Combining insulin with a glucagon-like peptide-1 receptor agonist (GLP-1RA) to treat type 2 diabetes (T2D) is common. While many studies have investigated concomitant therapy with basal ...insulin+GLP-1RA, few have reported on premixed insulin+GLP-1RA. We aimed to address this gap using data from the Clinical Practice Research Datalink Aurum database in England.
This retrospective cohort study with propensity score matching assessed glycaemic levels and other clinical outcomes in people with T2D, comparing biphasic insulin aspart 30/70 (BIAsp 30) + GLP-1RA with basal insulin (insulin detemir/glargine U100) + GLP-1RA (from 2006 to 2021).
In total, 4770 eligible people were identified; 1511 had a BIAsp 30 + GLP-1RA regimen and were propensity score-matched to an equal number receiving basal+GLP-1RA. There was no significant difference in glycated haemoglobin (HbA1c) reduction between cohorts at 6 months (p = 0.15), with a decrease of -1.07 (95% CI: -1.16; -0.98) %-points (-11.7 mmol/mol 95% CI: -12.7; -10.7) in the BIAsp 30 + GLP-1RA cohort, versus -0.97 (95% CI: -1.07; -0.88) %-points (-10.6 mmol/mol 95% CI: -11.7; -9.6) in the basal+GLP-1RA cohort. Body mass index (BMI) decreased by -0.35 kg/m
(95% CI: -0.52;-0.18) at 6 months with BIAsp 30 + GLP-1RA, versus -0.72 kg/m
(95% CI: -0.90;-0.54) with basal+GLP-1RA (p = 0.003). BMI was influenced by the initiation sequence of GLP-1RA in relation to insulin (p < 0.0001). Hypoglycaemia rates were low and not significantly different between cohorts.
Combining BIAsp 30 + GLP-1RA provides glycaemic control with no significant difference to that of propensity score-matched people receiving basal insulin+GLP-1RA, with no increase in hypoglycaemia risk or weight gain.
Established causes of diabetes do not fully explain the present epidemic. High-level arsenic exposure has been implicated in diabetes risk, but the effect of low-level arsenic exposure in drinking ...water remains unclear.
We sought to determine whether long-term exposure to low-level arsenic in drinking water in Denmark is associated with an increased risk of diabetes using a large prospective cohort.
During 1993-1997, we recruited 57,053 persons. We followed each cohort member for diabetes occurrence from enrollment until 31 December 2006. We traced and geocoded residential addresses of the cohort members and used a geographic information system to link addresses with water-supply areas. We estimated individual exposure to arsenic using all addresses from 1 January 1971 until the censoring date. Cox proportional hazards models were used to model the association between arsenic exposure and diabetes incidence, separately for two definitions of diabetes: all cases and a more strict definition in which cases of diabetes based solely on blood glucose results were excluded.
Over a mean follow-up period of 9.7 years for 52,931 eligible participants, there were a total of 4,304 (8.1%) diabetes cases, and 3,035 (5.8%) cases of diabetes based on the more strict definition. The adjusted incidence rate ratios (IRRs) per 1-μg/L increment in arsenic levels in drinking water were as follows: IRR = 1.03 (95% CI: 1.01, 1.06) and IRR = 1.02 (95% CI: 0.99, 1.05) for all and strict diabetes cases, respectively.
Long-term exposure to low-level arsenic in drinking water may contribute to the development of diabetes.
Noise from wind turbines (WTs) is associated with annoyance and, potentially, sleep disturbances.
Our objective was to investigate whether long-term WT noise (WTN) exposure is associated with the ...redemption of prescriptions for sleep medication and antidepressants.
For all Danish dwellings within a radius of Formula: see text heights and for 25% of randomly selected dwellings within a radius of Formula: see text heights, we estimated nighttime outdoor and low-frequency (LF) indoor WTN, using information on WT type and simulated hourly wind. During follow-up from 1996 to 2013, 68,696 adults redeemed sleep medication and 82,373 redeemed antidepressants, from eligible populations of 583,968 and 584,891, respectively. We used Poisson regression with adjustment for individual and area-level covariates.
Five-year mean outdoor nighttime WTN of Formula: see text was associated with a hazard ratio (HR) = 1.14 95% confidence interval (CI: 0.98, 1.33) for sleep medication and HR = 1.17 (95% CI: 1.01, 1.35) for antidepressants (compared with exposure to WTN of Formula: see text). We found no overall association with indoor nighttime LF WTN. In age-stratified analyses, the association with outdoor nighttime WTN was strongest among persons Formula: see text of age, with HRs (95% CIs) for the highest exposure group (Formula: see text) of 1.68 (1.27, 2.21) for sleep medication and 1.23 (0.90, 1.69) for antidepressants. For indoor nighttime LF WTN, the HRs (95% CIs) among persons Formula: see text of age exposed to Formula: see text were 1.37 (0.81, 2.31) for sleep medication and 1.34 (0.80, 2.22) for antidepressants.
