Prevalence of Type 2 Diabetic Patients within the Targets of Care Guidelines in Daily Clinical Practice: A Multi-Center Study in Brazil

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Abstract
The Review of Diabetic Studies,2006,3,2,82-87.
Published:August 2006
Type:Original Article
Authors:
Author(s) affiliations:

Marilia de Brito Gomes1, Daniel Gianella2, Manuel Faria3, Marcos Tambascia4, Reine Marie Fonseca5, Rosangela Réa6, Geísa Macedo7, João Modesto Filho8, Helena Schmid9, Alcina Vinhaes Bittencourt10, Saulo Cavalcanti11, Nelson Rassi12,13, Hermelinda Pedrosa13, Sérgio Atala Dib14

1Department of Medicine, Unit of Diabetes, State University Hospital of Rio de Janeiro, Brazil. 2USP/SP - Disciplina de Endocrinologia. 3Universidade Federal do Maranhão - Disciplina de Endocrinologia. 4UNICAMP/SP - Disciplina de Endocrinologia. 5CEDEBVA/BA - Serviço de Endocrinologia e Diabetes. 6UNIFE/PR - Disciplina de Endocrinologia. 7Hospital Agamenon Magalhães/PE - Serviço de Endocrinologia. 8PAM Jaguaribe/PB. 9Santa Casa de Porto Alegre/RS - Serviço de Endocrinologia. 10IAPSEB/BA - Serviço de Endocrinologia. 11Santa Casa de Belo Horizonte/MG - Serviço de Diabetes. 12Hospital Geral de Goiânia - Serviço de Endocrinologia. 13Secretaria Municipal de Saúde de Brasília. 14UNIFESP/SP- Disciplina de Endocrinologia.

Abstract:

Major clinical studies have shown that the targets for blood glucose, lipid profile and blood pressure in type 2 diabetic patients are difficult to maintain in clinical practice. However, there are few data concerning South American populations. Using guidelines represented by the Brazilian Diabetes Society, we evaluated cardiovascular (CV) risk factors, glycemic control and the availability of screening for diabetes complications in 2233 (60% females) outpatients with type 2 diabetes aged 59.2 ± 11.3 yr and with a known duration of diabetes of 9.2 ± 7.2 yr, collected from 8 Brazilian cities. The outcome showed that less intensive clinical care available for diabetic patients in Brazil compared to western industrialized countries leads to widespread poor metabolic control and health status. Less than 30% of the patients reached the target for systolic (28.5%, < 130 mmHg) and diastolic (19.3%, < 80 mmHg) blood pressure, BMI (24.6%, < 25 kg/m2), LDL cholesterol (20.6%, < 2.6 mmol/l) and only 46% reached the goal for HbA1c (one % point above the upper limits of normality for the method used). Only 0.2% of patients reached all the targets. A lower number of women reached the targets for HbA1c, LDL and HDL cholesterol than men (p < 0.001). Women were less likely than men to have funduscopy examinations and urine albumin testing (p < 0.001). We conclude that the national goals for glycemic control, blood pressure and lipid levels are rarely achieved in clinical practice, and that the availability for diabetic complication screening is low. The quality of diabetes care, in particular for women, is poor and should be further reviewed in developing countries.