Evaluation of clinical care in young type 1 diabetes subjects: a nationwide multicenter study in brazil
M Gomes1, A Matheus1, L Calliari2, J Luescher4, T Manna5, R Cobas1, B Tschiedel6, A Ramos7, R Fonseca8, N Araujo9, H Almeida10, N Melo11, D Jezini12 & C Negrato3
Introduction: The increasing incidence of type 1 diabetes (T1D) is a matter of concern because it negatively impacts both the quality of life and its duration, due to the great morbidity and mortality caused by its chronic complications.
Objective: To evaluate clinical care provided to Brazilian youths with T1D in daily practice, according to the American Diabetes Associations guidelines.
Methods: This was a cross-sectional, multicenter study conducted between December 2008/December 2010 in 28 public clinics, in 20 Brazilian cities. Data were obtained from 1692 patients (55.3% female, 56.4% Caucasian), age 13 (118) years, age at diagnosis of 7.1±4 years and diabetes duration of 5±3.7 years. Overall, 75% of the patients were from a low or very low economic status.
Results: 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. Three or more daily shots of short-acting insulin were reported by 57.9%, and self-monitoring of blood glucose (SMBG) by 73.5% of the patients. A first-degree familial history of type 2 diabetes, obesity, cardiovascular disease or hypertension was reported by 7.6, 12.9, 6.0 and 10.6% of the patients respectively. The rate of annual screening for complications was 66.2% for retinopathy, 69.7% for nephropathy and 62.7% for foot alterations. On multivariate analysis, age, insulin dose, economic status, number of daily SMBG and gender were independently associated with HbA1c levels (P<0.001).
Conclusions: Screening for diabetes complications and reaching goals for glucose, lipids and blood pressure are difficult to achieve in Brazilian T1D youths. The low economic status found in the majority of our patients might represent a barrier to reach these goals. Further studies are warranted to address this issue.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.