The impact of ethnicity, educational and economic status on the prescription of insulin therapeutic regimens and on glycemic control in patients with type 1 diabetes. A nationwide study in Brazil

Gomes, Marilia Brito; Rodacki, Melanie; Pavin, Elizabeth João; Cobas, Roberta Arnoldi; Felicio, João S.; Zajdenverg, Lenita; Negrato, Carlos Antonio

doi:10.1016/j.diabres.2017.09.013

Cited by 26Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

The impact of ethnicity, educational and economic status on the prescription of insulin therapeutic regimens and on glycemic control in patients with type 1 diabetes. A nationwide study in Brazil

Gomes, Marilia Brito, Rodacki, Melanie, Pavin, Elizabeth João, Cobas, Roberta Arnoldi, Felicio, João S., Zajdenverg, Lenita, Negrato, Carlos Antonio·2017·Diabetes Research and Clinical Practice

DOI 10.1016/j.diabres.2017.09.013

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Abstract

Aims Establish the relationship between demographic, educational and economic status on insulin therapeutic regimens (ITRs) and on glycemic control in patients with type 1 diabetes. Methods This was a cross-sectional, multicenter study with 1760 patients conducted between August 2011 and August 2014 in 10 Brazilian cities. Results Patients were stratified according to ITRs as follows: only NPH insulin (group 1, n=80(4.5%)); only long-acting insulin analogs (group 2, n=6(0.3%)); continuous subcutaneous insulin infusion (CSII) (group 3, n=62(3.5%)); NPH plus regular insulin (group 4, n=710(40.3%)); NPH plus ultra-rapid insulin analogs (group 5, n=259(14.8%)); long-acting insulin analogs plus regular insulin (group 6, n=25(4.4%)) and long-acting plus ultra-rapid insulin analogs (group 7, n=618 (35.1%)). As group A (provided free of charge by the government) we considered groups 1 and 4, and as group B (obtained through lawsuit or out-of-pocket) groups 2, 3 and 7. Multivariate logistic analysis showed that independent variables related to group B were older age, more years of school attendance, higher economic status and ethnicity (Caucasians). The independent variables related to better glycemic control were older age, higher adherence to diet, higher frequency of self-monitoring of blood glucose, more years of school attendance and belonging to group B. Conclusions In Brazilian National Health Care System, prescriptions of insulin analogs or CSII are more frequent in Caucasian…

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Among adults with type 1 diabetes, individuals who are older, male, ethnic minorities, or of lower income are significantly less likely to use insulin pumps.
“Indeed, among adults with type 1 diabetes, individuals who are older, male, ethnic minorities, or of lower income are significantly less likely to use insulin pumps.9–13”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [12]
These differences in insulin pump use have been observed in both countries with insulin pump funding programs (New Zealand, Denmark, France) and those without (USA, Brazil).
“These differences have been observed in both countries with insulin pump funding programs (New Zealand, Denmark, France)9–11 and those without (USA, Brazil).12 13”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [12]
Insulin pump use is consistently less common among lower income individuals compared with higher income individuals, even in countries with government-funded insulin pump programs.
“insulin pump use is consistently less common among lower income individuals compared with higher income individuals, even in countries with government-funded insulin pump programs.12 13”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [12]
Prior studies demonstrate prominent socioeconomic disparities in insulin pump use in regions without public funding, such as Brazil and the United States.
“Our findings of greater disparities in insulin pump use are consistent with prior studies demonstrating prominent socioeconomic disparities in regions without public funding, such as Brazil and the United States.”
From Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross‐sectional study using data from the Canadian <scp>T1D</scp> ( <scp>BETTER</scp> ) Registry (2025) · cites this paper as [36]

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Silva, L. C., Gomes, M. B., & JOSHIPURA, K. J. (2026) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-026-03090-z
Self-citation

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil
Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), Gomes, M. B., Negrato, C. A., Cobas, R. A., Tannus, L. R. M., GONÇALVES, P. R., da Silva, P. C. B., Carneiro, J. R. I., Matheus, A. S. D. M., Dib, S. A., et al. (2014) · Diabetology & Metabolic Syndrome · doi:10.1186/1758-5996-6-67 · Cited by 12 · see citing works
Self-citation
Racial Disparities in the Care of Patients with Type 1 Diabetes: Results from a Multicenter Study in Brazil
Silva, L. C., Gomes, M. B., & JOSHIPURA, K. J. (2026) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-026-03090-z
Self-citation
Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil
Gomes, M. B., Matheus, A. S. D. M., Calliari, L. E., Luescher, J. L., Manna, T. D., Savoldelli, R. D., Cobas, R. A., Coelho, W. S., Tschiedel, B., Ramos, A. J. S., et al. (2012) · Acta Diabetologica · doi:10.1007/s00592-012-0404-3 · Cited by 50 · see citing works
Self-citation
Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group
Gomes, M. B., Cobas, R. A., Matheus, A. S. D. M., Tannus, L. R. M., Negrato, C. A., Rodacki, M., de Araújo, N. B. C., Cordeiro, M. M., Luescher, J. L., Berardo, R. S., et al. (2012) · Diabetology & Metabolic Syndrome · doi:10.1186/1758-5996-4-44 · Cited by 39 · see citing works
Self-citation
Inter-relação de variáveis demográficas, terapêutica insulínica e controle glicêmico em pacientes com diabetes mellitus do tipo 1 atendidos em um hospital universitário
Júnior, G. R. D. S., Fuks, A. G., Cunha, E. F., Clemente, E. L. S., & Gomes, M. B. (1999) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27301999000200007 · Cited by 5 · see citing works
Self-citation

Authors: Gomes, M. B., Rodacki, M., Pavin, E. J., Cobas, R. A., Felicio, J. S., Zajdenverg, L., & Negrato, C. A.
Affiliations: Universidade Federal do Rio de Janeiro (BR)
Universidade Estadual de Campinas (UNICAMP) (BR)
Universidade do Estado do Rio de Janeiro (BR)
ORCID: Rodacki, Melanie
Pavin, Elizabeth João
Cobas, Roberta Arnoldi
Zajdenverg, Lenita
Venue: Diabetes Research and Clinical Practice
Publisher: Elsevier BV
Published: 2017-12
Volume: 134
Pages: 44-52
ISSN: 0168-8227 (ISSN-L)
DOI: 10.1016/j.diabres.2017.09.013
OpenAlex: W2757491520
Cited by: 26
References: 39
Citations by year: 2026: 2 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 5 · 2018: 2
FWCI: 2.16
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Diabetes Research and Clinical Practice (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: type 1 diabetes, glycemic control, insulin analogues, insulin pump therapy, NPH insulin, educational attainment, economic status, ethnicity, racial disparities, self-monitoring of blood glucose, dietary adherence, Brazil
MeSH terms: Adult, Blood Glucose, Brazil, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Economics, Female, Humans, Hypoglycemic Agents, Insulin, Male, Retrospective Studies, Multivariate Analysis

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The impact of ethnicity, educational and economic status on the prescription of insulin therapeutic regimens and on glycemic control in patients with type 1 diabetes. A nationwide study in Brazil

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