title: Prevalence of Type 2 diabetic patients within the targets of care guidelines in daily clinical practice: a multi-center study in Brazil.
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.
authors.affiliation: Department of Medicine, Unit of Diabetes, State University Hospital of Rio de Janeiro, Brazil. mariliabgomes@uol.com.br
authors.forename: Marilia de Brito
authors.initials: MB
authors.lastname: Gomes
authors.forename: Daniel
authors.initials: D
authors.lastname: Gianella
authors.forename: Manuel
authors.initials: M
authors.lastname: Faria
authors.forename: Marcos
authors.initials: M
authors.lastname: Tambascia
authors.forename: Reine Marie
authors.initials: RM
authors.lastname: Fonseca
authors.forename: Rosangela
authors.initials: R
authors.lastname: Réa
authors.forename: Geísa
authors.initials: G
authors.lastname: Macedo
authors.forename: João
authors.initials: J
authors.lastname: Modesto Filho
authors.forename: Helena
authors.initials: H
authors.lastname: Schmid
authors.forename: Alcina Vinhaes
authors.initials: AV
authors.lastname: Bittencourt
authors.forename: Saulo
authors.initials: S
authors.lastname: Cavalcanti
authors.forename: Nelson
authors.initials: N
authors.lastname: Rassi
authors.forename: Hermelinda
authors.initials: H
authors.lastname: Pedrosa
authors.forename: Sérgio
authors.initials: S
authors.lastname: Atala Dib