High prevalence of diabetes and intermediate hyperglycemia – The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

BackgroundThe global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.MethodsWe report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.FindingsWith this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).InterpretationThat four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity – diabetes epidemic in urban Brazil and indicates the need for urgent action.

Fatores de risco relacionados à carga global de doença do Brasil e Unidades Federadas, 2015

“…It is important to note the great change in the ranking, which points to rapid growth [25][26][27] . Elevated fasting plasma glucose also increased in the period, which is consistent with other longitudinal studies 28 and telephone 29 and household surveys 30 . Studies have explained this increase by the growth of obesity, aging of the population, and unhealthy lifestyles, such as inadequate diet and physical inactivity [28][29][30] .…”

Perfil clínico e antropométrico de pacientes idosos com diabetes mellitus tipo 2 atendidos em ambulatório

“…Ou seja, se o DM2 é geralmente diagnosticado após os 40 anos [7], os idosos deste estudo poderiam estar sofrendo as consequências do diagnóstico tardio. Estudo realizado em seis capitais brasileiras, com funcionários de universidades públicas, encontrou uma prevalência de DM2 em torno de 20% e cerca de metade dos indivíduos desconheciam sua condição clínica [16]. O subdiagnóstico pode contribuir para o agravamento do DM2 e aumento do risco para eventos cardiovasculares.…”

Avaliação da visita domiciliar para o empoderamento do autocuidado em diabetes

“…The higher prevalence among women has been reported in other studies in Brazil. (3,24) In this study, the time of diabetes diagnosis was up to five years among the majority of users who received home visits, unlike the control group, in which the majority claimed to have diabetes for more than five years. The time of diagnosis should be considered, since it can be difficult to determine the exact duration of diabetes time given the asymptomatic period before the diagnosis period.…”

“…(4) Complementarily, the home environment enabled the assistance to users regarding appropriate decision making for meeting goals in face of their specific needs and social context, which positively influenced self-care practices. (7,24) Corroborating evidence from the literature, home visits facilitate users' understanding on self-care with diet, physical exercise and weight control by improving their diabetes management continuously. (6,7,24) It is noteworthy that home visits as an educational strategy for adherence to diabetes selfcare practices allows monitoring the performance of the care executed by users and predicting the factors interfering in the development of care for diabetes control.…”

“…(7,24) Corroborating evidence from the literature, home visits facilitate users' understanding on self-care with diet, physical exercise and weight control by improving their diabetes management continuously. (6,7,24) It is noteworthy that home visits as an educational strategy for adherence to diabetes selfcare practices allows monitoring the performance of the care executed by users and predicting the factors interfering in the development of care for diabetes control. (17) Regarding empowerment for self-care practices, the results revealed an increase in the median score The users who participated in home visits increased confidence hence, improved their ability of making informed decisions and developing skills to improve self-care behaviors.…”