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Jude EB, Tentolouris N, Rastogi A, Yap MH, Pedrosa HC, Ling SF. Vitamin D prescribing practices among clinical practitioners during the COVID‐19 pandemic. Health Sci Rep 2022; 5:e691. [PMID: 35844828 PMCID: PMC9273939 DOI: 10.1002/hsr2.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Aims COVID‐19 has caused devastation globally. Low vitamin D status, particularly during the winter months, remains commonplace around the world, and it is thought to be one of the contributing factors toward causation and severity of COVID‐19. Many guidelines do not recommend vitamin D for the treatment or prevention of the disease. Hence, we set out to conduct a global survey to understand the use and prescribing habits of vitamin D among clinicians for COVID‐19. Methods An online anonymous questionnaire was sent to clinicians enquiring about their prescribing habits of vitamin D and personal use of vitamin D. Data of the survey were collected between January 15, 2021, and February 13, 2021. Results Four thousand four hundred forty practicing clinicians were included in the analysis, with the majority of those responding from Asia, followed by Europe. 82.9% prescribed vitamin D before COVID‐19, more commonly among general practitioners (GPs) in comparison with medical specialists, and Asian clinicians were more likely to prescribe vitamin D in comparison with Caucasian physicians (p < 0.01). GPs were also more likely to prescribe vitamin D prophylactically to prevent COVID‐19 in comparison with medical specialists (OR 1.47, p < 0.01). Most GPs (72.8%) would also prescribe vitamin D to treat COVID‐19 in comparison with medical specialists (OR 1.81, p < 0.01), as well as more Asian in comparison with Caucasian physicians (OR 4.57, p < 0.01). 80.4% of respondents were taking vitamin D, more so in the 45–54 and 65–74 age groups in comparison with the 18–24 years category (OR 2.15 and 2.40, respectively, both p < 0.05), many of whom did so before COVID‐19 (72.1%). Conclusion This survey has shown that many clinicians would prescribe vitamin D for the prevention and treatment of COVID‐19. The majority would also recommend measuring vitamin D levels, but not so in patients with COVID‐19.
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Affiliation(s)
- Edward B. Jude
- Department of Diabetes and Endocrinology Tameside and Glossop Integrated Care NHS Foundation Trust Ashton‐under‐Lyne UK
- Department of Diabetes and Endocrinology The University of Manchester Manchester UK
- Department of Diabetes and Endocrinology Manchester Metropolitan University Manchester UK
| | - Nikolaos Tentolouris
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens Laiko General Hospital Athens Greece
| | - Ashu Rastogi
- Department of Diabetes and Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Moi H. Yap
- Department of Diabetes and Endocrinology Manchester Metropolitan University Manchester UK
| | - Hermelinda C. Pedrosa
- Department of Diabetes and Endocrinology, Endocrinology Unit, Research Centre, Taguatinga Regional Hospital Secretariat of Health Brasilia‐DF Brazil
| | - Stephanie F. Ling
- Department of Diabetes and Endocrinology The University of Manchester Manchester UK
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Correr CJ, Coura-Vital W, Frade JCQP, Nascimento RCRM, Nascimento LG, Pinheiro EB, Ferreira WM, Reis JS, Melo KFS, Pontarolo R, Lenzi MSA, Almeida JV, Pedrosa HC, João WSJ. Prevalence of people at risk of developing type 2 diabetes mellitus and the involvement of community pharmacies in a national screening campaign: a pioneer action in Brazil. Diabetol Metab Syndr 2020; 12:89. [PMID: 33062060 PMCID: PMC7545923 DOI: 10.1186/s13098-020-00593-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Brazil is one of top 10 countries with the highest number of people with diabetes mellitus (DM), affecting 16.8 million peoples. It is estimated that 7.7 million people (20-79 years) in the country have not yet been diagnosed, representing an under-diagnosis rate of 46.0%. Herein we aimed to screen people for high blood glucose or risk for developing type 2 DM (T2DM) through community pharmacies in Brazil. METHODS A cross-sectional study was carried out in November 2018, involving 977 pharmacists from 345 municipalities in Brazil. The study evaluated people between 20 and 79 years old without a previous diagnosis of DM. Glycemia was considered high when its value was ≥ 100 mg/dL fasting and ≥ 140 mg/dL in a casual feeding state. The FINDRISC (Finnish Diabetes Risk Score) was used to estimate the risk for developing T2DM. The prevalence of high blood glucose was estimated and the associated factors were obtained using Poisson's multivariate analysis with robust variance. RESULTS