CME INDIA Presentation by Dr. Sanjeev Phatak, Dr. Banshi Saboo, Dr. Dhruvi Hasnani, Dr. P. Zinzuwadia, Dr. Dharmendra Panchal, Dr. Rikin Shah, Dr. Vipul Chavda, Dr. Kaumudi C, Dr. Rutul Thakkar, Dr. Akash Prajapati, Dr. Bhavesh Patel, Dr. Chintan Vyas, Dr. Dipal Parekh, Dr. Hemant Mankad, Dr. Jitendra Patel, Dr. Mahadev Desai, Dr. Mukul Oza, Dr. Manoj Vithalani, Dr. N. K. Singh, Dr. Navneet Shah, Dr. Om Lakhani, Dr. Parag Shah, Dr. Piyush Desai, Dr. Parikshit Goswami, Dr. Pratap Jethwani, Dr. Rucha Mehta, Dr. Ramesh Goyal, Dr. Shrikant Somani, Dr. Sandeep Desai, Dr. Shailesh Trivedi, Dr. Tiven Marvah, Dr. T. K. M. Eashwar, Dr. Urman Dhruv, Dr. Vivek Patel.

APICON 2023 (Ahmedabad) Insights

Blue Index: Indian Score shines

• The management of Type 2 Diabetes is no longer restricted to glucose control but also includes focus on Blood pressure and Cholesterol control along with Weight management so as to reduce microvascular and macrovascular complications of diabetes.
• STENO 2 study has demonstrated benefits of multifactorial intervention for reducing Diabetes related complications and improving survival.
• The second page addresses the most important Comorbidity i.e., Obesity and its management as well as guideline-based statements for prevention and management of macrovascular and microvascular complications.

(Prof V. G. Nadgouda Lecture – RSSDI-2021/ Acknowledgements – Dr. Banshi Saboo, Dr. Dharmendra Panchal, Dr. Dhruvi Hasnani, Dr. Padmanabh Zinzuwadia)

The following 10 commandments are an attempt to achieve diabetes management using a more holistic approach.

• The 10 Commandments of T2DM management presented here represent all the necessary steps a Physician should consider while managing his patient.
• The left side of the column represents the guideline-based statements while the right-side column represents guideline-based targets.

A B C

D E F

G H I

J

Download Blue Index PDF

What is BLUEINDEX?

• BLUEINDEX is a Diabetes health score that represents overall health of the T2DM patients not just glucose control the parameters of this comprehensive
• Diabetes care include 3 metabolic goals (A1C, Blood pressure, Cholesterol),
• Non-metabolic health parameters (General health, Infection, jeopardy related to Diabetes treatment)
• Selfcare parameters (Diet, Exercise, Follow up, and Habit avoidance).

F: Medicine Adherence/Follow Up

One point for each no.

The total score ranges from 0-10 with a higher score indicating better adherence

F: Medicine Adherence/Follow Up

G: General Health

1. Obesity: BMI ≥ 25 kg/m² & OSA: AHI ≥5 OR ESS ≥ 9
2. Inadequate Bone Health: Osteoporosis or Nontraumatic Fracture
3. Mental Health (Diabetes Distress): Clinical decision
4. Liver dysfunction -NAFLD: liver enzyme ≥3 times upper normal limit or chronic liver disease
5. Other endocrine disorders – i.e., Thyroid disease: Hypo/Hyperthyroidism
6. Chronic respiratory disease
7. Anemia Hb < 10 (female) and < 11 (male)

*Advanced disease: disease which is a constant threat to life or requires hospitalization at least ≥1 time in last 3 months.

H: Habits:
Tobacco / Alcohol / Screen Time

I: Infection Prevention

J: Jeopardy of Diabetes Management
(Hypoglycaemia, Drug ADR)

K-Komplications – C

Cardio-Cerebral / Macro-Vascular

K-Komplications – R

Reno-Retinal/ Micro-Vascular

K-Komplications – F
Foot Complications

K-Komplication Score

• C: Cardio-Cerebral / Macrovascular
• R: Reno-Retinal / Microvascular 
• F: Foot

Blue Index Strength – Patient-centered approach

• Continuous patient education and Motivation
• Strong tool for holistic evaluation of disease status, complications and overall health
• Comprehensive coverage of
  • Glucose control
  • Vasculo-metabolic / Renal health
  • General health
• Equal weightage to patient efforts and treatment targets
• Respectful of WHO definition of health

Blue Index: FAQ

• What is the evidence?
• Why some patients not included in the blue Index Group?
• Why equal weightage is given to all the parameters?
• What is the complication rate and mortality?
• Is it very time consuming in a busy outdoor?
• Which centers use Blue-Index?

CME INDIA Highlight

• Blue Index is Indian based simple scoring system which can be done in diabetologist’s clinic in 2 to 5 minutes and very useful to predict complications and understanding the smooth and green care of Diabetes.
• It needs validation and high-quality study for international review.
• In true sense The Blue Index is concordant with the bio-psycho-social model of health as well as WHO definition of health. This approach encourages proactive behaviour on part of Diabetes care provider as well as Care seeker and reflects ancient Indian Wisdom as written in Bhagavad Gita (people in goodness are proactive.)

References:

1. ADA Standards of Care, 2023,
2. KDIGO Clinical Practice Guidelines 2022
3. RSSDI Guidelines, 2022

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