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Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

2012; BioMed Central; Volume: 4; Issue: 1 Linguagem: Inglês

10.1186/1758-5996-4-44

1758-5996

Marília Brito Gomes, Roberta Arnoldi Cobas, Alessandra Saldanha de Mattos Matheus, Lucianne Righeti Monteiro Tannus, Carlos Antônio Negrato, Melanie Rodacki, Neuza Braga, Marilena M Cordeiro, Jorge Luiz Luescher, Renata S Berardo, Márcia Nery, Maria do Carmo Arruda-Marques, Luís Eduardo Calliari, Renata Maria de Noronha, Thaís Della Manna, Lenita Zajdenverg, Roberta Salvodelli, Fernanda G Penha, Milton César Foss, Maria Cristina Foss‐Freitas, António Pires, Fernando César Robles, Maria de Fátima S Guedes, Sérgio Atala Dib, Patrícia Médici Dualib, Saulo C Silva, Janice Sepulvida, Henrique A. Almeida, Emerson Sampaio, Rosângela Réa, Ana Cristina Ravazzani de Almeida Faria, Balduíno Tschiedel, Suzana Lavigne, Gustavo A Cardozo, Mirela Jobim de Azevedo, Luís Henrique Santos Canani, Alessandra Teixeira Netto Zucatti, Marisa Helena César Coral, Daniela Aline Pereira, Luiz Antônio de Araújo, Monica Tolentino, Hermelinda Cordeiro Pedrosa, Flaviane A Prado, Nelson Rassi, Leticia B Araujo, Reine Marie Chaves Fonseca, Alexis Dourado Guedes, Odelissa S Matos, Manuel dos Santos Faria, Rossana Santiago de Sousa Azulay, Adriana Costa e Forti, Cristina Figueiredo Sampaio Façanha, Ana Paula Dias Rangel Montenegro, Renan Magalhães Montenegro, Naira Horta Melo, Karla Freire Rezende, Alberto Ramos, João Sooares Felicio, Flávia Marques Santos, Déborah Laredo Jezini, Marilena M Cordeiro,

Diabetes and associated disorders

To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.