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

Abstract

BackgroundTo 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.MethodsThis 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).ResultsOverall, 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).ConclusionsA 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.

Regional Disparities in Diabetes Care for Pediatric Patients with Type 1 Diabetes. A Cross-sectional DPV Multicenter Analysis of 24 928 German Children and Adolescents

“…Regional disparities in diabetes care have been reported for several countries. Studies from the US and Brazil demonstrated regional differences in the frequency of control exams (e. g., measurements of HbA 1C and blood lipids), or screening for diabetes related complications (e. g., retinopathy and nephropathy) [6,7]. In Switzerland and Norway, regional differences have been observed with regard to HbA 1C , medical treatment and However, there is a lack of studies investigating regional differences of medical care in pediatric patients with type 1 diabetes in Germany.…”

Obesity and dyslipidemia – An urgent matter in youth from the general population and in type 1 diabetic patients

“…Recent data show that the prevalence of overweight/obesity in children and adolescents with type 1 diabetes in USA is 31% (11). A similar trend was observed in the Brazilian population according to the Brazilian Type 1 Diabetes Study Group (Brazdiab T1DSG) (12), which is a multicenter study that evaluated the care and the clinical condition of patients with T1D in the whole Brazilian population sponsored by the Brazilian Diabetes Association. Obesity might interfere in the development of chronic micro and macrovascular complications in patients with type 1 diabetes (13,14).…”

“…T1D treatment has significantly improved in the last decades. Although metabolic control is not ideal in the majority of patients with T1D worldwide (12,25), an evident catabolic state is not generally observed anymore. Therefore, this population is nearly as prone to develop overweight and obesity as the general population, which might influence their risk of hypertension, dyslipidemia, micro and macrovascular chronic complications.…”

Double-diabetes in a real-world sample of 2711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes?

“…In spite of our cross-sectional design, this finding strongly suggests weight excess to be unrelated to intensity of insulin treatment. Moreover, owing to marked social and economic differences observed in our country which have been previously described [23], this sample has a particularly high number of individuals on conventional therapy (i.e., one or two insulin injections per day). This feature is especially suitable to assess the role of intense insulin therapy in this sample.…”