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Rafi MA, Semanta S, Shahriar T, Hasan MJ, Hossain MG. An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh. PLoS One 2024; 19:e0309372. [PMID: 39186706 PMCID: PMC11346952 DOI: 10.1371/journal.pone.0309372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 08/10/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management. METHODS The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors. RESULTS Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care. CONCLUSION Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.
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Affiliation(s)
| | | | | | | | - Md. Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Saadeh R, Alsmadi H, Batieha A, Khader Y, Jaddou H, El-Khateeb M, Allouh MZ, Ajlouni K. Quality of care for type 2 diabetes in Jordan: A national study. MEDICINE INTERNATIONAL 2023; 3:27. [PMID: 37323128 PMCID: PMC10265394 DOI: 10.3892/mi.2023.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
The present study aimed to describe the quality of healthcare delivered to patients with type 2 diabetes in Jordan in 2017. Another objective was to identify the factors related to glycemic control and hospital admission due to type 2 diabetes. This was a national population-based household study. Aspects of care quality were evaluated in relation to outcomes, such as glycemic control [hemoglobin A1c; glycated hemoglobin (HbA1c) level <7%] and hospital admission owing to diabetes. A total of 754 patients previously diagnosed with type 2 diabetes and aged ≥25 years were recruited. The number of annual visits was >10 for 48.5% and 1-4 for 38.2% of patients. The proportion of patients achieving glycemic control was 33.0%. In total, 4 of 5 patients reported easy access to health facilities and good health team support. Foot and eye examinations were performed for 24.9 and 55.0% of the patients, respectively. Dietary advice was delivered to 87.5% of the patients. Glycemic control exhibited a significant inverse association with the duration of diabetes and the number of annual visits. Following a specific diet for managing diabetes and the cessation of medication after an improved well-being were independently associated with a higher likelihood of glycemic control (HbA1c <7%). On the whole, the present study demonstrates that a number of indicators for the quality of diabetes care in Jordan were relatively satisfactory; however, others require improvement. The findings demonstrate that numerous patients with diabetes in Jordan require education about the treatment and management of, and complications associated with diabetes, especially those who are recently diagnosed.
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Affiliation(s)
- Rami Saadeh
- Department of Public Health and Community Medicine, College of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Haya Alsmadi
- Jerash Medical Center, Dental Department, Jerash Governorate, Jordan Ministry of Health, Amman 11118, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, College of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, College of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hashem Jaddou
- Department of Public Health and Community Medicine, College of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammed El-Khateeb
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman 11942, Jordan
| | - Mohammed Z. Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman 11942, Jordan
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Camargo MS, Passos LCS, Mistro S, Soares DA, Kochergin CN, de Carvalho VCHDS, Macedo JCL, Cortes TBA, de Souza AA, Rumel D, Oliveira MG. Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study. Front Med (Lausanne) 2021; 8:734306. [PMID: 34881257 PMCID: PMC8645789 DOI: 10.3389/fmed.2021.734306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier. Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality. Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device. Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively. Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.
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Affiliation(s)
| | | | - Sostenes Mistro
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Daniela Arruda Soares
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | | | - Jéssica Caline Lemos Macedo
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Taciana Borges Andrade Cortes
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Amós Alves de Souza
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Davi Rumel
- Department of Community Health, School of Medicine, Municipal University of São Caetano do sul, São Caetano Do Sul, Brazil
| | - Marcio Galvão Oliveira
- Program of Post-graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Barriers to Diabetes Patients' Self-Care Practices in Eastern Ethiopia: A Qualitative Study from the Health Care Providers Perspective. Diabetes Metab Syndr Obes 2021; 14:4335-4349. [PMID: 34712054 PMCID: PMC8547594 DOI: 10.2147/dmso.s335731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient's health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients' self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia. METHODS Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question. RESULTS Researchers identified barriers to diabetes patients' self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers. CONCLUSION Multi-level barriers to diabetes patients' self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers' and patients' capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders' engagement and one-to-one or group interventions covering the multi-level challenges.