TYPE 2 DIABETES AND BONE HEALTH:an epidemiological approach

Despite its importance, bone health is often neglected in diabetes care.Type 2 diabetes and osteoporosis often develop simultaneously and represent critical public health challenges globally. Despite a normal or higher bone mineral density, individuals with type 2 diabetes are at increased risk of fractures related to osteoporosis. Consequently, conditional techniques used to detect and diagnose osteoporosis do not adequately identify or predict the risk of fractures associated with low bone quality in people with type 2 diabetes.This Ph.D. thesis presents the results of three published papers exploring the relationship between type 2 diabetes and bone health in Denmark, covering aspects such as the types of first osteoporotic fractures, diagnostics, and treatment strategies. The findings 1) suggest substantial bone health discrepancies between people with and without type 2 diabetes, 2) indicate a need for optimizing diagnostic and treatment strategies of osteoporosis in individuals with or at risk of type 2 diabetes, and 3) highlight the necessity for further investigation into the relationship between bone and glucose metabolism.The dearth of focus and acceptance of low bone quality as a diabetes-related complication could well impede fracture prevention in type 2 diabetes. There is an imperative to grasp type 2 diabetes as a risk factor for fractures and change perspectives

Six ways to help fix energy hardship in New Zealand

Energy hardship is caused by the interaction of factors including housing quality, appliance efficiency, energy source and price, and occupant needs and income. Multiple policy approaches are needed to address these varied causes of energy hardship, and the lack of an official definition and a measurement strategy in Aotearoa should not preclude policy action to address this critical social determinant of health. Here we outline six ways to help fix energy hardship in New Zealand

The impact of fungicide application method on soybean canopy coverage, disease, yield, seed quality, and seed fill duration.

As input costs continue to rise and profits fluctuate, soybean farmers have maintained interest in new fungicide applications methods. Customarily, fungicides are applied directly over the top of the soybean canopy as are herbicides and insecticides. However, fungicide application methods that could improve fungicide coverage within the canopy, such as undercover applications, has gained considerable interest. Undercover applications spray fungicides between the soybean rows, using multidirectional nozzles, and over the canopy with nozzles placed above the canopy. During 2017 and 2018, field experiments located in Iowa were used to investigate the effect of fungicide application methods on coverage, disease severity, yield, seed quality, and duration of seed fill. The objective of this research was to: (1) investigate how traditional and undercover application methods impact canopy coverage; (2) examine the effect of application method on disease control, seed quality, and yield; and (3) to determine if a fungicide application increases the rate or duration of seed fill. Studies were conducted in two small plot field experiments in 2017, six small plot field experiments in 2018, and two on-farm strip trials in 2018. Small plot and on-farm strip trials were analyzed separately. Fungicide coverage was detected in the upper, middle, and lower canopy in two different ways: (1) water sensitive spray cards; and (2) tracer dye. Results for spray card detection in small plot experiments showed one significant difference between traditional and undercover application technologies in the upper canopy (P=0.017). The middle and lower canopies coverage values were not significant between the traditional and undercover and no canopy zone was significantly different between traditional and undercover for on-farm strip trials when using spray cards as a detection method. Conversely, the amount of tracer dye detected in the upper and lower canopy in small plot experiments differed between the traditional and undercover (P=0.023 and P=0.034), but there were no significant differences between application method at the on-farm strip trials. For both years, the primary diseases present were frogeye leaf spot and Septoria brown spot. Greater disease severity for both diseases was observed in 2018 than in 2017. Regardless of the year, location in the canopy there was no significant difference between the treatments for foliar disease control. As a result, the inability to control disease led to there being no significant differences among seed quality and yield. Results from these trials show adequate coverage, but the inability to control disease suggests that resistance of QoI fungicide in pathogen population maybe an issue in Iowa. The last objective of this thesis is to investigate if a QoI fungicide affects the duration of seed fill. Four small plot field experiments were conducted in 2017 and 2018. There was no significant difference in both the seed growth rate and duration of the seed filling period, but at one location there was a difference in yield. These results support other studies that suggest the probability of affecting soybean yield beyond disease control is less likely. Soybean farmers should be aware that QoI fungicide resistance for the pathogens that cause frogeye leaf spot and Septoria brown spot have been identified in Iowa. Resistance to these two pathogens made it difficult to determine which fungicide application method was more effective. Future work comparing the traditional versus undercover applications may be necessary with more effective fungicide. Regardless of the application type it is important to only apply fungicides when necessary for disease management and to rotate mode of actions to mitigate the development of fungal resistance

Cold New Zealand Council Housing Getting an Upgrade

As people spend most of their time at home, residential thermal conditions are important. Central government debate about minimum temperature requirements for rental properties requires an evidence base of indoor temperature data. We collected temperature, humidity and energy data from 49 council housing dwellings in Wellington over winter, and self-reported thermal comfort and heating behaviour. Mean indoor temperature was 14.9°C, colder than the national average, with 67% of readings under 16°C, which the World Health Organization associates with health implications. With New Zealand’s high rate of excess winter mortality and children hospitalised for housing-related diseases, cold housing should be addressed

The Efficacy of Alendronate Versus Denosumab on Major Osteoporotic Fracture Risk in Elderly Patients With Diabetes Mellitus:A Danish Retrospective Cohort Study

