Poor glycemic control can lead to an early appearance of atherosclerosis in patients with type 1 diabetes - Can this be avoided by effective educational programs?

摘要

This issue of "Archives of Endocrinology and Metabolism" features two papers about type 1 diabetes mellitus (T1DM). Pacheco and cols. report the results of a structured education program for adults with T1DM from a single center in the south of Brazil. The education strategy consisted of workshops, individualized care and 24-hour distant support (1). The design of the program was inspired by the educational support provided in the Dose Adjustment for Normal Eating Study (DAFNE), performed in the UK (2). Fortunately, the authors report successful results, leading to a significant improvement in Hb A1c (approximately 20% in one year with an additional reduction of 11% in the next 8 months) (1). Achieving the Hb A1c goals in individuals with T1DM is still a major challenge worldwide. Although adults tend to have a slightly better glycemic control than younger patients, the proportion of individuals with 25 years of age or more who present Hb A1c below 7.5% still varies between 20.5% and 53.6% in different countries, with a mean Hb A1c between 8% and 8.5% in most populations that provide enough resources for diabetes care (3). A mean Hb A1c of 9.2% has been previously reported for the Brazilian population, where the resources for diabetes care are limited and efficient national programs for diabetes care are still lacking(4).