Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil

Diabetes is a significant public health burden on the basis of its increased incidence, morbidity, and mortality. This study aimed to estimate the prevalence of inadequate glycaemic control and its correlates in a large multicentre survey of Brazilian patients with diabetes. A cross-sectional study was conducted in a consecutive sample of patients aged 18 years or older with either type 1 or type 2 diabetes, attending health centres located in ten large cities in Brazil (response rate = 84%). Information about diabetes, current medications, complications, diet, and satisfaction with treatment were obtained by trained interviewers, using a standardized questionnaire. Glycated haemoglobin (HbA1c) was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA1c ≥ 7 were considered to have inadequate glycaemic control. Overall 6,701 patients were surveyed, 979 (15%) with type 1 and 5,692 (85%) with type 2 diabetes. The prevalence of inadequate glycaemic control was 76%. Poor glycaemic control was more common in patients with type 1 diabetes (90%) than in those with type 2 (73%), P < 0.001. Characteristics significantly associated with improved glycaemic control included: fewer years of diabetes duration, multi professional care, participation in a diabetes health education program, and satisfaction with current diabetes treatment. Despite increased awareness of the benefits of tight glycaemic control, we found that few diabetic patients in Brazil met recommended glycaemic control targets. This may contribute to increased rates of diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes

Glycemic control and its correlates in patients with diabetes in Venezuela: Results from a nationwide survey

Aims: To determine the prevalence of inadequate glycemic control and its correlates in a large multicenter survey of Venezuelan patients with diabetes.Methods: A cross-sectional study in a sample of adult patients with diabetes, attending health centers in Venezuela. Information about diabetes, current medications, complications, and diet were obtained by trained interviewers, using a standardized questionnaire. HbA(1c) was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA(1c) >= 7% were considered to have inadequate glycemic control.Results: Overall 4075 patients were surveyed, 349(8.6%) with type 1 diabetes (T1D) and 3726(91.4%) with type 2 diabetes(T2D). Subjects' mean age was 58 years, and 65% were female. the prevalence of inadequate glycemic control was 76%. Poor glycemic control was more common in T1D patients (87%) than in those with T2D(75%), p < 10(-4). Satisfaction with current diabetes treatment was associated with improved glycemic control among non-insulin-treated patients with T2D, but gender, multi-professional care, and participation in a diabetes education program were not.Conclusions: Despite clinical evidence supporting tight control of diabetes, few diabetic patients in Venezuela met recommended glycemic control targets. This may contribute to increased rates of diabetic complications. Our findings support the public health message of implementation of early, aggressive management of diabetes. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Venezuelan Endocrinology Society and La Federacion Nacional de Asociaciones y Unidades de Diabetes (FENADIABETES)Pfizer Inc., VenezuelaBrazilian Minist Hlth, Oswaldo Cruz Fdn, Goncalo Moniz Res Ctr, BR-40296 Salvador, BA, BrazilCharitable Works Fdn Sister Dulce, Clin Res Ctr, BR-40415 Salvador, BA, BrazilUniversidade Federal de São Paulo, BR-04023 São Paulo, BrazilPfizer Inc, BR-04717 São Paulo, BrazilCent Univ Venezuela, Caracas 1041A, VenezuelaUniversidade Federal de São Paulo, BR-04023 São Paulo, BrazilWeb of Scienc

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field