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Lin YC, Tu HP, Wang TN. Blood lipid profile, HbA1c, fasting glucose, and diabetes: a cohort study and a two-sample Mendelian randomization analysis. J Endocrinol Invest 2024; 47:913-925. [PMID: 37878156 DOI: 10.1007/s40618-023-02209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The prevalence of diabetes is increasing worldwide. The associations between the lipid profile and glycated hemoglobin (HbA1c), fasting glucose, and diabetes remain unclear, so we aimed to perform a cohort study and a two-sample Mendelian randomization (MR) study to investigate the causality between blood lipid profile and HbA1c, fasting glucose, and diabetes. METHODS A total of 25,171 participants from the Taiwan Biobank were enrolled. We applied a cohort study and an MR study to assess the association between blood lipid profile and HbA1c, fasting glucose, and diabetes. The summary statistics were obtained from the Asian Genetic Epidemiology Network (AGEN), and the estimates between the instrumental variables (IVs) and outcomes were calculated using the inverse-variance weighted (IVW) method. A series of sensitivity analyses were performed. RESULTS In the cohort study, high-density lipoprotein cholesterol (HDL-C) was negatively associated with HbA1c, fasting glucose, and diabetes, while the causal associations between HDL-C and HbA1c (βIVW = - 0.098, p = 0.003) and diabetes (βIVW = - 0.594, p < 0.001) were also observed. Furthermore, there was no pleiotropy effect in this study using the MR-Egger intercept test and MR-PRESSO global test. CONCLUSIONS Our results support the hypothesis that a genetically determined increase in HDL-C is causally related to a reduction in HbA1c and a lower risk of diabetes.
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Affiliation(s)
- Y-C Lin
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Shi-Chuan 1st Rd, Kaohsiung, 807, Taiwan
| | - H-P Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - T-N Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Shi-Chuan 1st Rd, Kaohsiung, 807, Taiwan.
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Sun K, Chen XS, Muzhylko T, Andrade FCD. Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil. Prev Med Rep 2023; 35:102315. [PMID: 37576845 PMCID: PMC10413139 DOI: 10.1016/j.pmedr.2023.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023] Open
Abstract
Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.
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Affiliation(s)
- Kang Sun
- University of Illinois at Urbana-Champaign, United States
| | | | - Tonya Muzhylko
- University of Illinois at Urbana-Champaign, United States
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Vieira da Silva MA, Gouvêa GR, João TMS, Agondi RDF, Mialhe FL. [Perceived barriers and coping strategies developed by patients with type 2 diabetes mellitus to join to walking]. Rev Salud Publica (Bogota) 2023; 22:537-543. [PMID: 36753223 DOI: 10.15446/rsap.v22n5.54427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/15/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To investigate the perceived barriers and coping strategies for the practice of walking identified among patients with diabetes mellitus (DM) in the scope of the Unified Health System (SUS). METHODOLOGY A sample of 83 individuals with DM, SUS users, was asked to reflect on the obstacles that prevented them from walking, as well as to formulate coping plans to overcome them. The obstacles raised and plans developed were categorized for similarity and subjected to frequency analysis. RESULTS The main obstacle reported was the feeling of "dismay" (36.1%). The most frequent coping plan to overcome the barriers found was 'social support from family members', 'neighbors' and 'friends'. CONCLUSION The results made it possible to know the difficulties and potential of the subjects related to self-care for DM regarding the practice of walking, knowledge that can help the multidisciplinary teams of the SUS.
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Affiliation(s)
| | - Giovana Renata Gouvêa
- GG: Cirurgiã-Dentista. Ph.D. Saúde Pública. Fundação Hermínio Ometto (FHO). Araras/SP, Brasil.
| | - Thaís Moreira São João
- TS: Enfermeira. Ph.D. Enfermagem. Faculdade de Enfermagem. Universidade Estadual de Campinas (UNICAMP). Campinas/SP, Brasil.
| | - Rúbia de Freitas Agondi
- RA. Enfermeira. M. Sc. Enfermagem. Secretaria Municipal de Saúde de Campinas. Campinas/SP, Brasil.
| | - Fábio Luiz Mialhe
- FM. Cirurgião-Dentista. Ph. D. Saúde Coletiva. Faculdade de Odontologia. Universidade Estadual de Campinas (UNICAMP). Piracicaba/SP, Brasil.
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The Nutrition Literacy Assessment Instrument for Brazilians, NLit-Br: An Exploratory Cross-Cultural Validity Study. Nutrients 2022; 14:nu14224914. [PMID: 36432600 PMCID: PMC9693279 DOI: 10.3390/nu14224914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to test the validity of the cross-cultural adapted Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). An observational cross-sectional study was performed in chronic disease clinics from the Brazilian Public Health System in two phases: (1) linguistic and cultural adaptation and (2) validity testing. Six registered dietitians and thirty adult patients diagnosed with at least one chronic disease participated in the study using the nutrition literacy assessment instrument (NLit-Br) and the short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18). Sample descriptive variables: age, sex, race, income, education, and occupation. To adapt the instrument to the Brazilian Portuguese and Brazilian culture, we tested cognitive interviewing and the Scale Content Validity Index (S-CVI) with a group of dietitians and patients. To test the tool’s validity, health literacy (SAHLPA-18) was used as a construct that presents similarities and differences with nutrition literacy (NLit-Br). The correlation of NLit-Br and the SAHLPA-18 was tested (Spearman’s Rho). Internal consistency was measured by Kuder−Richardson Formula 20 (KR-20). The NLit-Br content validity (S-CVI = 0.85) and internal consistency (KR-20 = 0.868) were confirmed. Additionally, NLit-Br presented a significant and robust correlation with SAHLPA-18 (r = 0.665, p < 0.001). Therefore, the NLit-Br was considered a linguistic, cultural, and valid instrument to measure Brazilian’s nutrition literacy.
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Verma AK, Goyal Y, Bhatt D, Dev K, Alsahli MA, Rahmani AH, Almatroudi A. A Compendium of Perspectives on Diabetes: A Challenge for Sustainable Health in the Modern Era. Diabetes Metab Syndr Obes 2021; 14:2775-2787. [PMID: 34168477 PMCID: PMC8216699 DOI: 10.2147/dmso.s304751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a chronic illness. Hyperglycemia is the characteristic of this disorder. Diabetes is a global crisis which affects the economy and health of all nations. Over the last decades, the number of individuals living with diabetes has significantly increased worldwide. Asia is a key epicenter of the emerging diabetes epidemic, with China and India the two nations having the highest number of diabetic people. Economic development, modernization, unhealthy diet, population aging, and sedentary lifestyles are the major factors responsible for the increasing diabetes epidemic. Diabetes is associated with several complications, and cardiovascular disease is the most important cause of morbidity and mortality among people with diabetes. These life-threatening problems can be prevented or delayed by proper management of diabetes. Lifestyle modification is an important factor to decrease the diabetes risk. The frequency of diabetic complications will rise if there is a lack of cost-effective and sustainable interventions. Hence, prevention of diabetes and its complications such as diabetic retinopathy and cardiovascular disease should be a crucial part of all future health-related public policies among all nations. This review summarizes current epidemiological aspects of diabetes in the world along with its complications, preventive measures, and treatment.
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Affiliation(s)
- Amit K Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Yamini Goyal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Deepti Bhatt
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Mohammed A Alsahli
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
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Correa R, Harsha Tella S, Elshimy G, Davidson JA. The status of diabetes and its complications in Latin-American population: A review article. Diabetes Res Clin Pract 2020; 168:108274. [PMID: 32562637 DOI: 10.1016/j.diabres.2020.108274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The Latino population consists of distinct cultural groups, with differences in dietary habits and lifestyle that can affect the risk for type 2 diabetes. The best terminology today is Latino/Hispanic, and it should only be used as ethnicity. Latin-America has different races such as Caucasians, Native Americans, Blacks and Asians, and many mixtures of all. The leading cause of death in Latin-America is Cardiovascular diseases and the most important risk factor is diabetes mellitus (DM). According to the latest estimates from the Global Burden of Disease, the burden of DM was greater than expected in Latin America and the Caribbean region. Extensive data illustrates that lower cardiovascular disease risk in Latino group is a paradox. Instead, it is evident that the cardiovascular disease is the leading cause of mortality in Latinos.
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Affiliation(s)
- Ricardo Correa
- University of Arizona College of Medicine-Phoenix. Phoenix, AZ, United States
| | - Sri Harsha Tella
- University of South Carolina School of Medicine, Columbia, SC, United States
| | - Ghada Elshimy
- University of Arizona College of Medicine-Phoenix. Phoenix, AZ, United States
| | - Jaime A Davidson
- The University of Texas Southwestern Medical Center, Touchstone Diabetes Center. Dallas, TX, United States.
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Prevalence and Risk Factors for Self-Report Diabetes Mellitus: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186497. [PMID: 32906612 PMCID: PMC7558180 DOI: 10.3390/ijerph17186497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022]
Abstract
The aim of this study was to estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in the adult population of the Central-West region of Brazil. In 2013, a cross-sectional study using the data from the National Health Survey and comprising 7519 individuals aged ≥18 years from the Central-West region was conducted. Participants were interviewed at their homes about sociodemographic data and risk factors for DM. To verify the risk factors with DM, the Poisson regression model was used. The analyses were performed for the total sample and stratified according to sex. The prevalence of DM was 6.5% (95% confidence interval [95% CI], 5.7–7.3). The diagnosis of self-reported DM was 4.3% in men and 7.5% in women. In the global sample, it was found that age between 40–59 years and ≥60 years, previous smoking (former smoker), self-reported hypertension, self-reported dyslipidemia, overweight, and obesity were independently associated with self-reported DM. In men, risk factors were: Age ≥ 60 years, self-reported hypertension, self-reported dyslipidemia, and obesity. In women, risk factors were: Age 30–39 years, 40–59 years, and ≥60 years, previous smoking (former smoker), self-reported hypertension, self-reported dyslipidemia, overweight, and obesity. Conclusion: The prevalence of DM was 6.5%. DM was associated with advanced age; previous smoking (former smoker), hypertension, dyslipidemia, overweight, and obesity. Some differences in risk factors between men and women were noted.
