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Published in: Acta Diabetologica 5/2013

01-10-2013 | Original Article

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

Authors: Marilia B. Gomes, Alessandra Saldanha de Mattos Matheus, Luis Eduardo Calliari, Jorge Luiz Luescher, Thais Della Manna, Roberta Diaz Savoldelli, Roberta A. Cobas, Wellington Siqueira Coelho, Balduino Tschiedel, Alberto José Ramos, Reine Marie Fonseca, Neuza Braga C. Araujo, Henriqueta Guido Almeida, Naira Horta Melo, Debora Laredo Jezini, Carlos Antonio Negrato

Published in: Acta Diabetologica | Issue 5/2013

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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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Literature
1.
go back to reference The DIAMOND Project Group (2006) Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabet Med 23(8):857–866CrossRef The DIAMOND Project Group (2006) Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabet Med 23(8):857–866CrossRef
2.
go back to reference Eurodiab, ACE Study Group (2000) Variation and trends in incidence of childhood diabetes in Europe. Lancet 355:873–876CrossRef Eurodiab, ACE Study Group (2000) Variation and trends in incidence of childhood diabetes in Europe. Lancet 355:873–876CrossRef
3.
go back to reference Negrato CA et al (2010) Temporal trends in incidence of type 1 diabetes between 1986 and 2006 in Brazil. J Endocrinol Invest 33:373–377PubMed Negrato CA et al (2010) Temporal trends in incidence of type 1 diabetes between 1986 and 2006 in Brazil. J Endocrinol Invest 33:373–377PubMed
4.
go back to reference Laing SP et al (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46(6):760–765PubMedCrossRef Laing SP et al (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46(6):760–765PubMedCrossRef
5.
go back to reference Secrest AM, Becker DJ, Kelsey SF, Ronald LE, Trevor OJ (2010) Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes 59:3216–3222PubMedCrossRef Secrest AM, Becker DJ, Kelsey SF, Ronald LE, Trevor OJ (2010) Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes 59:3216–3222PubMedCrossRef
6.
go back to reference Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G (2006) Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia 49:298–305PubMedCrossRef Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G (2006) Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia 49:298–305PubMedCrossRef
7.
go back to reference Orchard TJ, Costacou T, Kretowski A, Nesto RW (2006) Type 1 diabetes and coronary artery disease. Diabetes Care 29:2528–2538PubMedCrossRef Orchard TJ, Costacou T, Kretowski A, Nesto RW (2006) Type 1 diabetes and coronary artery disease. Diabetes Care 29:2528–2538PubMedCrossRef
8.
go back to reference DCCT (1993) The diabetes control and complications trial. N Engl J Med 329:977–986CrossRef DCCT (1993) The diabetes control and complications trial. N Engl J Med 329:977–986CrossRef
9.
go back to reference The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group (2005) Intensive diabetes treatment and cardiovascular disease in patients with diabetes type 1. N Engl J Med 353:2643–2653CrossRef The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group (2005) Intensive diabetes treatment and cardiovascular disease in patients with diabetes type 1. N Engl J Med 353:2643–2653CrossRef
10.
go back to reference Purnell JQ, Hakanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD (1998) Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure. JAMA 280:140–146PubMedCrossRef Purnell JQ, Hakanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD (1998) Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure. JAMA 280:140–146PubMedCrossRef
11.
go back to reference Ceriello A, Sudhesh K, Piconi L, Esposito K, Giugliano D (2007) Simultaneous control of hyperglycemia and oxidative stress normalizes endothelial function in type 1 diabetes. Diabetes Care 30(3):649–654PubMedCrossRef Ceriello A, Sudhesh K, Piconi L, Esposito K, Giugliano D (2007) Simultaneous control of hyperglycemia and oxidative stress normalizes endothelial function in type 1 diabetes. Diabetes Care 30(3):649–654PubMedCrossRef
12.
go back to reference Orchard TJ et al (2003) Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes. Diabetes Care 26(5):1374–1379PubMedCrossRef Orchard TJ et al (2003) Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes. Diabetes Care 26(5):1374–1379PubMedCrossRef
13.
go back to reference Gomes MB, Cobas RA, Nunes E, Castro-Faria-Neto HC, da Matta MF, Neves R (2009) Plasma PAF–acetylhydrolase activity, inflammatory markers and susceptibility of LDL to in vitro oxidation in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract 85:61–68PubMedCrossRef Gomes MB, Cobas RA, Nunes E, Castro-Faria-Neto HC, da Matta MF, Neves R (2009) Plasma PAF–acetylhydrolase activity, inflammatory markers and susceptibility of LDL to in vitro oxidation in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract 85:61–68PubMedCrossRef
14.
