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

• Main Authors: Gomes Marília B, Cobas Roberta A, Matheus Alessandra S, Tannus Lucianne R, Negrato Carlos, Rodacki Melanie, Braga Neuza, Cordeiro Marilena M, Luescher Jorge L, Berardo Renata S, Nery Marcia, Marques MariadoCarmo A, Calliari Luiz E, Noronha Renata M, Manna Thais D, Zajdenverg Lenita, Salvodelli Roberta, Penha Fernanda G, Foss Milton C, Foss-Freitas Maria C, Pires Antonio C, Robles Fernando C, Guedes MariadeFátimaS, Dib Sergio A, Dualib Patricia, Silva Saulo C, Sepulvida Janice, Almeida Henriqueta G, Sampaio Emerson, Rea Rosangela, Faria Ana Cristina R, Tschiedel Balduino, Lavigne Suzana, Cardozo Gustavo A, Azevedo Mirela J, Canani Luis, Zucatti Alessandra T, Coral Marisa Helena C, Pereira Daniela, Araujo Luiz, Tolentino Monica, Pedrosa Hermelinda C, Prado Flaviane A, Rassi Nelson, Araujo Leticia B, Fonseca Reine Marie C, Guedes Alexis D, Matos Odelissa S, Faria Manuel, Azulay Rossana, Forti Adriana C, Façanha Cristina, Montenegro Ana, Montenegro Renan, Melo Naira H, Rezende Karla F, Ramos Alberto, Felicio João, Santos Flavia M, Jezini Deborah L
• Format: Article
• Language: English
• Published: BMC 2012-10-01
• Series: Diabetology & Metabolic Syndrome
• Subjects: Type 1 diabetes; Glycemic control; Cardiovascular risk factors; Chronic complications; Economic status
• Online Access: http://www.dmsjournal.com/content/4/1/44

<p>Abstract</p> <p>Background</p> <p>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<b>.</b></p> <p>Methods</p> <p>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).</p> <p>Results</p> <p>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).</p> <p>Conclusions</p> <p>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.</p>