen University College. Three lectures were presented to the participants, all focusing on relevant topics in diabetes 4 research. ANNUAL Here REPORT is Associate professor Anne Haugstvedt. Photo: Marthe Berg-Olsen.
3. Activities in 2014 The past year has been an active one for DiaBEST researchers in terms of meetings, seminars and conference activities (see below). In April, the research group also organized a two day Scandinavian Conference for PhD, Postdoc and senior researchers to facilitate networking opportunities for PhD and Postdoc students in the field of diabetes nursing research, to encourage collaboration between Nordic researchers and to promote high quality research studies. This annual conference is a Nordic arena for the discussion of different perspectives on the key challenges faced by those working in diabetes prevention, treatment and education. Meetings within the research group: Research group meetings every month to discuss theoretical and methodological aspects, and further development of projects. Regular meetings for the PhD candidates with supervisors. DiaBEST Autumn meeting at Solstrand, Os, December 10-11. Conference, seminars and meetings hosted by the DiaBEST Research Group: Nordic Diabetes Nursing Science PhD and Post Doctorial Conference at Solstrand, Os, April. DiaHealth collaborative meetings and seminars, with collaborators at University of Bergen, University of Oslo, University of Stavanger, and international visitors; Associate Professor Janet Harris, University of Sheffield, UK, Professor Truls Østbye, Duke University Medical Center, USA, Professor Arun Sigurdardottir, Akureyri, Iceland, Professor Trisha Dunning, Deakin University, Australia, Professor Mark Peyrot, Loyola University, USA. World Diabetes Day, mini seminar, November 14th. National and international scientific meetings with collaborators: Oslo, Norway: European Academy of Nursing Science (EANS) Scientific Winter Meeting, hosted by Oslo and Akershus University College, Norway, January. Homepage: http://www.european-academy-of-nursing-science.com/activities/scientific-meetings/ Copenhagen, Denmark: TRICC Research Collaboration Meetings (TRanslational Interventions assisting people to live well with Chronic Conditions) April and November. Homepage: www.scantricc.org Santpoort, the Netherlands: EDID (European Depression in diabetes) Research Consortium collaborative meeting, May. Homepage: http://www.psad-easd.eu/ Santpoort, the Netherlands: the Psychosocial Aspects of Diabetes (PSAD) Study Group (an official Study Group of the EASD) spring meeting, May. Homepage: http://www.psad-easd.eu/ Tromsø, Norway: Livsforsk (Norwegian Network of Quality of Life Studies). September. Homepage: http://livsforsk.jimdo.com/ Levanger, Norway: HUNT 4 collaborative Meeting, hosted by the HUNT Research Centre. September. International visits: Central Manchester University Hospitals NHS Foundation Trust, UK, May (Iversen) DUKE University Medical Center, USA, October (Iversen) University of Sheffield, UK, November (Graue) 5 ANNUAL REPORT
Some of the PhD candidates have participated in the following activities: European Academy of Nursing Science (EANS) Summer School hosted by the EHESP School of Public Health in Rennes, Brittany, France, June 30 July 11 (Kolltveit and Smith-Strøm). Summer School Utrecht hosted by Utrecht University, Faculty of Social and Behavioural Sciences, the Netherlands, August 17-21 (Strandberg). Ongoing supervision: In 2014 the following PhD student projects are in progress (for further details see p. 8-14): Mohn JM: A randomized controlled intervention; implementing an evidence-based intervention in adults with type 1 diabetes. Main supervisor: Professor Berit Rokne. Strandberg RB: Psychosocial health, emotional distress and diabetes. Main supervisor: Professor Berit Rokne. Lie SS (maternity leave from February 2014): Development and testing of an internet-based guided self-determination program to promote self-management for adults with type 2 diabetes Main supervisor: Professor Bjørg Karlsen. Smith-Strøm H: Delivery of foot care to patients with diabetes. Main supervisor: Professor Berit Rokne. Kolltveit BCH: Process evaluation diabetes telemedicine foot care intervention. Main supervisor: Professor Marit Kirkevold. Davies TT: Diabetes, documentation and home care service - a study of Norwegian municipality care. Main supervisor: Professor Berit Rokne. Diabetes research group for Best Practice (DiaBEST) Project outline 2015-2016 Centre of evidence-based practice NorPhyPain Family and couple research Evidenced-based Practice Research DiaBEST DiaFamily DiaLife DiaHealth DiaRisk Anne Haugstvedt Marit Graue Marit Graue Marjolein M Iversen DiaWeb DiaTele DiaComp DiaPrim Bjørg Oftedal Marjolein M. Iversen Marit Graue Johannes Haltbakk Figure 2. Organization of the activities and the scientific environment 6 ANNUAL REPORT