go back to reference Grundy SM et al (1999) Diabetes and cardiovascular disease a statement for healthcare professionals from the American Heart Association. Circulation 100:1134–1146PubMedCrossRef Grundy SM et al (1999) Diabetes and cardiovascular disease a statement for healthcare professionals from the American Heart Association. Circulation 100:1134–1146PubMedCrossRef
15.
go back to reference Van Vliet M et al (2010) Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic Risk. J Pediatr 156(6):923–929PubMedCrossRef Van Vliet M et al (2010) Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic Risk. J Pediatr 156(6):923–929PubMedCrossRef
16.
go back to reference Schwab KO, Doerfer J, Marg W, Schober E, Holl RW, on behalf of the DPV science initiative and the competence network diabetes mellitus (2010) Characterization of 33488 children and adolescents with type 1 diabetes based on the gender-specific increase of cardiovascular risk factors. Pediatr Diabetes 11:357–363PubMedCrossRef Schwab KO, Doerfer J, Marg W, Schober E, Holl RW, on behalf of the DPV science initiative and the competence network diabetes mellitus (2010) Characterization of 33488 children and adolescents with type 1 diabetes based on the gender-specific increase of cardiovascular risk factors. Pediatr Diabetes 11:357–363PubMedCrossRef
17.
go back to reference Petitti DB et al. for Glycemic Control in Youth with Diabetes (2009) The SEARCH for diabetes in youth study. J Pediatr 155(5):668–672 Petitti DB et al. for Glycemic Control in Youth with Diabetes (2009) The SEARCH for diabetes in youth study. J Pediatr 155(5):668–672
18.
go back to reference Rodriguez BL et al. SEARCH Study Group (2010) Prevalence and correlates of elevated blood pressure in youth with diabetes mellitus: the search for diabetes in youth study. J Pediatr 157(2):245–251 Rodriguez BL et al. SEARCH Study Group (2010) Prevalence and correlates of elevated blood pressure in youth with diabetes mellitus: the search for diabetes in youth study. J Pediatr 157(2):245–251
19.
go back to reference Silverstein J et al (2005) Care of children and adolescents with type 1 diabetes—a statement of the American Diabetes Association. Diabetes Care 28(1):186–212PubMedCrossRef Silverstein J et al (2005) Care of children and adolescents with type 1 diabetes—a statement of the American Diabetes Association. Diabetes Care 28(1):186–212PubMedCrossRef
20.
go back to reference Gomes MB, On behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG) et al (2012) Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in Brazil”. Diabetes Res Clin Pract. doi:10.1016/j.diabres.2012.02.008 Gomes MB, On behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG) et al (2012) Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in Brazil”. Diabetes Res Clin Pract. doi:10.​1016/​j.​diabres.​2012.​02.​008
21.
go back to reference American Diabetes Association (2011) Clinical practice recommendations. Diabetes Care 34(Supplement 1):S11–S61CrossRef American Diabetes Association (2011) Clinical practice recommendations. Diabetes Care 34(Supplement 1):S11–S61CrossRef
22.
go back to reference Daniels SR, Greer FR, the Committee on Nutrition Pediatrics (2008) Blood pressure levels for girls and boys by age and height percentile. Pediatrics 122:198–208PubMedCrossRef Daniels SR, Greer FR, the Committee on Nutrition Pediatrics (2008) Blood pressure levels for girls and boys by age and height percentile. Pediatrics 122:198–208PubMedCrossRef
24.
go back to reference Friedwald WT, Levy R, Fredrickson DS (1972) Estimations of serum low density lipoprotein cholesterol without use of preparative ultracentrifuge. Clin Chem 18:499–502 Friedwald WT, Levy R, Fredrickson DS (1972) Estimations of serum low density lipoprotein cholesterol without use of preparative ultracentrifuge. Clin Chem 18:499–502
26.
go back to reference Malerbi DA, Franco LJ (1992) Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care 15:1509–1516PubMedCrossRef Malerbi DA, Franco LJ (1992) Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care 15:1509–1516PubMedCrossRef
28.
go back to reference Galler A, Lindau M, Ernert A, Thalemann R, Raile K (2011) Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes. Diabetes Care 34:2356–2359PubMedCrossRef Galler A, Lindau M, Ernert A, Thalemann R, Raile K (2011) Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes. Diabetes Care 34:2356–2359PubMedCrossRef
29.
go back to reference Muhlhauser I et al (1998) Social status and the quality of care for adult people with type I (insulin-dependent) diabetes mellitus—a population-based study. Diabetologia 41(10):1139–1150PubMedCrossRef Muhlhauser I et al (1998) Social status and the quality of care for adult people with type I (insulin-dependent) diabetes mellitus—a population-based study. Diabetologia 41(10):1139–1150PubMedCrossRef
30.
go back to reference Margeirsdottir HD, Larsen JR, Brunborg C, Overby NC, Dahl-Jorgensen K, the Norwegian Study Group for childhood diabetes (2008) High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia 51(554–561):31 Margeirsdottir HD, Larsen JR, Brunborg C, Overby NC, Dahl-Jorgensen K, the Norwegian Study Group for childhood diabetes (2008) High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia 51(554–561):31