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Gómez EJ. The international and domestic politics of type 2 diabetes policy reform in Brazil. BMJ Glob Health 2020; 5:bmjgh-2020-002457. [PMID: 32873596 PMCID: PMC7467506 DOI: 10.1136/bmjgh-2020-002457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Understanding the international and domestic political factors influencing the evolution of type 2 diabetes policies and primary care institutions is a new area of scholarly research. This article contributes to this area of inquiry by illustrating how a government’s shifting foreign policy aspirations, that is, to establish the government’s reputation as an internationally recognised leader in type 2 diabetes policy, and presidential electoral incentives provide alternative insights into the evolution of type 2 diabetes treatment policies and primary care institutional reforms. Methods I conduct a single-case study analysis with the usage of qualitative data; quantitative statistical data on epidemiological trends and government policy spending is also provided as supportive evidence. Results The case of Brazil illustrates how a reduction in foreign policy commitment to international reputation building in health as well as presidential electoral incentives to use diabetes policy as an electoral strategy account for a decline in sustaining policy and primary care institutional innovations in response to type 2 diabetes. Conclusion Future scholars interested in understanding the lack of sustainability and effectiveness in type 2 diabetes programmes should consider investigating the complex international and domestic political factors influencing political interests, incentives and commitment to reform.
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Affiliation(s)
- Eduardo J Gómez
- College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
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Veiga G, Alves B, Perez M, Alcantara LV, Raimundo J, Zambrano L, Encina J, Pereira EC, Bacci M, Murad N, Fonseca F. NGAL and SMAD1 gene expression in the early detection of diabetic nephropathy by liquid biopsy. J Clin Pathol 2020; 73:713-721. [PMID: 32184218 DOI: 10.1136/jclinpath-2020-206494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Diabetic nephropathy (DN) is a disease that progresses with the slow and progressive decline of the glomerular filtration rate (GFR); the installation of this pathology is silent and one of the major causes of death in patients with diabetes. AIMS To identify new molecular biomarkers for early identification of the onset of DN in patients with type II diabetes mellitus (DM2). We studied the expression profile of the genes; suppressor of mothers against decapentaplegic type 1 (SMAD1), neutrophil gelatinase-associated lipocalin (NGAL) and type IV collagen (COLIV1A) in peripheral blood and urine sediment samples. METHODS Ninety volunteers, 51 with DM2 and 39 healthy, were recruited from the Faculdade de Medicina do ABC outpatient clinic. We conducted an interview and collected anthropometric data, as well as blood and urine samples for biochemical evaluation and real-time PCR amplification of the genes of interest. RESULTS Gene expression data: peripheral blood NGAL (DM2 0.09758±0.1914 vs CTL 0.02293±0.04578), SMAD1 (blood: DM2 0.01102±0.04059* vs CTL 0.0001317±0.0003609; urine: DM2 0.7195±2.344* vs CTL 0.09812±0.4755), there was no significant expression of COLIV1A. These genes demonstrated good sensitivity and specificity in the receiving operating characteristic curve evaluation. CONCLUSION Our data suggest the potential use of NGAL and SMAD1 gene expression in peripheral blood and urine samples as early biomarkers of DN.
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Affiliation(s)
- Glaucia Veiga
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Beatriz Alves
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Matheus Perez
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | - Joyce Raimundo
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Lysien Zambrano
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
| | - Jessica Encina
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Edimar Cristiano Pereira
- Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
| | - Marcelo Bacci
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Neif Murad
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fernando Fonseca
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil.,Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
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Ben ÂJ, Neyeloff JL, de Souza CF, Rosses APO, de Araujo AL, Szortika A, Locatelli F, de Carvalho G, Neumann CR. Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:57-68. [PMID: 31674001 PMCID: PMC6978298 DOI: 10.1007/s40258-019-00528-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. METHODS A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters' uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). RESULTS Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = -0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. CONCLUSION Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.
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Affiliation(s)
- Ângela J Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | | | - Camila F de Souza
- Faculty of Medicine, Universidade do Vale do Taquari, Lajeado, Brazil
| | - Ana Paula O Rosses
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Aline L de Araujo
- Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Adriana Szortika
- Ophthalmology Service, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Franciele Locatelli
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela de Carvalho
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristina R Neumann
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Barim EM, McLellan KCP, Ribeiro RS, Carvalho JAMD, Lindström J, Tuomilehto J, Corrente JE, Murta-Nascimento C. Translation and cultural adaptation into Brazilian Portuguese of the Finnish Diabetes Risk Score (FINDRISC) and reliability assessment. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200060. [DOI: 10.1590/1980-549720200060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/16/2019] [Indexed: 12/30/2022] Open
Abstract
ABSTRACT: Introduction: The Finnish Diabetes Risk Score (FINDRISC) is a tool that was initially developed to predict the risk of developing type 2 diabetes mellitus in adults. This tool is simple, quick to apply, non-invasive, and low-cost. The aims of this study were to perform a translation and cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess test-retest reliability. Methodology: This work was done following the ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Once the final Brazilian Portuguese version (FINDRISC-Br) was developed, the reliability assessment was performed using a non-random sample of 83 individuals attending a primary care health center. Each participant was interviewed by trained registered dieticians on two occasions with a mean interval of 14 days. The reliability assessment was performed by analyzing the level of agreement between the test-retest responses of FINDRISC-Br using Cohen’s kappa coefficient and the intraclass correlation coefficient (ICC). Results: The steps of ISPOR guidelines were consecutively followed without major problems. Regarding the reliability assessment, the questionnaire as a whole presented adequate reliability (Cohen’s kappa = 0.82, 95%CI 0.72 - 0.92 and ICC = 0.94, 95%CI 0.91 - 0.96). Conclusion: FINDRISC was translated into Brazilian Portuguese and culturally adapted following standard procedures. FINDRISC-Br has thus become available for use and has potential as a screening tool in different Brazilian settings and applications.
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Affiliation(s)
| | | | | | | | | | - Jaakko Tuomilehto
- National Institute for Health and Welfare, Finland; University of Helsinki, Finland; King Abdulaziz University, Saudi Arabia
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Hovadick ACDA, Reis IA, Torres HC. Short Message Service (SMS) e promoção do autocuidado em DM2: revisão integrativa. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Sintetizar e analisar as evidências disponíveis na literatura científica sobre os efeitos do uso de Short Message Service (SMS) na promoção do autocuidado em diabetes mellitus tipo 2. Métodos: Foi desenvolvida uma revisão integrativa da literatura, no período de 2007 a 2017, utilizando para a busca dos estudos as seguintes bases de dados: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, Web of Science, Base de dados de enfermagem, Campus Virtual de Saúde Pública, Coleção Nacional das Fontes de Informação do Sistema Único de Saúde, Coordenadoria Regional de Saúde Sul, Índice Bibliográfico Español en Ciencias de la Salud (iBECS), Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed. Para isso, utilizou-se descritores como: mensagem de texto, autocuidado, educação em saúde, promoção em saúde e diabetes mellitus, bem como os respectivos descritores em inglês e espanhol, e os Medical Subject Headings associados. Foi identificada uma amostra inicial de 739 artigos, dos quais 23 foram classificados como elegíveis para compor a amostra final. Resultados: Em geral, os trabalhos reportaram resultados positivos. Dentre estes, destacam-se: melhora significativa dos níveis de hemoglobina glicada, maior adesão aos medicamentos, melhora das práticas de autocuidado, aumento do conhecimento acerca do diabetes e melhor cuidado com os pés. Conclusão: Evidências científicas na literatura mostram que o uso de SMS como estratégia metodológica pode favorecer a melhora das práticas de autocuidado em diabetes tipo 2.
