editorials December 01, 2017 December 01, 2017

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?

DOI: 10.1590/2359-3997000000304

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 (). 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 (). Fortunately, the authors report successful results, leading to a significant improvement in HbA1c (approximately 20% in one year with an additional reduction of 11% in the next 8 months) (). Achieving the HbA1c 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 HbA1c below 7.5% still varies between 20.5% and 53.6% in different countries, with a mean HbA1c between 8% and 8.5% in most populations that provide enough resources for diabetes care (). A mean HbA1c 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 ().

Pacheco and cols. () reported a mean HbA1c of approximately 10.7% in males and 9.6% in females before the initiation of the educational program in one center in south Brazil. The authors achieved a mean HbA1c of approximately 8.5% for both men and women in the end of the study, which is still above the recommended goals for T1DM but at the same range obtained for countries that offer more resources for diabetes treatment and glucose monitoring than Brazil. A control group that did not participate in the educational program did not show any differences in the glycemic control in a similar time period, which reinforces the impact of the intervention in this study group. These results indicate that education can be an effective tool to obtain significant improvements in diabetes care in patients with T1DM, including poor countries with limited health-care resources.

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