Assessment of arterial stiffness in type 1 diabetes using digital pulse contour analysis: Is it a reliable method?

AIMS: The aim of this study was to assess the arterial stiffness in patients with type 1 diabetes compared with a control group and determine the associated potential risk factors for its occurrence. METHODS: Fifty-seven subjects with type 1 diabetes and fifty-three healthy controls were submitted to clinical and laboratory evaluation. The peripheral waveform pressure was analyzed to assess arterial stiffness according to the reflection and stiffness index. RESULTS: Arterial stiffness did not differ between the controls and patients with type 1 diabetes. Pulse pressure showed no difference among both groups. In the group of patients with type 1 diabetes, the stiffness index was correlated with diabetes duration (r = 0.59, p < 0.001), body mass index (r = 0.27, p = 0.03), diastolic blood pressure (r = 0.33, p = 0.001), triglycerides (r = 0.35, p = 0.007), and age (r = 0.46, p < 0.001). The reflection index was correlated with the systolic blood pressure (r = 0.29, p = 0.02), diastolic blood pressure (r = 0.30, p = 0.02), and cardiac frequency (r = 0.48, p < 0.001). In the stepwise multivariate analysis, disease duration, diastolic blood pressure, and HDL cholesterol were the most important independent variables associated with arterial stiffness in patients with type 1 diabetes. CONCLUSIONS: We concluded that in the studied population, arterial stiffness showed no difference between patients with diabetes and controls; thus, the use of this method should not be indicated for routine clinical practice in type 1 diabetes.

Heterogeneity in the costs of type 1 diabetes in a developing country: what are the determining factors?

BACKGROUND AND AIMS: Regional differences in the clinical care of Type 1 diabetes (T1D) in Brazil have been recently described. This study aimed to estimate the costs of T1D from the public health care system's perspective across the regions of Brazil and to determine the components that influence these costs. METHODS: This was a retrospective, cross-sectional and nationwide multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The study included 3,180 T1D subjects receiving healthcare from the National Brazilian Healthcare System (NBHCS) with a follow-up of at least one year. The direct medical costs were derived from the costs of medications, supplies, examinations, visits to the center, medical procedures and hospitalizations that occurred during the previous year. Clinical and demographic factors that determined the differences in the cost across four geographic regions (southeast, south, north/northeast and mid-west) were investigated. RESULTS: The per capita mean annual direct medical costs of T1D in US$ were 1,466.36, 1,252.83, 1,148.09 and 1,396.30 in southeast, south, north/northeast and mid-west regions, respectively. The costs of T1D in the southeast region were higher compared to south (p < 0.001) and north/northeast regions (p = < 0.001), but not to the mid-west (p = 0.146) region. The frequency of self-monitoring of blood glucose (SMBG) was different across the regions as well as the daily number of SMBG, use of insulin pumps or basal or prandial insulin analogs. Age, ethnicity, duration of diabetes, level of care, socioeconomic status and the prevalence of chronic diabetic complications differed among the regions. In a regression model the determinants of the costs were the presence of microvascular diabetes-related complications (p < 0.001), higher economic status (p < 0.001), and being from the southeast region (p < 0.001). CONCLUSIONS: The present data reinforce the regional differences in the costs of T1D and in the socioeconomic profile and health care provided to the patients with T1D in specialized public centers in Brazil. Both factors influenced directly the costs of T1D and should be considered for discussing future health policies.

Prevalence, awareness, and treatment of hypertension in patients with type 1 diabetes: a nationwide multicenter study in Brazil.

Objective. This study evaluated the prevalence, awareness, and type of treatment for hypertension in Brazil in patients with type 1 diabetes (T1D). Methods. This was a cross-sectional, multicenter study that was conducted from December 2008 to December 2010 in 28 public clinics located in 20 Brazilian cities. Results. A total of 3,591 patients were studied, 56% female, average age 21.2 ± 11.7 years, with a median duration of diabetes 9.6 ± 8.1 years. Blood pressure levels were available for a total of 3,323 patients and 689 (19.2%) patients were hypertensive. Hypertensive patients were older, exhibited longer duration of diabetes, and had higher body mass index (BMI), total cholesterol, triglycerides, and LDL-C values (P < 0.001, for all comparisons), but only 370 (53.7%) received treatment. Patient awareness of hypertension was documented in 453 (65.5%) patients. However, only 76 (22.9%) of the treated patients attained the target systolic (sBP) and diastolic blood pressures (dBP). Conclusions. Our results demonstrate that a large number of T1D patients with hypertension do not receive appropriate treatment; few of the treated T1D patients achieved the target sBP and dBP values. Greater attention should be paid to blood pressure evaluation, hypertension diagnosis, and treatment of T1D patients in Brazil.