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Degu H, Wondimagegnehu A, Yifru YM, Belachew A. Is health related quality of life influenced by diabetic neuropathic pain among type II diabetes mellitus patients in Ethiopia? PLoS One 2019; 14:e0211449. [PMID: 30716109 PMCID: PMC6361436 DOI: 10.1371/journal.pone.0211449] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 01/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polyneuropathy is one of the commonest complications of long-standing diabetes. Progressive sensory loss can predispose patients to foot ulcer and the neuropathy oftentimes causes pain. The pain can significantly affect the quality of life of patients. OBJECTIVES To describes the health-related quality of life of patients with type II diabetes mellitus suffering from painful diabetic peripheral neuropathy at two referral hospitals in Addis Ababa, Ethiopia, 2017. METHODS An institution based cross sectional study with internal comparison was conducted among a sample of 220 type II diabetes mellitus patients in a 1:1 matched ratio of those with and without diabetes associated peripheral neuropathic pain. All were having regular follow up at two hospitals in Addis Ababa, Ethiopia. The Short Form (SF-36) health-related quality of life instrument was used to collect data on quality of life while basic socio-demographic and other disease specific features were collected using a structured questionnaire. Descriptive statistics was used to examine the mean scores of health related quality of life. Cronbach's alpha coefficient and Pearson's correlation coefficient were applied to estimate the internal consistency, and the level of agreement between the different domains of SF-36, respectively. To measure association between health related quality of life domains and explanatory variables, independent T-test and ANOVA were performed followed by multiple linear regression analyses. RESULTS The health related quality of life of type II diabetes mellitus patients with peripheral neuropathic pain was poorer than those without pain in all the eight domains and the two summary scores by SF-36 (p < 0.001). Higher mean score difference was observed in Mental Component Summary Score (MCS) (14.6) compared to Physical Component Score (PCS) (9.3). Among the eight domains, the largest mean difference was found with the physical one (39.1) followed by mental health (38.2) and physical functioning (30). Pain intensity had a statistically significant negative correlation with all domains as well as the two summary scores. Younger age, a higher level of education, being single, a higher monthly income, normal body mass index, HbA1c less than seven mmo/L, absence of other diabetic complications and taking only oral hypoglycemic agents were found to predict better health related quality of life. CONCLUSION The presence of diabetic peripheral neuropathic pain was found to negatively influence the health-related quality of life of type II diabetic patients; the greatest impact being on the 'role physical' and 'mental health' domains. Older age, presence of diabetes related complications, longer duration of illness negatively influenced the health-related quality of life.
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Affiliation(s)
- Hiwot Degu
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Mamushet Yifru
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayele Belachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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Nascimento GL, Pegado HM, Domingues ALC, Ximenes RADA, Itria A, Cruz LN, Oliveira MRFD. The cost of a disease targeted for elimination in Brazil: the case of schistosomiasis mansoni. Mem Inst Oswaldo Cruz 2019; 114:e180347. [PMID: 30652735 PMCID: PMC6340134 DOI: 10.1590/0074-02760180347] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Schistosomiasis mansoni is a poverty-related parasitic infection that has a
variety of clinical manifestations. We consider the disability and deaths
caused by schistosomiasis unacceptable for a tool-ready disease. Its
condition in Brazil warrants an analysis that will enable better
understanding of the local health losses and contribute to the complex
decision-making process. OBJECTIVE This study estimates the cost of schistosomiasis in Brazil in 2015. METHODS We conducted a cost of illness study of schistosomiasis mansoni in Brazil in
2015 based on a prevalence approach and from a societal perspective. The
study included 26,499 schistosomiasis carriers, 397 hepatosplenic cases, 48
cases with the neurological form, 284 hospitalisations, and 11,368.26 years
of life lost (YLL) of which 5,187 years are attributable to economically
active age groups. RESULTS The total cost of schistosomiasis mansoni in Brazil was estimated to be US$
41,7million in 2015 with 94.61% of this being indirect costs. CONCLUSIONS The economic burden of schistosomiasis mansoni in Brazil is high and results
in the loss of productivity. Its persistence in Brazil is a challenge to
public health and requires inter-sectorial interventions in areas such as
indoor water supply, basic sanitation, and education.
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Affiliation(s)
| | | | | | | | - Alexander Itria
- Universidade Federal de Goiás, Goiânia, GO, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| | | | - Maria Regina Fernandes de Oliveira
- Universidade de Brasília, Núcleo de Medicina Tropical, Brasília, DF, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
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Ramaglia AHF, Salzedas-Netto AA, Monteiro MM, Pimentel-Mota CFMG, Abranches DC, Rangel EB, Gonzalez AM. Necessidade de tratamento odontológico em pacientes candidatos a transplante simultâneo de pâncreas-rim e fígado num centro único. Rev Col Bras Cir 2019; 46:e20192224. [DOI: 10.1590/0100-6991e-20192224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
RESUMO Objetivo: avaliar as condições bucais e os principais fatores predisponentes para tratamento odontológico de pacientes em lista de espera para transplante simultâneo de pâncreas-rim e para transplante hepático, em um centro único. Métodos: foram avaliados 100 pacientes na fila de espera, 50 candidatos a transplante hepático e 50 a transplante simultâneo de pâncreas-rim, no período de agosto de 2015 a fevereiro de 2018. Exames extra e intrabucais foram correlacionados com variáveis demográficas pré-transplante. Resultados: a principal alteração bucal nos candidatos a transplante de pâncreas-rim e de transplante hepático foram dentes cariados, perdidos e obturados, presentes em 83% e 100% dos candidatos, respectivamente (P=0,03). A necessidade de tratamento odontológico foi igual nos dois grupos: 71% e 70%. Nos candidatos a transplante hepático, os fatores predisponentes para tratamento odontológico foram idade, cor e diagnóstico etiológico da cirrose hepática. Não identificamos fatores predisponentes para tratamento odontológico nos candidatos a transplante simultâneo pâncreas-rim. Conclusão: pacientes candidatos a transplante simultâneo de pâncreas-rim e transplante hepático apresentaram higiene bucal precária com presença de cárie, raízes residuais, gengivite e periodontite, revelando que a avaliação odontológica deve fazer parte do protocolo de atendimento dos pacientes em fila de espera para transplantes.
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Solis MA, Moreno Velásquez I, Correa R, Huang LLH. Stem cells as a potential therapy for diabetes mellitus: a call-to-action in Latin America. Diabetol Metab Syndr 2019; 11:20. [PMID: 30820250 PMCID: PMC6380040 DOI: 10.1186/s13098-019-0415-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
Latin America is a fast-growing region that currently faces unique challenges in the treatment of all forms of diabetes mellitus. The burden of this disease will be even greater in the coming years due, in part, to the large proportion of young adults living in urban areas and engaging in unhealthy lifestyles. Unfortunately, the national health systems in Latin-American countries are unprepared and urgently need to reorganize their health care services to achieve diabetic therapeutic goals. Stem cell research is attracting increasing attention as a promising and fast-growing field in Latin America. As future healthcare systems will include the development of regenerative medicine through stem cell research, Latin America is urged to issue a call-to-action on stem cell research. Increased efforts are required in studies focused on stem cells for the treatment of diabetes. In this review, we aim to inform physicians, researchers, patients and funding sources about the advances in stem cell research for possible future applications in diabetes mellitus. Emerging studies are demonstrating the potential of stem cells for β cell differentiation and pancreatic regeneration. The major economic burden implicated in patients with diabetes complications suggests that stem cell research may relieve diabetic complications. Closer attention should be paid to stem cell research in the future as an alternative treatment for diabetes mellitus.
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Affiliation(s)
| | | | - Ricardo Correa
- Department of Medicine, Warren Alpert School of Medicine, Brown University, Rhode Island, USA
- Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ USA
| | - Lynn L. H. Huang
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Research Center of Excellence in Regenerative Medicine, National Cheng Kung University, Tainan, Taiwan
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Castilho JL, Escuder MM, Veloso V, Gomes JO, Jayathilake K, Ribeiro S, Souza RA, Ikeda ML, de Alencastro PR, Tupinanbas U, Brites C, McGowan CC, Grangeiro A, Grinsztejn B. Trends and predictors of non-communicable disease multimorbidity among adults living with HIV and receiving antiretroviral therapy in Brazil. J Int AIDS Soc 2019; 22:e25233. [PMID: 30697950 PMCID: PMC6351749 DOI: 10.1002/jia2.25233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/19/2018] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) on antiretroviral therapy (ART) experience high rates of non-communicable diseases (NCDs). These co-morbidities often accumulate and older adults may suffer from multimorbidity. Multimorbidity has been associated with loss of quality of life, polypharmacy, and increased risk of frailty and mortality. Little is known of the trends or predictors NCD multimorbidity in PLHIV in low- and middle-income countries. METHODS We examined NCD multimorbidity in adult PLHIV initiating ART between 2003 and 2014 using a multi-site, observational cohort in Brazil. NCDs included cardiovascular artery disease, hyperlipidemia (HLD), diabetes, chronic kidney disease, cirrhosis, osteoporosis, osteonecrosis, venous thromboembolism and non-AIDS-defining cancers. Multimorbidity was defined as the incident accumulation of two or more unique NCDs. We used Poisson regression to examine trends and Cox proportional hazard models to examine predictors of multimorbidity. RESULTS Of the 6206 adults, 332 (5%) developed multimorbidity during the study period. Parallel to the ageing of the cohort, the prevalence of multimorbidity rose from 3% to 11% during the study period. Older age, female sex (adjusted hazard ratio (aHR) = 1.30 (95% confidence interval (CI) 1.03 to 1.65)) and low CD4 nadir (<100 vs. ≥200 cells/mm3 aHR = 1.52 (95% CI: 1.15 to 2.01)) at cohort entry were significantly associated with increased risk of multimorbidity. Among patients with incident multimorbidity, the most common NCDs were HLD and diabetes; however, osteoporosis was also frequent in women (16 vs. 35% of men and women with multimorbidity respectively). CONCLUSIONS Among adult PLHIV in Brazil, NCD multimorbidity increased from 2003 to 2014. Females and adults with low CD4 nadir were at increased risk in adjusted analyses. Further studies examining prevention, screening and management of NCDs in PLHIV in low- and middle-income countries are needed.
