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

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 13 years (range, 1-18), a mean age at diagnosis of 7.1 ± 4 years and diabetes duration of 5 ± 3.7 years. 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.

The costs of type 2 diabetes mellitus outpatient care in the Brazilian public health system.

OBJECTIVE: The prevalence of type 2 diabetes has shown a significant increase in parallel with health care costs. The objective of the Brazilian Study on Diabetes Costs (ESCUDI study) was to estimate direct and indirect costs of type 2 diabetes outpatient care in the Brazilian Public Health Care System. METHODS: Data were collected from different levels of health care in eight Brazilian cities in 2007. A total of 1000 outpatients were interviewed and had their medical records data analyzed. Direct medical costs included expenses with medications, diagnostic tests, procedures, blood glucose test strips, and office visits. Nonmedical direct costs included expenses with diet products, transportation, and caregivers. Absenteeism, sick leave, and early retirement were classified as indirect costs. RESULTS: Total annual cost for outpatient care was US$2108 per patient, out of which US$1335 per patient of direct costs (63.3%) and US$773 per patient of indirect costs (36.7%). Costs escalated as duration of diabetes and level of health care increased. Patients with both microvascular and macrovascular complications had higher costs (US$3199 per patient) compared to those with either microvascular (US$2062 per patient) or macrovascular (US$2517 per patient) complications only. The greatest portion of direct costs was attributed to medication (48.2%). CONCLUSIONS: Diabetes treatment leads to elevated costs both to Brazilian Public Health Care System and society. Costs increased along with duration of disease, level of care and presence of chronic complications, which suggested a need to reallocate health resources focusing on primary prevention of diabetes and its complications.

Management of prolactinomas in Brazil: an electronic survey.

Dopamine agonists are the treatment of choice for prolactinomas. However, there are still controversies concerning dose, treatment duration and criteria for drug withdrawal in different clinical situations. The aim of this study was to assess diagnostic and therapeutic approaches to prolactinomas among members of the Brazilian Society of Endocrinology and Metabolism (SBEM). SBEM members answered a questionnaire sent by e-mail that included 18 questions related to controversial issues about the management of prolactinomas. Among SBEM members, 721 (approximately 24% of total) answered the questionnaire. Concerning the diagnosis, 38% of the respondents stated that prolactin levels < 100 ng/ml would exclude the presence of a prolactinoma. Most of them favored the screening for macroprolactin in asymptomatic individuals instead of a routine screening (74% vs. 26%). Regarding the treatment, 70% of the respondents chose cabergoline as the drug of choice to treat macroprolactinomas whereas similar proportions advised cabergoline or bromocriptine as the best treatment for microprolactinomas (52% vs. 48%). Only 20% and 34% of respondents favored treatment withdrawal 2-3 years after prolactin normalization in patients with macroprolactinomas and microprolactinomas, respectively. In case of pregnancy, only 58 and 70% of respondents advocated discontinuation of treatment with dopamine agonists in patients with macroprolactinomas and microprolactinomas, respectively. Finally, only 36% would allow breast-feeding without restriction, 44% would restrict it to patients with microprolactinomas and 20% would not recommend it for women with prolactinomas There are several points of disagreement among SBEM members regarding the management of prolactinomas.

Avaliação do programa de rastreamento de doenças congênitas em campina Grande - PB, Brasil / Evaluation of screening program for congenital diseases in Campina Grande - PB, Brazil

INTRODUÇÃO: O hipotiroidismo congênito (HC) e a Fenilcetonúria (PKU) são as causas mais comuns de retardo mental preveníveis e têm os seus cursos naturais dramaticamente modificados, dependendo da época do diagnóstico e da instituição de tratamento adequado. OBJETIVOS: Avaliar o Programa para Rastreamento de HC e PKU, através do "teste do pezinho" na região de Campina Grande, entre O1 /03/00 e 28/02/01. MÉTODO: Avaliamos a cobertura do rastreamento de HC e PKU na cidade de Campina Grande no período; incidência de HC e PKU, idade da coleta; tempo do recebimento do resultado e início do tratamento. RESULTADOS: A cobertura do Programa foi de 32,2 por cento. Não foi diagnosticado nenhum caso de HC ou PKU no período do estudo. No serviço público, a média (ñDP) de idade para a coleta foi de 18,2ñ12,2 dias, e de recebimento 56,7ñ27,4 dias. CONCLUSÃO: A cobertura do programa foi muito baixa no período estudado. O tempo decorrido entre o nascimento e recebimento dos exames é inadequado. O programa deve seguir as normas estabelecidas pelo Ministério da Saúde.

Prevalência de doença tireoideana em pacientes com diabetes tipo 1 / Prevalence of thyroid disease in patients with type 1 diabetes

INTRODUÇÄO: O diabetes mellitus tipo 1 (DM1) freqüentemente se acompanha de outras doenças autoimunes, principalmente doença autoimune da tireóide (DAT). OBJETIVO: Determinar a prevalência de DAT em pacientes com DM1 e investigar possível relacionamento com outros fatores. MÉTODOS: Em 126 pessoas com DM1, foram mensurados TSH, T4 livre, anticorpo anti-peroxidase e hemoglobina A1c. RESULTADOS: DAT foi encontrada em 26 pacientes (20,6 por cento), sendo 11 (8,7 por cento) com hipotireoidismo clínico, 6 (4,8 por cento) com hipotireoidismo subclínico e 9 (7,1 por cento) com tireoidite sem disfunçäo tireoideana. Em um paciente (0,8 por cento), a DAT (hipertireoidismo) precedeu o DM1. Houve relaçäo entre DAT e idade atual e no diagnóstico do DM1. Näo foram encontradas significâncias para sexo, grupo racial, duraçäo do DM, paridade e local de moradia. CONCLUSÖES: A prevalência de DAT é bastante alta para justificar seu rastreamento e está relacionada com a idade atual e a idade do diagnóstico do DM1