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HEIDI NORBERG : Type 2 diabetes in primary care

With focus on patient-centered and epidemiological perspectives

PhD project participating in the National Research School in General Medicine.

Primary healthcare in Sweden was heavily loaded during the first years of the pandemic. There is a lack of knowledge on the pandemic response on health of patients with type 2 diabetes, and whether some suffer more than others. Patient-centered care is a cornerstone of primary health care but few studies shed light on patient perspectives in the evaluation of new drugs. The project studies patient experiences and health in type 2 diabetes. The project may pave the way to a more individualized care, prioritizing patients in greatest need, to promote health equity and patient experienced health

PhD Student

Heidi Norberg
Phd Student, Uppsala University

Project overview

Project period:

Start date: 2023-01-01

Project description


Type 2 diabetes (T2D) affects 5% of the Swedish population. A large proportion of the health budget is assigned to healthcare of patients with T2D, of what a majority is spent on care of diabetes complications. Hence, it is of interest to invest in preventive care, to maintain glycemic status and reduce the risk of complications. In Sweden monitoring is performed in primary care, that was challenged by the COVID-19 pandemic. It is still unclear whether support from healthcare was sufficient during the first years of the pandemic for T2D patients. There is a lack of knowledge with regard to the pandemic response on metabolic profile, and if subsets of T2D patients were affected to a greater extent.

Good health in type 2 diabetes (T2D) features, besides glycemic control, physical, mental and social well-being. The increased presence of depression and anxiety in T2D patients provide an additional challenge for self-care. Several new antidiabetic agents have been introduced the past decade, but little is known about their impact on health-related quality of life (HRQoL) and treatment satisfaction.


To study HRQoL and treatment satisfaction in patients with T2D. Moreover, to investigate the pandemic response on T2D care.

  1. Do patients with early stage T2D experience a reduced HRQoL as compared to the general population?
  2. Do HRQoL or treatment satisfaction differ between antidiabetic treatments of sodiumglucose cotransporter 2-inhibitors (SGLT2i) and metformin?
  3. What is the pandemic response on metabolic profile and monitoring, and have certain subsets of T2D patients been affected more than others?
  4. What is the experience of patients and healthcare personnel on T2D care during the pandemic?


The project arises from two large study populations, a national randomized controlled trial, SMARTEST, and from medical record and register data.

Study 1 & 2: Sub-studies of the SMARTEST trial, that compares SGLT2i and metformin as first-line treatment at early stage T2D.

  1. Questionnaire measurements of HRQoL at baseline, are compared to a published reference population in Sweden.
  2. Questionnaire measurements of HRQoL and treatment satisfaction are compared in treatment groups of metformin and SGLT2i respectively, at inclusion and up to 2 years of follow-up.
  3. Medical record data, from 2010 – 2022, of approximately 20,000 patients with T2D in Uppsala County Council, are analyzed to study possible changes by the pandemic response, on metabolic profile and healthcare contacts. Socioeconomic and disease related factors, as well as healthcare center characteristics are investigated to find potential subsets of patients that may suffer the most.
  4. Patient and healthcare professional experiences of the pandemic and T2D care are collected in structural interviews.


Few studies shed light on patient perspectives. The project may promote patient-oriented primary care. In a crisis, like a pandemic, healthcare may need to be redirected to optimize primary care resources, to attain equal care. The project may illustrate how ​​disruption of follow-up may affect subsets of patients, that may be useful when designing future care, to reduce inequities of health.

University affiliation

Uppsala University

Main supervisor

Janeth Leksell, Associate Professor

Latest update: 2024-02-07