Dental implants always produce metal artefacts in CBCT images, and these artefacts are affected by the anatomical location in the dental arch.

Objective To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. Methods A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters' uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). Results Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = −0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. Conclusion Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

SUMÁRIOO diabetes melito do tipo 2 (DM2) é responsável por 90% dos casos de diabetes e está associado a complicações micro e macrovasculares de elevada morbimortalidade. Os indivíduos com maior risco de desenvolvimento de DM incluem aqueles com glicemia de jejum alterada (GJA) e tolerância diminuída à glicose (TDG) e especialmente aqueles com as duas condições combinadas. Esses indivíduos fazem parte de um grupo hoje conhecido como pré-diabetes. Aproximadamente 25% dos indivíduos com pré-diabetes desenvolverão DM2 em três a cinco anos. A hiperglicemia, na ausência de DM, também foi associada ao aumento no risco de doença cardiovascular. Estudos demonstraram que mudanças no estilo de vida e intervenções medicamentosas são efetivas em retardar ou prevenir o DM2 em pacientes com pré-diabetes. GJA e TDG estão associadas ao desenvolvimento de DM2 e, apesar das controvérsias, a maioria dos estudos epidemiológicos reforça a importância dessas duas condições também no desenvolvimento de doença micro e macrovascular. Assim, intervenções em pacientes com pré-diabetes são importantes na prevenção primária do DM2 e de suas complicações crônicas. Arq Bras Endocrinol Metab. 2012;56(5):275-84 Descritores Pré-diabetes; diabetes melito; complicações microvasculares; doença cardiovascular; prevenção SUMMARY Type 2 diabetes mellitus accounts for 90% of diabetes cases and is associated with macro-and microvascular complications of high morbidity and mortality. Individuals with increased risk for type 2 diabetes include those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and especially those with combined IFG and IGT. These individuals are part of a group known as prediabetes patients. Approximately 25% of individuals with prediabetes will develop type 2 diabetes in three to five years. Hyperglycemia, in the absence of diabetes, is also associated with increased risk of cardiovascular disease. Studies have shown that changes in lifestyle and drug interventions are effective in delaying or preventing type 2 diabetes in patients with prediabetes. Metformin is the drug of choice when medical treatment is warranted. IGT and IFG are associated with type 2 diabetes and, despite controversy, most studies reinforce the importance of these conditions in the development of micro-and macrovascular disease. Thus, therapeutic interventions in patients with prediabetes are important in primary prevention of type 2 diabetes and its chronic complications. Arq Bras Endocrinol Metab. 2012;56(5):275-84

In this study, a significant decrease in HbA1c was observed during patients' follow-up, but it was similar in intervention and control groups. The diabetes mellitus education course delivered to community health workers was able to improve patients' lipid profile.