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

Abstract

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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“…The models explained 23% of variance in quality of life between the networks, much of which is related to contextual (sociodemographic characteristic, stage of diabetes, lifestyle) variables 32 . The findings of the Brazilian study showed that patients with T2DM (n = 100) were overall satisfied with the duration of diagnosis consultation and to a great extent seemed to understand the key topics of lifestyle changes, disease, its causes, treatment and the most of them seemed to accept T2DM in a positive way 33 . Motivational interviewing used in general practice can improve the outcomes of patients with T2DM as satisfactory with family doctor service, beliefs and understanding of diabetes, motivation for behavioral changes, clinical variables (blood pressure, dyslipidemia, glycemic state), and physical activities 34 .…”

Clinical Inertia in Glycemic Control among a Sample of Patients with Type 2 Diabetes in Erbil City, Iraq

“…A few studies on clinical inertia in the management of glycemic control among T2DM have been performed in the USA, Europe (7) and Brazil (17) and this is the first study in Iraq and Erbil city designed to find out the clinical inertia among physicians treating T2DM; the mean of inertia among physicians was 60.8% ± 24.5 in the current study, a result which is comparable to a USA study (New England and Florida) finding of 68% inertia in treating patients with HbA1c > 8% over 16 months (18), and another USA (Boston) (19) study and a Croatian study (7) (58%, and 57.7% respectively).…”

Tackling clinical inertia: Use of coproduction to improve patient engagement

“…Broadly, delays in treatment escalation can be divided into physician and patient factors. We touch briefly on the issues related to physicians, because they have been extensively reviewed elsewhere . We then focus on the engagement between physician and patient.…”

“…We touch briefly on the issues related to physicians, because they have been extensively reviewed elsewhere. 1,7,8 We then focus on the engagement between physician and patient.…”

“…The Time2DoMore project produced a series of signposts towards better diabetes management targeting both the person with diabetes and their health care provider. Based on the observation that in the counties with longest consultation period (specifically Brazil) adherence to medications was the highest, 8 the signposts focused on improved communication as a route to better control. However, communication without purpose is not a goal.…”