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Affiliation(s)
- Jessica L Castilho
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Maria M Escuder
- São Paulo State Department of HealthInstitute of HealthSão PauloBrazil
| | - Valdiléa Veloso
- National Institute of Infectology – Evandro ChagasOswaldo Cruz FoundationRio de JaneiroBrazil
| | - Jackeline O Gomes
- São Paulo State Department of HealthInstitute of HealthSão PauloBrazil
| | - Karu Jayathilake
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Sayonara Ribeiro
- National Institute of Infectology – Evandro ChagasOswaldo Cruz FoundationRio de JaneiroBrazil
| | - Rosa A Souza
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Maria L Ikeda
- School of HealthUniversity do Vale do Rio dos SinosPorto AlegreBrazil
| | - Paulo R de Alencastro
- Care and Treatment Clinic of the Partenon SanatoriumRio Grande do Sul State Department of HealthPorto AlegreBrazil
| | - Unai Tupinanbas
- Medical SchoolFederal University of Minas GeraisBelo HorizonteBrazil
| | - Carlos Brites
- Edgar Santos University Hospital ComplexFederal University of BahiaSalvadorBrazil
| | - Catherine C McGowan
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Alexandre Grangeiro
- Department of Preventive MedicineUniversity of São Paulo School of MedicineSão PauloBrazil
| | - Beatriz Grinsztejn
- National Institute of Infectology – Evandro ChagasOswaldo Cruz FoundationRio de JaneiroBrazil
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Silva DAS, Naghavi M, Duncan BB, Schmidt MI, de Souza MDFM, Malta DC. Physical inactivity as risk factor for mortality by diabetes mellitus in Brazil in 1990, 2006, and 2016. Diabetol Metab Syndr 2019; 11:23. [PMID: 30867683 PMCID: PMC6396532 DOI: 10.1186/s13098-019-0419-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aims of this study were to estimate the mortality due to diabetes mellitus attributed to physical inactivity in Brazil, to analyze these estimate in three points in time (1990, 2006 and, 2016), and to analyze these estimates according to the socioeconomic status of Brazilian states. METHODS All deaths and diseases recorded in Brazil during this period were analyzed. Surveys of the general adult population using random sampling procedures evaluating self-reported physical activity in all life domains in Brazil were included. The total number and the age-standardized rates of deaths, and population-attributable fraction (PAF) for diabetes mellitus attributed to physical inactivity in the years 1990, 2006, and 2016 were estimated. Socioeconomic Development Index (SDI) was used as an indicator of socioeconomic status of Brazilian states. RESULTS In relation to mortality due to diabetes mellitus attributed to physical inactivity, 736 deaths were estimated in 1990, 1337 deaths were estimated in 2006, and 1897 in 2016, which represented, in 1990, an age-standardized mortality rate (per 100,000 inhabitants) of 1.2, 2.1 in 2006, and 1.1 in 2016. Approximately 3.0% (PAF) of deaths due to diabetes mellitus could be avoided if the Brazilian population were physically active. In 2006 and 2016, Brazilian states with worst socioeconomic indicators had higher age-standardized mortality rate by diabetes mellitus due to physical inactivity. CONCLUSION These findings are the first to estimate the burden of diabetes mellitus due to physical inactivity in Brazil and support the promotion of physical activity in the Brazilian population to prevent and manage diabetes mellitus.
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Affiliation(s)
- Diego Augusto Santos Silva
- Research Center in Kinanthropometry and Human Performance, Sports Centre, Postgraduate Program in Physical Education, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, SC 88010-970 Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA USA
| | - Bruce B. Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Maria de Fatima Marinho de Souza
- Department of Surveillance of Noncommunicable Diseases, and Injuries, and Health Promotion, Ministry of Health, Brasília, DF Brazil
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil
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Mello Filho P, Andrade G, Maia A, Maia M, Biccas Neto L, Muralha Neto A, Moura Brasil O, Minelli E, Dalloul C, Iglicki M. Effectiveness and Safety of Intravitreal Dexamethasone Implant (Ozurdex) in Patients with Diabetic Macular Edema: A Real-World Experience. Ophthalmologica 2018; 241:9-16. [PMID: 30408801 DOI: 10.1159/000492132] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There are few real-life studies on the intravitreal 0.7-mg dexamethasone implant for the treatment of diabetic macular edema (DME) conducted in Latin America. We aimed to assess the effectiveness and safety of this implant in clinical practice. METHODS Twenty-seven centers from Brazil and one from Argentina provided information on patients with DME treated with Ozurdex. The efficacy outcome variables were best-corrected visual acuity (BCVA) in Snellen and central retinal thickness (CRT). Safety was assessed by the elevation in intraocular pressure (IOP), occurrence of cataracts, and adverse events. RESULTS A total of 329 eyes (both treated cases and naïve eyes) from 282 patients underwent treatment. The time since diagnosis of DME ranged from 1 to 156 months. The median BCVA was 0.7 logMAR/50 letters at baseline and 0.3 logMAR/70 letters after treatment (both p < 0.001). Median CRT values decreased from 425 µm at baseline to 270 µm after treatment (p < 0.001). Increases in IOP of at least 10 mm Hg were observed in 7.4% of eyes, and 4% of eyes had cataract evolution. No cases of endophthalmitis were reported. CONCLUSION These real-life results suggest that the intravitreal dexamethasone implant is effective and safe for eyes with DME.
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Affiliation(s)
- Paulo Mello Filho
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Gabriel Andrade
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,
| | - Andre Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Acacio Muralha Neto
- Department of Ophthalmology, Rio de Janeiro State University, Rio de Janeiro, Brazil
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DIRECT COSTS OF TYPE 2 DIABETES: A BRAZILIAN COST-OF-ILLNESS STUDY. Int J Technol Assess Health Care 2018; 34:180-188. [DOI: 10.1017/s026646231800017x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:The aim of this study was to evaluate the direct costs of type 2 diabetes mellitus patients treated in a Brazilian public hospital.Methods:This was an exploratory retrospective cost-of-illness study with quantitative approach, using medical records of patients treated in a public hospital (2012–14), with at least one consultation over a period of 12 months. Data on patient's profile, exams, number of consultations, medications, hospitalizations, and comorbidities were collected. The cost per patient per year (pppy) was calculated as well as the costs related to glycated hemoglobin (HbA1c) values, using thresholds of 7 and 8 percent.Results:Data of 726 patients were collected with mean age of 62 ± 11 years (68.3 percent female). A total of 67.1 percent presented HbA1c > 7 percent and 44.9 percent > 8 percent. The median cost of diabetes was United States dollar (USD) 197 pppy. The median costs of medication were USD 152.49 pppy, while costs of exams and consultations were USD 40.57 pppy and 8.70 pppy, respectively. Thirty-eight patients (4 percent) were hospitalized and presented a median cost of 3,656 per patient per hospitalization with a cost equivalent to 53.1 percent of total expenses. Total costs of patients with HbA1c ≤ 7 percent were lower for this group and also costs of medications and consultations, whereas for patients with HbA1c ≤ 8 percent, only total costs and costs of medications were lower when compared with HbA1c > 8 percent patients.Conclusions:Medications and hospitalizations were the major contributor of diabetes expenses. Preventing T2DM, or reducing its complications through adequate control, may help avoid the substantial costs related to this disease.
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Araujo MYC, Turi BC, Queiroz DC, Ferro IDS, Bortolatto CR, Codogno JS. Type 2 diabetes, healthcare expenditures and its correlation with anthropometric factors and physical activity: 18-month follow-up in a Brazilian city. MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-6574201800010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Affiliation(s)
| | - Bruna Camilo Turi
- Universidade Estadual Paulista, Brazil; Faculdades de Dracena, Brazil
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Borges DDB, Lacerda JTD. Ações voltadas ao controle do Diabetes Mellitus na Atenção Básica: proposta de modelo avaliativo. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-1104201811613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O artigo corresponde à apreciação da viabilidade para avaliação das ações voltadas ao controle do Diabetes Mellitus (DM) na Atenção Básica (AB) e apresenta uma proposta de modelo avaliativo. Análises documentais, revisão de literatura e reuniões com especialistas orientaram a elaboração do modelo. Para sua validação, utilizou-se a técnica de conferência de consenso. A matriz de análise e julgamento é composta por 19 indicadores agregados em duas dimensões. As ações voltadas ao controle do DM na AB são passíveis de avaliação. A aplicação do modelo avaliativo proposto permitirá ampliar o conhecimento dos mecanismos e processos implicados na operacionalização das ações, contribuindo para seu aperfeiçoamento.
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Wound infections and recovery time among patients with diabetic foot ulcer living in multiethnic Suriname, a developing country: a retrospective cohort study among patients from the One Stop Shop for chronic diseases Paramaribo. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Assunção SC, Fonseca AP, Silveira MF, Caldeira AP, Pinho LD. Knowledge and attitude of patients with diabetes mellitus in Primary Health Care. ESCOLA ANNA NERY 2017. [DOI: 10.1590/2177-9465-ean-2017-0208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To evaluate the knowledge and attitude of patients with diabetes mellitus in Primary Health Care and associated factors. Methods: Cross-sectional, quantitative and analytical study with 353 patients with type 2 diabetes mellitus in Family Health Strategy units. The Knowledge and Psychological Attitudes Questionnaires were used for data collection, as well as a script with sociodemographic, economic and clinical data. Results: The majority of the population was female (73.1%), aged more than 50 years (81.5%), diagnosed for more than five years (54.9%) and with a per capita income of up to half a minimum wage (59.3%). The scores of knowledge and attitude were low. Age (p = 0.001) and level of education (p = 0.002) were variables associated with knowledge about diabetes mellitus. Conclusion: Users had a low level of knowledge about diabetes, indicating an unsatisfactory result in self-care and mainly a negative attitude towards coping with this disease.