During the national screening campaign, 17,580 people were tested with the majority of the consultations (78.2%) being carried out in private pharmacies. The population was composed mainly of women (59.5%) and people aged between 20 and 45 years (47.9%). The frequency of participants with high blood glucose was 18.4% (95% CI 17.9-19.0). Considering the FINDRISC, 22.7% of people had a high or very high risk for T2DM. The risk factors associated with high blood glucose were: Body Mass Index > 25 kg/m2, abdominal circumference > 94 cm for men and > 80 cm for women; education level below 15 years of study, no daily intake of vegetables and fruits; previous diagnosis of arterial hypertension; history of high blood glucose and family history of DM. CONCLUSIONS This is the largest screening study that evaluated the frequency of high blood glucose and its associated factors in a population without a previous diagnosis ever performed in community pharmacies in Brazil. These results may help to improve public health policies and reinforce the role of pharmacists in screening and education actions aimed at this undiagnosed population in a continent-size country such as Brazil.
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Affiliation(s)
- Cassyano J. Correr
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná Brazil
| | - Wendel Coura-Vital
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | | | - Renata C. R. M. Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | - Lúbia G. Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | | | | | - Janice S. Reis
- Sociedade Brasileira de Diabetes, Ensino e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Karla F. S. Melo
- Sociedade Brasileira de Diabetes, Equipe de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Pontarolo
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná Brazil
| | | | - José V. Almeida
- Conselho Federal de Farmácia, Brasília, Distrito Federal Brazil
| | - Hermelinda C. Pedrosa
- Sociedade Brasileira de Diabetes, São Paulo, Brazil
- Secretaria de Estado da Saúde, Polo de Pesquisa da Unidade de Endocrinologia FEPECS-HRT, Brasília, Distrito Federal Brazil
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Melo KFS, Bahia LR, Pasinato B, Porfirio GJM, Martimbianco AL, Riera R, Calliari LEP, Minicucci WJ, Turatti LAA, Pedrosa HC, Schaan BD. Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr 2019; 11:2. [PMID: 30622653 PMCID: PMC6317184 DOI: 10.1186/s13098-018-0397-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/24/2018] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Strict glucose control using multiple doses of insulin is the standard treatment for type 1 diabetes mellitus (T1DM), but increased risk of hypoglycemia is a frequent drawback. Regular insulin in multiple doses is important for achieving strict glycemic control for T1DM, but short-acting insulin analogues may be better in reducing hypoglycemia and postprandial glucose levels. OBJECTIVE We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose in patients with T1DM. METHODS Searches were run on the electronic databases MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and DARE for RCTs published until August 2017. To be included in the study, the RCTs had to cover a minimum period of 4 weeks and had to assess the effects of short-acting insulin analogues vs regular human insulin on hypoglycemia and postprandial glucose levels in patients with T1DM. Two independent reviewers extracted the data and assessed the quality of the selected studies. The primary outcomes analyzed were hypoglycemia (total episodes, nocturnal hypoglycemia, and severe hypoglycemia) and postprandial glucose (at all times, after breakfast, after lunch, and after dinner). Glycated hemoglobin (HbA1c) levels and quality of life were considered secondary outcomes. The risk of bias of each RCT was assessed using the Cochrane Collaboration Risk of Bias table, while the quality of evidence for each outcome was assessed using the GRADEpro software. The pooled mean difference in the number of hypoglycemic episodes and postprandial glucose between short-acting insulin analogues vs. regular human insulin was calculated using the random-effects model. RESULTS Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87-0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40-0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60-0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD - 19.44 mg/dL; 95% CI - 21.49 to - 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD - 0,13%; IC 95% - 0.16 to - 0.10; 5204 patients; I2 = 73%) levels. CONCLUSIONS Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes: total hypoglycemic episodes, nocturnal hypoglycemia, severe hypoglycemia, postprandial glucose, and HbA1c.
