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Granstam, E., Rosenblad, A., Modher Raghib, A., Granström, T., Eriksson, J. W., Lindholm Olinder, A. & Leksell, J. (2019). Long-term follow-up of antivascular endothelial growth factor treatment for diabetic macular oedema: a four-year real-world study. Acta Ophthalmologica
Open this publication in new window or tab >>Long-term follow-up of antivascular endothelial growth factor treatment for diabetic macular oedema: a four-year real-world study
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2019 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768Article in journal (Refereed) In press
Abstract [en]

Purpose

To evaluate visual acuity (VA) and central retinal thickness (CRT) on optical coherence tomography during a 4‐year period in patients treated for sight‐threatening diabetic macular oedema (DMO) at two Swedish county hospitals. Additionally, to compare health‐related quality of life and subjective visual functioning before and after 4 years of treatment.

Methods

Fifty‐eight patients with DMO were evaluated after 4 years of antivascular endothelial growth factor (VEGF) treatment. VA, CRT and clinical data were retrospectively reviewed. Health‐related quality of life and subjective visual functioning were evaluated with Short Form Health Survey (SF‐36) and National Eye Institute Vision Functioning Questionnaire 25 (VFQ‐25). Comparisons between independent groups were performed using Pearson's χ2 test, Fisher's exact test or Mann–Whitney U test. Spearman's ρ was used for correlation analyses. Wilcoxon signed‐rank test was used for comparison between dependent groups. Logistic regression analysis was applied for analysis of VA and CRT over 4 years.

Results

Follow‐up data were obtained from 37 of 58 (63.8%) patients. Baseline characteristics were similar, regardless of follow‐up. VA improvement at 1 year (mean + 4.4, SD 7.5; ETDRS letter score) was maintained over 3 years, then declined. CRT was reduced throughout the study. In the first treatment year, eyes received 5.1 (1.4) anti‐VEGF injections, followed by approximately two injections yearly. Additional treatment included laser and dexamethasone implants. SF‐36 showed no change at 4 years, compared with baseline. VFQ‐25 demonstrated improvement in near vision activities (p = 0.036).

Conclusion

Significant long‐term improvement in visual function was present in patients with anti‐VEGF‐treated DMO.

Keywords
anti-VEGF treatment, diabetic macular oedema, long-term follow-up, longitudinal study, real-world study, visual acuity
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31172 (URN)10.1111/aos.14290 (DOI)2-s2.0-85074598945 (Scopus ID)
Available from: 2019-12-06 Created: 2019-12-06 Last updated: 2019-12-06Bibliographically approved
Granström, T., Forsman, H., Brorsson, A. L., Granstam, E. & Leksell, J. (2018). Patients’ experiences before starting anti-VEGF treatment for sight-threatening diabetic macular oedema: A qualitative interview study. Nordic journal of nursing research, 38(1), 11-17
Open this publication in new window or tab >>Patients’ experiences before starting anti-VEGF treatment for sight-threatening diabetic macular oedema: A qualitative interview study
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2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 1, p. 11-17Article in journal (Refereed) Published
Abstract [en]

The diabetic complication macular oedema (DME) is a growing problem worldwide because of the increasing number of patients suffering from diabetes mellitus (DM). DME is treated with injections of anti-vascular endothelial growth factor (anti-VEGF) in the eye. This real-world study aimed to describe patients’ experiences before they received their first injection in the eye. Twenty-one men and women aged 49 to 86 years were interviewed. The interviews were analysed using qualitative content analysis. Two categories and an overall theme ‘to be at a crossroads and a crucial phase in life with an uncertain outcome’ were found. The participants expressed thoughts and concerns at different levels, practical concerns about the treatment procedure, and other existential thoughts regarding hope for improved visual acuity or fear of deterioration. Cooperation between eye clinics and diabetes clinics should be strengthened to clarify who is responsible for providing the information and support required by patients.

Keywords
anti-VEGF treatment, diabetic macular oedema, qualitative research, visual impairment
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25211 (URN)10.1177/2057158517709409 (DOI)
Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2018-06-07Bibliographically approved
Brorsson, A. L., Lindholm Olinder, A., Viklund, G., Granström, T. & Leksell, J. (2017). Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study. BMJ Open Diabetes Research & Care, 5(1), Article ID e000432.
Open this publication in new window or tab >>Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study
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2017 (English)In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 5, no 1, article id e000432Article in journal (Refereed) Published
Abstract [en]

Objective Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents’ perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion.

Research design and methods In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts.

Results Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes.