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Objectively Measured Physical Activity and Healthcare Expenditures Related to Arterial Hypertension and Diabetes Mellitus in Older Adults: SABE Study. J Aging Phys Act 2017; 25:553-558. [PMID: 28181824 DOI: 10.1123/japa.2016-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Research using questionnaires has shown that physical activity level (PAL) is associated with healthcare costs. The purpose of this study was to examine the association between objectively measured PAL and healthcare costs among hypertensive and diabetic noninstitutionalized Brazilian older people. The method consisted of a cross-sectional study forming part of the SABE Study, composed of 377 older people interviewed in 2010. Expenditures were estimated taking into account self-reported medicine prescription, outpatient service, and hospitalizations, with the highest quartile of expenditures considered as a risk category. PAL was estimated using an Actigraph accelerometer. Associations were expressed as odds ratios and 95% confidence intervals, adjusted for covariates. Overall expenditures were higher in the sedentary group. The insufficiently active group presented greater odds for higher total, outpatient, and hospitalization expenditure. It was concluded that healthcare expenditures were lower in more active hypertensive and diabetic older people. The promotion of physical activity could be relevant in the attenuation of the burden of chronic diseases in economic losses.
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Machado-Duque ME, Ramírez-Riveros AC, Machado-Alba JE. Effectiveness and clinical inertia in patients with antidiabetic therapy. Int J Clin Pract 2017; 71. [PMID: 28524340 DOI: 10.1111/ijcp.12954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To establish the effectiveness of antidiabetic therapy and the frequency of clinical inertia in the management of type 2 diabetes mellitus in Colombia. METHODS A cross-sectional study with follow-up of patients who had been treated for at least 1 year and were receiving medical consultation for antidiabetic treatment. Effectiveness was established when haemoglobin-A1c levels were <7% and when clinical inertia was reached, which was defined as no therapeutic modifications despite not achieving management controls. Sociodemographic, clinical and pharmacological variables were evaluated, and multivariate analyses were performed. RESULTS In total, 363 patients with type 2 diabetes mellitus were evaluated, with a mean age of 62.0±12.2 years. A total of 1,016 consultations were evaluated, and the therapy was effective at the end of the follow-up in 57.9% of cases. Clinical inertia was found in 56.8% of patients who did not have metabolic control. The most frequently prescribed medications were metformin (84.0%), glibenclamide (23.4%) and insulin glargine (20.7%). Moreover, 57.6% of the patients were treated with two or more antidiabetic medications. Having metabolic control in the first consult of the follow-up was a protective factor against clinical inertia in the subsequent consultations (OR: 0.08; 95%CI: 0.04-0.15; P<.001). CONCLUSIONS The effectiveness of treatment for patients with type 2 diabetes mellitus has increased in Colombia, and for the first time, clinical inertia was identifiable and quantifiable and found in similar proportions to other countries. Clinical inertia is a relevant condition given that it interferes with the possibility of controlling this pathology.
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Affiliation(s)
- Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira, Colombia
| | | | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
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van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol 2017; 5:457-468. [PMID: 27499355 PMCID: PMC7104099 DOI: 10.1016/s2213-8587(16)30081-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/06/2023]
Abstract
Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands.
| | - Steven van de Vijver
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - David A J Moore
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Andrade FCD, López-Ortega M. Educational Differences in Health Among Middle-Aged and Older Adults in Brazil and Mexico. J Aging Health 2017; 29:923-950. [PMID: 28553819 DOI: 10.1177/0898264317705781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examines educational differences in health conditions among middle-aged and older adults in Brazil and Mexico. METHOD Cross-sectional data from the 2013 Brazilian National Health Survey and the 2012 Mexican National Health and Nutrition Survey were used in the analyses. We used multivariate Poisson regressions to examine the relationship between educational level and prevalence of common health conditions (obesity, abdominal obesity, diabetes, hypertension, heart disease, and hearing and visual impairments). RESULTS Socioeconomic and sex inequalities persist in both countries. In general, low levels of education were associated with higher risk for having health conditions. However, men of lower education had a smaller risk of abdominal obesity and hypertension. DISCUSSION Brazil and Mexico have expanded public health actions aimed at improving health behaviors, diagnosis, and access to treatment of chronic conditions. However, important social disparities remain. Improving lifestyle behaviors, such as physical activity and dietary habits, could benefit both countries.
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Schirr-Bonnans S, Costa N, Derumeaux-Burel H, Bos J, Lepage B, Garnault V, Martini J, Hanaire H, Turnin MC, Molinier L. Cost of diabetic eye, renal and foot complications: a methodological review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:293-312. [PMID: 26975444 DOI: 10.1007/s10198-016-0773-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic foot ulcer (DFU) represent a public health and economic concern that may be assessed with cost-of-illness (COI) studies. OBJECTIVES (1) To review COI studies published between 2000 and 2015, about DR, DKD and DFU; (2) to analyse methods used. METHODS Disease definition, epidemiological approach, perspective, type of costs, activity data sources, cost valuation, sensitivity analysis, cost discounting and presentation of costs may be described in COI studies. Each reviewed study was assessed with a methodological grid including these nine items. RESULTS The five following items have been detailed in the reviewed studies: epidemiological approach (59 % of studies described it), perspective (75 %), type of costs (98 %), activity data sources (91 %) and cost valuation (59 %). The disease definition and the presentation of results were detailed in fewer studies (respectively 50 and 46 %). In contrast, sensitivity analysis was only performed in 14 % of studies and cost discounting in 7 %. Considering the studies showing an average cost per patient and per year with a societal perspective, DR cost estimates were US $2297 (range 5-67,486), DKD cost ranged from US $1095 to US $16,384, and DFU cost was US $10,604 (range 1444-85,718). DISCUSSION This review reinforces the need to adequately describe the method to facilitate literature comparisons and projections. It also recalls that COI studies represent complementary tools to cost-effectiveness studies to help decision makers in the allocation of economic resources for the management of DR, DKD and DFU.
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Affiliation(s)
- Solène Schirr-Bonnans
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France.
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France.
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
| | - Nadège Costa
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Hélène Derumeaux-Burel
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Jérémy Bos
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Benoît Lepage
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Methodological Support Unit, Faculté de Médecine, University Hospital of Toulouse, USMR, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Valérie Garnault
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Jacques Martini
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Hélène Hanaire
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Marie-Christine Turnin
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Laurent Molinier
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
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Costa AF, Flor LS, Campos MR, Oliveira AFD, Costa MDFDS, Silva RSD, Lobato LCDP, Schramm JMDA. Burden of type 2 diabetes mellitus in Brazil. CAD SAUDE PUBLICA 2017; 33:e00197915. [PMID: 28380131 DOI: 10.1590/0102-311x00197915] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/02/2016] [Indexed: 01/18/2023] Open
Abstract
Type 2 diabetes mellitus currently ranks high among indicators used in Global Burden of Disease Studies. The current study estimated the burden of disease attributable to type 2 diabetes mellitus and its chronic complications in Brazil, 2008. We calculated disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) stratified by gender, age bracket, and major geographic region. Type 2 diabetes mellitus accounted for 5% of the burden of disease in Brazil, ranking 3rd in women and 6th in men in the composition of DALYs. The largest share of DALYs was concentrated in the 30-59-year age bracket and consisted mainly of YLDs. The highest YLL and YLD rates were in the Northeast and South of Brazil, respectively. Chronic complications represented 80% of YLDs from type 2 diabetes mellitus. Type 2 diabetes mellitus ranked as a leading health problem in Brazil in 2008, accounting for relevant shares of mortality and morbidity.
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Affiliation(s)
- Amine Farias Costa
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | - Luísa Sorio Flor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Mônica Rodrigues Campos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Maria de Fátima Dos Santos Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Raulino Sabino da Silva
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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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. BMC Health Serv Res 2017; 17:32. [PMID: 28086870 PMCID: PMC5237239 DOI: 10.1186/s12913-016-1968-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/22/2016] [Indexed: 12/30/2022] Open
Abstract
Background Rates 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. Methods Nineteen 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. Results Patients 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. Conclusion In 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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Silva SDS, Mambrini JVDM, Turci MA, Macinko J, Lima-Costa MF. [Use of health services by diabetics with private health insurance compared to users of the Brazilian Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil]. CAD SAUDE PUBLICA 2016; 32:e00014615. [PMID: 27783751 DOI: 10.1590/0102-311x00014615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
This study compared the use of health services and medication, screening test coverage, characteristics of primary care, and health behaviors in 370 diabetics 45 years or older according to sources of care: private health policyholders regardless of place of residence; residents in areas covered by the Family Health Strategy; and individuals covered by a "traditional" Primary Care Unit. The study used data from the 2nd Adult Health Survey in Belo Horizonte Metropolitan Region (2010), Minas Gerais State, Brazil. Use of health services, use of medication, coverage of follow-up tests, alcohol abuse, and smoking did not differ significantly according to source of care. Prevalence rates for insufficient leisure-time physical exercise and sedentary lifestyle were higher among individuals covered by the Family Health Strategy or "traditional" Primary Care Unit. The primary care characteristics (access, comprehensiveness, continuity, and family focus) performed better among individuals with private health insurance, even after adjusting for age, sex, and schooling. The study identified two main challenges for the Brazilian Unified National Health System in managing patients with diabetes in the city of Belo Horizonte: the promotion of physical exercise and reorganization to improve performance in primary care, especially in access to medical appointments.