In 2014 the following master students finished their theses or projects are in progress (for further details; see p 8-14): Johansson HM: Diabetes follow-up procedures and documentation in nursing homes - a pilot study. Main supervisor: Associate Professor Anne Haugstvedt. Herre AJ: People with type 2 diabetes experiences of what knowledge and skills that are essential in order to manage their disease - a qualitative study. Main supervisor: Professor Marit Graue. Solberg H: A follow-up study among obese people, with or without diabetes, who have gone through Gastric Bypass surgery. Main supervisor: Professor Marit Graue. Meyer MS: The Hordaland Health Study. Main supervisor: Marjolein M. Iversen. Hunnestad M: Patients with type 2 diabetes in primary health care. A grounded theory study. Main supervisor: Associate Professor Milka Satinovitc. Landbakk TL: Knowledge and skills among nurses, health care workers and assistant in nursing homes. Main supervisor: Associate Professor Anne Haugstvedt. Fløde M: Evaluation of coping and knowledge levels in people with type 2 diabetes, before and after group based diabetes self-management education. Main supervisor: Associate Professor Johannes Haltbakk. Bendixen B: Experiences of carers of people with diabetes receiving home care services a qualitative study. Main supervisor: Associate Professor Johannes Haltbakk. Hernar I: Lipohypertrophy in adult persons with type 1 diabetes and associations to trait, psychosocial characteristics, and reported injection technique a cross sectional study. Main supervisor: Associate Professor Johannes Haltbakk. Titlestad I: Patient safety in diabetes care and implementation of guidelines in nursing homes. Main supervisor: Professor Marit Graue. Holvik T: Fear of hypoglycemia and perceived diabetes-related burden among parents of children with type 1 diabetes. A population-based, cross-sectional study. Main supervisor: Associate Professor Anne Haugstvedt. Naalsund B: Lipohypertrophy among children with type 1 diabetes a cross sectional study. Main supervisor: Associate Professor Anne Haugstvedt. Teigland T: Diabetes and gastroparese a follow-up study. Main supervisor: Associate Professor Marjolein M Iversen. Staff M: Challenges related to obesity in adolescence. Main supervisor: Associate Professor Marjolein M Iversen. 7 ANNUAL REPORT
4. Research projects Research in DiaBEST is organized into the following areas: A. Diabetes and family research (DiaFamily) B. Psychosocial health and diabetes self-management (DiaLife) C. Diabetes in primary health care (DiaHealth) D. Diabetes research investigating risk for complications and comorbidity (DiaRisk) Figure 2 shows the organization of the research activities and the scientific environment. In this model the research is organized in four projects. The title of projects, members and research collaboration are listed below. A. Diabetes and family research (DiaFamily) Project leader: Associate Professor Anne Haugstvedt Type 1 diabetes is one of the most common chronic conditions of childhood in industrialized countries. Achievement of tight blood glucose control is difficult to maintain, and many children and adolescents demonstrate poor glycemic control. The considerable demands of managing the disease; including both treatment and self-care, represent a challenge to family life. Project A1: Fear of hypoglycemia and perceived diabetes-related burden among parents of children with type 1 diabetes. A population-based, cross-sectional study. Project group: Anne Haugstvedt, Tore Wentzel-Larsen, Berit Rokne, Marit Graue, Morten Aarflot and Tom Holvik (master student). International collaboration: Linda Gonder-Frederick, University of Virginia, USA. Contact person: anne.haugstvedt@hib.no Project A2: Mothers and fathers lived experiences of having a child aged 0-7 years diagnosed with type 1 diabetes. Project group: Anne Solveig Iversen, Anne Haugstvedt, Marit Graue and Målfrid Raheim. Contact person: anne.solveig.iversen@hib.no Project A3: Celiac disease among children with type 1 diabetes a review of guidelines. Project group: Bente Naalsund (master student) and Anne Haugstvedt. Contact person: anne.haugstvedt@hib.no Project A4: Lipohypertrophy among children with type 1 diabetes a cross sectional study. Project group: Bente Naalsund (master student) and Anne Haugstvedt. Contact person: anne.haugstvedt@hib.no Project A5: Parent involvement and distribution of responsibility between parents and children/ adolescents with type 1 diabetes. An integrative review of the literature. Project group: Anne Haugstvedt and Marit Graue. International collaboration: Anna Lindholm Olinder, Sachska Children s Hospital Sodersjukhuset Sweden, Gitte Husted, Steno Hospital, Denmark and Lena Hanberger, Linkjoping University, Sweden. Contact person: anne.haugstvedt@hib.no 8 ANNUAL REPORT
B. Psychosocial health and diabetes self-management (DiaLife) Project leader: Professor Marit Graue Diabetes is a chronic condition that affects most aspects of life, with psychosocial aspects having especially great importance for diabetes regulation and how the individual deals with the condition. Central within this area of research is the development of new knowledge of factors that motivate selfmanagement and adequate health behavior. To identify patient competence and motivational challenges at an early stage is important to prevent self-management problems and the development of long-term complications. Project B1: Mental health and diabetes Project group: Ragnhild Bjarkøy Strandberg (PhD student), Marit Graue, Tore Wentzel-Larsen, Norwegian Centre for Violence and Traumatic Stress Studies, Norway, Hrafnkell Thordarson, Haukeland University Hospital, Norway and Berit Rokne. International collaboration: Mark Peyrot, Loyola University, Maryland, USA. Contact person: ragnhild.bjarkoy.strandberg@hib.no Project B2: Using Guided Self-Determination (GSD) to promote improved self-management in adults with type 1 diabetes a multicenter intervention study. Project