title: Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group.
abstract: BACKGROUND
  To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.
  
  
  METHODS
  This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).
  
  
  RESULTS
  Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).
  
  
  CONCLUSIONS
  A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20,551-030, Rio de Janeiro, Brazil. mariliabgomes@gmail.com.
authors.forename: Marília B
authors.initials: MB
authors.lastname: Gomes
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Cobas
authors.forename: Alessandra S
authors.initials: AS
authors.lastname: Matheus
authors.forename: Lucianne R
authors.initials: LR
authors.lastname: Tannus
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Negrato
authors.forename: Melanie
authors.initials: M
authors.lastname: Rodacki
authors.forename: Neuza
authors.initials: N
authors.lastname: Braga
authors.forename: Marilena M
authors.initials: MM
authors.lastname: Cordeiro
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Luescher
authors.forename: Renata S
authors.initials: RS
authors.lastname: Berardo
authors.forename: Marcia
authors.initials: M
authors.lastname: Nery
authors.forename: Maria do Carmo A
authors.initials: MC
authors.lastname: Arruda-Marques
authors.forename: Luiz E
authors.initials: LE
authors.lastname: Calliari
authors.forename: Renata M
authors.initials: RM
authors.lastname: Noronha
authors.forename: Thais D
authors.initials: TD
authors.lastname: Manna
authors.forename: Lenita
authors.initials: L
authors.lastname: Zajdenverg
authors.forename: Roberta
authors.initials: R
authors.lastname: Salvodelli
authors.forename: Fernanda G
authors.initials: FG
authors.lastname: Penha
authors.forename: Milton C
authors.initials: MC
authors.lastname: Foss
authors.forename: Maria C
authors.initials: MC
authors.lastname: Foss-Freitas
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Pires
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Robles
authors.forename: Mariadefátimas
authors.initials: M
authors.lastname: Guedes
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Dib
authors.forename: Patricia
authors.initials: P
authors.lastname: Dualib
authors.forename: Saulo C
authors.initials: SC
authors.lastname: Silva
authors.forename: Janice
authors.initials: J
authors.lastname: Sepulvida
authors.forename: Henriqueta G
authors.initials: HG
authors.lastname: Almeida
authors.forename: Emerson
authors.initials: E
authors.lastname: Sampaio
authors.forename: Rosangela
authors.initials: R
authors.lastname: Rea
authors.forename: Ana Cristina R
authors.initials: AC
authors.lastname: Faria
authors.forename: Balduino
authors.initials: B
authors.lastname: Tschiedel
authors.forename: Suzana
authors.initials: S
authors.lastname: Lavigne
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Cardozo
authors.forename: Mirela J
authors.initials: MJ
authors.lastname: Azevedo
authors.forename: Luis Henrique
authors.initials: LH
authors.lastname: Canani
authors.forename: Alessandra T
authors.initials: AT
authors.lastname: Zucatti
authors.forename: Marisa Helena C
authors.initials: MH
authors.lastname: Coral
authors.forename: Daniela Aline
authors.initials: DA
authors.lastname: Pereira
authors.forename: Luiz Antonio
authors.initials: LA
authors.lastname: Araujo
authors.forename: Monica
authors.initials: M
authors.lastname: Tolentino
authors.forename: Hermelinda C
authors.initials: HC
authors.lastname: Pedrosa
authors.forename: Flaviane A
authors.initials: FA
authors.lastname: Prado
authors.forename: Nelson
authors.initials: N
authors.lastname: Rassi
authors.forename: Leticia B
authors.initials: LB
authors.lastname: Araujo
authors.forename: Reine Marie C
authors.initials: RM
authors.lastname: Fonseca
authors.forename: Alexis D
authors.initials: AD
authors.lastname: Guedes
authors.forename: Odelissa S
authors.initials: OS
authors.lastname: Matos
authors.forename: Manuel
authors.initials: M
authors.lastname: Faria
authors.forename: Rossana
authors.initials: R
authors.lastname: Azulay
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Forti
authors.forename: Cristina
authors.initials: C
authors.lastname: Façanha
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Montenegro
authors.forename: Renan
authors.initials: R
authors.lastname: Montenegro
authors.forename: Naira H
authors.initials: NH
authors.lastname: Melo
authors.forename: Karla F
authors.initials: KF
authors.lastname: Rezende
authors.forename: Alberto
authors.initials: A
authors.lastname: Ramos
authors.forename: João Sooares
authors.initials: JS
authors.lastname: Felicio
authors.forename: Flavia M
authors.initials: FM
authors.lastname: Santos
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jezini
authors.forename: Marilena M
authors.initials: MM
authors.lastname: Cordeiro