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Affiliation(s)
- Sara de Souza Silva
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
| | - Juliana Vaz de Melo Mambrini
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Maria Aparecida Turci
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - James Macinko
- Fielding School of Public Health, University of California, Los Angeles, U.S.A
| | - Maria Fernanda Lima-Costa
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Telo GH, Cureau FV, de Souza MS, Andrade TS, Copês F, Schaan BD. Prevalence of diabetes in Brazil over time: a systematic review with meta-analysis. Diabetol Metab Syndr 2016; 8:65. [PMID: 27610204 PMCID: PMC5015260 DOI: 10.1186/s13098-016-0181-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/29/2016] [Indexed: 01/04/2023] Open
Abstract
Diabetes is one of the most important epidemic diseases of this century and the number of people with diabetes has more than doubled over the past three decades. Our aim was to estimate the prevalence of diabetes in the adult Brazilian population and analyze the trends for the last three decades through a systematic review with meta-analysis. This review included observational studies published between 1980 and 2015, which were independently identified by two reviewers in five databases. Random effect models were used to estimate the prevalence and trends of diabetes. In total, 50 articles were included in this review. Three different patterns for diabetes diagnosis were identified: self-report (36 studies), fasting glucose (7 studies), and complex diagnosis (fasting glucose, oral glucose tolerance test, and self-report; 7 studies). The prevalence of diabetes was 5.6 % (95 % CI 5.0-6.3; I(2) = 100 %) by self-report, 6.6 % (95 % CI 4.8-8.9; I(2) = 94 %) by fasting glucose, and 11.9 % (95 % CI 7.7-17.8 I(2) = 100 %) by complex diagnosis. In trend analyses, we observed an increase in the prevalence of diabetes over time. The biggest increase was detected in studies using complex diagnosis: 7.4 % (95 % CI 7.1-7.7) in the 1980s to 15.7 % (95 % CI 9.8-24.3) in the 2010s. In conclusion, despite high heterogeneity, this study observed a high prevalence of diabetes in Brazilian adults over time and with a progressive increase in the last 35 years.
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Affiliation(s)
- Gabriela H. Telo
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Felipe Vogt Cureau
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Martina S. de Souza
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Thais S. Andrade
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Fabiana Copês
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
- Departament of Nutrition, Universidade Federal do Pampa, Campus Itaqui, Brazil
| | - Beatriz D. Schaan
- Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, CEP 90035-903 Brazil
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Abstract
Public policies, population health initiatives, and targeted behavioral change interventions for individuals at risk for developing diabetes are all essential for diabetes prevention in Latin American countries (LACs). This scoping review examines (1) the current evidence on diabetes prevention policies and interventions in LACs to identify components of effective diabetes prevention models in those countries and (2) effective diabetes prevention interventions targeting Latino populations in the USA to explore possible lessons from these interventions for LACs. Diabetes prevention programs in LACs evaluated to date consist of short-term health professional-led face-to-face behavioral counseling sessions. Intervention components of US-based programs for Latinos that might benefit diabetes prevention programs in Latin America include (1) deployment of community health workers ("promotoras") for diabetes screening and delivery of lifestyle modification programs, (2) multiple modes of program delivery beyond face-to-face sessions, (3) information technology to automate and enhance program delivery, (4) leveraging of pre-existing familial relationships to engage in and sustain lifestyle modifications, and (5) innovative environmental change strategies such as collaborations with local food stores and markets to promote healthy behaviors.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Center for Clinical Management Research (CCMR), Ann Arbor Veterans' Affairs (VA) Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- Michigan Center for Diabetes Translational Research (MCDTR), University of Michigan, Ann Arbor, MI, USA.
| | - Elizabeth Kaselitz
- Center for Clinical Management Research (CCMR), Ann Arbor Veterans' Affairs (VA) Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
- Global REACH and Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gurpreet K Rana
- Taubman Health Sciences Library, University of Michigan, 1135 East Catherine Street, Ann Arbor, MI, 48109, USA
| | - John D Piette
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research (CCMR), Ann Arbor Veterans' Affairs (VA) Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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Fernandes BSM, Reis IA, Pagano AS, Cecilio SG, Torres HDC. Construção, validação e adequação cultural do protocolo COMPASSO: Adesão ao autocuidado em diabetes. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Realizar a construção, validação de conteúdo e adequação cultural do protocolo Compasso para promover a adesão às práticas de autocuidado em diabetes via intervenção telefônica. Métodos Pesquisa metodológica de elaboração de instrumentos abrangendo as etapas: construção do protocolo; validação de conteúdo; adequação cultural. Participaram das fases de construção e validação um total de 14 profissionais das áreas da Saúde, Linguística e Estatística, e, da fase de adequação, 341 usuários com diabetes Mellitus. Os dados para validação e adequação foram coletados através da plataforma web e-Surv e analisados no ambiente R. Resultados O protocolo Compasso aborda os seguintes domínios: aspectos comportamental e psicossocial, rede de apoio, barreiras e práticas do autocuidado. A avaliação do protocolo apresentou boa concordância entre os avaliadores, com IVC médio de 0,96. Conclusão Considera-se validado o conteúdo do protocolo Compasso e adequado culturalmente para promover a adesão às práticas de autocuidado em diabetes via intervenção telefônica.
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Weng W, Liang Y, Kimball ES, Hobbs T, Kong S, Sakurada B, Bouchard J. Drug usage patterns and treatment costs in newly-diagnosed type 2 diabetes mellitus cases, 2007 vs 2012: findings from a large US healthcare claims database analysis. J Med Econ 2016; 19:655-62. [PMID: 26855139 DOI: 10.3111/13696998.2016.1151795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective To explore trends in demographics, comorbidities, anti-diabetic drug usage, and healthcare utilization costs in patients with newly-diagnosed type 2 diabetes mellitus (T2DM) using a large US claims database. Methods For the years 2007 and 2012, Truven Health Marketscan Research Databases were used to identify adults with newly-diagnosed T2DM and continuous 12-month enrollment with prescription benefits. Variables examined included patient demographics, comorbidities, inpatient utilization patterns, healthcare costs (inpatient and outpatient), drug costs, and diabetes drug claim patterns. Results Despite an increase in the overall database population between 2007-2012, the incidence of newly-diagnosed T2DM decreased from 1.1% (2007) to 0.65% (2012). Hyperlipidemia and hypertension were the most common comorbidities and increased in prevalence from 2007 to 2012. In 2007, 48.3% of newly-diagnosed T2DM patients had no claims for diabetes medications, compared with 36.2% of patients in 2012. The use of a single oral anti-diabetic drug (OAD) was the most common diabetes medication-related claim (46.2% of patients in 2007; 56.7% of patients in 2012). Among OAD monotherapy users, metformin was the most commonly used and increased from 2007 (74.7% of OAD monotherapy users) to 2012 (90.8%). Decreases were observed for sulfonylureas (14.1% to 6.2%) and thiazolidinediones (7.3% to 0.6%). Insulin, predominantly basal insulin, was used by 3.9% of patients in 2007 and 5.3% of patients in 2012. Mean total annual healthcare costs increased from $13,744 in 2007 to $15,175 in 2012, driven largely by outpatient services, although costs in all individual categories of healthcare services (inpatient and outpatient) increased. Conversely, total drug costs per patient were lower in 2012 compared with 2007. Conclusions Despite a drop in the rate of newly-diagnosed T2DM from 2007 to 2012 in the US, increased total medical costs and comorbidities per individual patient suggest that the clinical and economic trends for T2DM are not declining.
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Affiliation(s)
- W Weng
- a Novo Nordisk Inc. , Plainsboro , NJ , USA
| | - Y Liang
- b Truven Health Analytics , Cambridge , MA , USA
| | | | - T Hobbs
- a Novo Nordisk Inc. , Plainsboro , NJ , USA
| | - S Kong
- a Novo Nordisk Inc. , Plainsboro , NJ , USA
| | - B Sakurada
- a Novo Nordisk Inc. , Plainsboro , NJ , USA
| | - J Bouchard
- a Novo Nordisk Inc. , Plainsboro , NJ , USA
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Fantinati MS, Mendonça DEO, Fantinati AMM, Santos BFD, Reis JCO, Afonso CL, Vinaud MC, Lino Júnior RDS. Low intensity ultrasound therapy induces angiogenesis and persistent inflammation in the chronic phase of the healing process of third degree burn wounds experimentally induced in diabetic and non-diabetic rats. Acta Cir Bras 2016; 31:463-71. [DOI: 10.1590/s0102-865020160070000006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/22/2016] [Indexed: 12/25/2022] Open
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Weng W, Liang Y, Kimball ES, Hobbs T, Kong SX, Sakurada B, Bouchard J. Decreasing incidence of type 2 diabetes mellitus in the United States, 2007-2012: Epidemiologic findings from a large US claims database. Diabetes Res Clin Pract 2016; 117:111-8. [PMID: 27267430 DOI: 10.1016/j.diabres.2016.04.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/16/2016] [Accepted: 04/22/2016] [Indexed: 01/02/2023]
Abstract
AIMS To explore epidemiological trends in type 2 diabetes mellitus (T2D) in the US between 2007 and 2012 using a large US claims database, with a particular focus on demographics, prevalence, newly-diagnosed cases, and comorbidities. METHODS Truven Health MarketScan® Databases were used to identify patients with claims evidence of T2D in the years 2007 and 2012. Newly-diagnosed T2D was characterized by an absence of any T2D claims or related drug claims for 6months preceding the index claim. Demographic and comorbidity characteristics of the prevalent and new-onset T2D groups were compared and analyzed descriptively for trends over time. RESULTS The overall prevalence of T2D remained stable from 2007 (1.24 million cases/15.07 million enrolled; 8.2%) to 2012 (2.04 million cases/24.52 million enrolled; 8.3%), while the percentage of newly-diagnosed cases fell dramatically from 2007 (152,252 cases; 1.1%) to 2012 (147,011 cases; 0.65%). The mean age of patients with prevalent T2D was similar in 2007 (60.6y) and 2012 (60.0y), while the mean age of newly-diagnosed T2D patients decreased by 3years from 2007 (57.7y) to 2012 (54.8y). Hypertension and hyperlipidemia were the most common comorbidities, evident in 50-75% of T2D patients, and increased markedly from 2007 to 2012 in both prevalent and new-onset T2D populations. Cardiovascular disease decreased slightly in prevalent (-0.9%) and new-onset (-2.8%) cases. CONCLUSIONS This large US health claims database analysis suggests stabilization in prevalence and declining incidence of T2D over a recent 5-year period, a downward shift in age at T2D diagnosis, but increases in several comorbidities.