group: Jannike Mohn (PhD student), Marit Graue, Jörg Assmus, Haukeland University Hospital, Bergen, Hrafnkell Thordarson, Haukeland University Hospital, Norway and Berit Rokne. International collaboration: Vibeke Zoffmann, The Juliane Marie Centre, Denmark and Mark Peyrot, Loyola University, Maryland, USA. Contact person: jannike.mohn@hib.no Project B3: Motivation for self-regulation among adults with type 2 diabetes. Project group: Bjørg Karlsen, Bjørg Oftedal, Svein Skeie, Stavanger University Hospital, Norway and Edvin Bru, University of Stavanger, Norway. International collaboration: Berit Lundman, University of Umeå, Sweden and Barbara Paterson, Thompson Rivers University, Canada. Contact person: bjorg.karlsen@uis.no Project B4: Effectiveness of self-management interventions in chronically ill patients from the lower social economic classes- a systematic literature review. International project group: Ann van Hecke, Gent University, Belgium, Betsie van Gaal, Radboud University, the Netherlands, Maud Heinen, Radboud University, the Netherlands, Sascha Köpke, University of Lübeck, Germany, Bente Høy, Via University College, Denmark, Jeroen Hendriks, Maastricht University, the Netherlands, Maria Lithner, Lunds University, Sweden, Paz Fernandez Ortega, Catalan Institute of Oncology, Spain and Marit Graue. Contact person: marit.graue@hib.no Project B5: Translating person-centeredness into the care of people with chronic conditions - Comparison of Motivational Interviewing, Illness Integration Support and Guided Self-Determination. International project group: Vibeke Zoffmann, The Juliane Marie Centre, Denmark, Åsa Hörnsten, Umeå University, Sweden, Solveig Storbækken, Bergen Clinics Foundation, Norway, Marit Graue, Bodil Rasmussen, Deakin University, Australia, Astrid K. Wahl, University of Oslo and Marit Kirkevold, University of Oslo. Contact person: marit.graue@hib.no 9 ANNUAL REPORT
C. Diabetes in primary health care (DiaHealth) Project leader: Professor Marit Graue Promoting patient and professional competencies in diabetes care and management is a prerequisite for high-quality evidence-based health care. This project intends to expand the evidence-based decision base for innovation in patient self-management competencies and to advocate the renewal of health care providers professional delivery of diabetes care and management. Web-based interventions have the potential to develop a more modern, dynamic and flexible diabetes care based on the individuals needs, which in turn, can increase people with type 2 diabetes motivation for diabetes management. In specialist care, data have been collected to analyze characteristics and referral data of people with diabetes related foot ulcers attending specialist health care settings. These results inform an ongoing telemedicine follow-up care intervention for people with diabetes-related foot ulcers in municipal primary health care in collaboration with specialist health care. Data collection is also ongoing in sub-studies in home care service. User involvement is emphasized in all phases of the research project. Read more on: prosjekt.hib.no/diahealth Project C1: Developing and feasibility testing an internet-based guided self-determination programme to promote self-management for adults with type 2 diabetes (DiaWeb). Project group: Bjørg Oftedal, Silje Stangeland Lie, Bjørg Karlsen, Marit Graue, Berit Rokne. International collaboration: Vibeke Zoffmann, The Juliane Marie Centre, Copenhagen, Denmark and Mark Peyrot, Loyola University, Maryland, USA. Contact person: bjorg.oftedal@uis.no Project C2: Process evaluation of an Internet-based self-management support program in general practice to promote self-management among adults with type 2 diabetes (DiaComp). Project group: Marit Graue, Bjørg Oftedal, Bjørg Karlsen, Beate-Christin Hope Kolltveit and Marit Kirkevold. International collaboration: Vibeke Zoffmann, The Juliane Marie Centre, Denmark, Åsa Hörnsten, University of Umeå Sweden, Trisha Dunning, Deakin University, Australia and Janet Harris, University of Sheffield, UK. Contact person: marit.graue@hib.no Project C3: Experience of knowledge and skills that are essential in self-managing a chronic condition a focus group study among people with type 2 diabetes. Project group: Ann Jorunn Herre (master student), Eva Gjengedal, University of Bergen, Beate-Christin Hope Kolltveit and Marit Graue. Contact person: marit.graue@hib.no Project C4: Patients with type 2 diabetes in primary health care. A grounded theory study. Project group: Malin Hunnestad (master student), Milka Satinovitc, Bergen University College and Marit Graue. Contact person: milka.satinovitc@hib.no Project C5: Evaluation of coping and knowledge levels in people with type 2 diabetes, before and after group based diabetes self-management education. Project group: Mari Fløde (master student), Marjolein M. Iversen, Morten Aarflot and Johannes Haltbakk. Contact person: johannes.haltbakk@hib.no 10 ANNUAL REPORT
