Key result
Among Brazilian adults with known diabetes, only 28.6% achieved all three targets for glucose, blood pressure, and lipid control, with higher income and private health insurance associated with better target achievement.
Why the study?
Control of glucose, blood pressure, cholesterol, and smoking improves prognosis in diabetes mellitus, but the level of control and correlates of target achievement in Brazilian adults with known diabetes needed evaluation.
Cross-Sectional (n=2,062)
Yes
In a Brazilian cohort of adults with diabetes, only 28.6% achieved combined targets for glucose, blood pressure, and LDL-cholesterol, with social factors strongly influencing control.
Answers are grounded in this paper and cite their sources.
Highlights gaps in combined target achievement among adults with diabetes; leaves open social determinants' role and requires prospective confirmation.
BACKGROUND Control of glucose, blood pressure, cholesterol, and smoking improves the prognosis of individuals with diabetes mellitus. Our objective was to assess the level of control of these risk factors in Brazilian adults with known diabetes and evaluate correlates of target achievement. METHODS Cross-sectional sample of the Brazilian Longitudinal Study of Adult Health, composed of participants reporting a previous diagnosis of diabetes or the use oof antidiabetic medication. We measured glycated hemoglobin (HbA1c) and LDL-cholesterol at a central laboratory and blood pressure following standardized protocols. We defined HbA1c < 7% as glucose control (target A); blood pressure < 140/90 mmHg (or < 130/80 mmHg in high cardiovascular risk) as blood pressure control (target B), and LDL-c < 100 mg/dl (or < 70 mg/dl in high risk) as lipid control (target C), according to the 2022 American Diabetes Association guidelines. RESULTS Among 2062 individuals with diabetes, 1364 (66.1%) reached target A, 1596 (77.4%) target B, and 1086 (52.7%) target C; only 590 (28.6%) achieved all three targets. When also considering a non-smoking target, those achieving all targets dropped to 555 (26.9%). Women (PR = 1.13; 95%CI 1.07–1.20), those aged ≥ 74 (PR = 1.20; 95%CI 1.08–1.34), and those with greater per capita income (e.g., greatest income PR = 1.26; 95%CI 1.10–1.45) were more likely to reach glucose control. Those black (PR = 0.91; 95%CI 0.83-1.00) or with a longer duration of diabetes (e.g., ≥ 10 years PR = 0.43; 95%CI 0.39–0.47) were less likely. Women (PR = 1.05; 95%CI 1.00-1.11) and those with private health insurance (PR = 1.15; 95%CI 1.07–1.23) were more likely to achieve two or more ABC targets; and those black (PR = 0.86; 95%CI 0.79–0.94) and with a longer duration of diabetes (e.g., > 10 years since diabetes diagnosis, PR = 0.68; 95%CI 0.63–0.73) less likely. CONCLUSION There is room for improvement in controlling these modifiable prognostic factors, especially LDL-C. Our findings reinforce the importance of social factors in determining the ABC control of diabetes.
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Chwal et al. (2022) conducted a cross-sectional in Diabetes Mellitus (n=2,062). Sociodemographic and clinical factors vs. Reference groups was evaluated on Achievement of all three ABC targets (glucose, blood pressure, and lipids). Among Brazilian adults with known diabetes, only 28.6% achieved all three targets for glucose, blood pressure, and lipid control, with higher income and private health insurance associated with better target achievement.
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