We observed high levels of outdoor WTN to be associated with redemption of sleep medication and antidepressants among the elderly, suggesting that WTN may potentially be associated with sleep and mental health. https://doi.org/10.1289/EHP3909.
It has been suggested that air pollution may increase the risk of type 2 diabetes but data on particulate matter with diameter <2.5μm (PM2.5) are inconsistent. We examined the association between ...long-term exposure to PM2.5 and diabetes incidence.
We used the Danish Nurse Cohort with 28,731 female nurses who at recruitment in 1993 or 1999 reported information on diabetes prevalence and risk factors, and obtained data on incidence of diabetes from National Diabetes Register until 2013. We estimated annual mean concentrations of PM2.5, particulate matter with diameter <10μm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2) at their residence since 1990 using a dispersion model and examined the association between the 5-year running mean of pollutants and diabetes incidence using a time-varying Cox regression.
Of 24,174 nurses 1137 (4.7%) developed diabetes. We detected a significant positive association between PM2.5 and diabetes incidence (hazard ratio; 95% confidence interval: 1.11; 1.02–1.22 per interquartile range of 3.1μg/m3), and weaker associations for PM10 (1.06; 0.98–1.14 per 2.8μg/m3), NO2 (1.05; 0.99–1.12 per 7.5μg/m3), and NOx (1.01; 0.98–1.05 per 10.2μg/m3) in fully adjusted models. Associations with PM2.5 persisted in two-pollutant models. Associations with PM2.5 were significantly enhanced in never smokers (1.24; 1.09–1.42), and augmented in obese (1.25; 1.06–1.47) and subjects with myocardial infarction (1.32; 0.86–2.02), but without significant interaction.
Fine particulate matter may the most relevant pollutant for diabetes development among women, and non-smokers, obese women, and heart disease patients may be most susceptible.
•Evidence on association of PM2.5 with diabetes is inconsistent.•We linked residential PM2.5 to diabetes incidence in Danish Nurse Cohort.•We found 39% (4–86%) increased risk of diabetes per 10μg/m3 increase in PM2.5.•PM2.5 may be the most relevant pollutant for diabetes development.•Non-smokers, obese, and heart disease patients may be most susceptible.
Noise from wind turbines (WTs) is reported as more annoying than traffic noise at similar levels, raising concerns as to whether WT noise (WTN) increases risk for cardiovascular disease, as observed ...for traffic noise.
We aimed to investigate whether long-term exposure to WTN increases risk of myocardial infarction (MI) and stroke.
We identified all Danish dwellings within a radius 20 times the height of the closest WT and 25% of the dwellings within Formula: see text the height of the closest WT. Using data on WT type and simulated hourly wind at each WT, we estimated hourly outdoor and low frequency (LF) indoor WTN for each dwelling and derived 1-y and 5-y running nighttime averages. We used hospital and mortality registries to identify all incident cases of MI (Formula: see text) and stroke (Formula: see text) among all adults age 25-85 y (Formula: see text), who lived in one of these dwellings for Formula: see text over the period 1982-2013. We used Poisson regression to estimate incidence rate ratios (IRRs) adjusted for individual- and area-level covariates.
IRRs for MI in association with 5-y nighttime outdoor WTN Formula: see text (vs. Formula: see text) dB(A) and indoor LF WTN Formula: see text (vs. Formula: see text) dB(A) were 1.21 95% confidence interval (CI): 0.91, 1.62; 47 exposed cases and 1.29 (95% CI: 0.73, 2.28; 12 exposed cases), respectively. IRRs for intermediate categories of outdoor WTN 24-30, 30-36, and Formula: see text vs. Formula: see text were slightly above the null and of similar size: 1.08 (95% CI: 1.04, 1.12), 1.07 (95% CI: 1.00, 1.12), and 1.06 (95% CI: 0.93, 1.22), respectively. For stroke, IRRs for the second and third outdoor exposure groups were similar to those for MI, but near or below the null for higher exposures.
We did not find convincing evidence of associations between WTN and MI or stroke. https://doi.org/10.1289/EHP3340.
Aims
This study investigated the ethnic differences in glycaemic levels and clinical characteristics among insulin‐naïve people with type 2 diabetes (T2D) initiating biphasic insulin aspart 30/70 ...(BIAsp 30) in primary practice in England.
Materials and Methods
Retrospective, observational cohort study utilizing data from the Clinical Practice Research Datalink Aurum database, including White, South Asian, Black and Chinese insulin‐naïve adults with T2D, initiating BIAsp 30. The index date was that of the first BIAsp 30 prescription. Endpoints included change in glycated haemoglobin (HbA1c) and body mass index (BMI) 6 months post index.