Project C6: Delivery of foot care to patients with diabetes (DiaTele). Project group: Hilde Smith-Strøm (PhD student), Marjolein M. Iversen, Svein Skeie, Stavanger University Hospital, Norway, Grete S. Tell, University of Bergen, Norway Marie F. Hausken, Stavanger University Hospital, Norway, John Cooper, Stavanger University Hospital, Norway, Marit Kirkevold, Marit Graue and Berit Rokne. International collaboration: Truls Østbye, Duke University Medical Center, USA. Contact person: hilde.smith-strom@hib.no Project C7: Effect of telemedicine follow-up care of leg and foot ulcers: a systematic review. Project group: Lena V. Norheim, Bergen University College, Norway, Marianne Tveit Henanger (master student) and Marjolein M. Iversen Contact person: marjolein.iversen@hib.no Project C8: Diabetes-related foot ulcers and associated factors from the North Trøndelag Health Study (HUNT 3) (2006 2008) Project group: Anne Karin Molvær (master student), Marit Graue, Birgitte Espehaug, Kristian Midthjell and Marjolein M Iversen. International collaboration: Truls Østbye, Duke University Medical Centre, USA. Contact person: marjolein.iversen@hib.no Project C9: Depression - a risk factor for foot ulcers among individuals with diabetes? 11 years follow-up of the North Trøndelag Health Study (HUNT2 and HUNT3 studies). Project group: Marjolein M. Iversen, Birgitte Espehaug, Bergen University College, Norway, Kristian Midthjell, HUNT Research Center, Norway, Line Iden Berge, Haukeland University Hospital, Marit Graue, Berit Rokne and Grethe S. Tell, University of Bergen, Norway. International collaboration: Truls Østbye, Duke University Medical Centre, USA. Contact person: marjolein.iversen@hib.no Project C10: Improved job satisfaction, competence and communication between levels of care by using telemedicine technology in diabetes foot care service delivery. A focus group study (DiaComp). Project group: Beate-Chrisin Hope Kolltveit (PhD student), Eva Gjengedal, Marjolein M Iversen, Marit Graue and Marit Kirkevold. International collaboration: Trisha Dunning, Deakin University, Australia. Contact person: beate-christin.hope.kolltveit@hib.no Project C11: Diabetes, documentation and home care service - a study of Norwegian municipality care (DiaPrim). Project group: Therese Thuen Davies (PhD student), Johannes Haltbakk, Grete S. Tell, University of Bergen, Norway, Marit Kirkevold, Marit Graue, Marjolein M. Iversen, Morten Aarflot, Kåre Birkeland, University of Oslo, Norway, and Berit Rokne International collaboration: Mark Peyrot, Loyola University, Maryland, USA. Contact person: therese.thuen.davies@hib.no 11 ANNUAL REPORT
Project C12: Comorbidity, functional status, risk of hospitalization and mortality among persons with and without diabetes with contracted home care services - a national based register based study (2009-2013) (DiaPrim). Project group: Marjolein M. Iversen, Johannes Haltbakk, Anne Haugstvedt, Marit Graue, Therese Thuen Davies, Birgitte Espehaug, Bergen University College, Norway, Morten Aarflot, Kåre Birkeland, University of Oslo, Norway, Marit Kirkevold, Grete S. Tell, University of Bergen, Norway and Berit Rokne. International collaboration: Mark Peyrot, Loyola University, Maryland, USA Contact person: marjolein.iversen@hib.no Project C13: Diabetes care in home-based care and nursing homes developing and feasibility testing a diabetes competence program for health care professionals in municipal diabetes care (DiaPrim). Project group: Anne Haugstvedt, Ann Kristin Berge, Bergen Municipality, Norway, Linda Heimvik, Bergen Municipality, Norway, Irit Titlestad (master student), Marit Kirkevold and Marit Graue. International collaboration: Trisha Dunning, Deakin University, Australia. Contact person: anne.haugstvedt@hib.no Project C14: Diabetes in nursing homes knowledge and competence among nurses, health care providers and assistants in nursing homes. Project group: Anne Haugstvedt, Tilla Landbakk (master student), Marit Graue and Morten Aarflot. Contact person: anne.haugstvedt@hib.no Project C15: Diabetes-related documentation routines in 4 Norwegian nursing homes. Project group: Anne Haugstvedt and Hilde Merete Johansson (master student). Contact person: anne.haugstvedt@hib.no Debatt 27 Stavanger aftenblad fredag 14. november 2014 Debattleder: Torgeir Vølstad Tlf. 05150 Epost: debatt@aftenbladet.no, kronikk@aftenbladet.no Diabetes Strategi De siste årenes framskritt i behandling og overvåking av diabetes må følges opp med styrket vekt på forebygging, også ved hjelp av ny teknologi. Foto: Scanpix Innsatsen mot diabetes 2 må settes inn tidligere. Blant annet via internett. Fra behandling til handling Det er velkjent at den beste måten å forhindre eller bli kvitt type 2 diabetes på er å trene og spise riktig mat. Likevel øker forekomsten av sykdommen. Ved å investere ressurser på et tidligere tidspunkt i behandlingskjeden kan vi dreie fokuset fra behandling til handling og gjøre flere friske. Løsningen kan være tettere oppfølging på internett. Det er ikke for alle å skulle «gå hjem og gjøre livsstilsendringer» når diagnosen er et faktum. Å endre livsstil krever tid, kunnskap og motivasjon, og de fleste som får sykdommen trenger støtte fra helsepersonell til å lage rutiner for trening og kosthold utfra sin egen livssituasjon. Fornye og Forsterke: Mange pasienter med type 2 diabetes oppnår ikke behandlingsmålene. Derfor ligger det et stort potensial for nye tilnærminger i det tradisjonelle tjenestetilbudet på fastlegekontorene til denne pasientgruppen. I dagens arbeids- og samfunnsliv har pasientene behov for løsninger som er mye mer fleksible og tilpasset den enkeltes hverdag. Vi trenger nye arbeidsmetoder som har større vekt på veiledning og samtale om livsstilsendringer slik at flere kan bli friske eller få en bedre diabetesregulering. I vår forskning arbeider vi derfor med å utvikle et tiltak til bruk på fastlegekontorene hvor dia- Bjørg