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Affiliation(s)
- Karla F. S. Melo
- Diabetes Division, Hospital de Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes, Rua Afonso Brás, Rua Afonso Brás, 579, cjs 72/74, Vila Nova Conceição, 04511-011 São Paulo, SP Brazil
- Quasar Telemedicina Ltda, São Paulo, Brazil
| | - Luciana R. Bahia
- Sociedade Brasileira de Diabetes, Rua Afonso Brás, Rua Afonso Brás, 579, cjs 72/74, Vila Nova Conceição, 04511-011 São Paulo, SP Brazil
- Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Bruna Pasinato
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Rachel Riera
- Cochrane Brazil, São Paulo, Brazil
- School of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis E. P. Calliari
- Pediatric Endocrine Unit, Pediatric Department, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Walter J. Minicucci
- Sociedade Brasileira de Diabetes, Rua Afonso Brás, Rua Afonso Brás, 579, cjs 72/74, Vila Nova Conceição, 04511-011 São Paulo, SP Brazil
| | - Luiz A. A. Turatti
- Sociedade Brasileira de Diabetes, Rua Afonso Brás, Rua Afonso Brás, 579, cjs 72/74, Vila Nova Conceição, 04511-011 São Paulo, SP Brazil
| | - Hermelinda C. Pedrosa
- Sociedade Brasileira de Diabetes, Rua Afonso Brás, Rua Afonso Brás, 579, cjs 72/74, Vila Nova Conceição, 04511-011 São Paulo, SP Brazil
| | - Beatriz D. Schaan
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Toscano CM, Sugita TH, Rosa MQM, Pedrosa HC, Rosa RDS, Bahia LR. Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study. Int J Environ Res Public Health 2018; 15:ijerph15010089. [PMID: 29316689 PMCID: PMC5800188 DOI: 10.3390/ijerph15010089] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 12/30/2022]
Abstract
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.
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Affiliation(s)
- Cristiana M Toscano
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Tatiana H Sugita
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Michelle Q M Rosa
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| | | | - Roger Dos S Rosa
- Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Luciana R Bahia
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
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Calliari LE, Cudizio L, Tschiedel B, Pedrosa HC, Rea R, Pimazoni-Netto A, Hirsch L, Strauss K. Insulin Injection Technique Questionnaire: results of an international study comparing Brazil, Latin America and World data. Diabetol Metab Syndr 2018; 10:85. [PMID: 30498521 PMCID: PMC6258451 DOI: 10.1186/s13098-018-0389-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/21/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In 2014-2015, the largest international survey of insulin injection technique in patients with diabetes taking insulin was conducted in 42 countries, totaling 13,289 participants. In Brazil, patients from five public health centers were included. This study aims to evaluate insulin injection technique in Brazilian patients and compare results with Latin America (LatAm) and World data. METHODS The insulin Injection Technique Questionnaire (ITQ) survey consisted of an initial patient section (questions applied by an experienced nurse), followed by observation of injection technique and examination of the injection sites by the health care professional. RESULTS In Brazil, 255 patients were evaluated: 25% had type 1 diabetes mellitus (T1DM) and 75% had T2DM. In this study, 79% of patients injected less than 4 times a day, and 17.3% used insulin pens, compared to 28% in LatAm and 86% worldwide. Syringes were used by 78% of patients in Brazil, compared to 65% in LatAm and 10% globally. Differences in needle length were substantial-nearly 64% in Brazil inject with 8 mm length needle compared to 48% in LatAm and 27% worldwide. Additionally, 48% of patients in Brazil skip doses, 80% reuse pen needles and 57% reuse syringes with 27% having lipohypertrophy by exam. CONCLUSION Brazilian patients use syringes more and pens less, inject with larger needles and have more lipohypertrophy when compared to Latin America and World data. Their re-use of needles and syringes is also high. This study showed that in Brazil, teaching of proper injection technique has to be more widespread, and more intensive during diabetes educational sessions, and the type of delivered supplies must be updated to smaller, shorter needles preferred by patients, in order to facilitate adherence to treatment. From the ITQ, we conclude that there are many aspects of insulin injection technique that may be improved in Brazil.
