Related Experiment Video
Updated: May 16, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Are diabetes management guidelines applicable in 'real life'?
Luciana V Viana1, Cristiane B Leitão, Maria de Fátima Grillo
1Endocrine Division and Primary Care Unit, Hospital de Clinicas de Porto Alegre and Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350 - Prédio 12 - 4° andar, Porto Alegre, RS 90035-003, Brazil. jorgeluizgross@gmail.com.
Diabetology & Metabolic Syndrome
|November 23, 2012
Summary
Implementing American Diabetes Association (ADA) guidelines in Brazil
Area of Science:
- Endocrinology
- Public Health
- Diabetes Management
Background:
- American Diabetes Association (ADA) treatment algorithms lack real-world validation.
- Assessing feasibility of ADA guidelines within Brazil's public healthcare system.
Purpose of the Study:
- To evaluate the effectiveness of ADA guidelines in achieving HbA1c <7.0% in Brazil.
- To analyze resource utilization in a public healthcare setting for diabetes management.
Main Methods:
- One-year, single-arm interventional study in a Brazilian primary care unit.
- Intensified lifestyle changes and sequential pharmacotherapy based on ADA guidelines.
- Utilized medications available through the Unified Health System (SUS).
Main Results:
- Increased OAD classes, OAD pills, and insulin dosage per patient.
- Higher insulin initiation rate, but no significant improvement in mean HbA1c (7.2% vs. 7.3%).
- No significant change in the proportion of patients achieving HbA1c <7% (53.3% vs. 48.9%).
Conclusions:
- ADA/EASD guidelines achieved HbA1c <7% in a small proportion of patients.
- Feasibility of ADA guidelines is limited within Brazil's public healthcare system.
- Further strategies are needed to improve glycemic control in this population.
Related Concept Videos
01:15Diabetes: Management and Pharmacotherapy
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:22Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
01:22Diabetes Mellitus: Overview and Type I Subtype
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:25Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
Type 2 diabetes mellitus develops gradually and is often asymptomatic in early stages.Clinical ManifestationsWhen symptoms appear, they include fatigue, blurred vision, pruritus, delayed wound healing, and recurrent infections, particularly candidal infections. Peripheral neuropathy may present as numbness or tingling in the extremities. Classic hyperglycemia symptoms—polyuria, polydipsia, and polyphagia—are less common. Most patients are overweight and frequently have associated hypertension...
01:15Diabetes: Symptoms, Diagnosis, and Complications
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is based on...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...