Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil

Abstract

The aim of this study is to evaluate the influence of economic status on clinical care provided to Brazilian youths with type 1 diabetes in daily practice, according to the American Diabetes Association's guidelines. This was a cross-sectional, multicenter study conducted between 2008 and 2010 in 28 public clinics in Brazil. Data were obtained from 1,692 patients (55.3% female, 56.4% Caucasian), with a mean age of 13years (range, 1-18), a mean age at diagnosis of 7.1±4years and diabetes duration of 5±3.7years. Overall, 75% of the patients were of a low or very low economic status. HbA1c goals were reached by 23.2%, LDL cholesterol by 57.9%, systolic blood pressure by 83.9% and diastolic blood pressure by 73.9% of the patients. In total, 20.2% of the patients were overweight and 9.2% were obese. Patients from very low economic status were less likely to attend tertiary care level when compared with those from low, medium and high economic status, 64.2% versus 75.5% versus 78.3% and 74.0%; p<0.001, respectively. The rate of annual screening for retinopathy, nephropathy and for foot alterations was 66.2, 69.7 and 62.7%, respectively. Insulin dose, age, very low economic status, daily frequency of self-blood glucose monitoring and female gender were independently associated with poor glycemic control. Screening for diabetic complications and attaining glucose, lipid and blood pressure goals present a challenge for young Brazilian type 1 diabetes patients. The low economic status of the majority of our patients may represent a barrier to reaching these goals.