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.