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Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil

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Abstract

The aim of this study is to evaluate the influence of economic status on clinical care provided to Brazilian youths with type 1 diabetes in daily practice, according to the American Diabetes Association’s guidelines. This was a cross-sectional, multicenter study conducted between 2008 and 2010 in 28 public clinics in Brazil. Data were obtained from 1,692 patients (55.3 % female, 56.4 % Caucasian), with a mean age of 13 years (range, 1–18), a mean age at diagnosis of 7.1 ± 4 years and diabetes duration of 5 ± 3.7 years. Overall, 75 % of the patients were of a low or very low economic status. HbA1c goals were reached by 23.2 %, LDL cholesterol by 57.9 %, systolic blood pressure by 83.9 % and diastolic blood pressure by 73.9 % of the patients. In total, 20.2 % of the patients were overweight and 9.2 % were obese. Patients from very low economic status were less likely to attend tertiary care level when compared with those from low, medium and high economic status, 64.2 % versus 75.5 % versus 78.3 % and 74.0 %; p < 0.001, respectively. The rate of annual screening for retinopathy, nephropathy and for foot alterations was 66.2, 69.7 and 62.7 %, respectively. Insulin dose, age, very low economic status, daily frequency of self-blood glucose monitoring and female gender were independently associated with poor glycemic control. Screening for diabetic complications and attaining glucose, lipid and blood pressure goals present a challenge for young Brazilian type 1 diabetes patients. The low economic status of the majority of our patients may represent a barrier to reaching these goals.

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Abbreviations

CV:

Cardiovascular

CVD:

Cardiovascular disease

ESRD:

End-stage renal disease

T1D:

Type 1 diabetes

T2D:

Type 2 diabetes

BDS:

Brazilian Diabetes Society

sBP:

Systolic blood pressure

dBP:

Diastolic blood pressure

BMI:

Body mass index

HbA1c:

Glycated hemoglobin

NBHCS:

National Brazilian Health Care System

SBGM:

Self-blood glucose monitoring

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

NGSP:

National Glycohemoglobin Standardization Program

DCCT:

Diabetes Control and Complications Trial

EDIC:

Epidemiology of Diabetes Interventions and Complications Trial

TSH:

Thyroid stimulating hormone

IBGE:

Brazilian Institute of Geography and Statistics

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Acknowledgments

We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance. Marilia B Gomes is the principal investigator and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil.

Author information

Authors and Affiliations

  1. Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Avenida 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20.551-030, Brazil

    Marilia B. Gomes, Alessandra Saldanha de Mattos Matheus, Roberta A. Cobas & Wellington Siqueira Coelho

  2. Pediatric Endocrinology Unit, Santa Casa of Misericórdia of São Paulo, São Paulo, São Paulo, Brazil

    Luis Eduardo Calliari

  3. Department of Internal Medicine, Bauru’s Diabetics Association, Bauru, São Paulo, Brazil

    Carlos Antonio Negrato

  4. Endocrinology Unit of Children′s Institute, Federal University Hospital of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

    Jorge Luiz Luescher

  5. Endocrinology Unit of Children’s Institute, Clinical Hospital, University of São Paulo Medical School, São Paulo, São Paulo, Brazil

    Thais Della Manna & Roberta Diaz Savoldelli

  6. Diabetic Children’s Institute of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Balduino Tschiedel

  7. University Hospital of Campina Grande, Campina Grande, Paraíba, Brazil

    Alberto José Ramos

  8. Diabetes and Metabolism Research Center, Salvador, Bahia, Brazil

    Reine Marie Fonseca

  9. General Federal Hospital of Bonsucesso, Rio de Janeiro, Rio de Janeiro, Brazil

    Neuza Braga C. Araujo

  10. Diabetes Unit of State University Hospital of Londrina, Londrina, Paraná, Brazil

    Henriqueta Guido Almeida

  11. Federal University of Sergipe, Aracaju, Sergipe, Brazil

    Naira Horta Melo

  12. Federal University Hospital of Amazonas, Manaus, Amazonas, Brazil

    Debora Laredo Jezini

Authors
  1. Marilia B. Gomes
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  2. Alessandra Saldanha de Mattos Matheus
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  3. Luis Eduardo Calliari
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  6. Roberta Diaz Savoldelli
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  7. Roberta A. Cobas
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  8. Wellington Siqueira Coelho
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  12. Neuza Braga C. Araujo
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  13. Henriqueta Guido Almeida
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  14. Naira Horta Melo
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  15. Debora Laredo Jezini
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  16. Carlos Antonio Negrato
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Corresponding author

Correspondence to Marilia B. Gomes.