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Affiliation(s)
- Luis Eduardo Calliari
- Pediatric Endocrine Unit, Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, SP Brazil
| | - Laura Cudizio
- Pediatric Endocrine Unit, Department of Pediatrics, Santa Casa de Sao Paulo, Sao Paulo, SP Brazil
| | | | - Hermelinda C. Pedrosa
- Endocrinology Unit and Research Center–FEPECS, Taguatinga Regional Hospital, Secretariat of Health, Brasília, DF Brazil
| | - Rosangela Rea
- Diabetes Unit, Endocrinology and Metabolism Service, Federal University of Parana, Curitiba, PR Brazil
| | - Augusto Pimazoni-Netto
- Diabetes, Education and Control Group, Kidney Hospital, Federal University of Sao Paulo, Sao Paulo, SP Brazil
| | - Laurence Hirsch
- VP Medical Affairs, BD Diabetes Care, Franklin Lakes, NJ USA
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Eliaschewitz FG, de Paula MA, Pedrosa HC, Pires AC, Salles JEN, Tambascia MA, A Turatti LA. Barriers to insulin initiation in elderly patients with type 2 diabetes mellitus in Brazil. Diabetes Metab Syndr 2018; 12:39-44. [PMID: 28864058 DOI: 10.1016/j.dsx.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 12/25/2022]
Abstract
AIMS We aimed to explore insulin initiation barriers in the Brazilian Type 2 Diabetes Mellitus (T2DM) elderly population, according to the physician's perspective, and suggest strategies to overcome them. METHODS A 45-questions survey addressing issues as clinical characteristics, barriers to insulinization, and treatment strategies in elderly patients with T2DM, was sent to six endocrinologists from different Brazilian locations. Thereafter, all the respondents participated in a panel discussion to validate their responses and collect additional relevant data. RESULTS Endocrinologists had at least 15 years of experience, with a mean of 63 elderly patients per month. Nearly 25% of the elderly patients were treated in the Brazilian public healthcare system (SUS, Unified Health System); only a quarter presented proper glycemic control. In contrast, 55% of the patients from private healthcare system presented adequate glycemic control. The main barriers for insulin initiation for patients, according to physicians' perspective, are side effects and negative perception over treatment (100%). For endocrinologists, main barriers were lack of time to guide patients and concern over side effects (83%). Therefore, specialists considered education for both healthcare professionals and patients as one of the most important strategies to circumvent the current scenario related insulin therapy among elderly patients in the country. CONCLUSION Insulin therapy remains underused due to several barriers, such as concern over side effects and negative perception. Educational measures for patients and HCPs could improve the current scenario.
