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A recent study published in the Journal of the Association of Physicians of India showed that the index includes a range of parameters that address various facets of diabetes care, including complications. The researchers suggest that it can be utilized by not only endocrinologists but also all physicians as a resource for monitoring and enhancing diabetic care.

Diabetes is a complex condition that requires meticulous management to prevent complications such as cardiovascular disease, neuropathy, and kidney failure. Traditional assessment methods often focus on isolated metrics, which can overlook the multifaceted nature of the disease. Assessing diabetes health encompasses a range of factors, including metabolic and nonmetabolic measures, as well as self-care practices such as diet, exercise, and follow-up habits. In contrast, the complications index focuses on macro and microvascular issues related to diabetes and foot complications.

The Blue Index (BI) is a comprehensive tool that integrates these health-related parameters and the systemic complications arising from diabetes into a unified assessment. In the study, Rupak Chatterjee, Senior Resident, Department of Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India, and colleagues sought to assess the diabetes control status of patients using a single index.

For this purpose, the researchers conducted a prospective, observational study involving 100 adult diabetic patients, assessing their diabetic health status (DHS) and Komplications Score (KS) related to cardiovascular/macrovascular, microvascular, and foot complications. The Blue Index (BI) was calculated as a composite ratio, with measurements taken at baseline, after three months, and again at six months. The collected data was then statistically analyzed.

The following were the key findings of the study:

• Diabetic health status showed a significant increase in both the third and sixth months compared to baseline.
• The Komplications Score decreased significantly at these time points relative to baseline measures.
• The composite BI scores exhibited a steady rise, with increases of 9.62 at three months and 13.14 at six months compared to baseline.
• When analyzing based on the duration of diabetes diagnosis, DHS, KS, and BI scores demonstrated consistent changes.
• In terms of gender differences, DHS was notably higher in females at baseline compared to males, with both groups showing gradual improvements over time.
• Males had significantly lower KS scores than females, with a gradual decrease over the study period, indicating an improvement in complications.
• DHS was significantly correlated with both the duration of diabetes detection and age.

The findings suggest that the Blue Index (BI) is a straightforward tool that integrates multiple parameters addressing various facets of diabetes care, including complications. It can be utilized not only by endocrinologists but by all physicians to monitor and enhance diabetic management.

However, the authors noted some limitations, including a small sample size and its single-center design. Additionally, there were challenges in establishing clear distinctions based on the grading of retinopathy in the complications score, resulting in some overlaps.

Reference:

Chatterjee R, Naskar A, Samajdar SS, et al. Blue Index as a Comprehensive, Patient-centered Assessment of Care in Diabetic Patients. J Assoc Physicians India 2024;72(10):e1–e5.

The research, published in the Journal of Diabetes, revealed that GLP-1 receptor agonists were linked to a lower likelihood of requiring additional glucose-lowering medications and demonstrated superior control of glycated hemoglobin levels overall. However, in patients with prediabetes, metformin was associated with higher rates of treatment adherence.

GLP-1 RAs are increasingly being prescribed in drug-naive patients. Kathrine Kold Sørensen, Department of Cardiology, Nordsjælland Hospital, Hillerød, Denmark, and colleagues aimed to compare add-on therapy, adherence, and changes in biomarkers one year after starting treatment with either GLP-1 receptor agonists or metformin.

For this purpose, the researchers utilized Danish nationwide registers to include new users of GLP-1 receptor agonists or metformin from 2018 to 2021, specifically those with glycated hemoglobin (HbA1c) levels of ≥42 mmol/mol. GLP-1 RA initiators were matched to metformin initiators in a 1:1 ratio to evaluate outcomes in both prediabetes and diabetes.

The main outcomes analyzed included the one-year risk of requiring additional glucose-lowering medications and the one-year risk of non-adherence. One-year risks were estimated using multiple logistic regression and standardized methods, while multiple linear regression was applied to assess average differences in changes to biomarkers.

