Relationship between health care insurance status, social determinants and prevalence of diabetes-related microvascular complications in patients with type 1 diabetes: a nationwide survey in Brazil

  • Marilia Brito Gomes
  • Deborah Conte Santos
  • Marcela Haas Pizarro
  • Laura Gomes Nunes Melo
  • Bianca Senger Vasconcelos Barros
  • Renan MontenegroJr
  • Virginia Fernandes
  • Carlos Antonio NegratoEmail author
Original Article
Part of the following topical collections:
  1. Health Education and psycho-social aspects



To evaluate the relationship between social determinants, health care insurance status and occurrence of diabetes-related chronic complications (DRCC) in Brazilian patients with type 1 diabetes.


A multicenter cross-sectional study conducted between August 2011 and August 2014 in 14 public clinics in 10 Brazilian cities. Data were obtained from 1760 patients, aged 29.9 ± 11.9 years, with diabetes duration of 15.5 ± 9.3 years; 55.9% female, 54.5% Caucasians, 69.7% were attended exclusively by the public Brazilian National Health Care System (BNHCS) and 30.3% had also private health care insurance. Patients’ information was obtained through a questionnaire and a chart review form.


The social determinants associated with having both private and public health care insurance were being employed, belonging to medium or high socioeconomic status, having more years of school attendance and having younger age. Regarding DRCC, patients that had private and public health care had lower rates of diabetic retinopathy and of any other DRCC. Chronic kidney disease was not associated with health care coverage status after adjusting for classical clinical risk factors.


Brazilian patients with type 1 diabetes had better clinical control and lower rates of DRCC, mainly retinopathy, when also having private health care insurance. These patients presented less frequently predictors of chronic complications such as high levels of HbA1c and blood pressure. BNHCS should change the approach for screening DRCC such as diabetic retinopathy, using methods such as telemedicine that would lead to earlier diagnosis, better outcomes and will be cost-effective sometime after its implementation.


Type 1 diabetes Microvascular chronic complications Health care insurance Retinopathy 



Funding was provided by Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (E-26/110.170/2013) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (563753/2010-2).

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

592_2019_1308_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 KB)


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  • Marilia Brito Gomes
    • 1
  • Deborah Conte Santos
    • 1
  • Marcela Haas Pizarro
    • 1
  • Laura Gomes Nunes Melo
    • 1
  • Bianca Senger Vasconcelos Barros
    • 1
  • Renan MontenegroJr
    • 2
  • Virginia Fernandes
    • 2
  • Carlos Antonio Negrato
    • 3
    Email author
  1. 1.Diabetes Unit, Department of Internal MedicineState University of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Department of Internal MedicineFederal University of CearaFortalezaBrazil
  3. 3.Bauru’s Diabetics AssociationBauruBrazil

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