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Open Access Research

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

Marília B Gomes*, Roberta A Cobas, Alessandra S Matheus, Lucianne R Tannus, Carlos Antonio Negrato, Melanie Rodacki, Neuza Braga, Marilena M Cordeiro, Jorge L Luescher, Renata S Berardo, Marcia Nery, Maria do Carmo Arruda-Marques, Luiz E Calliari, Renata M Noronha, Thais D Manna, Lenita Zajdenverg, Roberta Salvodelli, Fernanda G Penha, Milton C Foss, Maria C Foss-Freitas, Antonio C Pires, Fernando C Robles, MariadeFátimaS Guedes, Sergio A Dib, Patricia Dualib, Saulo C Silva, Janice Sepulvida, Henriqueta G Almeida, Emerson Sampaio, Rosangela Rea, Ana Cristina R Faria, Balduino Tschiedel, Suzana Lavigne, Gustavo A Cardozo, Mirela J Azevedo, Luis Henrique Canani, Alessandra T Zucatti, Marisa Helena C Coral, Daniela Aline Pereira, Luiz Antonio Araujo, Monica Tolentino, Hermelinda C Pedrosa, Flaviane A Prado, Nelson Rassi, Leticia B Araujo, Reine Marie C Fonseca, Alexis D Guedes, Odelissa S Matos, Manuel Faria, Rossana Azulay, Adriana C Forti, Cristina Façanha, Ana Paula Montenegro, Renan Montenegro, Naira H Melo, Karla F Rezende, Alberto Ramos, João Sooares Felicio, Flavia M Santos, Deborah L Jezini and Marilena M Cordeiro

Author Affiliations

Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil

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Diabetology & Metabolic Syndrome 2012, 4:44  doi:10.1186/1758-5996-4-44

Published: 29 October 2012

Abstract

Background

To 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.

Methods

This 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).

Results

Overall, 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).

Conclusions

A 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.

Keywords:
Type 1 diabetes; Glycemic control; Cardiovascular risk factors; Chronic complications; Economic status