Results
In total, 11 186 eligible people were selected (9443 White, 1116 South Asian, 594 Black, 33 Chinese). HbA1c decreased across all subgroups 6 months post index: estimated %‐point changes 95% CI of −2.32 (−2.36; −2.28) (White); −1.91 (−2.02; −1.80) (South Asian); −2.55 (−2.69; −2.40) (Black); and −2.64 (−3.24; −2.04) (Chinese). The BMI increased modestly 6 months post index in all subgroups estimated changes (95% CI) kg/m2: White, 0.92 (0.86; 0.99); South Asian, 0.60 (0.41; 0.78); Black, 1.41 (1.16; 1.65); and Chinese, 0.32 (−0.67; 1.30). In the overall population, hypoglycaemic event rates increased from 0.92 events per 100 patient‐years before the index to 3.37 events per 100 patient‐years post index; event numbers were too low to be analysed by subgroup.
Conclusions
Among insulin‐naïve people with T2D initiating BIAsp 30, clinically meaningful HbA1c reductions in all ethnicities were observed. Some ethnic groups had larger reductions than others, but differences were small. In all groups, small BMI increases were seen, with small differences observed between groups. Hypoglycaemia rates were low.
High arsenic concentration in drinking water is associated with a higher incidence rate of stroke, but only few studies have investigated an association with arsenic in drinking water at low ...concentration (<50 μg/L).
To examine if arsenic in drinking water at low concentration was associated with higher incidence rate of stroke in Denmark.
A total of 57,053 individuals from the Danish Diet, Cancer, and Health cohort was included in the study (enrolment in 1993–1997, age 50–64 years), of which 2195 individuals had incident stroke between enrolment and November 2009. Individuals were enrolled in two major cities (Copenhagen and Aarhus). Residential addresses in the period 1973–2009 were geocoded and arsenic concentration in drinking water at each address was estimated by linking addresses with water supply areas. Associations between arsenic concentration and incidence rate of stroke were analysed using a generalized linear model with a Poisson distribution. Incidence rate ratios (IRR) were adjusted for differences in age, sex, calendar-year, lifestyle factors, and educational level.
Median arsenic concentration in drinking water was 0.7 μg/L at enrolment addresses (range: 0.03 to 25 μg/L), with highest concentrations in the Aarhus area. The adjusted IRRs were 1.17 (95% CI: 1.04–1.32) for the highest arsenic quartile (1.93–25.3 μg/L) when compared with the lowest quartile (0.049–0.57 μg/L), but the highest IRR was seen in the second quartile (0.57–0.76 μg/L) (IRR = 1.21; 95% CI: 1.07–1.36). The highest IRR in the upper quartile was seen in the Aarhus area (IRR = 1.79; 95% CI: 1.41–2.26). Having ever been exposed to10 μg/L or more arsenic in drinking water resulted in an IRR at 1.44 (95% CI: 1.00–2.08) for all strokes and 1.63 (95% CI: 1.11–2.39) for ischemic strokes.
The results indicate that arsenic in drinking water even at low concentration is associated with higher incidence rate of stroke.
•A prospective cohort study of arsenic in drinking water among 57,053 individuals•20-year time-weighted average of arsenic was associated with the incidence rate of stroke.•Ever been exposed to 10 μg/L or more arsenic was associated with incidence rate of stroke.•The association was most pronounced for ischemic stroke.
Noise from wind turbines (WTs) has been reported more annoying than traffic noise at similar levels, and concerns have been raised about whether WT noise (WTN) can increase risk for cardiovascular ...disease. We aimed to investigate if long-term exposure to WTN increases risk for hypertension, estimated as redemption of prescriptions for antihypertensive drugs. We identified all Danish dwellings within a radius of 20 WT heights from a WT and 25% randomly selected dwellings within 20–40 WT heights radius. Using data on WT type and hourly wind conditions at each WT, we estimated hourly outdoor (10–10,000 Hz) and low frequency (LF: 10–160 Hz) indoor WTN for all dwellings, and aggregated it as long-term nighttime running means. From nationwide registries, we identified 535,675 persons age 25–85 years living in these dwellings for >1 year from 1996 to 2013, of whom 83,729 fulfilled our case definition of redeeming ≥2 prescriptions and ≥180 defined daily doses of antihypertensive drugs within a year. Data were analyzed using Poisson regression according to categories of WTN exposure and adjustment for individual and area-level covariates. We found no associations between 5-year mean exposure to WTN during night and redemption of antihypertensives, with hazard ratios (HR) of 0.91 (95% confidence intervals (CI): 0.78–1.06) for outdoor WTN ≥ 42 dB(A) and of 1.06 (CI: 0.83–1.35) for indoor LF WTN ≥ 15 dB(A) when compared to the reference WTN levels (<24 dB(A) and <5 dB(A), respectively). The lack of association was consistent across sub-populations of people living on farms, far from major roads and with high validity of the noise estimate. For people younger than 65 years we found HRs of 0.81 (95% CI: 0.67–0.98) and 0.94 (95% CI: 0.68–1.30) for outdoor WTN ≥ 42 dB(A) and indoor WTN ≥ 15 dB(A), respectively, whereas for people above 65 years the corresponding HRs were 1.17 (95% CI: 0.90–1.52) and 1.28 (95% CI: 0.87–1.88). In conclusion, the present study does not support an association between WTN and redemption of antihypertensive medication.
