Original Data

Prevalence of Type 2 Diabetic Patients Within the Targets of Care Guidelines in Daily Clinical Practice: A Multi-Center Study in Brazil

Marilia de Brito Gomes¹, Daniel Gianella², Manuel Faria³, Marcos Tambascia⁴, Reine Marie Fonseca⁵, Rosangela Réa⁶, Geísa Macedo⁷, João Modesto Filho⁸, Helena Schmid⁹, Alcina Vinhaes Bittencourt¹⁰, Saulo Cavalcanti¹¹, Nelson Rassi^12,13, Hermelinda Pedrosa¹³, Sérgio Atala Dib¹⁴

Keywords: glycemic control, type 2 diabetes, blood pressure control, guidelines, diabetic complications

Abstract

Major clinical studies have shown that the targets for blood glucose, lipid profile and blood pressure in type 2 diabetic patients are difficult to maintain in clinical practice. However, there are few data concerning South American populations. Using guidelines represented by the Brazilian Diabetes Society, we evaluated cardiovascular (CV) risk factors, glycemic control and the availability of screening for diabetes complications in 2233 (60% females) outpatients with type 2 diabetes aged 59.2 ± 11.3 yr and with a known duration of diabetes of 9.2 ± 7.2 yr, collected from 8 Brazilian cities. The outcome showed that less intensive clinical care available for diabetic patients in Brazil compared to western industrialized countries leads to widespread poor metabolic control and health status. Less than 30% of the patients reached the target for systolic (28.5%, < 130 mmHg) and diastolic (19.3%, < 80 mmHg) blood pressure, BMI (24.6%, < 25 kg/m2), LDL cholesterol (20.6%, < 2.6 mmol/l) and only 46% reached the goal for HbA1c (one % point above the upper limits of normality for the method used). Only 0.2% of patients reached all the targets. A lower number of women reached the targets for HbA1c, LDL and HDL cholesterol than men (p < 0.001). Women were less likely than men to have funduscopy examinations and urine albumin testing (p < 0.001). We conclude that the national goals for glycemic control, blood pressure and lipid levels are rarely achieved in clinical practice, and that the availability for diabetic complication screening is low. The quality of diabetes care, in particular for women, is poor and should be further reviewed in developing countries.

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