Oftedal Førsteamanuensis, uis Marit Graue Professor, Høgskolen i Bergen Stavanger Aftenblad arbeider etter Vær Varsom-plakatens regler for god presseskikk. Den som mener seg rammet av urettmessig avisomtale, oppfordres til å ta kontakt med redaksjonen. betessykepleiere kan følge opp personer med diabetes via internett. Den nye tilnærmingen vil bli systematisk testet ut i studien. Vi trenger å ta innover oss at en person med diabetes i 1994, før internettets inntog, ikke er den samme pasienten som kommer inn døren for diabeteskonsultasjon i 2014. Dagens e-pasient har helt andre muligheter for å øke kunnskapen sin om diabetes enn bare for få år siden. Kunnskap kan søkes opp gjennom blogger, forum, helseinformasjonssider og etter hvert også elektroniske journalsystemer der den enkelte kan logge seg inn og få tilgang på egne helseopplysninger via BankID. Programmer for e-konsultasjon muliggjør og utfordrer en annen form for dialog mellom helsepersonell og pasienter. Norge har høy levestandard og en befolkning som er blant de beste i verden til å ta i bruk nye tekniske muligheter. Forholdene ligger dermed svært godt til rette for å ta i bruk den nye teknologien. Finnøy kommune har allerede testet ut oppfølging via internett i diabetesomsorgen. Tiltaket har resultert i at 180 personer har slanket vekk nærmere ett tonn. livsstilsendringer: For personer med type 2 diabetes kan krav om livsstilsendringer kollidere med viktige verdier i livet, slike verdier som har betydning for personens Pressens faglige utvalg (PFU) er et klageorgan oppnevnt av Norsk presseforbund. Organet, som har medlemmer fra presseorganisasjonene og fra allmenheten, behandler klager mot pressen i presseetiske spørsmål (trykt presse, radio og fjernsyn). identitet og selvfølelse. Hva ville du tenkt dersom du hadde måtte kutte ut mye av det du liker i dag for å hindre diabeteskomplikasjoner i fremtiden? «Mine interesser er dataspill, lesing og film. Ganske stillesittende og rolige aktiviteter. Jeg har med andre ord mine interesser på områder som passer svært dårlig sammen med diabetes». Noen opplever det å skulle oppsøke treningssenter som en enorm barriere. Kanskje bærer man på noen kilo for mye, og føler seg dårlig i møte med spretne og spreke kropper på tredemøllene. Nødvendige livsstilsendringer kan også komme i konflikt med samvær med venner og familie, og er vanskelig å kombinere med arbeidslivets effektivitetskrav. Den helsemessige gevinsten ved å gjøre endringer er stor. Man kan få tilbake en god blodsukkerbalanse uten bruk av medisiner, eller få redusert bruken av medisiner, og dermed også utsette videre sykdomsutvikling med tilhørende komplikasjoner som eksempelvis hjerte- og karsykdom. nasjonalt samfunnsansvar: Årsakene til økningen i forekomsten av type 2 diabetes er sammensatte, og vi har ikke noe enkelt svar. Det vi vet, er at det ligger et betydelig uutnyttet potensial i å satse på veilederkompetanse hos diabetessykepleiere, og en diabetesplan som Adresse: Rådhusgt. 17, Postboks 46, Sentrum 0101 Oslo. Telefon: 22 40 50 40 Telefaks: 22 40 50 55 E-post: pfu@presse.no retter et særlig søkelys på den moderne pasienten som er motivert til å gå nye veier for å nå sine mål. Å bremse antall nye personer som får type 2 diabetes, og støtte den som allerede har utviklet sykdommen til å forhindre eller forsinke utviklingen av komplikasjoner, er et nasjonalt samfunnsansvar. Det er på tide at helsemyndighetene legger resurser i diabetesomsorgen der det faktisk monner kommunehelsetjenestens veiledningskompetanse må prioriteres og verdsettes på lik linje med medisinsk behandling for denne pasientgruppen. Helsepersonell trenger mer pedagogisk og teknologisk kompetanse til å utvikle og ta i bruk nye e- konsultasjonsprogrammer med fokus på varige livsstilsendringer for personer md type 2 diabetes. Verdens diabetesdag hh14. november er Verdens diabetesdag. hhdiabetes er en av de største helsemessige utfordringene verden står overfor i det 21. århundre. Det er anslått at 350.000 personer i Norge har sykdommen, et tall som dessverre vil øke de neste årene. hhden internasjonale diabetesføderasjonen (IDF) regnet i 2013 med 352 millioner tilfeller av diabetes på verdensbasis. Innen 2035 er dette tallet anslått til å stige til 592 millioner i 2035. Aftenbladet betinger seg retten til å publisere i alle Aftenbladets mediekanaler, herunder å legge stoffet inn i et elektronisk arkiv eller andre databaser som avisen samarbeider med. Unntak fra dette må avtales skriftlig. Publiseringsvilkårene gjelder for såvel honorert som ikke honorert stoff. Associate Professor Bjørg Oftedal and professor Marit Graue had an article published in Stavanger Aftenblad regarding web-based consultation in diabetes treatment in November. Photo: Stavanger Aftenblad. 12 ANNUAL REPORT
