Gomes Marilia de Brito, Gianella Daniel, Faria Manuel, Tambascia Marcos, Fonseca Reine Marie, Réa Rosangela, Macedo Geísa, Modesto Filho João, Schmid Helena, Bittencourt Alcina Vinhaes, Cavalcanti Saulo, Rassi Nelson, Pedrosa Hermelinda, Atala Dib Sérgio
Department of Medicine, Unit of Diabetes, State University Hospital of Rio de Janeiro, Brazil.
Rev Diabet Stud. 2006 Summer;3(2):82-7. doi: 10.1900/RDS.2006.3.82. Epub 2006 Aug 10.
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.
主要临床研究表明，2型糖尿病患者的血糖、血脂和血压目标在临床实践中难以维持。然而，关于南美人群的数据很少。我们依据巴西糖尿病协会制定的指南，对来自巴西8个城市的2233名（60%为女性）2型糖尿病门诊患者进行了评估，这些患者年龄为59.2±11.3岁，已知糖尿病病程为9.2±7.2年，评估内容包括心血管（CV）危险因素、血糖控制情况以及糖尿病并发症筛查的可及性。结果显示，与西方工业化国家相比，巴西糖尿病患者可获得的临床护理不够强化，这导致广泛的代谢控制不佳和健康状况较差。不到30%的患者达到收缩压（28.5%，<130 mmHg）和舒张压（19.3%，<80 mmHg）目标、BMI（24.6%，<25 kg/m2）、低密度脂蛋白胆固醇（20.6%，<2.6 mmol/l）目标，只有46%的患者达到糖化血红蛋白目标（比所用方法的正常上限高1个百分点）。只有0.2%的患者达到所有目标。达到糖化血红蛋白、低密度脂蛋白和高密度脂蛋白胆固醇目标的女性人数低于男性（p<0.001）。女性接受眼底检查和尿白蛋白检测的可能性低于男性（p<0.001）。我们得出结论，在临床实践中，很少能实现血糖控制、血压和血脂水平的国家目标，糖尿病并发症筛查的可及性较低。糖尿病护理质量较差，尤其是对女性而言，在发展中国家应进一步审视这一问题。
