Marilia Brito Gomes1, Melanie Rodacki2, Elizabeth João Pavin3, Roberta Arnoldi Cobas1, João S Felicio4, Lenita Zajdenverg2, Carlos Antonio Negrato5. 1. Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Brazil. 2. Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Brazil. 3. Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil. 4. University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belém, Pará, Brazil. 5. Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil. Electronic address: carlosnegrato@uol.com.br.
Abstract
AIMS: Establish the relationship between demographic, educational and economic status on insulin therapeutic regimens (ITRs) and on glycemic control in patients with type 1 diabetes. METHODS: This was a cross-sectional, multicenter study with 1760 patients conducted between August 2011 and August 2014 in 10 Brazilian cities. RESULTS: Patients were stratified according to ITRs as follows: only NPH insulin (group 1, n=80(4.5%)); only long-acting insulin analogs (group 2, n=6(0.3%)); continuous subcutaneous insulin infusion (CSII) (group 3, n=62(3.5%)); NPH plus regular insulin (group 4, n=710(40.3%)); NPH plus ultra-rapid insulin analogs (group 5, n=259(14.8%)); long-acting insulin analogs plus regular insulin (group 6, n=25(4.4%)) and long-acting plus ultra-rapid insulin analogs (group 7, n=618 (35.1%)). As group A (provided free of charge by the government) we considered groups 1 and 4, and as group B (obtained through lawsuit or out-of-pocket) groups 2, 3 and 7. Multivariate logistic analysis showed that independent variables related to group B were older age, more years of school attendance, higher economic status and ethnicity (Caucasians). The independent variables related to better glycemic control were older age, higher adherence to diet, higher frequency of self-monitoring of blood glucose, more years of school attendance and belonging to group B. CONCLUSIONS: In Brazilian National Health Care System, prescriptions of insulin analogs or CSII are more frequent in Caucasian patients with type 1 diabetes, with higher economic status and more years ofschool attendance. Among these variables years of school attendance was the only one associated with better glycemic control.
AIMS: Establish the relationship between demographic, educational and economic status on insulin therapeutic regimens (ITRs) and on glycemic control in patients with type 1 diabetes. METHODS: This was a cross-sectional, multicenter study with 1760 patients conducted between August 2011 and August 2014 in 10 Brazilian cities. RESULTS:Patients were stratified according to ITRs as follows: only NPH insulin (group 1, n=80(4.5%)); only long-acting insulin analogs (group 2, n=6(0.3%)); continuous subcutaneous insulin infusion (CSII) (group 3, n=62(3.5%)); NPH plus regular insulin (group 4, n=710(40.3%)); NPH plus ultra-rapid insulin analogs (group 5, n=259(14.8%)); long-acting insulin analogs plus regular insulin (group 6, n=25(4.4%)) and long-acting plus ultra-rapid insulin analogs (group 7, n=618 (35.1%)). As group A (provided free of charge by the government) we considered groups 1 and 4, and as group B (obtained through lawsuit or out-of-pocket) groups 2, 3 and 7. Multivariate logistic analysis showed that independent variables related to group B were older age, more years of school attendance, higher economic status and ethnicity (Caucasians). The independent variables related to better glycemic control were older age, higher adherence to diet, higher frequency of self-monitoring of blood glucose, more years of school attendance and belonging to group B. CONCLUSIONS: In Brazilian National Health Care System, prescriptions of insulin analogs or CSII are more frequent in Caucasian patients with type 1 diabetes, with higher economic status and more years ofschool attendance. Among these variables years of school attendance was the only one associated with better glycemic control.
Authors: Deborah Conte Santos; Laura Gomes Nunes de Melo; Marcela Haas Pizarro; Bianca S V Barros; Carlos Antonio Negrato; Luís Cristóvão Porto; Dayse A Silva; Karla Rezende Guerra Drummond; Luiza Harcar Muniz; Tessa Cerqueria Lemos Mattos; André Araújo Pinheiro; Felipe Mallmann; Franz Schubert Lopes Leal; Fernando Korn Malerbi; Paulo Henrique Morales; Marília Brito Gomes Journal: Acta Diabetol Date: 2020-03-03 Impact factor: 4.280
Authors: Paulo H R F Almeida; Brian Godman; Vania Dos Santos Nunes-Nogueira; Lívia L P de Lemos; Francisco de Assis Acúrcio; Augusto A Guerra-Junior; Vânia E de Araújo; Alessandra M Almeida; Juliana Alvares-Teodoro Journal: Clin Diabetes Date: 2022
Authors: Rebecca O La Banca; Lori M B Laffel; Lisa K Volkening; Valéria C Sparapani; Emilia C de Carvalho; Lucila C Nascimento Journal: J Spec Pediatr Nurs Date: 2020-09-18 Impact factor: 1.260
Authors: Laura Gomes Nunes Melo; Paulo Henrique Morales; Karla Rezende Guerra Drummond; Deborah Conte Santos; Marcela Haas Pizarro; Bianca Senger Vasconcelos Barros; Tessa Cerqueria Lemos Mattos; André Araújo Pinheiro; Felipe Mallmann; Franz Schubert Lopes Leal; Fernando Korn Malerbi; Marilia Brito Gomes Journal: BMC Public Health Date: 2018-08-08 Impact factor: 3.295