31.
go back to reference Rosilio M et al (1998) Factors associated with glycemic control a cross-sectional nationwide study in 2,579 French children with type 1 diabetes. Diabetes Care 21(7):1146–1153PubMedCrossRef Rosilio M et al (1998) Factors associated with glycemic control a cross-sectional nationwide study in 2,579 French children with type 1 diabetes. Diabetes Care 21(7):1146–1153PubMedCrossRef
32.
go back to reference Fagulha A, Santos I, e Grupo de estudo da Diabetes Mellitus (2004) Controle Glicémico e Tratamento da Diabetes tipo 1 da criança e adolescente em Portugal. Acta Méd Port 17:173–179PubMed Fagulha A, Santos I, e Grupo de estudo da Diabetes Mellitus (2004) Controle Glicémico e Tratamento da Diabetes tipo 1 da criança e adolescente em Portugal. Acta Méd Port 17:173–179PubMed
33.
go back to reference Ziegler R, Heidtmann B, Hilgard D, Hofer S, Rosenbauer J, Holl R, for the dpv-wiss-initiative (2011) Frequency of SBGM correlates with Hba1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 12:11–17PubMedCrossRef Ziegler R, Heidtmann B, Hilgard D, Hofer S, Rosenbauer J, Holl R, for the dpv-wiss-initiative (2011) Frequency of SBGM correlates with Hba1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 12:11–17PubMedCrossRef
34.
go back to reference Urbach SL, LaFranchi S, Lambert L, Lapidus JA, Daneman D, Becker TM (2005) Predictors of glucose control in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 6(2):69–74PubMedCrossRef Urbach SL, LaFranchi S, Lambert L, Lapidus JA, Daneman D, Becker TM (2005) Predictors of glucose control in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 6(2):69–74PubMedCrossRef
35.
go back to reference Hood KK, Peterson CM, Rohan JM, Drotar D (2011) Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics 124(6):1171–1179CrossRef Hood KK, Peterson CM, Rohan JM, Drotar D (2011) Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics 124(6):1171–1179CrossRef
36.
go back to reference Anderson B, Ho J, Brackett J, Finkelstein D, Laffel L (1997) Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. J Pediatr 130:257–265PubMedCrossRef Anderson B, Ho J, Brackett J, Finkelstein D, Laffel L (1997) Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. J Pediatr 130:257–265PubMedCrossRef
37.
go back to reference Helgeson VS, Honcharuk E, Becker D, Escobar O, Siminerio L (2011) A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency. Pediatr Diabetes 12:25–30PubMedCrossRef Helgeson VS, Honcharuk E, Becker D, Escobar O, Siminerio L (2011) A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency. Pediatr Diabetes 12:25–30PubMedCrossRef
38.
go back to reference Dahl-Jørgensen K (1987) Near-normoglycemia and late diabetic complications. The Oslo study. Acta Endocrinol Suppl 284:1–38 Dahl-Jørgensen K (1987) Near-normoglycemia and late diabetic complications. The Oslo study. Acta Endocrinol Suppl 284:1–38
39.
go back to reference IBGE Diretoria de Pesquisas. Coordenação de Trabalho e Rendimento. Pesquisa de Orçamentos Familiares (POF) 2008–2009. Available from (www. www.ibge.gov.br). Accessed in 9 Dec 2011 IBGE Diretoria de Pesquisas. Coordenação de Trabalho e Rendimento. Pesquisa de Orçamentos Familiares (POF) 2008–2009. Available from (www. www.​ibge.​gov.​br). Accessed in 9 Dec 2011
40.
go back to reference Zgibor JC, Wilson RR, Orchard TJ (2005) Has control of hypercholesterolemia and hypertension in type 1 diabetes improved over time? Diabetes Care 28(3):521–526PubMedCrossRef Zgibor JC, Wilson RR, Orchard TJ (2005) Has control of hypercholesterolemia and hypertension in type 1 diabetes improved over time? Diabetes Care 28(3):521–526PubMedCrossRef
42.
go back to reference Negrato CA et al. On behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG) (2012) Temporal changes in the diagnosis of type 1 diabetes by diabetic ketoacidosis in Brazil: a nationwide survey. Diabet Med. doi:10.1111/j.1464-5491.2012.03590.x (ahead of print) Negrato CA et al. On behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG) (2012) Temporal changes in the diagnosis of type 1 diabetes by diabetic ketoacidosis in Brazil: a nationwide survey. Diabet Med. doi:10.​1111/​j.​1464-5491.​2012.​03590.​x (ahead of print)
Metadata
Title
Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil
Authors
Marilia B. Gomes
Alessandra Saldanha de Mattos Matheus
Luis Eduardo Calliari
Jorge Luiz Luescher
Thais Della Manna
Roberta Diaz Savoldelli
Roberta A. Cobas
Wellington Siqueira Coelho
Balduino Tschiedel
Alberto José Ramos
Reine Marie Fonseca
Neuza Braga C. Araujo
Henriqueta Guido Almeida
Naira Horta Melo
Debora Laredo Jezini
Carlos Antonio Negrato
Publication date
01-10-2013
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 5/2013
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-012-0404-3

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