Diabetes Care in Brazil

Coutinho, Walmir; Júnior, Wellington Santana da Silva

doi:10.1016/j.aogh.2015.12.010

Cited by 36 publications

(32 citation statements)

References 27 publications

(55 reference statements)

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“…As in other countries, T2DM rather than type 1 DM (which accounts for approximately 5% of cases of diabetes in Brazil) constitutes the bulk of this morbidity, mortality, and costs. Moreover, although there is no systematic screening for prediabetes, it is estimated that prevalence of prediabetes in Brazil is high and increasing rapidly [14]. Simōes et al describe programs implemented by the Brazilian Ministry of Health to address this diabetes epidemic, but there is not yet evidence on the effectiveness of these interventions.…”

Section: Introductionmentioning

confidence: 99%

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

Nascimento

Resnicow

Nery

et al. 2017

BMC Health Serv Res

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BackgroundRates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil.MethodsNineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients’ reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients’ reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs’ fidelity to and experiences with the intervention.ResultsPatients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/−19) to 68 (+/−21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (−16.1 mg/dL, p = .005) and triglyceride levels (−38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium- or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many described a shift from advice-giving to encouraging patients to define their own goals.ConclusionIn resource-scarce settings, it is essential to fully utilize existing primary care resources to stem the epidemic of diabetes and other NCDs. Our pilot results support the potential of training CHAs to incorporate effective diabetes self-management support into their routine patient encounters.Trial registration NCT02994095 12/14/2016 Registered retrospectively.

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Section: Introductionmentioning

confidence: 99%

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

Nascimento

Resnicow

Nery

et al. 2017

BMC Health Serv Res

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“…The patients enrolled for diabetic retinopathy screening with a portable retinal camera adequately represent the population with DM2 treated in primary health care, characterized by the predominance of the elderly, mostly women, diabetes duration over 10 years and regular glycemic control. Arterial hypertension and dyslipidemia were the most prevalent comorbidities associated with DM [20]. We observed that patients with referable DR had higher A1c than those with DR absent or non-referable, while other clinical and demographic variables were similar.…”

Section: Discussionmentioning

confidence: 56%

Diabetic Retinopathy Screening in Urban Primary Care Setting with a Handheld Smartphone-based Retinal Camera.

Queiroz

Carvalho²,

Bortoto

et al. 2020

Preprint

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Aims: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary health care setting; to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience on retinal imaging. Methods: Prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according need of referral. Results: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years-old, diabetes duration 10.7 ± 8.2 years and A1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher A1c was associated with referable DR. Conclusion: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of Covid-19 pandemic.

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“…26 In Mexico and Brazil, certain drugs are not available in public healthcare system due to the high cost, despite of some medications are subsidized by government. 27,28 In our study this is a limitation, because both national health surveys not distinguish between groups of medications. Other factor that could contribute to this relation is the adherence to the treatment.…”

Section: Discussionmentioning

confidence: 94%

Comparison of Prevalence of Diabetes Complications in Brazilian and Mexican Adults

Martins

Ordaz-Briseño

Flores-Hernández

et al. 2019

Preprint

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[EXSCINDED] Abstract Abstract Abstract Abstract Abstract Abstract Background Brazil and Mexico are the most populous countries in Latin America. Diabetes is a global growing problem. Although there are laws in the constitutions of both countries, Mexico and Brazil, regarding ensuring access to health, emphasizing the issue of diabetes, both populations are affected for this disease from different perspectives. The objective of this study was comparing the results of the National Health Survey “PNS” in Brazil and the National Survey Health and Nutrition “ENSANUT” in Mexico regarding prevalence, complications and healthcare issues of diabetes in both countries.Methods A cross-sectional study was conducted with data from the National Health Survey (PNS) in Brazil, and the National Survey of Health and Nutrition (ENSANUT) in Mexico. The variables used in the PNS were taken from module P - Lifestyles and the Q module - Chronic Diseases The corresponding variables were searched in ENSANUT, module III - Diabetes Mellitus and module XIII - Risk Factors. The odds ratio for having any diabetes complication was calculated for all variables which were significant (p<0.05) in the descriptive analyses in two logistic regression models: simple models, with a regression performed with each variable separated and an adjusted model with all variables included.Results The prevalence of diabetic was 6.8% in Brazil and 9.4% in Mexico. There were significant differences between age and time with diabetes between both countries. The odds of a Mexican comparing to a Brazilian diabetic patient of having a complication was 2.01 in the simple logistic regression model and 3.04 in the adjusted model (p<0.0001). Loss vision was the most frequent complication. Protector factors were physical exercise and drinking alcohol less than monthly.Conclusions Diabetes complications are important health problems in Brazil and Mexico. National health surveys add significant information about the impact of diabetes in these Latin American populations. This comparison of data could provide available information to guide national policies and program decisions in both countries.

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Diabetes Care in Brazil

Cited by 36 publications

References 27 publications

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

Diabetic Retinopathy Screening in Urban Primary Care Setting with a Handheld Smartphone-based Retinal Camera.

Comparison of Prevalence of Diabetes Complications in Brazilian and Mexican Adults

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