Abbreviations: (ADA) American Diabetes Association, (BMI) body mass index, (CAN) cardiac autonomic neuropathy, (HbA1c) hemoglobin A1c, (HRV) heart rate variability, (T1DM) type 1 diabetes mellitus, (T2DM) type 2 diabetes mellitus

Background:To reduce colorectal cancer (CRC) mortality through population-based screening programmes using faecal tests, it is important that individuals continue to participate in the repeated rounds of screening. We aimed to identify lifestyle predictors for discontinuation of faecal immunochemical test (FIT) screening after the first round, as well as lifestyle predictors for colorectal neoplasia detected in the second-round FIT screening.Methods:In this longitudinal study, we invited 6959 individuals aged 50–74 years from south-east Norway for a first round of FIT screening and to complete a self-reported lifestyle questionnaire on demographic factors, body mass index (BMI, kg m−2), smoking habits, physical activity, consumption of alcohol and dietary items. Two years later, we estimated the associations between these factors, non-participation and screening results in the second round of FIT screening using adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Results:Of the 3114 responders to the questionnaire who completed the first-round FIT and who were invited to participate in second-round FIT screening, 540 (17%) did not participate. The OR and (95% CI) for discontinuation of FIT screening after the first round was 1.61 (1.24–2.10) for current smoking compared with non-smoking; 2.01 (1.25–3.24) for BMI⩾35 kg m−2 compared with BMI 16.9–24.9 kg m−2 and 0.70 (0.52–0.94) for physical activity in the third quartile vs the first. Among participants, smoking, high BMI and high alcohol consumption were associated with an increased odds of detecting colorectal neoplasia (n=107).Conclusions:These results may indicate that Norwegian FIT screening participants who discontinue after the first round have lifestyle behaviours associated with increased risk of CRC.

Neurological and Microvascular Function Autonomic neuropathy affects both the sympathetic and parasympathetic nervous system, which provides a rapidly responding mechanism to control a wide range of functions such as cardiovascular, respiratory, gastrointestinal, renal, endocrine, and other systems. 1,2 The balance/imbalance in the autonomic nervous system can be determined by computerassisted and complex analyses of variations in blood pressure and in electrocardiographic measurements. 2 For clinical use the gold standard tests are heart rate response to (1) change from supine to upright position, (2) deep breathing, and (3) the Valsalva manoeuvre. 3 In the diabetic population abnormal results in 2 or more of the gold standard tests constitutes a surrogate measure and a subclinical diagnostic marker of cardiovascular autonomic neuropathy (CAN). 3 We have recently 528616D STXXX10.

Neurological and Microvascular FunctionHeart rate variability (HRV) is a widely accepted noninvasive measure of balance/imbalance in the autonomic nervous system, HRV is defined as the variation in heart rate from beat to beat (RR interval) caused by changes in breathing, blood pressure, sympathoadrenal hormones, as well as mental, physical, and certain pathological conditions. In the general population, low HRV has been associated with compromised health and independently predicts all-cause mortality. [1][2][3] Moreover, in diabetes patients, the presence of autonomic dysfunction has been suggested as a prognostic marker of complications 4,5 and the presence of autonomic dysfunction may occur before other late complications. 5Detailed HRV analysis, including both cardiovascular reflex tests and frequency domain analysis, are an important tool to estimate cardiac autonomic nervous activity. 6,7 Several studies indicate that spectral analysis in particular, describing frequency-specific fluctuations in heart rate, may be a more sensitive tool to detect autonomic imbalance compared to active tests. 8,9 However, it is unknown if the cardiovascular reflex tests and frequency domain analysis decrease according to the severity of microvascular complications or are limited to diagnose cardiovascular autonomic neuropathy (CAN).The objective of this study was therefore to elucidate the association between the degree of autonomic modulation, The objective of this study was to elucidate whether the degree of autonomic modulation is associated with the degree of microvascular complications in patients with type 1 diabetes. Methods: A total of 290 type 1 individuals with diabetes were randomly recruited during normal visits to outpatient clinics at 4 Danish hospitals. The degree of autonomic modulations was quantified by measuring heart rate variability (HRV) during passive spectral analysis and active tests (valsalva ratio [VT], response to standing [RT], and deep breathing [E:I]). To describe possible associations between severity of microvascular complications and measures of autonomic modulation, multivariate analysis was performed. Results: After adjusting for diabetes duration, sex, age, pulse pressure, heart rate, and smoking, autonomic dysfunction remained significantly correlated with severity of retinopathy, nephropathy, and peripheral neuropathy in individuals with type 1 diabetes patients. Conclusions: Autonomic dysfunction is present in early stages of retinopathy, nephropathy, and peripheral neuropathy in patients with type 1 diabetes.

Repeated rounds of faecal immunochemical testing (FIT) for occult blood is a common method for screening for colorectal cancer (CRC). However, the time interval between FIT rounds is not thoroughly investigated. In a CRC screening trial in South‐Eastern Norway, individuals were invited for biennial FIT between 2012 and 2019. The positivity threshold was >15 mcg haemoglobin/g faeces (mcg/g). Due to organizational challenges, the interval between screening rounds randomly varied between 1.5 and 3.5 years, forming a natural experiment. We investigated the detection rate of CRC and advanced neoplasia (AN: CRC or advanced adenoma) at the subsequent round (FIT2), according to the faecal haemoglobin concentration (f‐Hb) at the initial screening round (FIT1), and time between the two screening rounds. 18 522 individuals with negative FIT1 who attended FIT2 were included in this study. 245 AN were detected at FIT2, of which 34 were CRC. The CRC detection rate at FIT2 for participants with FIT1 = 0 mcg/g was 0.09% while it was 0.28% for participant with 0 > FIT1 ≤ 15 mcg/g; odds ratio (OR) 3.22, 95% CI 1.49‐6.95. For each 3 months' increment between FITs, the OR for detecting CRC was 1.33 (95% CI 0.98‐1.79), while the OR was 1.13 (1.02‐1.26) for AN. Individuals with FIT1‐value of 0 mcg/g, had a lower AN detection rate compared with participants with 0 > FIT1 ≤ 15 mcg/g, irrespective of time between tests. Although CRC and AN detection rates increase with increasing time interval between FITs, individuals with undetectable f‐Hb at first screen have substantially lower risk of CRC at the next screening round compared with individuals with detectable f‐Hb.