Abstract
Objective: The objective of this study is to evaluate glycemic control, comorbidities, diabetes-related complications, and mortality among people with DM followed-up at an outpatient clinic based at a Diabetes Association in Brazil. Methods: Sociodemographic, medical and mortality data were obtained from 1,173 patients with type 1 (T1DM) and type 2 diabetes (T2DM) who were evaluated once between 1996-2011 and whose vital status was checked in 2022. Data were analyzed using statistical tests to find out different characteristics between patients with DM1 and DM2. Results: 204 patients had T1DM (17.3%), 969 T2DM (82.6%) and 404 (34.4%) died during the study period (2.8% T1DM and 31.6% T2DM). Among T1DM, 82.3% had inadequate glycemic control, 61.2% had no associated comorbidity and presented varied causes of death. Regarding T2DM, 64.18% had inadequate glycemic control, had more comorbidities, higher rates of smoking and died more frequently due to cardiovascular diseases. Conclusion: Based on glycemic control, current care model provided needs to be rethought to provide more frequent clinical follow-up and structured education. Training health professionals, general practitioners and specialists is urgently needed as well as further long-term prospective studies in this topic.
References
ALI MK, et al. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia, 2022; 65(1): 3-13.
AMERICAN DIABETES ASSOCIATION. Standards of Medical Care in Diabetes. Diabetes Care, 2021; 1(44).
ARMSTRONG DG, et al. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med 2017; 376: 2367-75.
BARROSO WKS, et al. Diretrizes Brasileiras de Hipertensão Arterial – 2020. Arq. Bras. Cardiol., 2021;116(3): 516-658.
BERTOLUCI MC, et al. Diretriz Oficial da Sociedade Brasileira de Diabetes. 2022nd ed., Conectando Pessoas, 2022.
BRASIL. Ministério da Saúde. Programa Farmácia Popular do Brasil: manual básico. Fundação Oswaldo Cruz. Brasília: Editora do Ministério da Saúde, 2005.
BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde. Vigitel Brasil 2011: Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Ministério da Saúde, Secretaria de Vigilância em Saúde – Brasília: Ministério da Saúde, 2012.
CHATURVEDI N, et al. EURODIAB Prospective Complications Study. Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes. Diabetes Care, 2001; 24(2): 284-9.
DAVISON KA, et al. Brazilian Type 1 Diabetes Study Group (BrazDiab1SG). 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 Mar 7; 13:19.
EEG-OLOFSSON K, et al. Glycemic control and cardiovascular disease in 7,454 patients with type 1 diabetes: an observational study from the Swedish National Diabetes Register (NDR). Diabetes Care, 2010; 33(7): 1640-6.
FALUDI AA, et al. Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose - 2017. Arquivos Brasileiros de Cardiologia, 2017; 109(1).
FARIA AN, et al. Tratamento de Diabetes Mellitus e Hipertensão Arterial no paciente obeso. In: -- Arquivo Brasileiro de Endocrinologia Metabólica, 2022; 46(2): p.137-142.
FERRANNINI E, CUSHMAN WC. Diabetes and hypertension: the bad companions. Lancet. 2012 Aug 11; 380(9841): 601-10.
FRIEDEWALD WT, et al. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972, 18; 499-502.
GOMES MB, et al. Prevalência de sobrepeso e obesidade em pacientes com diabetes mellitus do tipo 2 no Brasil: estudo multicêntrico nacional [Nationwide multicenter study on the prevalence of overweight and obesity in type 2 diabetes mellitus in the Brazilian population]. Arq Bras Endocrinol Metabol. 2006 Feb; 50(1): 136-44.
GOMES MB, NEGRATO CA. Adherence to insulin therapeutic regimens in patients with type 1 diabetes. A nationwide survey in Brazil, Diabetes Research and Clinical Practice, 2016; 120: p47-55, ISSN 0168-8227.
GORDON DJ, et al. High-density lipoprotein cholesterol and cardiovascular disease. Four pro-spective American studies. Circulation. 1989; 79: 8-15.
IGLAY K, et al. Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin. 2016 Jul; 32(7): 1243-52.
INTERNATIONAL DIABETES FEDERATION. IDF. Diabetes and cardiovascular disease. Brussels, Belgium: International Diabetes Federation, 2016; p. 1–144 .
INTERNATIONAL DIABETES FEDERATION. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021.
INTERNATIONAL WORKING GROUP ON THE DIABETIC FOOT. IWGDF. Consenso Internacional, tradução integral de Pedrosa HC e Andrade AC. Secretaria de Estado de Saúde do Distrito Federal, 2001.
JIA G, SOWERS JR. Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease. Hypertension., 2021; 78(5): 1197-1205.
LUNETTA M, et al. A simplified diagnostic test for ambulatory screening of peripheral diabetic neuropathy. Diabetes Res Clin Pract. 1998; 39(3): 165-72.
MENDES AB, et al. Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol, 2010; 47(2): 137-45.
MILLER KM, et al. T1D Exchange Clinic Network Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry..Diabetes Care, 2015; 38(6): 971-8.
MORAES CMD et al. Prevalência de sobrepeso e obesidade em pacientes com diabetes tipo 1. Arquivos Brasileiros de Endocrinologia & Metabologia [online], 2003; 47(6).
NETTEN, JAAP J., et al. Definitions and Criteria for Diabetic Foot Disease. Diabetes/Metabolism Research and Reviews, 2020; 36(S1).
NORDESTGAARD BG, et al. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007; 298: 299-308.
PITITTO B, et al. Metas no tratamento do diabetes. Diretriz Oficial da Sociedade Brasileira de Diabetes (2022).
PORTA M, BANDELLO F. Diabetic retinopathy. A clinical update. Diabetologia. 2002; 45: 1617-34.
POUPLIER S, et al. The development of multimorbidity during 16 years after diagnosis of type 2 diabetes. J Comorb. , 2018; 24; 8(1):2235042X18801658.
RITZ E. Nephropathy in type 2 diabetes. J Intern Med, 1999; 245(2): 111-26.
ROSSING P, et al. “KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease.” Kidney International, 2022; 102(5); pp. S1–127.
RZEWUSKA M, et al. Epidemiology of multimorbidity within the Brazilian adult general population: evidence from the 2013 National Health Survey (PNS 2013). PLoS One. 2017; 12(2): e0171813.
ŚLIWIŃSKA-MOSSOŃ M, MILNEROWICZ H. The impact of smoking on the development of diabetes and its complications. Diab Vasc Dis Res, 2017; 14(4): 265-276.
SOWERS JR. Recommendations for special populations: diabetes mellitus and the metabolic syndrome. Am J Hypertens, 2003; 16(11 Pt 2): 41S-45S.
TOLONEN N, et al. Finndiane Study Group. Relationship between lipid profiles and kidney function in patients with type 1 diabetes.Diabetologia, 2008; 51(1): 12-20.
VAN DEN BOOM L, et al. Multimorbidity Among Adult Outpatients With Type 1 Diabetes in Germany. Journal of Diabetes Science and Technology., 2022; 16(1): 152-160.
WORLD HEALTH ORGANIZATION. WHO. Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation. In WHO Obesity. Technical Report Series, n.284. Genova: World Health Organization; 2000:256.
WORLD HEALTH ORGANIZATION. WHO. WHO global report on trends in prevalence of tobacco use 2000–2025, 4th ed. World Health Organization. 2021.