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Malhão TA, Brito ADS, Pinheiro RS, Cabral CDS, de Camargo TMCR, Coeli CM. Sex Differences in Diabetes Mellitus Mortality Trends in Brazil, 1980-2012. PLoS One 2016; 11:e0155996. [PMID: 27275600 PMCID: PMC4898826 DOI: 10.1371/journal.pone.0155996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/02/2016] [Indexed: 01/15/2023] Open
Abstract
Aims To investigate the hypothesis that the change from the female predominance of diabetes mellitus to a standard of equality or even male preponderance can already be observed in Brazilian mortality statistics. Methods Data on deaths for which diabetes mellitus was listed as the underlying cause were obtained from the Brazilian Mortality Information System for the years 1980 to 2012. The mortality data were also analyzed according to the multiple causes of death approach from 2001 to 2012. The population data came from the Brazilian Institute of Geography and Statistics. The mortality rates were standardized to the world population. We used a log-linear joinpoint regression to evaluate trends in age-standardized mortality rates (ASMR). Results From 1980 to 2012, we found a marked increment in the diabetes ASMR among Brazilian men and a less sharp increase in the rate among women, with the latter period (2003–2012) showing a slight decrease among women, though it was not statistically significant. Conclusions The results of this study suggest that diabetes mellitus in Brazil has changed from a pattern of higher mortality among women compared to men to equality or even male predominance.
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Affiliation(s)
- Thainá Alves Malhão
- Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- * E-mail: (TAM); (CMC)
| | - Alexandre dos Santos Brito
- Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Claudia Medina Coeli
- Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- * E-mail: (TAM); (CMC)
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DALLEDONE M, BRANCHER JA, de SOUZA JF, TOMAZINHO FSF, LEONARDI DP, BARATTO-FILHO F. Evaluation of the Oral Condition of Women Predisposed to Diabetes Mellitus. IRANIAN JOURNAL OF PUBLIC HEALTH 2016; 45:820-1. [PMID: 27648428 PMCID: PMC5026840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mariana DALLEDONE
- Clinical Dentistry, Positivo University, Curitiba, Brazil,Corresponding Author:
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Longitudinal Changes in Medical Services and Related Costs in a Single Cohort of Patients Newly Diagnosed With Type 2 Diabetes, 2006 to 2012. Clin Ther 2016; 38:1314-1326. [DOI: 10.1016/j.clinthera.2016.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/21/2022]
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Vargas-Uricoechea H, Casas-Figueroa LÁ. [Epidemiology of diabetes mellitus in South America: The experience of Colombia]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:245-256. [PMID: 26949070 DOI: 10.1016/j.arteri.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/26/2022]
Abstract
According to the International Diabetes Federation, 8.3% of the world population suffers from diabetes mellitus, and it is expected that the number of individuals with the disease will increase to over 592 million. In South and Central America, it is estimated that the increase in the number of cases diagnosed in the period from 2013 to 2035 will be 59.8% (from 24 to 38.5 millions). According to the World Health Organisation, the prevalence of fasting hyperglycaemia in the region of the Americas in 2014 was 9.3% in men and 8.1% in women. The countries with the highest prevalence of diabetes mellitus in adults ≥18years were: Guyana, Surinam, Chile, and Argentina. In Colombia, the prevalence of type 2 diabetes mellitus is variable, depending on the population range assessed and the diagnostic criteria used.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- División de Endocrinología y Metabolismo, Departamento de Medicina Interna, Universidad del Cauca, Popayán, Cauca, Colombia.
| | - Luz Ángela Casas-Figueroa
- División de Endocrinología, Fundación Clínica Valle de Lili, Universidad CES e ICESI, Cali, Valle del Cauca, Colombia
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de Oliveira C, Marmot MG, Demakakos P, Vaz de Melo Mambrini J, Peixoto SV, Lima-Costa MF. Mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults (The ELSA and Bambui cohort ageing studies). Eur J Public Health 2015; 26:831-835. [PMID: 26666869 PMCID: PMC5054267 DOI: 10.1093/eurpub/ckv225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main aim of this study was to quantify and compare 6-year mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults. This study represents a rare opportunity to approach the subject in two different social and economic contexts. METHODS Data from the data from the English Longitudinal Study of Ageing (ELSA) and the Bambuí Cohort Study of Ageing (Brazil) were used. Deaths in both cohorts were identified through mortality registers. Risk factors considered in this study were baseline smoking, hypertension and diabetes mellitus. Both age-sex adjusted hazard ratios and population attributable risks (PAR) of all-cause mortality and their 95% confidence intervals for the association between risk factors and mortality were estimated using Cox proportional hazards models. RESULTS Participants were 3205 English and 1382 Brazilians aged 60 years and over. First, Brazilians showed much higher absolute risk of mortality than English and this finding was consistent in all age, independently of sex. Second, as a rule, hazard ratios for mortality to smoking, hypertension and diabetes showed more similarities than differences between these two populations. Third, there was strong difference among English and Brazilians on attributable deaths to hypertension. CONCLUSIONS The findings indicate that, despite of being in more recent transitions, the attributable deaths to one or more risk factors was twofold among Brazilians relative to the English. These findings call attention for the challenge imposed to health systems to prevent and treat non-communicable diseases, particularly in populations with low socioeconomic level.
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Affiliation(s)
- Cesar de Oliveira
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Michael G Marmot
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Panayotes Demakakos
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Sérgio Viana Peixoto
- Rene Rachou Research Center, the Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Fernanda Lima-Costa
- Rene Rachou Research Center, the Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil
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Prevalence and risk factors of chronic complications of type 2 diabetic inpatients in Hubei Province of central China: results from a multiple-hospital study. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0452-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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da Cruz Anjos DM, de Souza Moreira B, Pereira DS, Picorelli AMA, Pereira DAG, Kirkwood RN, Dias RC, Pereira LSM. Impact of Type-2 Diabetes Time Since Diagnosis on Elderly Women Gait and Functional Status. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 22. [DOI: 10.1002/pri.1651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/15/2015] [Accepted: 07/17/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Daniela Maria da Cruz Anjos
- Graduate Programme in Rehabilitation Sciences; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
- Physical Therapy Course; Faculdade Estácio de Sá; Belo Horizonte Minas Gerais Brazil
| | - Bruno de Souza Moreira
- Graduate Programme in Rehabilitation Sciences; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - Daniele Sirineu Pereira
- Physical Therapy Course, Nursing School; Universidade Federal de Alfenas; Alfenas Minas Gerais Brazil
| | | | - Danielle Aparecida Gomes Pereira
- Graduate Programme in Rehabilitation Sciences; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
- Department of Physical Therapy; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - Renata Noce Kirkwood
- Graduate Programme in Rehabilitation Sciences; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
- Department of Kinesiology and Physical Education; Wilfrid Laurier University; Waterloo Ontario Canada
| | - Rosângela Corrêa Dias
- Graduate Programme in Rehabilitation Sciences; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - Leani Souza Máximo Pereira
- Graduate Programme in Rehabilitation Sciences; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
- Department of Physical Therapy; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
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Klafke A, Duncan BB, Stevens A, Rosa RDS, de Moura L, Malta D, Schmidt MI. The decline in mortality due to acute complications of diabetes mellitus in Brazil, 1991-2010. BMC Public Health 2015; 15:772. [PMID: 26259708 PMCID: PMC4531850 DOI: 10.1186/s12889-015-2123-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 08/05/2015] [Indexed: 12/17/2022] Open
Abstract
Background Mortality from acute complications of diabetes, a predominantly preventable condition, although controlled in high income countries, remains a major challenge for low/middle income countries. The aim of this study is to describe trends in mortality from acute complications of diabetes between 1991 and 2010 in Brazil, a period during which a national health system was implemented offering broad access to diabetes treatment. Methods We obtained the number of deaths listed in the Brazilian Mortality Information System between 1991 and 2010 as due to acute complications of diabetes (ICD-9 250.1, .2, or .3 and ICD-10 E10–14.0 or 1), corrected this number for ill-defined causes of death and incompleteness in mortality reporting, and calculated mortality rates standardized to the world’s population. We describe mortality trends with Joinpoint regressions. Results Over this 20 year period, mortality due to the acute complications of diabetes fell 70.9 % (95 % CI 67.2 to 74.5 %), from 8.42 (95 % CI 8.27 to 8.57) deaths per 100000 inhabitants in 1991 to 2.45 (95 % CI 2.38 to 2.52) per 100000 in 2010. The reduction occurred in men and women, in all age groups, and in all regions of Brazil. Conclusions Mortality from acute complications of diabetes in Brazil has declined markedly in parallel with the implementation of a national health system providing access to insulin and organization of health care. Further decline is possible and necessary.
