OBJECTIVE:To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil.METHOD:A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG) (n = 36) received standard care, patients in the intervention group (IG) (n = 34) received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires.RESULTS:Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group.CONCLUSION:The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy.

BackgroundTo determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors.MethodsThis was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years.ResultsOverall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01).ConclusionsOur results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.

The majority of our patients (88.5%) performed three or more self-monitoring tests daily, with more frequent testing reported by females, younger patients, those on intensive insulin regimens and of higher socio-economic status. No additional benefit was found in patients who performed self-monitoring more than four times daily. The diabetes care team must improve patients' education regarding self-monitoring of blood glucose and its benefits.

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.

Esta dissertação me leva a acreditar que uma missão foi cumprida, ao menos em parte. Obviamente, porém, eu não teria conseguido sem a colaboração das pessoas a quem agradeço aqui, responsáveis não apenas pelo meu desenvolvimento profissional mas, especialmente, pelo ganho pessoal ocorrido durante o percurso. Aos meus pais, Pedro e Marilza, pelos exemplos de vidas, boa parte delas dedicadas exaustivamente à minha irmã e a mim. Agradeço, reconheço e procuro sempre retribuir o apoio incondicional às minhas decisões, mesmo que dolorosas às vezes. À minha irmã, Carolina, pela amizade e pelo companheirismo, pelo apoio nos momentos difíceis, pela alegria dos bons momentos, pela ajuda profissional. Aos demais familiares, pela torcida e pelos ultimamente escassos, porém, singulares e felizes momentos de união. Aos meus amigos, pelo apoio e preocupação constantes e, principalmente, pela compreensão quando não pude estar ou quando estive por pouco tempo. À Disciplina de Endocrinologia por proporcionar aos profissionais não médicos oportunidades de integração. À Capes, pelo apoio financeiro. À minha orientadora, Dra. Márcia, por ter acreditado em mim, por ter aceitado e sucedido no desafio de orientar uma farmacêutica que tinha o sonho de desenvolver um projeto de farmácia clínica em diabete. À Dra. Márcia Queiroz, pela prontidão e disposição em ajudar sempre, pelas orientações técnicas e burocráticas. Ao Dr. Simão pelos conselhos e pelo incentivo constante. Aos demais médicos assistentes do grupo e aos residentes da Endocrinologia. Aos pacientes, não apenas pela participação voluntária, mas pela humildade e simplicidade no lidar e, sobretudo, pela realização proporcionada pelos agradecimentos sinceros. À companheira de pós Patrícia, pela amizade, atenção, acolhimento, compreensão e ensinamentos diversos, pelas horas de conversa e gargalhadas, e por praticamente me proporcionar outro título de graduação!! À Laura, amiga, epidemiologista e estatística. Pela disposição e disponibilidade verdadeira em ajudar, por defender as minhas causas, por agora também avaliar a adesão dos seus pacientes! Pelas conversas descontraídas, pelas trocas de experiências, pela convivência. À Maria Lúcia, pela amizade, pela torcida, pelo apoio e atenção, pela descontração e alegria, pelas agradáveis conversas durante as pausas para o café. Às companheiras de grupo, Maria do Carmo e Adriana, cujos momentos de trabalho ao longo desses anos também proporcionaram momentos agradáveis e engraçados. Aos demais funcionários do grupo.