title: Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil.
abstract: 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.
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Marilia Brito
authors.initials: MB
authors.lastname: Gomes
authors.affiliation: Bauru's Diabetics Association, Bauru, São Paulo, Brazil.
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Negrato
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Roberta
authors.initials: R
authors.lastname: Cobas
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Lucianne Righeti Monteiro
authors.initials: LR
authors.lastname: Tannus
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Paolla Ribeiro
authors.initials: PR
authors.lastname: Gonçalves
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Pedro Carlos Barreto
authors.initials: PC
authors.lastname: da Silva
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: João Regis Ivar
authors.initials: JR
authors.lastname: Carneiro
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Alessandra Saldanha Mattos
authors.initials: AS
authors.lastname: Matheus
authors.affiliation: Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil.
authors.forename: Sergio Atala
authors.initials: SA
authors.lastname: Dib
authors.affiliation: Federal University Hospital of Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Mirela Jobim
authors.initials: MJ
authors.lastname: Azevedo
authors.affiliation: Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil.
authors.forename: Márcia
authors.initials: M
authors.lastname: Nery
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Melanie
authors.initials: M
authors.lastname: Rodacki
authors.affiliation: Federal University of Ceará, Ceará, Brazil.
authors.forename: Lenita
authors.initials: L
authors.lastname: Zajdenverg
authors.affiliation: Federal University of Ceará, Ceará, Brazil.
authors.forename: Renan Magalhães
authors.initials: RM
authors.lastname: Montenegro Junior
authors.affiliation: Santa Casa Misericórdia, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Janice
authors.initials: J
authors.lastname: Sepulveda
authors.affiliation: Santa Casa Misericórdia São Paulo, São Paulo, Brazil.
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Calliari
authors.affiliation: Universidade Federal Amazonas, Manaus, Brazil.
authors.forename: Deborah
authors.initials: D
authors.lastname: Jezini
authors.affiliation: Hospital Geral de Bonsucesso, Rio de Janeiro, Brazil.
authors.forename: Neuza
authors.initials: N
authors.lastname: Braga
authors.affiliation: Hospital Universitário Clementino Fraga Filho - IPPMG, Rio de Janeiro, Brazil.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Luescher
authors.affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Renata S
authors.initials: RS
authors.lastname: Berardo
authors.affiliation: University Hospital of São Paulo, São Paulo, Brazil.
authors.forename: Maria Carmo
authors.initials: MC
authors.lastname: Arruda-Marques
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Renata M
authors.initials: RM
authors.lastname: Noronha
authors.affiliation: Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Thais D
authors.initials: TD
authors.lastname: Manna
authors.affiliation: Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Roberta
authors.initials: R
authors.lastname: Salvodelli
authors.affiliation: Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Fernanda G
authors.initials: FG
authors.lastname: Penha
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil.
authors.forename: Milton C
authors.initials: MC
authors.lastname: Foss
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, Brazil.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Foss-Freitas
authors.affiliation: Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Pires
authors.affiliation: Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Robles
authors.affiliation: Bauru's Diabetics Association, Bauru, São Paulo, Brazil.
authors.forename: Maria de Fátima S
authors.initials: Mde F
authors.lastname: Guedes
authors.affiliation: Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Dualib
authors.affiliation: Clínica de Endocrinologia da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil.
authors.forename: Saulo C
authors.initials: SC
authors.lastname: Silva
authors.affiliation: Universidade Estadual de Londrina, Londrina, Brazil.
authors.forename: Emerson
authors.initials: E
authors.lastname: Sampaio
authors.affiliation: Hospital de Clínicas da Universidade Federal do Paraná, Porto Alegre, Brazil.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Rea
authors.affiliation: Hospital de Clínicas da Universidade Federal do Paraná, Porto Alegre, Brazil.
authors.forename: Ana Cristina R
authors.initials: AC
authors.lastname: Faria
authors.affiliation: Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil.
authors.forename: Balduino
authors.initials: B
authors.lastname: Tschiedel
authors.affiliation: Instituto da Criança com Diabete Rio Grande Sul, Rio Grande do Sul, Brazil.
authors.forename: Suzana
authors.initials: S
authors.lastname: Lavigne
authors.affiliation: Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil.
authors.forename: Luis Henrique
authors.initials: LH
authors.lastname: Canani
authors.affiliation: Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil.
authors.forename: Alessandra T
authors.initials: AT
authors.lastname: Zucatti
authors.affiliation: Hospital Universitário de Santa Catarina, Florianópolis, Brazil.
authors.forename: Marisa Helena C
authors.initials: MH
authors.lastname: Coral
authors.affiliation: Hospital Universitário de Santa Catarina, Florianópolis, Brazil.
authors.forename: Daniela Aline
authors.initials: DA
authors.lastname: Pereira
authors.affiliation: Instituto de Diabetes-Endocrinologia de Joinville, Joinville, Brazil.
authors.forename: Luiz Antonio
authors.initials: LA
authors.lastname: Araujo
authors.affiliation: Hospital Regional de Taguatinga, Brasília, Brasilia, Brazil.
authors.forename: Monica
authors.initials: M
authors.lastname: Tolentino
authors.affiliation: Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil.
authors.forename: Hermelinda C
authors.initials: HC
authors.lastname: Pedrosa
authors.affiliation: Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil.
authors.forename: Flaviane A
authors.initials: FA
authors.lastname: Prado
authors.affiliation: Hospital Geral de Goiânia, Goiânia, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Rassi
authors.affiliation: Hospital Geral de Goiânia, Goiânia, Brazil.
authors.forename: Leticia B
authors.initials: LB
authors.lastname: Araujo
authors.affiliation: Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil.
authors.forename: Reine Marie C
authors.initials: RM
authors.lastname: Fonseca
authors.affiliation: Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil.
authors.forename: Alexis D
authors.initials: AD
authors.lastname: Guedes
authors.affiliation: Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil.
authors.forename: Odelissa S
authors.initials: OS
authors.lastname: Matos
authors.affiliation: Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil.
authors.forename: Catia C
authors.initials: CC
authors.lastname: Palma
authors.affiliation: Universidade Federal do Maranhão, São Luís, Brazil.
authors.forename: Rossana
authors.initials: R
authors.lastname: Azulay
authors.affiliation: Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil.
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Forti
authors.affiliation: Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil.
authors.forename: Cristina
authors.initials: C
authors.lastname: Façanha
authors.affiliation: Federal University of Ceará, Ceará, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Montenegro
authors.affiliation: Universidade Federal de Sergipe, Aracaju, Brazil.
authors.forename: Naira H
authors.initials: NH
authors.lastname: Melo
authors.affiliation: Universidade Federal de Sergipe, Aracaju, Brazil.
authors.forename: Karla F
authors.initials: KF
authors.lastname: Rezende
authors.affiliation: Hospital Universitário Alcides Carneiro, Campina Grande, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ramos
authors.affiliation: Hospital Universitário João de Barros Barreto, Pará, Belém, Brazil.
authors.forename: João Soares
authors.initials: JS
authors.lastname: Felicio
authors.affiliation: Hospital Universitário João de Barros Barreto, Pará, Belém, Brazil.
authors.forename: Flavia M
authors.initials: FM
authors.lastname: Santos
keywords: Brazil; Chronic complications; Insulin regimens; Type 1 diabetes