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Affiliation(s)
- André Klafke
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. .,Community Health Service, Grupo Hospitalar Conceição, Av. Francisco Trein, 596, Porto Alegre, RS, CEP 91.350-200, Brazil.
| | - Bruce Bartholow Duncan
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil.
| | - Antony Stevens
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil.
| | - Roger dos Santos Rosa
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil.
| | - Lenildo de Moura
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. .,Pan American Health Organization, Setor de Embaixadas Norte, Lote 19, 70800-400, Brasilia, DF, CEP 70.312-970, Brazil.
| | - Deborah Malta
- Department of Chronic Disease Surveillance and Health Promotion, Secretariate of Health Surveillance, Brazilian Ministry of Health, SAF Sul, Trecho 2, Lote 5/6, Bloco F, Torre 1, Edifício Premium, Térreo, Sala 16, Brasilia, DF, CEP 70.070-600, Brazil.
| | - Maria Inês Schmidt
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil.
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Santos ADL, Teston EF, Latorre MDRDDO, Mathias TADF, Marcon SS. Tendência de hospitalizações por diabetes mellitus: implicações para o cuidado em saúde. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar a tendência de hospitalizações por diabetesmellitus em um período de 15 anos, segundo sexo e faixa etária. Métodos Estudo descritivo, de séries temporais com dados de hospitalização por diabetes mellitus em indivíduos de ambos os sexos, com 20 ou mais anos, obtidos no sistema de informações do sistema único de saúde e analisados segundo estatística descritiva e regressão polinomial. Resultados Foram registradas 117.717 hospitalizações, sendo 61,6% de mulheres. A tendência geral foi de estabilidade, embora tenha sido crescente para os homens (r2=0,83; p<0,001) e estável para mulheres. As faixas etárias de 50 a 59 e maiores de 80 anos (r2=0,78; p<0,001 ambos) apresentaram tendência crescente para homens, enquanto para todas as idades houve estabilidade ou em declínio para mulheres. Conclusão A tendência de hospitalização por diabetes mellitusestratificada por sexo e idade, foi crescente apenas para homens entre 50 a 59 anos e maiores de 80 anos.
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Cortez DN, Reis IA, Souza DAS, Macedo MML, Torres HDC. Complicações e o tempo de diagnóstico do diabetes mellitus na atenção primária. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Analisar a associação entre o tempo da doença e o aparecimento de complicações do diabetes mellitus e descrever as características da população de diabéticos de um município de médio porte do Centro Oeste mineiro. Métodos: Estudo transversal realizado com 1320 usuários com diabetes mellitus. Os dados foram obtidos do sistema de cadastramento de Hipertensos e Diabéticos e foram avaliadas as variáveis: características sociodemográficas, duração da doença e complicações do diabetes. Resultados: Entre os usuários que possuem o diagnóstico da doença há mais de 10 anos, o percentual daqueles que apresentam complicações 156 (32,2%) é maior do que entre os que possuem o diagnóstico da doença há menos de 10 anos 45 (12,1%). Conclusão: Os resultados apontaram que a presença de complicações relacionadas ao diabetes pôde ser associada ao tempo de duração da doença.
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Paz-Salinas KC, Padilla-Raygoza N, Delgado-Sandoval SC, Olvera-Villanueva G, Ruiz-Paloalto ML. Do People with Type 2 Diabetes Think They are Unhealthy?: A Cross-Sectional Study in Celaya, Mexico. Cent Asian J Glob Health 2015; 4:207. [PMID: 29138715 PMCID: PMC5661197 DOI: 10.5195/cajgh.2015.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a chronic disease that presents a significant burden on health care systems in many countries. With the rise of obesity, the incidence of Type 2 diabetes has also been steadily increasing. A healthy lifestyle and understanding of diabetes management are important factors for delaying the onset of comorbidities associated with Type 2 diabetes. The objective of this study was to evaluate the self-perception of health in individuals with Type 2 diabetes as it relates to BMI status, which has important implications for the implementation of preventive programs. METHODS A cross-sectional lifestyle survey was implemented in the region of Celaya, Guanajuato, Mexico, targeting 100 participants diagnosed with Type 2 diabetes. Anthropometric measurements and participant characteristics were also obtained. Fisher's exact test was used to determine if the proportions of lifestyles perceptions differed by BMI status. RESULTS Participants had a mean age of 56.12 ± 10.26, a mean BMI of 29.13 ± 5.48 kg/m2, were mostly married (67.0%), and female (70.0%). None of the normal weight participants perceived themselves as unhealthy. 95% of overweight/obese participants perceived themselves to be healthy, despite a diagnosis of diabetes and being overweight/obese, while only 5% perceived themselves to be unhealthy. However, these differences in the perceptions of health classified by BMI status were not statistically significant (p = 0.42). CONCLUSION Our findings indicate that overweight and obese persons with Type 2 diabetes in Celaya, Mexico may have misperceptions about their own health, even though these findings were not statistically significant. These preliminary data highlight the importance of implementing prevention and educational programs among those with diabetes, in order to combat health misperceptions and raise awareness about the dangers of diabetes and obesity. Furthermore, more research with larger sample sizes is needed in order to fully understand the effects of perception of health on actual health.
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Affiliation(s)
- Karla C Paz-Salinas
- Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato, Mexico
| | - Nicolas Padilla-Raygoza
- Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato, Mexico
- Department of Nursing and Obstetrics, Campus Celaya Salvatierra, University of Guanajuato, Mexico
| | - Silvia C Delgado-Sandoval
- Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato, Mexico
- Department of Nursing and Obstetrics, Campus Celaya Salvatierra, University of Guanajuato, Mexico
| | - Georgina Olvera-Villanueva
- Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato, Mexico
- Department of Nursing and Obstetrics, Campus Celaya Salvatierra, University of Guanajuato, Mexico
| | - Ma Laura Ruiz-Paloalto
- Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato, Mexico
- Department of Clinical Nursing, Campus Celaya Salvatierra, University of Guanajuato, Mexico
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Simoes EJ, Bouras A, Cortez-Escalante JJ, Malta DC, Porto DL, Mokdad AH, de Moura L, Morais Neto OL. A priority health index identifies the top six priority risk and related factors for non-communicable diseases in Brazilian cities. BMC Public Health 2015; 15:443. [PMID: 25924606 PMCID: PMC4425866 DOI: 10.1186/s12889-015-1787-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background In Brazil, 72% of all deaths in 2007 were attributable to non-communicable diseases (NCD). We used a risk and related factor based index to prioritize NCD prevention programs in the combined 26 capital cities and the federal district (i.e., Brasilia) of Brazil. Methods We used 2006–2011 data (adults) from census and Brazil's surveillance of 12 NCD risk factors and 74 disease group mortality. The risk and related factors were: smoking, physical inactivity, overweight-obesity, low fruits and vegetables intake, binge drinking, insufficient Pap smear screening (women aged 25 to 59 years), insufficient mammography screening (women aged 50 to 69 years), insufficient blood pressure screening, insufficient blood glucose screening, diagnosis of hypercholesterolemia, diagnosis of hypertension and diagnosis of diabetes. We generated six indicators: intervention reduction of the risk factor prevalence, intervention cost per person, prevalence of risk factor, deaths attributable to risk factor, risk factor prevalence trend and ratio of risk factor prevalence between people with and without a high school education. We transformed risk and related factor indicators into priority scores to compute a priority health index (PHI). We implemented sensitivity analysis of PHI by computing it with slightly altered formulas and altering values of indicators under the assumption of bias in their estimation. We ranked risk factors based on PHI values. Results We found one intermediate (i.e., overweight-obesity) and six top risk and related factors priorities for NCD prevention in Brazil's large urban areas: diagnosed hypertension, physical inactivity, blood pressure screening, diagnosed hypercholesterolemia, smoking and binge drinking. Conclusion Brazil has already prioritized the six top priorities (i.e., hypertension, physical inactivity, blood pressure screening, hypercholesterolemia, smoking and binge drinking) and one intermediate priority (i.e., overweight-obesity) for NCD prevention identified in this report. Because effective interventions to reduce disease burden associated with each of the six priority risk factors are available, strategies based on these interventions need to be sustained in order to reduce NCD burden in Brazil. PHI can be used to track NCD prevention and health promotion actions at the local and national level in Brazil and in countries with similar public health surveillance systems. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1787-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eduardo J Simoes
- Department of Health Management and Informatics, Universityof Missouri School of Medicine, Columbia, USA.
| | - Adam Bouras
- Department of Health Management and Informatics, Universityof Missouri School of Medicine, Columbia, USA.
| | - Juan Jose Cortez-Escalante
- Min. Saude, Secret. de Vigil.Saude, Depart. de Vigilancia de Doencas e Agravos Nao Transmiss. & Promocao de Saude, Coord. Geral de Inform. e Analise Epidemiologica, Brasilia, Brazil.
| | - Deborah C Malta
- Min. Saude, Secret. de Vigil.Saude, Depart. de Vigilancia de Doencas e Agravos Nao Transmiss. & Promocao de Saude, Coord. Geral de Inform. e Analise Epidemiologica, Brasilia, Brazil.
| | - Denise Lopes Porto
- Min. Saude, Secret. de Vigil.Saude, Depart. de Vigilancia de Doencas e Agravos Nao Transmiss. & Promocao de Saude, Coord. Geral de Inform. e Analise Epidemiologica, Brasilia, Brazil.
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
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