Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society

Lerário, A. C.; Chacra, Antônio Roberto; Pimazoni-Netto, Augusto; Malerbi, Domingos Augusto Cherino; Gross, Jorge Luiz; Oliveira, José Ep de; Gomes, Marı́lia B.; Santos, Raul D.; Fonseca, Reine Mc; Betti, Roberto; Raduan, Roberto

doi:10.1186/1758-5996-2-35

Cited by 20 publications

(17 citation statements)

References 11 publications

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“…This is illustrated by three type 2 diabetes mellitus guidelines from LMICs in three continents [5][6][7] (table 3). Apart from weaknesses in the content (such as lack of adequate and systematic considerations of translatability, ethical, legal, socioeconomic implications), appropriate user-friendly dissemination channels to target audiences were not clearly articulated.…”

Section: Partnersmentioning

confidence: 99%

“…Apart from weaknesses in the content (such as lack of adequate and systematic considerations of translatability, ethical, legal, socioeconomic implications), appropriate user-friendly dissemination channels to target audiences were not clearly articulated. [5][6][7] ENGAGING STAKEHOLDERS IN THE DELIVERY OF RECOMMENDATIONS Bulky consensus guidelines published by many professional bodies in academic journals to increase healthcare providers' awareness of evidence-based approaches to disease management have often neither percolated down to the stakeholders nor produced the desired results. 18 Dissemination of high-level CVD recommendations in LMICs, therefore, must be transformed and combined with effective implementation strategies to drastically improve the knowledge, attitude, behaviour and practice of all stakeholders and foster an enabling implementation environment so as to produce and sustain the desired effects (tables 1 and 2).…”

Section: Partnersmentioning

confidence: 99%

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Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

et al. 2016

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Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact.

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Section: Partnersmentioning

confidence: 99%

Section: Partnersmentioning

confidence: 99%

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

et al. 2016

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“…This might reflect an acknowledgement of Brazilian Diabetes Society’s guidelines, suggesting rapid escalation of treatment until fasting glucose <100 mg/dL, pre-prandial glycaemia <130 mg/dL, postprandial glycaemia ≤160 mg/dL, and HbA1c <7% to avoid clinical inertia [12]. …”

Section: Discussionmentioning

confidence: 99%

Understanding the barriers and improving care in type 2 diabetes: Brazilian perspective in time to do more in diabetes

Vencio

Paldánius

Blüher

et al. 2017

Diabetol Metab Syndr

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BackgroundType 2 diabetes mellitus (T2DM) is a complex disease, particularly in a continental country like Brazil. We attempted to understand and evaluate the perceptions and routines of Brazilians with T2DM and physicians, compared with other countries.MethodsWe compared the results from a 20-min online survey in Brazil with simultaneously collated data from India, Japan, Spain, UK and USA.ResultsIn total, 652 adults with T2DM and 337 treating physicians were enrolled, of whom 100 patients and 55 physicians were from Brazil. The numbers of primary care physicians from the five countries were 221 versus 43 in Brazil, diabetes specialists were 61 versus 12. There was disconnect between the opinions of physicians and people with diabetes globally. Further, there were differences between clinical practices in Brazil versus the rest of the world, in many areas Brazilians were performing better.ConclusionsCommunication between patients and physicians should be clearer. There is an urgent need to identify the deficits in education, in order to address the clinical inertia within the diabetes management team. There is a necessity to understand the specific requirements of the Brazilian population in order to contextualise international guidelines and implement local changes in practice.

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“…In an article published by the Brazilian Society of Diabetes, 217 members evaluated the recommendations of the ADA/EASD [31]. The majority were unable to apply the pharmacotherapy sequence of the algorithm in their patients.…”

Section: Challenges In the Implementation Of The Guidelinesmentioning

confidence: 99%

Management of Type 2 Diabetes: More Evidence is Required to Address the Clinical and Contextual Facets

Hernández-Jiménez¹,

Aguilar-Salinas²,

Mehta³

et al. 2011

CDR

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Evidence based medicine has changed the manner in which medicine is practiced and learned. Epidemiological studies, meta-analyses and systematic reviews have been used to create algorithms for the treatment of hyperglycemia in patients with type 2 diabetes. Recently, several randomized controlled trials (i.e. ACCORD, ADVANCE, VADT) have generated new and valuable information regarding the benefits and risks of achieving optimal glucose control. As a result, guidelines and algorithms have been updated. However, many aspects remain controversial. In this article, the clinical implications of the existing guidelines are critically analyzed. The limitations of the current guidelines include the lack of applicability to relevant diabetic subgroups, the exclusion of important factors that modify the therapeutic response to glucose-lowering agents and the limited recognition of the importance of the socioeconomic situation on treatment efficacy. Many subgroups of patients have not been included in the studies used to generate recommendations. There is insufficient evidence to support the use of current treatment recommendations in patients with early onset type 2 diabetes, patients with advanced microvascular complications, and the elderly with or without chronic complications. The characteristics of the candidates for conservative or intensive treatment are poorly defined. Interventions are recommended without considering clinical variables (i.e. obesity, time since diagnosis or prolonged exposure to hyperglycemia) that may modify treatment efficacy and the occurrence of side effects. Finally, no consideration is given to the socioeconomic context of the population in which the guidelines are to be applied. In summary, this manuscript highlights the key areas which require further work. If these issues are adequately addressed, the guidelines for the management of type 2 diabetes will be relevant and applicable to all diabetic groups.

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Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society

Cited by 20 publications

References 11 publications

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

Understanding the barriers and improving care in type 2 diabetes: Brazilian perspective in time to do more in diabetes

Management of Type 2 Diabetes: More Evidence is Required to Address the Clinical and Contextual Facets

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