SUN-159 Evaluation of Underestimating the Diagnosis of LADA in a Population in the Southeastern Region of Brazil

Background: Diabetes is one of the most prevalent chronic-degenerative diseases worldwide and has historically had a higher burden in high-income countries, but the disease is growing rapidly in low-to-middle-income countries. Brazil is an upper middle-income country with the fourth higher prevalence of diabetes and the fifth in diabetes-related health expenditure. The aim of this study was to investigate the status of glycemic control by type of diabetes in patients from the Southeastern of Brazil. Methods: Data from 662 patients with diabetes attending public and private Endocrinology units were analyzed after reviewing medical records in Minas Gerais (southeastern), Brazil. Results: We reviewed the medical records from a total of 662 patients. Among the types of diabetes, the sample included 602 type 2 diabetic (T2D) patients (90.9%) and 54 patients with type 1 diabetes (8.1%), 6 (1%) patients diagnosed with LADA. The highest proportion of overweight and obesity was found in T2D patients (35% overweight and 42% obese). Most patients with T1D were of normal weight (72%) and LADA all eutrophics. Most patients were female with T2D (68%), median age of 55.1 years. Regarding the main parameter of treatment control, glycated hemoglobin presented alarming data for glycemic control: only 14.81% of type 1 diabetics presented good control (HbA1c <7%), 35.58% of type 2 diabetics and 33.3% of LADA. Among type 2 diabetic patients, there was a difference between the median HbA1c between patients taking insulin (8.7%) and no insulin patients (7%) p 0.001. Among the antihyperglycaemic drugs, metformin was the most used (70% in type 2 diabetics). The second most commonly used class of antihyperglycaemic agents were sulphonylureas (31.8% isolated or associated with metformin). Median HbA1c among T2D on insulin was 8.6%, very similar to a median of patients with T1D (8.65%), LADA 7.7%. The association between insulin treatment and poor diabetes control is reported in other countries. In keeping with this, insulin was used predominantly in the group of patients with longer duration of diabetes, and this could reflect the difficulty in achieving adequate control in the setting of beta cell pancreatic failure, not due to insulin treatment per se. Conclusion: The non-diagnosis of LADA may increase the risk of early failure of beta-pancreatic cells, since in the developing countries sulfonylureas are still the second class most prescribed due to the lower cost of these drugs. Thus, it is necessary to alert the scientific community about the importance of LADA screening. Our findings reaffirm the need that others types of diabetes must be discussed. It is therefore possible that health policies focusing patients with these features might favorably affect glycemic control among patients with diabetes.