D. Diabetes research investigating risk for complications and comorbidity (DiaRisk) Project leader: Associate Professor Marjolein M. Iversen. The rapid increase of people with diabetes requires having a solid epidemiological knowledge base and developing high quality health care services and effective preventive strategies. Issues investigated in this area cover a broad range of epidemiological studies in diabetes and issues related to prevention, risk factors and mortality in diabetes. We will make use of large population surveys such as The Nord Trøndelag Health Survey and health records, such as the Norwegian Patient Registry. Research opportunities are significant and will be exploited by couplings with Death Registry and Norwegian Prescription Database. An important element of the research in this area will be a close cooperation with relevant clinical environments on studies related to diabetes related complications and comorbidity. Project D1: Associations between anxiety, depression and initiation of insulin therapy in individuals with type 2 diabetes (HUNT2, HUNT3 and NorPD registries). Project group: Marjolein M. Iversen, Grethe S. Tell, University of Bergen, Norway, Kristian Midthjell, HUNT Research Center, Norway, Birgitte Espehaug, Bergen University College, Norway and Marit Graue. International collaboration: Giesje M. Nefs and Frans Pouwer, Tilburg University, the Netherlands. Contact person: marjolein.iversen@hib.no Project D2: Anxiety, depression and mortality in insulin-naïve individuals with type 2 diabetes (HUNT2 and HUNT3). Project group: Marjolein M. Iversen, Grethe S. Tell, University of Bergen, Norway, Kristian Midthjell, HUNT Research Center, Norway, Birgitte Espehaug Bergen University College, Norway and Marit Graue. International collaboration: Giesje M. Nefs and Frans Pouwer, Tilburg University, The Netherlands. Contact person: marjolein.iversen@hib.no Project D3: Diabetes and eye care follow-up health care among persons with type 1 and type 2 diabetes and severe diabetic retinopathy. Project group: Jorgen G. Krohn, Ragnhild W. Jansson, Hilde N. Kilstad, all Haukeland University Hopsital, Norway and Marit Graue. Contact person: marit.graue@hib.no Project D4: Effects of systematic telemedicine follow-up of diabetes-related foot ulcers in community health-care services - a cluster-randomized controlled intervention (DiaFOTo). Project group: Marjolein M. Iversen, Marie F. Hausken, Stavanger University Hospital, Norway, John Cooper, Stavanger University Hospital, Norway, Svein Skeie, Stavanger University Hospital, Norway, Berit Rokne, Grete S. Tell, University of Bergen, Norway and Marit Graue. International collaboration: Truls Østbye, Duke University Medical Centre, USA. Contact person: marjolein.iversen@hib.no Project D5: A pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in patients with diabetes in Norway. Project group: Anita Skafjeld (master student), Marjolein M. Iversen, Ingar Holme, Lis Ribu, Kjetil Hvaal, AN Smeby and Bente K. Kilhov. Contact person: marjolein.iversen@hib.no 13 ANNUAL REPORT
Project D6: Low-level laser therapy and skin wound healing in streptozotocine-induced diabetic rats. Project group: Dancakova L, Vasilenko T, Kovač I, Jakubčova K, Chovan M, Ichniovska Z, Peržeľova V, Revajova V, Sabol F, Tomori Z, Gal P, Lopes-Martins RAB, Marjolein M. Iversen, Jon Joensen, Bergen University College, Norway and Jan Magnus Bjordal, Bergen University College, Norway. Contact person: marjolein.iversen@hib.no Project D7: DIALONG: Diabetes type 1 long term survivors with a new syndrome of late complication? Project group: Kristine Bech Holte, Kristian F. Hanssen, Knut Dahl-Jorgensen, Kari Anne Sveen, Ingebjorg Seljeflot, Nils E. Klow, Jon Havard Loge, Niels Gunnar Juel, Marjolein M. Iversen and Tore Julsrud Berg. Contact person: marjolein.iversen@hib.no 5. Research group management Professor Marit Graue, is the secretary of the Scientific Advisory Committee and the Steering Group, and is responsible for the daily management of the research group and the progress of projects in collaboration with the members of the group. The established international Scientific Advisory Committee; Professor Trisha Dunning, Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong, Australia and Professor Mark Peyrot, Department of Sociology, Loyola University, Maryland, USA contributes expertise and provides guidance concerning the scientific development of the research group to ensure that international research standards are met and maintained. In addition, Professor Truls Østbye, Duke University Medical Center, USA is an advisor for the larger DiaHealth project funded by the Norwegian Research Council. The Steering Group evaluates progress and resources in the projects and the members from the two universities in the region; Professor Berit Rokne, University of Bergen and Professor Bjørg Karlsen, University of Stavanger contribute to annual reports. The larger research team contributes in the planning and monitoring of each of the projects. The thematic leaders are responsible for developing the research themes by initiating new and overseeing existing projects. It allows researchers to acquire leadership training, and inclusion of early-stage researchers, PhD and master students to be invited to participate in existing projects. 6. Scientific publications and dissemination of results The number of scientific publications as well as presentations at national and international conferences has increased during the last three years (2012-2014). For further details see publication list (Appendix C). 14 ANNUAL REPORT
