BackgroundTo 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.MethodsThis 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).ResultsOverall, 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).ConclusionsA 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.

BackgroundIn type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities.MethodsThis was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected.ResultsWe have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined.ConclusionsOur study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.

BackgroundTo evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).MethodsThis multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.ResultsWe obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).ConclusionsGiven the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.

Background Type 2 Diabetes Mellitus (T2DM) patients are twice as likely to develop dementia. The study’s goal was to evaluate cognitive performance and risk factors for cognitive decline in this population. Methods Prospective observational study was conducted with 400 T2DM adults, of whom, during routine baseline and follow-up appointments, had socio-demographic, clinical, and laboratory data collected, and underwent physical examination, screening for depression symptoms (Patient Health Questionaire-9-PHQ-9), and cognitive tests: Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A/B, and Word Memory Tests. Each cognitive test score was converted to a z-score and its average resulted in a new variable called Global Cognitive z-Score [GCS(z)]. Averages of the cognitive test scores and GCS(z) at both moments were compared by the Student’s T-Test for paired samples. Multivariate binary logistic regression models were built to assess the association of GCS(z) < zero with risk factors for cognitive decline at the baseline and follow-up. Results After exclusions, 251 patients were eligible, being 56.6% female, mean age of 61.1 (± 9.8) years, 12.6 (± 8.9) years of DM duration, and 7.6 (± 4.2) years of school education. Follow-up had 134 patients reevaluated and took place after a mean of 18.4(± 5.0) months. Eleven (14%) patients with a GCS(z) ≥ 0 at baseline turned into a GCS(z) < 0 at follow-up. There were no significant differences between the means of cognitive test scores and GCS(z) at the two evaluation moments. At the baseline, the multivariate logistic regression model identified five risk factors associated with GCS(z) < zero: age ≥ 65 years, schooling ≤ 6 years, arterial hypertension, depression symptoms, and diabetic retinopathy (DR), with odds ratio (OR) and 95% confidence interval (CI95%) respectively: 5.46 (2.42–12.34); 12.19 (5.62–26.46); 2.55 (0.88–7.39); 3.53 (1.55–8.07) e 2.50 (1.18–5.34). At follow-up, the risk factors for GCS(z) < zero were: schooling ≤ 6 years, DM duration ≥ 10 years, depression symptoms, arterial hypertension, and cardiovascular disease (CVD), OR and CI95% respectively: 10.15 (3.68–28.01); 2.68 (0.96–7.48); 4.92 (1.77–13.70); 7.21 (1.38–35.71) e 5.76 (1.93–17.18). Conclusions Based on our results, cognitive evaluation and follow-up should be incorporated on the routine of T2DM patients, especially for those with advanced age, low education level, prolonged DM duration, arterial hypertension, depression symptoms, CVD, and DR.

RESUMOIntrodução: O diabetes mellitus resulta em defeitos na ação e/ou secreção da insulina e possui profundo impacto na qualidade de vida. O diabetes mellitus tipo 2 (DM2) compreende 85-95% dos casos com pico de incidência aos 60 anos. As complicações crônicas podem ser evitadas ou retardadas através do bom controle glicêmico. Objetivo: Conhecer a qualidade de vida através de um questionário aplicado em diabéticos tipo 2, no distrito Portão, município de Curitiba-PR, e correlaciona-lo com o uso de insulina. Métodos: Trata-se de um estudo com delineamento transversal. A amostra consiste em 156 diabéticos tipo 2 com mais de 18 anos de idade, cadastrados nas Unidades Básicas de Saúde e Unidades de Estratégia Saúde da Família no Distrito Portão do município de Curitiba -PR. O instrumento utilizado baseia-se no questionário Diabetes Quality of Life Measures (DQOL -Brasil). As questões eram de caráter objetivo, questionando aspectos da doença, satisfação pessoal, impacto, preocupações sociais e vocacionais e preocupações relacionadas ao DM2. Resultados: 67,2% eram do sexo feminino, 58,9% tinham mais de 60 anos de idade e 46,9% eram aposentados. O tratamento com insulina associado ou não a comprimidos era utilizado por 37,2% dos pacientes. A média da hemoglobina glicada foi de 7,96% e 80,8% desconhecia sua utilidade. Foi encontrada diferença significativa (p<0,05) em todos os módulos do DQOL, mostrando maiores índices de insatisfação em usuários de insulina. Conclusão: Os pacientes com DM2 que utilizam insulina possuem piores índices de qualidade de vida quando comparados aos que não usam insulina e o uso de insulina se mostrou como fator independente na redução da qualidade de vida no distrito do Portão em Curitiba-PR.Palavras-chave: Diabetes Mellitus, DM2, Qualidade de vida, Insulina. ABSTRACTIntroduction: Diabetes mellitus is a chronic disease characterized by impaired action and/or secretion of insulin that produces a profound impact in the quality of life of its bearers. Type 2 Diabetes Mellitus (T2DM) accounts for 85-95% of all cases, achieving its peak incidence in the sixth decade. Chronic complications can be avoided or delayed through a good glycemic control. Objective: To access the quality of life of type 2 diabetics in Portão district, in the city of Curitiba, by the means of a questionnaire, and to confront this data with the use of insulin. Methods: This is a cross-sectional study. The sample consists of 156 type 2 diabetic patients over 18 years, enrolled in Basic Health Units and Units of Family Health Strategy in the District of Portão, Curitiba-PR. The instrument used in the research was based on a questionnaire entitled the Diabetes Quality of Life Measures (DQOL -Brazil). There were multiple-choice objective questions about the aspects of the disease, personal satisfaction, impact on social and vocational concerns and those related to T2DM. Results: 67,2% were female, 58,9% had more than 60 years old and 46,9% were retired. Treatment with insulin associated or not with oral drugs was used by 37,2%...