Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Diabetology & Metabolic Syndrome

Flavia M Santos^2,22  João Soares Felicio^2,22  Alberto Ramos^2,23  Karla F Rezende^2,24  Naira H Melo^2,24  Ana Paula Montenegro^2,27  Cristina Façanha^1,18  Adriana C Forti^1,18  Rossana Azulay²  Catia C Palma⁶  Odelissa S Matos^1,12  Alexis D Guedes^1,12  Reine Marie C Fonseca^1,12  Leticia B Araujo⁵  Nelson Rassi⁵  Flaviane A Prado^1,15  Hermelinda C Pedrosa^1,15  Monica Tolentino^2,21  Luiz Antonio Araujo^1,13  Daniela Aline Pereira^1,11  Marisa Helena C Coral^1,11  Alessandra T Zucatti⁹  Luis Henrique Canani⁹  Suzana Lavigne^1,16  Balduino Tschiedel⁸  Ana Cristina R Faria^3,30  Rosangela Rea^3,30  Emerson Sampaio^2,25  Saulo C Silva^3,33  Patricia Dualib^1,15  Maria de Fátima S Guedes^1,17  Fernando C Robles⁹  Antonio C Pires⁹  Maria C Foss-Freitas^2,26  Milton C Foss^2,26  Fernanda G Penha^1,14  Roberta Salvodelli^1,14  Thais D Manna^1,14  Renata M Noronha¹  Maria Carmo Arruda-Marques^1,19  Renata S Berardo^2,20  Jorge L Luescher⁷  Neuza Braga^3,31  Deborah Jezini^3,32  Luis Eduardo Calliari^2,28  Janice Sepulveda⁴  Renan Magalhães Montenegro Junior^2,27  Lenita Zajdenverg^2,27  Melanie Rodacki^2,20  Márcia Nery^2,29  Mirela Jobim Azevedo^1,10  Sergio Atala Dib³  Alessandra Saldanha Mattos Matheus⁶  João Regis Ivar Carneiro⁶  Pedro Carlos Barreto da Silva⁶  Paolla Ribeiro Gonçalves⁶  Lucianne Righeti Monteiro Tannus⁶  Roberta Cobas⁶  Carlos Antonio Negrato^1,17  Marilia Brito Gomes⁶ 

[1] Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil;Universidade Federal do Maranhão, São Luís, Brazil;Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil;Santa Casa Misericórdia, Belo Horizonte, Minas Gerais, Brazil;Hospital Geral de Goiânia, Goiânia, Brazil;Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil;Hospital Universitário Clementino Fraga Filho – IPPMG, Rio de Janeiro, Brazil;Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil;Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil;Federal University Hospital of Porto Alegre, Rio Grande do Sul, Brazil;Hospital Universitário de Santa Catarina, Florianópolis, Brazil;Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil;Instituto de Diabetes-Endocrinologia de Joinville, Joinville, Brazil;Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil;Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil;Instituto da Criança com Diabete Rio Grande Sul, Rio Grande do Sul, Brazil;Bauru’s Diabetics Association, Bauru, São Paulo, Brazil;Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil;University Hospital of São Paulo, São Paulo, Brazil;Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;Hospital Regional de Taguatinga, Brasília, Brasilia, Brazil;Hospital Universitário João de Barros Barreto, Pará, Belém, Brazil;Hospital Universitário Alcides Carneiro, Campina Grande, Brazil;Universidade Federal de Sergipe, Aracaju, Brazil;Universidade Estadual de Londrina, Londrina, Brazil;Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil;Federal University of Ceará, Ceará, Brazil;Santa Casa Misericórdia São Paulo, São Paulo, Brazil;Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil;Hospital de Clínicas da Universidade Federal do Paraná, Porto Alegre, Brazil;Hospital Geral de Bonsucesso, Rio de Janeiro, Brazil;Universidade Federal Amazonas, Manaus, Brazil;Clínica de Endocrinologia da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

关键词: Brazil;    Insulin regimens;    Chronic complications;    Type 1 diabetes;   

Others  :  802275
DOI  :  10.1186/1758-5996-6-67

 received in 2014-03-25, accepted in 2014-05-20,  发布年份 2014

【 摘 要 】

Background

To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).

Methods

This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.

Results

We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).

Conclusions

Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.

【 授权许可】

   
2014 Gomes et al.; licensee BioMed Central Ltd.

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