Diabetes care below average for patients in Brazil
MedWire News: Study findings from Brazil show that a significant proportion of patients with diabetes do not meet metabolic control goals and are not screened for diabetic complications, which may increase their risk for chronic long-term disease.
"Sufficient screening for diabetic complications and the target levels for glycemic control, blood pressure, and lipids are difficult to achieve in patients with Type 1 diabetes mellitus (T1DM)," say Marilia Gomes (State University Hospital of Rio de Janeiro, Brazil) and colleagues.
For the study, the researchers collected data from 1774 patients (mean age 30.3 years) who attended 28 public clinics in 20 Brazilian cities during 2008-2010. Patients had an average T1DM duration of 14.3 years, with 52.4% and 27.1% of individuals reporting durations of at least 15 years and 10-15 years, respectively.
Over an average 8.5-year follow-up, the team found that the most commonly used (80.8%) therapeutic regimen was a combination of intermediate-acting or long-acting insulin plus short-acting insulin.
According to guidelines from the American Diabetes Association, systolic and diastolic blood pressure was at target levels in 40.3% and 20.2% of patients with hypertension. Indeed, only 57% of the 560 patients with hypertension were receiving treatment.
Goals for low-density lipoprotein (LDL) cholesterol and glycated hemoglobin were met in just 45.2% and 13.2% of patients, respectively but most patients were at their total cholesterol and triglyceride goals (72.5% and 77.4%). Statins were used by 14.8% of patients, with 42.2% of these individuals within the target range for LDL cholesterol.
Patients treated at secondary centers were more likely to be within body mass index targets than those at tertiary centers (73.2 vs 65.1%). By contrast, diastolic blood pressure and LDL cholesterol targets were met in a greater proportion of patients attending tertiary than secondary centers (56.8 vs 50.7%, and 54.9 vs 47.8%, respectively).
Screening for retinopathy was performed in the preceding year in 70.1% of patients with a disease duration lasting longer than 5 years, , while nephropathy and foot complications were screened in 63.1% and 65.1% of these patients.
"The quality of diabetes care must be substantially improved in Brazil," conclude the researchers in Diabetes Research and Clinical Practice.
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By Ingrid Grasmo