Poor glycaemic control in Brazilian patients with type 2 diabetes attending the public healthcare system: a cross-sectional study

Abstract

ObjectivesTo describe the clinical profile of Brazilian patients with type 2 diabetes attending the public healthcare system and identify factors associated with poor glycaemic control.DesignCross-sectional study.Setting14 centres in five regions of Brazil, including primary care units and outpatient clinics of University Hospitals.ParticipantsPatients with type 2 diabetes attending outpatient clinics of public healthcare system.Main outcome measuredGlycated haemoglobin (HbA1c), centrally measured by high-performance liquid chromatography (National Glycohemoglobin Standardization Program certified).ResultsA total of 5750 patients aged 61±10 years, with 11±8 years of diabetes duration (66% women, 56% non-white, body mass index: 28.0±5.3 kg/m2) were analysed. Mean HbA1c was 8.6±2.2%, and median HbA1c was 8.1% (6.9% to 9.9%). HbA1c <7% was observed in only 26% of patients. Mean HbA1c was higher (p < 0.01) in the North (9.0±2.6%) and Northeast (8.9±2.4%) than in the Midwest (8.1±2%), Southeast (8.4±2.1%) and South regions (8.3±1.9%). Using the cut-off value of HbA1c above the median, age (0.986 (0.983 to 0.989)), white ethnicity (0.931 (0.883 to 0.981)) and being from Midwest region (0.858 (0.745 to 0.989)) were protective factors, while diabetes duration (1.015 (1.012 to 1.018)), use of insulin (1.710 (1.624 to 1.802)) and living in the Northeast region (1.197 (1.085 to 1.321)) were associated with HbA1c >8%.ConclusionsThe majority of Brazilian patients with type 2 diabetes attending the public healthcare system had HbA1c levels above recommended targets. The recognition of Northeast residents and non-white patients as vulnerable populations should guide future policies and actions to prevent and control diabetes.

The rs10885122 polymorphism of the adrenoceptor alpha 2A (ADRA2A) gene in Euro-Brazilians with type 2 diabetes mellitus

“…Few studies were available that compared the association of SNPs with T2D in the Brazilian population. In our study, we revealed that the characteristics of the T2D group indicated poor glycemic control, as demonstrated by the concentration of the biomarkers HbA1C (> 7%) and 1,5-anhydroglucitol (< 10 µg/mL) (21,22). In addition, the minor but significant reduction in serum albumin concentration associated with high frequency of hypertension in the T2D group could suggest an increase in albumin loss (microalbuminuria) by the kidney (23,24).…”

Glycemic Control Rate in Type 2 Diabetes Mellitus Patients at a Public Referral Hospital in Rio de Janeiro, Brazil: Demographic and Clinical Factors

“…Another Brazilian study performed between 2006 and 2011, with 5,750 diabetic patients seen in a public health system found mean HbA1c of 8.1% (8.6±2.2%) [6]. However, in our study, 49% of our patients were above glycemic control target, with a median HbA1c of 8.7%, a worse percentage than encountered in, for example, Germany (40%) [32], the Netherlands (42%) [33] and USA (43%) [34].…”

“…Data from several epidemiological studies worldwide have shown that the majority of patients do not obtain, nor maintain glycemic control among satisfactory range defined by international societies [4][5][6][7][8]. Thus, diabetes' management remains challenging.…”

Diabetes Mellitus tipo 2: caracterização da assistência à saúde, parâmetros clínicos e estado nutricional de idosos em uma Unidade Básica de Saúde, em dois períodos de acompanhamento

“…O maior número de mulheres com DM tipo 2 foi verificado em outros estudos (VIANA et al, 2013;FONTBONNE et al, 2013, CAMPOLINA et al, 2013. LOYOLA FILHO et al, 2013FARIA et al, 2014).…”