OBJECTIVE: Patients with diabetes mellitus have an increased risk of fractures; however, the underlying mechanism is largely unknown. We aimed to investigate whether the risk of major osteoporotic fractures in diabetes patients differs between subjects initiated with alendronate and denosumab, respectively. METHODS AND RESEARCH DESIGN: We conducted a retrospective nationwide cohort study through access to all discharge diagnoses (ICD-10 system) from the National Danish Patient Registry along with all redeemed drug prescriptions (ATC classification system) from the Health Service Prescription Registry. We identified all subjects with a diabetes diagnosis between 2000 and 2018 and collected data on the first new prescription of anti-osteoporotic treatment between 2011 and 2018. Exposure was defined as either alendronate or denosumab treatment initiated after diabetes diagnosis. Outcome information was collected by identification of all major osteoporotic fracture (MOF) diagnoses, i.e., hip, spine, forearm, and humerus, from exposure until 2018 or censoring by emigration or death. The risk of fracture was calculated as hazard ratios (HR) using multiply adjusted Cox proportional models with death as a competing risk. RESULTS: We included 8,745 subjects initiated with either alendronate (n = 8,255) or denosumab (n = 490). The cohort consisted of subjects with a mean age of 73.62 (SD ± 9.27) years, primarily females (69%) and suffering mainly from type 2 diabetes (98.22%) with a median diabetes duration at baseline of 5.45 years (IQR 2.41–9.19). Those in the denosumab group were older (mean 75.60 [SD ± 9.72] versus 73.51 [SD ± 9.23] years), had a higher proportion of women (81% versus 68%, RR 1.18 [95% CI 1.13–1.24], and were more comorbid (mean CCI 2.68 [95% CI 2.47–2.88] versus 1.98 [95% CI 1.93–2.02]) compared to alendronate initiators. In addition, denosumab users had a higher prevalence of previous fractures (64% versus 46%, RR 1.38 [95% CI 1.28–1.48]). The adjusted HR for any MOF after treatment initiation with denosumab was 0.89 (95% CI 0.78–1.02) compared to initiation with alendronate. CONCLUSION: The risk of incident MOF among subjects with diabetes was similar between those initially treated with alendronate and denosumab. These findings indicate that the two treatment strategies are equally effective in preventing osteoporotic fractures in subjects with diabetes

Alendronate Use and Risk of Type 2 Diabetes:A Nationwide Danish Nested Case-Control Study

OBJECTIVE: A link has been proposed between glucose homeostasis and bone metabolism. Bisphosphonates are first-line treatment of osteoporosis, and we aimed to investigate whether the risk of developing type 2 diabetes was associated with prior use of alendronate. RESEARCH DESIGN AND METHODS: We conducted a population-based nested case-control study through access to all discharge diagnoses (ICD-10 system) from the National Danish Patient Registry along with all redeemed drug prescriptions (ATC classification system) from the Health Service Prescription Registry. All cases with a diagnosis of type 2 diabetes between 2008 and 2018 were matched on sex and age with 3 randomly selected controls by incidence-density sampling. Exposure was defined as ever use of alendronate and further grouped as effective and compliant use. ORs were calculated by conditional logistic regression analysis with adjustment for several confounders and test for trend for dose-response relationship. RESULTS: We included 163,588 patients with type 2 diabetes and 490,764 matched control subjects with a mean age of 67 years and 55% male subjects. The odds of developing type 2 diabetes were lower among ever users of alendronate (multiple adjusted OR: 0.64 [95% CI 0.62-0.66]). A test for trend suggested a dose-response relationship between longer effective use of alendronate and lower risk of type 2 diabetes. CONCLUSION: These results suggest a possible protective effect of alendronate in a dose-dependent manner against development of type 2 diabetes

The Use of Intermediate Facilities in Winter Gritting Operations

Planning gritting services is a large-scale task that involves a significant number of physical and economic resources. During extreme cold weather conditions, roads become slippery and with it, the number of accidents increase. While gritting services prevent accidents and increases safety conditions, without them costs of accidents and delays would be enormous. For planning gritting services, many considerations must be included such as the capacity of gritters and the sequence in which a highway is going to be gritted. In this study, heuristic models were created in order to obtain the optimal sector partition, the routing plans and the calculations for the total distance travelled to grit a given area in two conditions: when turning is possible everywhere and when turning is restricted to turning nodes. In both conditions, scenarios without the use and with the use of intermediate facilities were considered. The complexity of the analysed scenarios gradually increases, starting by simple configurations with just one facility as the replenishment point and ending with multiple facilities configurations where turning is limited. This study does not consider costs and time-limitation variables as constraints for developing the heuristic model

SGLT2 inhibitor treatment is not associated with an increased risk of osteoporotic fractures when compared to GLP-1 receptor agonists:A nationwide cohort study

BACKGROUND: Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. It is debated whether sodium-glucose cotransporter 2 (SGLT2) inhibitors influence fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) with SGLT2 inhibitors compared to glucagon-like peptide 1 (GLP-1) receptor agonists when used as add-on therapies to metformin. METHODS: We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either SGLT2 inhibitors or GLP-1 receptor agonists were identified and enrolled from 2012 to 2018. Subjects were then propensity-score matched 1:1 based on age, sex, and index date. Major osteoporotic fractures (MOF) were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator. RESULTS: In total, 27,543 individuals treated with either combination were identified and included. After matching, 18,390 individuals were included in the main analysis (9,190 in each group). Median follow-up times were 355 [interquartile range (IQR) 126-780] and 372 [IQR 136-766] days in the SGLT2 inhibitor and GLP-1 receptor agonist group, respectively. We found a crude HR of 0.77 [95% CI 0.56-1.04] for MOF with SGLT2 inhibitors compared to GLP-1 receptor agonists. In the fully adjusted model, we obtained an unaltered HR of 0.77 [95% CI 0.56-1.05]. Results were similar across subgroup- and sensitivity analyses. CONCLUSION: These results suggest that SGLT2 inhibitors have no effect on fracture risk when compared to GLP-1 receptor agonists. This is in line with results from previous studies