Hypoglycemia frequency and treatment satisfaction in patients receiving insulin analogues for treatment of type 1 diabetes mellitus

ABSTRACT Objective: The aim of this study was to evaluate the frequency of hypoglycemia and the treatment satisfaction in patients with type 1 diabetes (T1D) using insulin analogues. Subjects and methods: This observational retrospective study included 516 adult patients with T1D from 38 cities in Southern Brazil. Demographics and clinical data were collected using a self-report questionnaire. Hypoglycemia was defined as an event based on either symptoms or self-monitored blood glucose < 70 mg/dL. Treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and with a specific question with scores ranging from 0-10. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12). Results: Overall, the mean age was 38 ± 14 years and 52% of the participants were women. The median diabetes duration was 18 years. The scores for insulin analogue treatment satisfaction were higher than those for previous treatments. DTSQ scores had a median value of 32 (interquartile range 29-35) and remained unchanged over time. The percentage of patients with hypoglycemia (including severe and nocturnal) was comparable across groups divided according to duration of use of insulin analogues. Most patients (n=395, 77%) screened positive for common mental disorders. Conclusions: Patient satisfaction with insulin analogue treatment was high and remained unchanged with time. Episodes of hypoglycemia also remained unchanged over time among patients using insulin analogues.

Evaluation of severe hypoglycemia and common mental disorders in patients receiving insulin analogues for treatment of type 1 diabetes

ABSTRACT This is a retrospective report of the frequency of severe hypoglycemia and the association between common mental disorders and type 1 diabetes mellitus treated with insulin analogues. Patients with severe hypoglycemia compared with those without this complication had a higher prevalence of positive screening for common mental disorders (88% vs.77%, respectively, p = 0.03).

Criação da Secretaria de Atenção Primária à Saúde e suas implicações para o SUS / Creation of the Primary Health Care Secretariat and its implications for SUS

Resumo Em 20 de maio de 2019, um dia após a celebração mundial do "Dia do Médico de Família", o Ministério da Saúde publicou o Decreto nº 9.795, de 17 de maio de 2019, que alterou o organograma desse órgão federal. Foi criada, pela primeira vez na história do País, uma Secretaria específica responsável pela Atenção Primária à Saúde e pela Estratégia Saúde da Família (ESF), que completou 25 anos em 2019. A nova Secretaria de Atenção Primária à Saúde (SAPS) abriga três departamentos: o já existente Departamento de Ações Programáticas Estratégicas (DAPES), um Departamento de Saúde da Família (DESF) e um novo Departamento de Promoção da Saúde (DPS). A Secretaria apresenta entre suas competências, compromissos que buscam enfrentar desafios de ordem estruturante, mesmo diante de um cenário de restrição orçamentária que vem sendo observado desde 2014. Entre os compromissos colocados estão: (i) ampliação do acesso da população às unidades de saúde da família, (ii) definição de um novo modelo de financiamento baseado em resultados em saúde e eficiência, (iii) definição de um novo modelo de provimento e formação de médicos para áreas remotas, (iv) fortalecimento da clínica e do trabalho em equipe, (v) ampliação da informatização das unidades e prontuário eletrônico.

Abstract On May 20, 2019, one day after the world's celebration of the Family Physician's Day, the Ministry of Health published Decree N. 9,795 of May 17, 2019, which changed the organization chart of this federal body. For the first time in the country's history, a specific Secretariat responsible for Primary Health Care and the Family Health Strategy (ESF) was created. The ESF celebrated its 25th anniversary in 2019. The new Primary Health Care Secretariat (SAPS) has three departments: the already existing Department of Strategic Programmatic Actions (DAPES), a Department of Family Health (DESF) and a new Department of Health Promotion (DPS). The Secretariat has, among its competencies, commitments that seek to meet structural challenges, even in the face of a budget constraint scenario that has been observed since 2014. Among the commitments are: (i) increasing the population's access to family health units , (ii) definition of a new funding model based on health and efficiency results, (iii) definition of a new model for the provision and training of physicians for remote areas, (iv) strengthening of clinic and teamwork, v) expansion of the computerization of units and electronic medical records.

Addition of long-distance heart procurement promotes changes in heart transplant waiting list status / Incorporação da captação à distância promove mudanças na situação dos receptores em fila para transplante cardíaco

Objective: Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list. Methods: Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 26 (36%) and heart recovery occurred in 5 (7%). Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73%) transplants were performed with local donors and 11 (27%) with long-distance donors (mean distance=792 km±397). Results: Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001). Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23) and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank) were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05) with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18). There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09). Conclusion: Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time. .

Objetivo: Mostrar a incorporação da captação a distância em um programa de transplante cardíaco e a situação dos receptores em fila após a organização deste sistema. Métodos: Entre setembro de 2006 e outubro de 2012, 72 pacientes foram incluídos na fila de transplante cardíaco. Transplante cardíaco foi realizado em 41 (57%), óbito em fila em 26 (36%) e melhora clínica em 5 (7%). Inicialmente, todos os transplantes foram realizados com captação local. Em fevereiro de 2011, teve início a captação a distância interestadual. Foram realizados 30 (73%) transplantes com captações locais e 11 (27%) em outros estados (distância média=792 km±397). Resultados: Pacientes submetidos à captação à distância tiveram maior tempo de isquemia fria (212 min±32 versus 90 min±18; P<0,0001). A taxa de disfunção primária de enxerto (distância 9,1% versus local 26,7%; P=0,23) e de sobrevida atuarial em 1 mês e 12 meses (distância 90,1% e 90,1% versus local 90% e 86,2%; P=0,65 log rank) foram similares entre os grupos. Houve expressivo aumento na capacidade do centro em transplantar (64,4% versus 40,7%, P=0,05) com tendência a redução de tempo em fila de espera (mediana 1,5 mês versus 2,4 meses, P=0,18). Houve ainda tendência a redução na mortalidade em fila de espera (28,9% versus 48,2%, P=0,09). Conclusão: A incorporação da captação a distância, apesar de associada a tempos prolongados de isquemia, não aumenta a morbimortalidade após o transplante cardíaco e aumenta o pool de doadores viáveis, podendo diminuir a mortalidade em fila e o tempo de espera por um órgão. .