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Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil

Kariane A K Davison129*, Carlos A Negrato1, Roberta Cobas2, Alessandra Matheus2, Lucianne Tannus2, Catia S Palma2, Leticia Japiassu2, Joao R I Carneiro2, Melanie Rodacki3, Lenita Zajdenverg3, Neuza B C Araújo4, Marilena M Cordeiro4, Jorge Luiz Luescher5, Renata S Berardo5, Marcia Nery6, Catarina Cani6, Maria do Carmo A Marques6, Luiz Eduardo Calliari7, Renata M Noronha7, Thais D Manna8, Roberta Savoldelli8, Fernanda G Penha8, Milton C Foss9, Maria Cristina Foss-Freitas9, Maria de Fatima Guedes1, Sergio A Dib10, Patricia Dualib10, Saulo C Silva11, Janice Sepúlveda11, Emerson Sampaio12, Rosangela R Rea13, Ana Cristina R A Faria13, Balduino Tschiedel14, Suzana Lavigne14, Gustavo A Cardozo14, Antonio C Pires15, Fernando C Robles15, Mirela Azevedo16, Luis Henrique Canani16, Alessandra T Zucatti16, Marisa H C Coral17, Daniela A Pereira17, Luiz Antonio Araujo18, Hermelinda C Pedrosa19, Monica Tolentino19, Flaviene A Prado19, Nelson Rassi20, Leticia B Araujo20, Reine M C Fonseca21, Alexis D Guedes21, Odelisa S Mattos21, Manuel Faria22, Rossana Azulay22, Adriana C Forti23, Cristina F S Façanha23, Renan Montenegro Jr24, Ana Paula Montenegro24, Naira H Melo25, Karla F Rezende25, Alberto Ramos26, João S Felicio27, Flavia M Santos27, Deborah L Jezini28, Marilia B Gomes2 and On Behalf of the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG)

Author Affiliations

1 Bauru’s Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil

2 Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil

3 Federal University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil

4 General Hospital of Bonsucesso, Rio de Janeiro, Brazil

5 University Hospital Clementino Fraga Filho-Children Institute Martagão Teixeira, Rio de Janeiro, Brazil

6 Diabetes Unit, University Hospital of São Paulo, Sao Paulo, Brazil

7 Pediatric Unit of Endocrinology-Santa Casa Hospital, São Paulo, Brazil

8 Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil

9 Ribeirão Preto Medical School of São Paulo University, Sao Paulo, Brazil

10 Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil

11 Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Minas Gerais, Brazil

12 Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil

13 Clinical Hospital of the Federal University of Paraná, Paraná, Brazil

14 Institute of Diabetic Children, Rio Grande Sul, Brazil

15 Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São Paulo, Brazil

16 Clinical Hospital of Porto Alegre, Rio Grande do Sul, Brazil

17 University Hospital of Santa Catarina, Santa Catarina, Brazil

18 Endocrinology and Diabetes Institute of Joinville, Santa Catarina, Brazil

19 Regional Hospital of Taguatinga, Brasília, Brazil

20 General Hospital of Goiânia, Goiás, Brazil

21 Diabetes and Endocrinology Center of Bahia, Bahia, Brazil

22 Federal University of Maranhão, Maranhão, Brazil

23 Diabetes and Hypertension Center of Ceará, Ceará, Brazil

24 Federal University of Ceará, Ceará, Brazil

25 Federal University of Sergipe, Sergipe, Brazil

26 Federal University Hospital of Campina Grande, Paraíba, Brazil

27 Federal University Hospital of Pará, Pará, Brazil

28 Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas, Brazil

29 Rua Saint Martin 27-07, Vila Universitária, Bauru, São Paulo 17012-433, Brazil

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Nutrition Journal 2014, 13:19  doi:10.1186/1475-2891-13-19

Published: 7 March 2014



To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors.


This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years.


Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01).


Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.

Type 1 diabetes; Glycemic control; Dietitian; Diet; Diabetes care; Adherence to diet