Based on the study, the researchers reported the following findings:

• The study included 1,778 individuals initiating treatment with GLP-1 receptor agonists or metformin.
• After adjusting for various factors, GLP-1 RA was linked to a lower one-year risk of requiring additional glucose-lowering treatment in patients with prediabetes (one-year risk ratio [RR]: 0.27) and diabetes (RR: 0.67).
• Among patients with prediabetes, GLP-1 RA was associated with a higher one-year risk of nonadherence (RR: 1.60), while there was no significant difference in patients with diabetes (RR: 0.88).
• Compared to metformin, GLP-1 RA was associated with greater reductions in HbA1c levels, with a decrease of −2.59 mmol/mol for prediabetes and −3.79 mmol/mol for diabetes.

The findings indicated that in patients with prediabetes, starting treatment with GLP-1 receptor agonists was linked to a reduced risk of needing additional glucose-lowering therapy compared to metformin. However, those initiating metformin demonstrated significantly higher levels of adherence.

“In patients with diabetes, GLP-1 RA initiation similarly resulted in a lower risk of requiring extra glucose-lowering therapy, but there was no difference in nonadherence rates when compared to metformin initiation,” the researchers wrote.

Reference:

Sørensen, K. K., Gerds, T. A., Køber, L., Fosbøl, E. L., Poulsen, H. E., Møller, A. L., Andersen, M. P., Pedersen-Bjergaard, U., Torp-Pedersen, C., & Zareini, B. (2024). Comparing Glucagon-like peptide-1 receptor agonists versus metformin in drug-naive patients: A nationwide cohort study. Journal of Diabetes, 16(10), e70000. https://doi.org/10.1111/1753-0407.70000

The prospective research, conducted over 12 months, showed that R20 may be an effective predictor of future exacerbations in asthma patients. The findings could enhance the evaluation of adults with asthma who have normal FEV1 levels.

“Our findings established the baseline FOT as an important tool for predicting clinical remission in adults with asthma over 12 months,” the researchers wrote. “Notably, FOT parameters, especially resistance at 20 Hz (R20), effectively differentiated between those who achieved clinical remission and those who did not. Lower R20 values were significantly linked to clinical remission, with an adjusted odds ratio of 0.32.”

Asthma exacerbations can significantly impact patients’ quality of life, leading to increased healthcare costs and reduced lung function. Traditional methods of monitoring asthma rely on FEV1 measurements, which can sometimes fail to capture the complexity of the disease in certain patients.

The forced oscillation technique (FOT) is a minimally invasive method for assessing asthma during resting ventilation. However, its effectiveness in long-term evaluations, such as monitoring clinical remission, is still not well understood. Therefore, Yoshito Miyata, Showa University School of Medicine, Tokyo, Japan, and colleagues aimed to evaluate asthma clinical remission over time and identify parameters from baseline FOT that predict remission at the 12-month mark.

For this purpose, the researchers enrolled adult patients with asthma at their university hospital from April 2022 to May 2023 in a prospective observational study. Participants were evaluated over 12 months to determine if they met the clinical remission criteria: an asthma control test score of ≥20 at both enrollment and 12 months, no exacerbations during that period, and no regular oral corticosteroid use. The FOT parameters collected at enrollment were then analyzed for their association with clinical remission.

The following were the key findings of the study:

• Ninety-four asthma patients completed the study and were divided into clinical and non-clinical remission groups.
• Comparing pulmonary function tests, including FOT, revealed significant differences in resistance at 5 Hz and 20 Hz (R20), while there were no differences in FEV1.
• Multivariate logistic regression analysis indicated that R20 was linked to clinical remission, with adjusted odds ratios of 0.32 for R20.

The study emphasizes the value of baseline forced oscillation technique measurements, particularly R20, in predicting future exacerbations in adults with asthma. These insights could transform clinical practices, allowing for more effective monitoring and management of asthma, especially in patients with normal lung function.

“As the medical community continues to seek innovative ways to enhance asthma care, FOT may play a pivotal role in shaping future treatment strategies,” the researchers concluded.

Reference:

Miyata Y, Tanaka A, Ebato T, Kashima A, Nojo M, Matsunaga T, Kaneko K, Okazaki T, Ohta S, Homma T, Watanabe Y, Kusumoto S, Suzuki S, Sagara H. Baseline forced oscillation technique predicting lack of exacerbations in adult with asthma: A 12-month prospective. Ann Allergy Asthma Immunol. 2024 Oct 4:S1081-1206(24)01553-9. doi: 10.1016/j.anai.2024.09.018. Epub ahead of print. PMID: 39370038.