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Affiliation(s)
- Freddy G Eliaschewitz
- Centro de Pesquisas Clínicas, Rua Goias, 193, São Paulo, São Paulo, 01244-030, Brazil.
| | - Mauricio A de Paula
- Medical Manager at Sanofi, Avenida Major Sylvio de Magalhães Padilha, 5200, São Paulo, São Paulo, 05693-000, Brazil.
| | - Hermelinda C Pedrosa
- Unidade de Endocrinologia-Polo de Pesquisa, Hospital Regional de Taguatinga, Secretaria de Estado de Saúde do Distrito Federal, St. C Norte Área Especial 24, Taguatinga Norte, Brasília, Distrito Federal, 72120-970, Brazil.
| | - Antônio Carlos Pires
- Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil.
| | - João Eduardo N Salles
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Motta Júnior, 61, São Paulo, São Paulo, 01221-020, Brazil.
| | - Marcos Antônio Tambascia
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo, 13083-887, Brazil.
| | - Luiz Alberto A Turatti
- Sociedade Brasileira de Diabetes, Rua Afonso Braz, 579, São Paulo, São Paulo, 04511-011, Brazil.
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Parisi MCR, Moura Neto A, Menezes FH, Gomes MB, Teixeira RM, de Oliveira JEP, Pereira JRD, Fonseca RMC, Guedes LBA, Costa e Forti A, de Oliveira AMA, de Medeiros Nóbrega MB, Colares VNQ, Schmid H, Nienov OH, Nery M, Fernandes TD, Pedrosa HC, Schreiber de Oliveira CDS, Ronsoni M, Rezende KF, Quilici MTV, Vieira AEF, de Macedo GMC, Stuchi-Perez EG, Dinhane KGI, Pace AE, de Freitas MCF, Calsolari MR, Saad MJA. Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study. Diabetol Metab Syndr 2016; 8:25. [PMID: 26989446 PMCID: PMC4794830 DOI: 10.1186/s13098-016-0126-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/25/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. METHODS This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. RESULTS Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. CONCLUSIONS Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.
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Affiliation(s)
- Maria Candida R. Parisi
- />Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil
- />Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Arnaldo Moura Neto
- />Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil
| | - Fabio H. Menezes
- />Faculty of Medical Sciences, State University of Campinas, Campinas, SP 13083-887 Brazil
| | - Marilia Brito Gomes
- />Unity of Diabetes, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | - Helena Schmid
- />Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Santa Casa de Porto Alegre, Porto Alegre, RS Brazil
| | - Otto Henrique Nienov
- />Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Santa Casa de Porto Alegre, Porto Alegre, RS Brazil
| | - Marcia Nery
- />Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Túlio Diniz Fernandes
- />Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Marcelo Ronsoni
- />Faculdade de Medicina, Federal University of Santa Catarina, Florianopolis, Brazil
| | | | | | | | | | | | | | - Ana Emilia Pace
- />Universidade de São Paulo, Faculdade de Medicina, Ribeirão Preto, Brazil
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Gomes MB, Negrato CA, Cobas R, Tannus LRM, Gonçalves PR, da Silva PCB, Carneiro JRI, Matheus ASM, Dib SA, Azevedo MJ, Nery M, Rodacki M, Zajdenverg L, Montenegro Junior RM, Sepulveda J, Calliari LE, Jezini D, Braga N, Luescher JL, Berardo RS, Arruda-Marques MC, Noronha RM, Manna TD, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes MDFS, Dualib P, Silva SC, Sampaio E, Rea R, Faria ACR, Tschiedel B, Lavigne S, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Tolentino M, Pedrosa HC, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Matos OS, Palma CC, Azulay R, Forti AC, Façanha C, Montenegro AP, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM. Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil. Diabetol Metab Syndr 2014; 6:67. [PMID: 24920963 PMCID: PMC4052842 DOI: 10.1186/1758-5996-6-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Marilia Brito Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Roberta Cobas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Lucianne Righeti Monteiro Tannus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Paolla Ribeiro Gonçalves
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Pedro Carlos Barreto da Silva
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - João Regis Ivar Carneiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Sergio Atala Dib
- Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Márcia Nery
- Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Melanie Rodacki
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Neuza Braga
- Hospital Geral de Bonsucesso, Rio de Janeiro, Brazil
| | - Jorge L Luescher
- Hospital Universitário Clementino Fraga Filho – IPPMG, Rio de Janeiro, Brazil
| | | | | | - Renata M Noronha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Thais D Manna
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Salvodelli
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda G Penha
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Milton C Foss
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil
| | - Maria C Foss-Freitas
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil
| | - Antonio C Pires
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | - Fernando C Robles
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | | | - Patricia Dualib
- Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil
| | - Saulo C Silva
- Clínica de Endocrinologia da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Rosangela Rea