•We identified all Danes exposed to wind turbine noise (WTN) from 1982 to 2013.•Outdoor and indoor low frequency WTN were modelled as 1- and 5-year running means.•At start of follow-up, 7650 persons were exposed to ≥36 dB(A) outdoor WTN and 4081 persons to ≥10 dB indoor WTN.•People redeeming anti-hypertensive medication (AHT) were identified from a register.•We found no overall association between WTN and redemption of AHT.
Aims: Investigate glycemic control and risk of perinatal complications in women with type 1 diabetes (T1D) treated with insulin pump vs. multiple daily injections (MDI) during pregnancy.
Methods: A ...secondary analysis of a prospective cohort of 2003 pregnant women. Odds ratios (OR) were estimated by logistic regression in crude and adjusted models for potential confounders.
Results: In total, 723 women were treated with pump and 1280 were treated with MDI. At baseline (gestational weeks 8.6 (IQR: 7-10)) pump users had significant lower mean HbA1c (51.0 (10.2) mmol/mol (6.8 (0.9) %) vs. 54.2 (14.5) mmol/mol (7.1 (1.3) %), P < 0.001), longer diabetes duration (mean (SD) 18.3 (7.8) vs. 14.5 (8.3) years, p < 0.001) and higher prevalence of retinopathy (35.5% vs. 24.8%, p < 0.001). HbA1c in late pregnancy was similar (46.2 (9.4) mmol/mol (6.4 (0.9) %) vs. 46.4 (10.8) mmol/mol (6.4 (1.0) %), P=0.7458). Proportion of offspring being large for gestational age (LGA) was 59.0% (pump) vs. 52.2% (MDI) (adjusted OR 1.33 95%CI 1.07;1.65, P=0.009) and born preterm 39.6% vs. 32.1% (adjusted OR 1.52 95%CI 1.23;1.87, P=0.0001) (Table). No statistically significant difference was observed for other endpoints.
Conclusion: Insulin pump treatment in pregnant women with T1D was associated with higher risk of LGA offspring and preterm delivery compared with MDI.
Disclosure
I.H.Thorius: Employee; Novo Nordisk A/S. L.N.Husemoen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. R.Baastrup nordsborg: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. A.Alibegovic: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. M.Gall: Employee; Novo Nordisk A/S. P.Damm: Other Relationship; Novo Nordisk A/S. J.Petersen: Research Support; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Vertex Pharmaceuticals Incorporated, Gilead Sciences, Inc. E.R.Mathiesen: Advisory Panel; Novo Nordisk, Research Support; Novo Nordisk, Speaker's Bureau; Novo Nordisk.
Non-Hodgkin lymphoma (NHL) is a frequent cancer and incidence rates have increased markedly during the second half of the 20(th) century; however, the few established risk factors cannot explain this ...rise and still little is known about the aetiology of NHL. Spatial analyses have been applied in an attempt to identify environmental risk factors, but most studies do not take human mobility into account. The aim of this study was to identify clustering of NHL in space and time in Denmark, using 33 years of residential addresses. We utilised the nation-wide Danish registers and unique personal identification number that all Danish citizens have to conduct a register-based case-control study of 3210 NHL cases and two independent control groups of 3210 each. Cases were identified in the Danish Cancer Registry and controls were matched by age and sex and randomly selected from the Civil Registration System. Residential addresses of cases and controls from 1971 to 2003 were collected from the Civil Registration System and geocoded. Data on pervious hospital diagnoses and operations were obtained from the National Patient Register. We applied the methods of the newly developed Q-statistics to identify space-time clustering of NHL. All analyses were conducted with each of the two control groups, and we adjusted for previous history of autoimmune disease, HIV/AIDS or organ transplantation. Some areas with statistically significant clustering were identified; however, results were not consistent across the two control groups; thus we interpret the results as chance findings. We found no evidence for clustering of NHL in space and time using 33 years of residential histories, suggesting that if the rise in incidence of NHL is a result of risk factors that vary across space and time, the spatio-temporal variation of such factors in Denmark is too small to be detected with the applied method.
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