Additional information

Communicated by Guido Pozza.

This study was conducted on behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG). Please refer the "Appendix" section for the Brazilian Type 1 Diabetes Study Group members.

Appendix 1

Appendix 1

Brazilian Type 1 Diabetes Study Group.

Executive steering committee: Marilia Brito Gomes (chair), Roberta Cobas, Sergio Atala Dib, Carlos Negrato.

Principal investigators are indicated with an asterisk. Program coordinators are underlined.

Universidade Estado Rio de Janeiro: Roberta Cobas*, Alessandra Matheus, Lucianne Tannus; Universidade Federal Rio de Janeiro: Dra. Lenita Zajdenverg*, Melanie Rodacki; Hospital Geral de Bonsucesso: Neuza Braga Campos de Araújo*, Marilena de Menezes Cordeiro; Hospital Universitário Clementino Fraga Filho—IPPMG: Dr. Jorge Luiz Luescher*; Renata Szundy Berardo; Serviço de Diabetes da Disciplina de Endocrinologia e Metabologia do Hospital das Clínicas da Universidade de São Paulo: Marcia Nery*; Catarina Cani; Maria do Carmo Arruda Marques; Unidade de Endocrinologia Pediátrica da Santa Casa de Misericórdia de São Paulo: Luis Eduardo Calliari*; Renata Maria de Noronha; Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo: Thais Della Manna*, Dra. Roberta Savoldelli, Dra. Fernanda Garcia Penha; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto—USP: Milton Cesar Foss*, Dra. Maria Cristina Foss; Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto: Antonio Carlos Pires*, Fernando Cesar Robles; Associação de Diabéticos de Bauru: Carlos Antonio Negrato*, Maria de Fatima Guedes; Centro de Diabetes da Escola Paulista de Medicina: Sergio Atala Dib*, Patricia Dualib; Clínica de Endocrinologia da Santa Casa de Belo Horizonte Setor Diabetes Tipo 1: Saulo Cavalcanti da Silva*, Janice Sepulveda; Ambulatório Multiprofissional de Atendimento à Diabetes do Hospital de Clínicas da Universidade Estadual de Londrina: Henriqueta Guidio de Almeida*, Emerson Sampaio; Hospital de Clínicas da Universidade Federal do Paraná:Rosangela Roginski Rea*, Ana Cristina Ravazzani de Almeida Faria; Instituto da Criança com Diabetes do Rio Grande Sul (Grupo Hospitalar Conceição): Balduino Tschiedel*, Suzana Lavigne, Gustavo Adolfo Cardozo; Hospital de Clínicas de Porto Alegre:Mirela Azevedo*, Luis Henrique Canani, Alessandra Teixeira Zucatti; Hospital Universitário de Santa Catarina: Marisa Helena Cesar Coral*, Daniela Aline Pereira; Instituto de Diabetes-Endocrinologia de Joinville: Luiz Antonio de Araujo*; Hospital Regional de Taguatinga, Brasília: Hermelinda Cordeiro Pedrosa*, Monica Tolentino; Flaviene Alves Prado; Hospital Geral de Goiânia: Dr Alberto Rassi; Nelson Rassi*, Leticia Bretones de Araujo; Centro de Diabetes e Endocrinologia do Estado da Bahia: Reine Marie Chaves Fonseca*; Alexis Dourado Guedes, Odelisa Silva de Mattos; Universidade Federal do Maranhão: Manuel Faria*, Rossana Azulay; Centro Integrado de Diabetes e Hipertensão do Ceará: Adriana Costa e Forti*; Maria Cristina Façanha; Universidade Federal do Ceará: Renan Montenegro Junior*, Ana Paula Montenegro; Universidade Federal de Sergipe: Naira Horta Melo*, Karla Freire Rezende; Hospital Universitário Alcides Carneiro: Alberto Ramos *; Hospital Universitário João de Barros Barreto, Pará: João Felício Soares*, Flavia Marques Santos; Hospital Universitário Getúlio Vargas, Hospital Adriano Jorge: Deborah Laredo Jezini*.

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Gomes, M.B., de Mattos Matheus, A.S., Calliari, L.E. et al. Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil. Acta Diabetol 50, 743–752 (2013). https://doi.org/10.1007/s00592-012-0404-3

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