- Hospital de Clínicas da Universidade Federal do Paraná, Porto Alegre, Brazil
| | | | - Balduino Tschiedel
- Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Suzana Lavigne
- Instituto da Criança com Diabete Rio Grande Sul, Rio Grande do Sul, Brazil
| | - Luis Henrique Canani
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | - Alessandra T Zucatti
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | | | | | | | | | | | - Flaviane A Prado
- Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil
| | | | | | | | - Alexis D Guedes
- Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil
| | - Odelissa S Matos
- Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil
| | - Catia C Palma
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Adriana C Forti
- Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil
| | - Cristina Façanha
- Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil
| | | | - Naira H Melo
- Universidade Federal de Sergipe, Aracaju, Brazil
| | | | - Alberto Ramos
- Hospital Universitário Alcides Carneiro, Campina Grande, Brazil
| | | | - Flavia M Santos
- Hospital Universitário João de Barros Barreto, Pará, Belém, Brazil
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Davison KAK, Negrato CA, Cobas R, Matheus A, Tannus L, Palma CS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, Araújo NBC, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo A Marques M, Calliari LE, Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, de Fatima Guedes M, Dib SA, Dualib P, Silva SC, Sepúlveda J, Sampaio E, Rea RR, Faria ACRA, Tschiedel B, Lavigne S, Cardozo GA, Pires AC, Robles FC, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Mattos OS, Faria M, Azulay R, Forti AC, Façanha CFS, Montenegro R, Montenegro AP, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM, Jezini DL, Gomes MB. Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil. Nutr J 2014; 13:19. [PMID: 24607084 PMCID: PMC3995939 DOI: 10.1186/1475-2891-13-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/25/2014] [Indexed: 11/28/2022] Open
Abstract
Background To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. Methods This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years. Results Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01). Conclusions Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.
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Affiliation(s)
- Kariane A K Davison
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
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10
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Gomes MB, Cobas RA, Matheus AS, Tannus LR, Negrato CA, Rodacki M, Braga N, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Arruda-Marques MDC, Calliari LE, Noronha RM, Manna TD, Zajdenverg L, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes M, Dib SA, Dualib P, Silva SC, Sepulvida J, Almeida HG, Sampaio E, Rea R, Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo MJ, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Tolentino M, Pedrosa HC, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Matos OS, Faria M, Azulay R, Forti AC, Façanha C, Montenegro AP, Montenegro R, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM, Jezini DL, Cordeiro MM. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2012; 4:44. [PMID: 23107314 PMCID: PMC3538646 DOI: 10.1186/1758-5996-4-44] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/19/2012] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Marília B Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Roberta A Cobas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alessandra S Matheus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Lucianne R Tannus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Carlos Antonio Negrato
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Neuza Braga
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marilena M Cordeiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Jorge L Luescher
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renata S Berardo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marcia Nery
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Maria do Carmo Arruda-Marques
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luiz E Calliari
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renata M Noronha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Thais D Manna
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Roberta Salvodelli
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Fernanda G Penha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Milton C Foss
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Maria C Foss-Freitas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Antonio C Pires
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Fernando C Robles
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - MariadeFátimaS Guedes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Sergio A Dib
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Patricia Dualib
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Saulo C Silva
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Janice Sepulvida
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Henriqueta G Almeida
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Emerson Sampaio
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Rosangela Rea
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Ana Cristina R Faria
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Balduino Tschiedel
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Suzana Lavigne
