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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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Felício JS, de Souza ACCB, Koury CC, Neto JFA, Miléo KB, Santos FM, Motta ARB, Silva DD, Arbage TP, Carvalho CT, de Rider Brito HA, Yamada ES, Cobas RA, Matheus A, Tannus L, Palma CCS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, de Araújo NBC, de Menezes Cordeiro M, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo Arruda Marques M, Calliari LE, de Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Negrato CA, de Fatima Guedes M, Dib SA, Dualib P, da Silva SC, Sepúlveda J, Sampaio E, Rea RR, de Almeida Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, de Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, de Araujo LB, Fonseca RMC, Guedes AD, de Mattos OS, Faria M, Azulay R, e Forti AC, Façanha CFS, Junior RM, Montenegro AP, Melo NH, Rezende KF, Ramos A, Jezini DL, Gomes MB. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2015; 7:87. [PMID: 26448787 PMCID: PMC4596564 DOI: 10.1186/s13098-015-0081-9] [Citation(s) in RCA: 6] [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: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
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Affiliation(s)
- João Soares Felício
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Camila Cavalcante Koury
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - João Felício Abrahão Neto
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Karem Barbosa Miléo
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Flávia Marques Santos
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Regina Bastos Motta
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Denisson Dias Silva
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Thaís Pontes Arbage
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Carolina Tavares Carvalho
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Hana Andrade de Rider Brito
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Elizabeth Sumi Yamada
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Roberta Arnoldi Cobas
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Alessandra Matheus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lucianne Tannus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Catia Cristina Sousa Palma
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Leticia Japiassu
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - João Regis Ivar Carneiro
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Melanie Rodacki
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lenita Zajdenverg
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | | | | | - Jorge Luiz Luescher
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Renata Szundy Berardo
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Marcia Nery
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Catarina Cani
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | | | | | | | - Thais Della Manna
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Roberta Savoldelli
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Fernanda Garcia Penha
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Milton Cesar Foss
- />Ribeirão Preto Medical School of São Paulo University, Ribeirão Preto, Brazil
| | | | - Antonio Carlos Pires
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | - Fernando Cesar Robles
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | | | | | - Sergio Atala Dib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | - Patricia Dualib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Janice Sepúlveda
- />Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Emerson Sampaio
- />Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil
| | | | | | - Balduino Tschiedel
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | - Suzana Lavigne
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | | | - Mirela Azevedo
- />Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Faria
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | - Rossana Azulay
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | | | | | | | | | | | | | - Alberto Ramos
- />Federal University Hospital of Campina Grande, Campina Grande, Paraíba Brazil
| | - Deborah Laredo Jezini
- />Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas Brazil
| | - Marilia Brito Gomes
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
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