Conclusions GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach.

Keywords
adolescent, patient education, qualitatve research, type 1 diabetes
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26578 (URN)29225894 (PubMedID)
Funder
Swedish Diabetes Association
Note

Open Access APC beslut 28/2017

Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-09-11Bibliographically approved
Granström, T. (2016). Anti-VEGF treatment of patients with diabetic macular edema: Studies of visual acuity, macular edema and patient-reported outcomes. (Licentiate dissertation). Uppsala: Uppsala universitet
Open this publication in new window or tab >>Anti-VEGF treatment of patients with diabetic macular edema: Studies of visual acuity, macular edema and patient-reported outcomes
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe and evaluate visual acuity, macular edema and patientreported outcomes (PRO) following anti-VEGF treatment of diabetic macular edema (DME) patients in a real-world setting. Using a longitudinal study design, a cohort of DME patients was followed from baseline to 1 year after treatment start. Data were collected from two eye clinics at two county hospitals. Social background characteristics, medical data and PRO were measured before treatment initiation, at four month and after 1 year. A total of 57 patients completed the study. Mean age was 69 years and the sample was equally distributed regarding sex. At baseline, the patients described their general health as low. One year after treatment initiation, 30 patients had improved visual acuity and 27 patients had no improvement in visual acuity. The patients whose visual acuity improved reported an improvement in several subscales in patient-reported outcome measures (PROM), which was in contrast to the group that experienced a decline in visual acuity, where there was no improvement in PROM. Outcomes from the study can be useful for developing and providing relevant information and support to patients undergoing this treatment.

Place, publisher, year, edition, pages
Uppsala: Uppsala universitet, 2016. p. 38
National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-22715 (URN)
Supervisors
Available from: 2016-08-18 Created: 2016-08-18 Last updated: 2016-09-26Bibliographically approved
Granström, T., Forsman, H., Lindholm Olinder, A., Gkretsis, D., Eriksson, J. W., Granstam, E. & Leksell, J. (2016). Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting. Diabetes Research and Clinical Practice, 121, 157-165
Open this publication in new window or tab >>Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting
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2016 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 121, p. 157-165Article in journal (Refereed) Published
Abstract [en]

Aims

To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12 months in a real world setting.

Methods

In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68 years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used.

Results

The total patient group had significantly improved visual acuity and reduced retinal thickness at 4 months and remains at 12 months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12 months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity.

Conclusions

Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12 months after treatment start.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Patient-reported measurements; Diabetic macular edema; Anti-VEGF treatment; Visual function
National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23260 (URN)10.1016/j.diabres.2016.09.015 (DOI)000390460100020 ()27718374 (PubMedID)
Available from: 2016-10-14 Created: 2016-10-14 Last updated: 2017-11-29Bibliographically approved
Granström, T., Leksell, J. & Forsman, H. (2015). Quality of life among patients with diabetes macular edema. In: : . Paper presented at 15th European Doctoral Conference in Nursing Science (EDCNS), 18-19 September 2015, Graz, Austria.
Open this publication in new window or tab >>Quality of life among patients with diabetes macular edema
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Vision loss have a significant negative impact on quality of life. One of the most common causes of vision loss in patients with diabetes is diabetic macular edema - DME. Among DME patients, visual impairment is regarded as the most feared late diabetic complication. In January 2011 a new treatment for DME was approved, called anti-Vascular Endothelial Growth Factor, anti-VEGF- treatment. The treatment involves 3 injections every 4 weeks into the eye. The new treatment places increasing demands on the patient because of more visits and a stressful treatment. Beside that it is of great importance to learn more about the patient's experiences about the visual impairment and the new treatment.

The aim of the study is to measure the effects of anti-VEGF treatment on vision related functioning, quality of life and sight-related variables.

Fifty-nine patients are included in this longitudinal study at the eye clinics of two Swedish county hospitals. All patients who started anti-VEGF treatment were asked to participate.

We have measured visual functioning with the eye-specific questionnaire - National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ-25), quality of life was measured with the general questionnaire Short Form- 36 (SF-36). Medical variables were collected at baseline, after 4 months and one year respectively.

A large number of patients are affected by diabetes each year and may suffer from visual impairment. These patients may be treated with this new form of treatment. Therefore it is of great importance to examine the patient's experiences of treatment and self-percieved quality of life to be able to provide the best possible information and procedures at the eye clinics.