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Gustavo A Cardozo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Mirela J Azevedo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luis Henrique Canani
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alessandra T Zucatti
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marisa Helena C Coral
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Daniela Aline Pereira
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luiz Antonio Araujo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Monica Tolentino
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Hermelinda C Pedrosa
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Flaviane A Prado
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Nelson Rassi
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Leticia B Araujo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Reine Marie C Fonseca
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alexis D Guedes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Odelissa S Matos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Manuel Faria
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Rossana Azulay
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Adriana C Forti
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Cristina Façanha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Ana Paula Montenegro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renan Montenegro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Naira H Melo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Karla F Rezende
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alberto Ramos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - João Sooares Felicio
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Flavia M Santos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Deborah L Jezini
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marilena M Cordeiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
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Rezende KF, Ferraz MB, Malerbi DA, Melo NH, Nunes MP, Pedrosa HC, Chacra AR. Predicted annual costs for inpatients with diabetes and foot ulcers in a developing country-a simulation of the current situation in Brazil. Diabet Med 2010; 27:109-12. [PMID: 20121897 DOI: 10.1111/j.1464-5491.2009.02871.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS The objective of this cost-of-illness analysis was to quantify the annual costs associated with hospital admission for people with diabetes and foot ulcers in Brazil. METHODS A hypothetical cohort was simulated using a decision tree model. Prevalence and incidence rates and clinical outcomes were estimated from published studies and applied to the general Brazilian population over 30 years. Costs were quoted in Brazilian real (BRL) and converted to US dollars ($US) at the 2008 currency exchange rate ($US1 = BRL 1.64). In the sensitivity analysis, we reduced and increased rates to assess the robustness of the cost estimates. RESULTS In this hypothetical cohort there are 6.48 million (95% confidence interval 4.47-7.12) Brazilians citizens with Type 2 diabetes. Each year, approximately 323,000 (89,500-484,500) of these people develop foot ulcers and almost 97,200 (17,900-169,600) require hospital admission as a result. Each year, almost 46,300 (8500-80,900) limb amputations and 12,400 (2300-21,700) deaths occur as a result of diabetic foot disease in Brazil. The annual cost associated with these hospital admissions is estimated to be almost $US264m ($US51m-461m). The estimated cost for patients with amputation is nearly $US128m ($US24.5m-222.3m). CONCLUSIONS Our model shows that the social and economic impact of diabetic foot disease in Brazil is high. Government decision makers should reflect on the current situation and provide organized foot care throughout the whole country.
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Affiliation(s)
- K F Rezende
- Sergipe Federal University, Aracaju, Brazil.
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Abstract
Although excess ethanol consumption is often considered to lead to adiposity, the metabolic routes by which this might occur are not clear. We have investigated some metabolic consequences of acute ethanol ingestion by measuring arteriovenous differences across forearm muscle and subcutaneous adipose tissue for 6 hours after ingestion of 47.5 g ethanol, in seven normal subjects fasted overnight. The expected systemic effects of ethanol ingestion were observed: slight lowering of the plasma glucose concentration, depression of plasma nonesterified fatty acid (NEFA) concentrations, and elevation of the blood lactate/pyruvate and 3-hydroxybutyrate/acetoacetate ratios. There was a marked reduction in blood total ketone bodies in relation to plasma NEFA concentrations. However, the only major change observed in peripheral tissue metabolism was an increased uptake of acetate into forearm muscle, equivalent, in whole-body terms, to only 3% of the ethanol load. Adipose tissue appeared to show a reduced cytoplasmic state in that it exported an increased ratio of lactate to pyruvate after ethanol ingestion. However, this reduced state did not lead to increased fatty acid reesterification within adipose tissue. No mechanism was clearly identified whereby ethanol ingestion might lead to net deposition of triacylglycerol in adipose tissue.
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Affiliation(s)
- K N Frayn
- Sheikh Rashid Diabetes Unit, Radcliffe Infirmary, Oxford, UK
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