Diabetic bone disease (DBD) is a frequent complication in patients with type 2 diabetes mellitus (T2DM), characterised by altered bone mineral density (BMD) and bone turnover marker (BTMs) levels. The impact of different anti-diabetic medications on the skeleton remains unclear, and studies have reported conflicting results; thus, the need for a comprehensive systematic review is of paramount importance. A systematic search was conducted in PubMed and the Cochrane Library. The primary outcomes assessed were changes in BMD in relation to different anatomical sites and BTMs, including mainly P1NP and CTX as well as OPG, OCN, B-ALP and RANK-L. Risk of bias was evaluated using the JADAD score. The meta-analysis of 19 randomised controlled trials comprising 4914 patients showed that anti-diabetic medications overall increased BMD at the lumbar spine (SMD: 0.93, 95% CI [0.13, 1.73], p = 0.02), femoral neck (SMD: 1.10, 95% CI [0.47, 1.74], p = 0.0007) and in total hip (SMD: 0.33, 95% CI [−0.25, 0.92], p = 0.27) in comparison with placebo, but when compared with metformin, the overall effect favoured metformin over other treatments (SMD: −0.23, 95% CI [−0.39, −0.07], p = 0.004). GLP-1 receptor agonists and insulin analogues seem to improve BMD compared to placebo, while SGLT2 inhibitors and thiazolidinediones (TZDs) showed no significant effect, although studies’ number cannot lead to safe conclusions. For BTMs, TZDs significantly increased P1NP levels compared to placebo. However, no significant differences were observed for CTX, B-ALP, OCN, OPG, and RANK-L between anti-diabetic drugs and metformin or placebo. High heterogeneity and diverse follow-up durations among studies were evident, which obscures the validity of the results. This review highlights the variable effects of anti-diabetic drugs on DBD in T2DM patients, emphasising the need for long-term trials with robust designs to better understand these relationships and inform clinical decisions.

Type 2 diabetes mellitus (T2DM) is a major global health concern with increasing prevalence and healthcare costs. Despite the availability of pharmacological interventions, sustained glycemic control and disease remission remain challenging. Dietary strategies such as low-carbohydrate diets (LCDs) and ketogenic diets (KDs) are gaining attention for their potential to improve metabolic parameters and induce T2DM remission. The objective of this review is to evaluate the long-term efficacy and safety of low-carbohydrate and ketogenic diets in the management and remission of type 2 diabetes mellitus. The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched using predefined keywords and filters. Studies included randomized and non-randomized clinical trials published in English within the last 24 years. Eligible studies involved adult T2DM patients on LCDs/KDs with a follow-up period of at least 12 months. The primary outcomes were T2DM remission, changes in glycated hemoglobin (HbA1c), body weight, body mass index (BMI), and secondary outcomes included blood pressure, lipid profiles, and adverse effects. Out of 124 initially identified studies, six studies met the inclusion criteria, with follow-up durations ranging from one to eight years. Low-carbohydrate and ketogenic diets led to significant reductions in HbA1c, body weight, BMI, and systolic blood pressure. In terms of long-term studies, remission rates were highest at one year (up to 62%) and declined to 13% by year five. Participants in the intervention groups also experienced reduced dependency on glucose-lowering and antihypertensive medications. Despite some weight regain and glycemic relapse over time, the overall metabolic improvements suggest a beneficial role of dietary intervention in T2DM management. Low-carbohydrate and ketogenic diets appear to be effective in improving metabolic outcomes and inducing remission in T2DM. These dietary interventions may serve as viable alternatives to pharmacological treatments or bariatric surgery, provided that long-term adherence and support mechanisms are in place. Further research is needed to address long-term safety, sustainability, and individualized dietary approaches.

Background In coastal Bangladesh, while men predominantly engage in direct fishing from rivers and the Bay of Bengal, women are mostly engaged in fish processing. Due to the different roles of men and women in fisheries, occupational hazards and risks can also be distinctive. However, there is limited comparative evidence on the role of gender in occupational hazards and risks among men and women working in fisheries sector. Objective This study investigated and compared the prevalence, type, and severity of occupational health hazards and associated risks among male and female fisherfolk in Chattogram and Cox’s Bazar, Bangladesh. Methods An explanatory sequential mixed-methods design was used. The qualitative component included nine focus group discussions on gendered exposures and hazards, which informed a subsequent cross-sectional survey of 407 fisherfolk (n = 200 males; n = 207 females). Gender-disaggregated responses were analysed using descriptive statistics, chi-square tests, and radar charts. Key qualitative themes were developed and used for cross-method triangulation. Results In the fish industry, male workers were predominantly engaged in direct fishing (male 52.5% vs. female 0%, p < 0.001), whereas female workers were majorly found involved in dry fish processing (54.1% vs. 14.5%, p < 0.001). Most risk factors, such as sun and salt exposure and lack of sanitary latrines, were reported by both men and women at consistently high rates. Females were found to have higher chemical exposure (53.6% vs. 35.0%; p < 0.001), and males had higher exposure to heavy weight (93.0% vs. 82.6%, p = 0.002). High prevalence of occupational risks, including skin issues, musculoskeletal disorders, and diarrhea, found in both groups with similar likelihood. Conditions like fish stings/bites, seasickness, and earache were significantly higher among male workers. Inaccessibility to toilets, absence of menstrual hygiene kits, lack of breastfeeding space, and lack of maternity leave were some of the unique concerns of women. Drowning and falling overboard, cyclones and storms, and attacks from pirates are unique hazards for men. Men are more prone to fatality due to their engagement in acute life-threatening tasks. PPE use is significantly lower for both sexes, with 65% to 99% not using the respective PPE. Conclusions This study revealed a high burden of occupational hazards and risks among both male and female workers in the fisheries sector in Bangladesh from a gender lens. A gender-sensitive occupational safety and health strategy and action plan strategy is crucial to attain the health, wellbeing, dignity, productivity, and protection of the men and women in fisherfolk communities in Bangladesh.