Background: The associations between sociodemographic factors and HbA1c variability in type 2 diabetes are not yet established. Examining group differences in HbA1c variability may help identify patient characteristics related to diabetes management. The present study examined differences in baseline HbA1c and HbA1c variability between groups with regard to sex, level of education, civil status, age, and BMI, in a sample of individuals with type 2 diabetes. Methods: The study was a prospective exploratory cohort study. Differences in HbA1c variability between sociodemographic groups were analyzed in 158 individuals. HbA1c variability was assessed as the standard deviation (SD) and coefficient of variation (CV) over five measured points, and a questionnaire was used to assess sociodemographic factors. Results: The results showed significantly higher HbA1c variability in men compared to women (mean difference 1.44 mmol/mol [95% CI: 0.58 to 2.31]), and significantly higher HbA1c variability in individuals with a BMI characterized as obese compared to individuals with a BMI characterized as normal weight (mean difference 1.56 mmol/mol [95% CI: 0.25 to 2.88]). There were no significant associations between HbA1c variability and civil status or education. Conclusions: Men and individuals with obesity may be more vulnerable to future diabetic complications than other groups, since they have greater long-term glycemic variability.

The lack of effective, scalable solutions for lifestyle treatment is a global clinical problem, causing severe morbidity and mortality. We developed a method for lifestyle treatment that promotes self-reflection and iterative behavioral change, provided as a digital tool, and evaluated its effect in 370 patients with type 2 diabetes (ClinicalTrials.gov identifier: NCT04691973). Users of the tool had reduced blood glucose, both compared with randomized and matched controls (involving 158 and 204 users, respectively), as well as improved systolic blood pressure, body weight and insulin resistance. The improvement was sustained during the entire follow-up (average 730 days). A pathophysiological subgroup of obese insulin-resistant individuals had a pronounced glycemic response, enabling identification of those who would benefit in particular from lifestyle treatment. Natural language processing showed that the metabolic improvement was coupled with the self-reflective element of the tool. The treatment is cost-saving because of improved risk factor control for cardiovascular complications. The findings open an avenue for self-managed lifestyle treatment with long-term metabolic efficacy that is cost-saving and can reach large numbers of people.

Aims The aim of the present study was to explore patients' experiences of diabetes self-management and views on a digital lifestyle intervention using self-affirmation to motivate lifestyle changes. Methods Semi-structured interviews focusing on needs, attitudes, and barriers to diabetes self-management were conducted with 22 individuals with type 2 diabetes recruited from the All New Diabetics in Scania (ANDIS) cohort. The interviews were followed by three additional study visits, where participants gave feedback on computer-based assignments based on self-affirmation. Interviews and feedback were qualitatively analyzed using thematic analysis. Results Participants described a range of barriers to diabetes self-management, and a varying sense of urgency and distress related to diabetes management. A need for accessible, reliable, and relevant information was reported, as well as a sense that required lifestyle changes was incompatible with current life situation. Further, the use of self-affirmation was described as relevant, motivating and engaging. Conclusions Barriers to diabetes self-management need to be addressed when supporting diabetes self-management, e.g. through carefully matching the support to the patient's readiness to change, supporting patient autonomy and focusing on long-term changes. Using self-affirmation may raise acceptability of a digital lifestyle intervention and help connect diabetes self-management with overall life context, by guiding the patient to focus on personal relevance.

Aims: HbA1c variability is targeted as a part of clinical risk assessment in type 2 diabetes. Psychological factors such as patient competence, adjustment to diabetes, and motivation, may influence glycemic control. The objective of the present study was to determine if perceived competence, diabetes appraisal, and motivation predicted HbA1c variability, and to examine differences regarding these factors in relation to diabetes duration, in individuals with type 2 diabetes. Methods: Data on perceived competence, appraisal of diabetes, and motivation orientation from 158 individuals with type 2 diabetes were analyzed as potential predictors of HbA1c at five measurement points over a time period of 24 months. Associations between psychological factors and HbA1c variability were examined through multiple linear regression analyses, and differences in psychological measures between groups with different diabetes duration were examined using ANOVA. Results: Negative appraisal of diabetes predicted higher HbA1c variability and was associated with higher baseline HbA1c, and greater perceived competence predicted lower HbA1c variability. Conclusions:The results indicate that lower levels of diabetes distress, as well as confidence in one's ability to manage diabetes, could potentially predict better glycemic control.