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Alkaff FF, Illavi F, Salamah S, Setiyawati W, Ramadhani R, Purwantini E, Tahapary DL. The Impact of the Indonesian Chronic Disease Management Program (PROLANIS) on Metabolic Control and Renal Function of Type 2 Diabetes Mellitus Patients in Primary Care Setting. J Prim Care Community Health 2021; 12:2150132720984409. [PMID: 33472499 PMCID: PMC7829517 DOI: 10.1177/2150132720984409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Indonesia through its government National Health Insurance System has launched a non-communicable and chronic disease management program named Indonesian Chronic Disease Management Program (PROLANIS), with Type 2 Diabetes Mellitus (T2DM) and hypertension as the main focus. However, study that evaluates the clinical impact of PROLANIS in patients with T2DM is still scarce to this date. This study aims to evaluate the metabolic control and renal function of PROLANIS participants with T2DM every six month within the first 18-months of implementation. METHODS This study was a retrospective cohort study conducted at Wates sub-district, East Java using secondary data from PROLANIS group report from April 2018 to October 2019. The study population was T2DM patients who voluntarily joined the PROLANIS group in April 2018. The six-month-evaluation included metabolic parameters [body mass index (BMI), blood pressure, hemoglobin A1C, total cholesterol, high-density lipid, low-density lipid, and triglyceride (TG)] and renal parameters [blood urea nitrogen (BUN), creatinine serum, and urinary microalbumin]. Paired t-test and wilcoxon signed-rank test was used for the analysis, and the P-value was adjusted using Bonferroni correction. A P-value < .0015 was considered statistically significant, while a P-value between .0015 and .003 was considered as marginally significant. RESULTS A total of 30 participants were included in the analysis. Following the PROLANIS implementation, the only parameter of metabolic control that showed significant improvement was TG serum level (P < .001). Despite the worsening status of other metabolic parameters, the changes were not statistically significant except for BMI that was marginally significant (P = .002). From renal function, only BUN serum level was significantly deteriorated (P < .001), while the others did not significantly change. CONCLUSION PROLANIS implementation in our study population seems to be ineffective. Future study with more primary healthcare centers needs to be done to scrutinize the clinical impact of this program nationwide.
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Affiliation(s)
- Firas Farisi Alkaff
- Department of Pharmacology and Therapy,
Faculty of Medicine Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fauzan Illavi
- Department of Internal Medicine,
Dr.Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia,
Central Jakarta, Jakarta, Indonesia
| | - Sovia Salamah
- Department of Public Health and
Preventive Medicine, Faculty of Medicine Universitas Airlangga, Surabaya, East Java,
Indonesia
| | - Wiwit Setiyawati
- Faculty of Medicine Universitas
Airlangga, Surabaya, East Java, Indonesia
| | - Ristra Ramadhani
- Faculty of Medicine Universitas
Airlangga, Surabaya, East Java, Indonesia
| | - Elly Purwantini
- Politeknik Elektronika Negeri Surabaya,
Surabaya, East Java, Indonesia
| | - Dicky L. Tahapary
- Department of Internal Medicine,
Dr.Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia,
Central Jakarta, Jakarta, Indonesia
- Metabolic, Cardiovascular, and Aging
Cluster, The Indonesian Medical Education and Research Institute,Faculty of Medicine
Universitas Indonesia, Central Jakarta, Jakarta, Indonesia
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Birabwa C, Bwambale MF, Waiswa P, Mayega RW. Quality and barriers of outpatient diabetes care in rural health facilities in Uganda - a mixed methods study. BMC Health Serv Res 2019; 19:706. [PMID: 31619234 PMCID: PMC6796349 DOI: 10.1186/s12913-019-4535-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. METHODS This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. RESULTS The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. CONCLUSION The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Mulekya F. Bwambale
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Roy W. Mayega
- Department of Epidemiology and Biostatistics, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
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Schneiders J, Telo GH, Bottino LG, Pasinato B, Neyeloff JL, Schaan BD. Quality indicators in type 2 diabetes patient care: analysis per care-complexity level. Diabetol Metab Syndr 2019; 11:34. [PMID: 31073334 PMCID: PMC6498653 DOI: 10.1186/s13098-019-0428-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System's primary and tertiary health care centers within a local population. METHODS This was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%). RESULTS In the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered. CONCLUSIONS Our results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.
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Affiliation(s)
- Josiane Schneiders
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Gabriela H. Telo
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Leonardo Grabinski Bottino
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Bruna Pasinato
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Jeruza Lavanholi Neyeloff
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
| | - Beatriz D. Schaan
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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