Master student Mari Fløde won an award for best abstract from Norwegian Nurses Organisation in September. From left: Associate professor Marjolein Iversen, Mari Fløde and Elsa Orvik, representing the organisation s expert group in diabetes. Photo: Marthe Berg-Olsen. Appendic A - Scientific members of DiaBEST Research Group Bergen University College and the Western Health Trust Professor Marit Graue, Faculty of Health and Social Science and Haukeland University Hospital. Associate Professor Marjolein M Iversen, Faculty of Health and Social Science and Stavanger University Hospital. Associate Professor Johannes Haltbakk, Faculty of Health and Social Science. Associate Professor Anne Solveig Iversen, Faculty of Health and Social Science. Associate Professor Anne Haugstvedt, Faculty of Health and Social Science. Research Fellow Jannike Mohn, Faculty of Health and Social Science and Haukeland University Hospital. Research Fellow Ragnhild Bjarkøy Strandberg, Faculty of Health and Social Science. Research Fellow Hilde Smith-Strøm, Faculty of Health and Social Science. Research Fellow Beate-Christin Hope Kolltveit, Faculty of Health and Social Science and Vossevangen Medical Centre. Research Fellow Therese Thuen Davies, Faculty of Health and Social Science. Assistant Professor Wenche Sofie Nilsen, Faculty of Health and Social Sciences. Statistician Morten Aarflot, Faculty of Health and Social Sciences. Project coordinators Marthe Berg-Olsen and Hanna Nykvist, Faculty of Health and Social Sciences. 15 ANNUAL REPORT
University of Bergen, University of Stavanger and Haukeland University Hospital Professor Berit Rokne, Department of Global Health and Primary Health Care UiB and Haukeland University Hospital. Professor Bjørg Karlsen, Faculty of Social Sciences, Department of Health Studies UiS. Associate Professor Bjørg Oftedal, Faculty of Social Sciences, Department of Health Studies UiS. Research Fellow Silje Stangeland Lie, Faculty of Social Sciences, Department of Health Studies UiS. University of Oslo and Bergen University College Professor Marit Kirkevold, Department of Nursing Science, UiO and Bergen University College. International research collaboration The Juliane Marie Centre, Denmark Associate Professor Vibeke Zoffmann, The Research Unit Women s and Children s Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark University of Sheffield, UK Associate Professor Janet Harris, School of Health and Related Research (ScHARR), UK University of Akureyri, Iceland Professor Árún Sigurdardottir, School of Health Sciences, Akureyri Umeå University, Sweden Associate Professor Åsa Hörnsten, Department of Nursing, Umeå University of Tilburg, the Netherlands Professor Frans Pouwer, Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, the Netherlands Associate Professor Giesje Nefs,Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, the Netherlands DUKE University, USA Professor Truls Østbye, Duke University Medical Center, North Carolina, USA Loyola University, USA Professor Mark Peyrot, Department of Sociology, Maryland, USA Deakin University, Australia Associate Professor Bodil Rasmussen, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia Professor Trisha Dunning, Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong, Australia 16 ANNUAL REPORT
Appendix B - Aims and objectives (2015-2016) Projects in the DiaBEST research group aim to contribute to research for best practice in diabetes health care and the implementation of evidence-based practice in diabetes health care services. The overall aims of DiaBEST are: 1. To develop high quality research within the field of diabetes and psychosocial health, with specific focus on promoting patient competence and motivation of self-management for living with diabetes. 2. To develop new knowledge of factors promoting high quality diabetes care and enhanced patient and professional competencies in diabetes care and management. A specific focus is on the challenges of coordination between specialist and primary health care services. 3. To contribute to a solid epidemiological knowledge base within the field of diabetes with a specific focus on challenges related to risk for complications and comorbidity. Intermediate objectives: 1. To develop a strong research environment within psychosocial health and diabetes to ensure that treatment and follow-up are based on the best available knowledge. 2. To develop knowledge about the motivation to self-manage their condition and the promotion of life skills for living with the disease. 3. To contribute to the development of high-quality health care services, effective preventive strategies for people with diabetes, and health care strategies that enhance the quality of care for people with diabetes. 4. To develop knowledge about factors promoting patient involvement in practice, interaction between professionals on different levels, and multidisciplinary work in diabetes care. 5. To build up a research network within an area that can be on the forefront internationally, strengthen the international research collaboration and increase the level of external funding. 6. To contribute to researcher recruitment through a systematic effort of student involvement at different levels. 7. To strengthen the research collaboration between the Western Norway Regional Health Authority (HelseVest), health care authorities in municipalities in Western Norway and the DiaBEST research group at Bergen University College, University of Bergen and University of Stavanger. 8. To make the research in DiaBEST available to the scientific research community through publications primarily in level 2 scientific journals, to professional health care workers through publications in journals of relevance for health care professions and to the general public, in particular people with diabetes and their families, through the publication of popular scientific literature. 17 ANNUAL REPORT