National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19094 (URN)
Conference
15th European Doctoral Conference in Nursing Science (EDCNS), 18-19 September 2015, Graz, Austria
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2017-11-22Bibliographically approved
Granström, T., Forsman, H., Leksell, J., Jani, S., Modher Raghib, A. & Granstam, E. (2015). Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema. Journal of diabetes and its complications, 29(8), 1183-1190
Open this publication in new window or tab >>Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema
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2015 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 29, no 8, p. 1183-1190Article in journal (Refereed) Published
Abstract [en]

Purpose

To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME).

Material and methods

In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36).

Results

The participants consisted of 30 men and 29 women (mean age, 68.5 years); 54 (92 %) patients had type 2 diabetes; Five (9%) patients had moderate or severe visual impairment; 28 (47 %) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision.

Conclusions

Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.

Keywords
Patient-reported measurements; health-related quality of life; visual function; diabetic macula edema; anti-VEGF treatment
National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19091 (URN)10.1016/j.jdiacomp.2015.07.026 (DOI)000366884900036 ()26318959 (PubMedID)
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2017-12-04Bibliographically approved
Granström, T., Leksell, J. & Forsman, H. (2015). Visual functioning and quality of life among patients with diabetic macular edema. In: : . Paper presented at 20th annual Foundation of European Nurses in Diabetes (FEND) conference, 11-12 September, Stockholm.
Open this publication in new window or tab >>Visual functioning and quality of life among patients with diabetic macular edema
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background

One of the most common causes of vision impairment in patients with diabetes is diabetic macular edema (DME) and is regarded as the most feared late diabetic complication. In January 2011 a treatment for DME was approved, called anti-Vascular Endothelial Growth Factor treatment. The treatment involves an injection into the vitreous of the eye and places increasing demands on the patient because of more visits and a stressful treatment. Therefore it is of most importance to capturing patients’ thoughts and feelings, so called Patient reported Outcome (PRO).

Aim

To examine patient-reported outcome (PRO) in a selected group of Swedish patients with diabetes-related macula edema about to receive anti-vascular endothelial growth factor treatment for diabetic macular edema.

Method

Visual functioning was measured with National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ-25), quality of life was measured with Short Form- 36 (SF-36). The initial eye examination included measurement of visual acuity with the ETDRS, and retinal thickness by OCT. In addition, medical variables were collected. The data collection was performed at baseline, after 4 months and one year. In this abstract we reported the result from the baseline.

Result

The participants were 30 men and 29 women (mean age, 68.5 years) and 92% of them had type 2 diabetes. With NEI VFQ-25, the participants showed the lowest score for the subscale of general health (mean 35.65 ± 22.04) and the highest for dependency (mean 93.48 ± 18.12). For SF-36, the participants gave the lowest score in the subscale of general health (mean 56.55 ± 22.14) and the highest for the subscale of role emotional (mean 88.73 ± 22.32). The mean ETDRS score in the eye planned for treatment was 63.9 (± 13.2) and the mean central retinal thickness was 396 (± 129).

Conclusions: Patients diagnosed with diabetes macula edema about to receive anti-VEGF treatment reported low general health. Hence, it is of most importance to follow up patients’ thoughts and feelings (PRO) after the treatment is performed in order to promote improvements in the quality of patient care.

National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19093 (URN)
Conference
20th annual Foundation of European Nurses in Diabetes (FEND) conference, 11-12 September, Stockholm
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2017-11-22Bibliographically approved
Granström, T., Leksell, J., Forsman, H. & Granstam, E. (2015). Visual functioning and quality of life among patients with macular edema: a quantitative study. In: : . Paper presented at EDCNS 2015 European Doctoral Conference in Nursing Science, Graz, Austria, 18-19 September 2015.
Open this publication in new window or tab >>Visual functioning and quality of life among patients with macular edema: a quantitative study
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19955 (URN)
Conference
EDCNS 2015 European Doctoral Conference in Nursing Science, Graz, Austria, 18-19 September 2015
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2015-11-06Bibliographically approved
Granström, T., Leksell, J., Forsman, H. & Granstam, E. (2013). Anti-VEGF treatment for diabetic macular edema: a qualitative evaluation of patients experiences. In: : . Paper presented at FEND 18th Annual Conference Barcelona Spain 20-21 September 2013.
Open this publication in new window or tab >>Anti-VEGF treatment for diabetic macular edema: a qualitative evaluation of patients experiences
2013 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-13987 (URN)
Conference
FEND 18th Annual Conference Barcelona Spain 20-21 September 2013
Available from: 2014-04-05 Created: 2014-04-05 Last updated: 2017-11-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7721-8794

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