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African-American adults tend to have higher acute insulin response to glucose, lower insulin sensitivity, and lower hepatic insulin clearance. Catharine A. Couch, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, and colleagues conducted the study to test the hypothesis that the proinsulin–to–C-peptide ratio, as an index of proinsulin secretion, would be higher and associated with indices of β-cell function in African American people relative to European-American adults without type 2 diabetes.

For this purpose, 114 African-American and European-American adult women and men were included. A 2-h oral glucose tolerance test was conducted to measure insulin, glucose, proinsulin, and C-peptide and derive indices of β-ce9ll response to glucose.

The Matsuda index was calculated as an insulin sensitivity measure. The disposition index (DI) was calculated for each phase of β-cell responsivity. DI is the product of insulin sensitivity and β-cell response. Pearson correlations were used to determine the relationship of the PI-to-CP ratio with each β-cell response phase (basal, Φb; dynamic, Φd; static, Φs; total, Φtot), insulin sensitivity, and disposition indices (DId, DIs, DItot). Multiple linear regression analysis was used to evaluate independent contributions of BMI, race, and glucose tolerance status on PI-to-CP levels before and after adjustment for insulin sensitivity.

The study led to the following findings:

• African American participants had higher fasting and 2-h PI-to-CP ratios.
• The fasting PI-to-CP ratio was positively associated with Φb, and the fasting PI-to-CP ratio and 2-h PI-to-CP ratio were inversely associated with DId and insulin sensitivity only in African-American participants.

“The findings reveal that the proinsulin-to–C-peptide ratio could be helpful in the early identification of β-cell dysfunction in African American individuals,” the researchers concluded.

Reference:

Catharine A. Couch, Francesca Piccinini, Lauren A. Fowler, W. Timothy Garvey, Barbara A. Gower; Proinsulin–to–C-Peptide Ratio as a Marker of β-Cell Function in African American and European American Adults. Diabetes Care 1 December 2023; 46 (12): 2129–2136. https://doi.org/10.2337/dc22-1763

Dupilumab-induced hypereosinophilia is mediated by blockade of the IL-4/IL-13 pathway, which reduces eosinophil migration from peripheral blood. The increase in peripheral blood eosinophils may lead to chronic eosinophilic pneumonia (CEP) and/or eosinophilic granulomatosis with polyangiitis, but a direct causal connection between dupilumab and eosinophilic lung diseases has not been established.

A 33-year-old Japanese woman with bronchial asthma since age three was treated with fluticasone propionate plus salmeterol twice daily after several asthma exacerbations at age 17. Her course was complicated by chronic eosinophilic pneumonia at age 33 which resolved without the need for systemic steroids. However, in the four months following resolution of her chronic eosinophilic pneumonia, the patient had three asthma exacerbations, and a recurrence of chronic eosinophilic pneumonia, with blood leukocytes of 8500/µL, of which 25.0% were eosinophils. She was treated with prednisolone 50 mg/day, but she could not continue this dose due to the onset of myalgia. Then she had relapsing chronic eosinophilic pneumonia twice within three months. She was treated with prednisolone 15 mg/day for chronic eosinophilic pneumonia, but she had persistent asthma for more than one month; dupilumab was added at 600 mg, followed by 300 mg every two weeks. In the first month of treatment with dupilumab, the patient’s asthma symptoms resolved completely, and she had only one relapse of chronic eosinophilic pneumonia. In 12 months of follow-up, she had neither an asthma exacerbation nor another relapse of chronic eosinophilic pneumonia. Dupilumab may be a promising treatment for patients with refractory asthma complicated by recurring chronic eosinophilic pneumonia and undesirable steroid side effects.

Reference:

Masumoto N, Oshikata C, Nakadegawa R, Motobayashi Y, Osada R, Manabe S, Kaneko T, Tsurikisawa N. Dupilumab suppresses relapsing chronic eosinophilic pneumonia with severe asthma. Nagoya J Med Sci. 2023 Nov;85(4):857-865. doi: 10.18999/nagjms.85.4.857. PMID: 38155613; PMCID: PMC10751507.

Keywords:

Dupilumab, promising, treatment, refractory, asthma, complicated, recurring, chronic, eosinophilic, pneumonia, Masumoto N, Oshikata C, Nakadegawa R, Motobayashi Y, Osada R, Manabe S, Kaneko T, Tsurikisawa N, chronic eosinophilic pneumonia, dupilumab, eosinophils, severe asthma, biologic drugs, Nagoya Journal of Medical Science

A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. RESULTS:A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy. In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded

Jeffrey L. Carson, Maria Mori Brooks, Paul C. Hébert, Shaun G. Goodman, Marnie Bertolet, Simone A. Glynn, Bernard R. Chaitman, Tabassome Simon, Renato D. Lopes, Andrew M. Goldsweig, Andrew P. DeFilippis, J. Dawn Abbott. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med 2023; 389:2446-2456. DOI: 10.1056/NEJMoa2307983

Keywords:

Liberal, Transfusion, Strategy, fails, reduce, risk, recurrence, death, MI patients, anemia, The New England Journal of Medicine, Jeffrey L. Carson, Maria Mori Brooks, Paul C. Hébert, Shaun G. Goodman, Marnie Bertolet, Simone A. Glynn, Bernard R. Chaitman, Tabassome Simon, Renato D. Lopes, Andrew M. Goldsweig, Andrew P. DeFilippis, J. Dawn Abbott