Appendix C - publications and presentations 2014 Peer-reviewed scientific publications 1. Naalsund B, Haugstvedt A (2014) Ulike anbefalinger: Screening for cøliaki hos barn og unge med type 1 diabetes. Sykepleien Forskning 9 (4): 314-322, doi: 10.4220/sykepleienf.2014.0170. 2. Nordheim L, Haavind M, Iversen MM (2014). Effect of telemedicine follow-up care of leg and foot ulcers: a systematic review. BMC Health Services Research Nov 6;14(1):565. [Epub ahead of print] 3. Strandberg RB, Graue M, Wentzel-Larsen T, Peyrot M, Rokne B.(2014) Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes. Journal of Psychosomatic Research 77: 174-179. 4. Kolltveit BCH, Graue M, Zoffmann V, Gjengedal E. (2014) Experiences of nurses as they introduce the Guided Self-Determination (GSD) counselling approach in outpatient nurse consultations among people with type 1 diabetes. Vård i Norden.34.(2):59-63. 5. Karlsen, B. and Bru, E. (2014) The relationship between diabetes-related distress and clinical variables and perceived support among adults with type 2 diabetes: A prospective study. International Journal of Nursing Studies, 51: 438 447. 6. Iversen MM, Tell GS, Espehaug B, Midthjell K, Graue M, Rokne B, Iden Berge L, Østbye T. (2014) Is depression a risk factor for foot ulcers among individuals with diabetes? 11 years follow-up of the Nord-Trøndelag Health Study. Journal of Diabetes and Its Complications. Sep 16. pii: S1056-8727(14)00263-3. doi: 10.1016/j.jdiacomp.2014.09.006. [Epub ahead of print] 7. Molvær AK; Graue M, Espehaug B, Østbye T, Midthjell K, Iversen MM (2014). Diabetes-related foot ulcers and associated factors: results from the Nord-Trøndelag Health Survey (HUNT3) (2006-2008). Journal of Diabetes and Its Complications p 156 161. 8. Oftedal, BF (2014) Perceived support from family and friends among adults with type 2 diabetes. European Diabetes Nursing 11(2) p. 43-48 9. Foss B. Løkken A, Leland A, Stordalen J, Mordt P, Oftedal BF (2014) Digital game-based learning: a supplement for medication calculation drills in nurse education. E-Learning and Digital Media 11.(4) s. 342-349 Popular scientific publications 10. Titlestad I, Graue M, Haugstvedt A (2014). Individualisering av behandlingsmål for eldre med diabetes. Geriatrisk Sykepleie. 3:10-17. 11. Hanssen TA, Graue M (2014) Styrker sykepleieforskning det er viktig at sykepleieforskere deltar i internasjonale forskningsnettverk Tidsskriftet Sykepleien 7:41-43 12. Oftedal BF, Hvidsten V, Tillerli K, Foss B (2014) God læring med digitalt verktøy. Tidsskriftet sykepleien 7:46-48 13. Kvinge LM, Tangeraas A, Oftedal BF (2014) Gruppebasert læring- og mestringstiltak for personar med type 2 diabetes- Evalueringsrapport: FOUSAM rapportserie; 38 s. Books/book chapters 14. Iversen MM (2014). Diabetes. In: Geriatrisk sykepleie: god omsorg til den gamle pasienten. Red. Kirkevold, M., Brodtkorb, A.H.R. Oslo, Gyldendal akademiske, 2008 / 2. Edition 2014. Internasjonal oral and poster presentations 15. Iversen MM (2014). The diabetic foot patient. Characteristics and outcomes Nordic Diabetic Foot Symposium, 5-6 November Malmø, Sverige (Invited speaker) 16. Iversen MM (2014). Research within diabetes and diabetes foot ulcers. Presentation at Research group of Professor Boulton at Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. 19. Mai. 18 ANNUAL REPORT
Associate professor Marjolein M. Iversen received the DiaBEST Research group s Publication award, for her excellent work in promoting her research in 2014. Here with professor and project leader Marit Graue. Photo: Marthe Berg-Olsen. 17. Iversen MM (2014). Foot ulcers and their consequences for people with diabetes. Conclusions from HUNT3 and proposals for HUNT4. Jubileumsseminar HUNT- 30 year anniversary seminar, 26. September, Levanger. 18. Nortvedt MW, Graverholt B, Iversen MM (2014). Bergen University and Future Opportunities for DUSON. DUKE, School of Nursing, October 14. 19. Kolltveit BCH (2014) A qualitative study of health-care professionals using telemedicine in diabetes foot care. 25. november, Århus, Danmark. 20. Kolltveit BCH (2014) A focus-group study of health-care professionals - diabetes telemedicine foot care intervention. European Academy of Nursing Science (EANS) summer school, Rennes, Brittany, France, 30th June-11th. 21. Smith-Strøm, H. (2014) Delivery of foot care for patients with diabetes. European Academy of Nursing Science (EANS) summer school, Rennes, Brittany, France, 30th June-11th July. 22. Smith-Strøm H. (2014) Delivery of foot care for patients with diabetes. 7th Nordic Diabetes Ph.d and Post doc Research. Conference for Nurses. Solstrand. 28.-29. April. 23. Davies TT. (2014) Prevalence of diabetes in the home care service, and the association between HbA1c, self-reported health, quality of life, functional status, cognitive status and symptoms. 7th Nordic Diabetes Phd and Post doc Research Conference 28.-29. April. Solstrand, Os 24. Bjarkøy R. (2014) Emotional health and glycemic control. The 7th Nordic Diabetes Ph.d and Post doc Research Conference, Solstrand, 28.-29.04. 25. Kolltveit BCH (2014) Process evaluation diabetes telemedicine foot care intervention. 7th Nordic Diabetes Ph.d and Post doc Research Conference. 28.-29. April Solstrand, Os. 26. Haugstvedt A, Graue M (2014). Diabetes knowledge and self-reported professional competence among nurses and nursing aides in home based care and nursing homes. 7th Nordic Diabetes Phd and Post doc Research Conference. 28.-29. April, Solstrand, Os. 19 ANNUAL REPORT