Control of Glucose, Blood Pressure, and Cholesterol among Adults with Diabetes: The Brazilian National Health Survey

Achievement of Treatment Goals and Mortality in Individuals with Diabetes: The ELSA-Brasil Study

BACKGROUND

To prevent diabetes complications, the American Diabetes Association (ADA) has recommended the treatment of blood glucose, blood pressure, and LDL-cholesterol (LDL-c) to target levels. Our aim is to characterize the risk of death according to the achievement of these goals in subjects with diabetes participating in the ELSA-Brasil study.

METHODS

ELSA-Brasil is an occupational cohort study of middle-aged and elderly adults followed from a 2008-2010 baseline to 2019 by two additional clinic visits and annual telephone interviews. We ascertained known diabetes by self-reported diagnosis or anti-diabetic medication use. We used treatment targets based on the 2022 ADA guidelines. We ascertained deaths from any cause based on the annual surveillance confirmed by death certificates.

RESULTS

After 11 (1.8) years of follow-up, 261 subjects had died among 2423 with known diabetes. Within-target HbA1c was associated with the greatest protection (HR = 0.66; 95%CI 0.50-0.88) against all-cause mortality. Achieving both glycemic and blood pressure targets conferred substantial protection (HR = 0.54; 95%CI 0.37-0.78). Within-target LDL-c, however, was associated with increased mortality (HR = 1.44; 95%CI 1.11-1.88).

CONCLUSIONS

Glucose and blood pressure control, especially when concomitant, reduced mortality. The increased mortality associated with achieving the LDL-c target merits further investigation.

Levels and correlates of risk factor control in diabetes mellitus -ELSA-Brasil

BACKGROUND

Control of glucose, blood pressure, cholesterol, and smoking improves the prognosis of individuals with diabetes mellitus. Our objective was to assess the level of control of these risk factors in Brazilian adults with known diabetes and evaluate correlates of target achievement.

METHODS

Cross-sectional sample of the Brazilian Longitudinal Study of Adult Health, composed of participants reporting a previous diagnosis of diabetes or the use oof antidiabetic medication. We measured glycated hemoglobin (HbA1c) and LDL-cholesterol at a central laboratory and blood pressure following standardized protocols. We defined HbA1c  < 7% as glucose control (target A); blood pressure  < 140/90 mmHg (or  < 130/80 mmHg in high cardiovascular risk) as blood pressure control (target B), and LDL-c  < 100 mg/dl (or  < 70 mg/dl in high risk) as lipid control (target C), according to the 2022 American Diabetes Association guidelines.

RESULTS

Among 2062 individuals with diabetes, 1364 (66.1%) reached target A, 1596 (77.4%) target B, and 1086 (52.7%) target C; only 590 (28.6%) achieved all three targets. When also considering a non-smoking target, those achieving all targets dropped to 555 (26.9%). Women (PR = 1.13; 95%CI 1.07-1.20), those aged  ≥ 74 (PR = 1.20; 95%CI 1.08-1.34), and those with greater per capita income (e.g., greatest income PR = 1.26; 95%CI 1.10-1.45) were more likely to reach glucose control. Those black (PR = 0.91; 95%CI 0.83-1.00) or with a longer duration of diabetes (e.g., ≥ 10 years PR = 0.43; 95%CI 0.39-0.47) were less likely. Women (PR = 1.05; 95%CI 1.00-1.11) and those with private health insurance (PR = 1.15; 95%CI 1.07-1.23) were more likely to achieve two or more ABC targets; and those black (PR = 0.86; 95%CI 0.79-0.94) and with a longer duration of diabetes (e.g., > 10 years since diabetes diagnosis, PR = 0.68; 95%CI 0.63-0.73) less likely.

CONCLUSION

Control of ABC targets was poor, notably for LDL-c and especially when considering combined control. Indicators of a disadvantaged social situation were associated with less frequent control.

PANCREATIC CANCER MORTALITY TRENDS AND CORRELATION WITH HUMAN DEVELOPMENT INDEX (HDI) IN BRAZIL OVER 40 YEARS

BACKGROUND

Pancreatic cancer mortality is greater in countries with a high Human Development Index (HDI). This study analyzed pancreatic cancer mortality rates trends, and their correlation with HDI in Brazil over 40 years.

METHODS

Data on pancreatic cancer mortality in Brazil between 1979 and 2019 were obtained from the Mortality Information System (SIM). Age-standardized mortality rates (ASMR) and Annual Average Percent Change (AAPC) were calculated. Pearson's correlation test was applied to compare mortality rates and HDI for three periods: 1986-1995 was correlated with HDI of 1991, 1996-2005 with HDI of 2000, and 2006-2015 with HDI of 2010; and to the correlation of AAPC versus the percentage change in HDI from 1991 to 2010.

RESULTS

A total of 209,425 deaths from pancreatic cancer were reported in Brazil, with an annual increase of 1.5% in men and 1.9% in women. There was an upward trend for mortality in most Brazilian states, with the highest trends observed in the North and Northeast states. A positive correlation between pancreatic mortality and HDI was observed over the three decades (r>0.80, P<0.05) and also between AAPC and HDI improvement by sex (r=0.75 for men and r=0.78 for women, P<0.05).

CONCLUSION

There was an upward trend in pancreatic cancer mortality in Brazil for both sexes, but rates among women were higher. Mortality trends were higher in states with a higher percentage improvement in HDI, such as the North and Northeast states.

Atenção primária à saúde para o século XXI: primeiros resultados do novo modelo de financiamento

Resumo O Brasil, desde 1994, oferta serviços de atenção primária à saúde (APS) a partir da Estratégia Saúde da Família (ESF). A ESF alcançou resultados importantes. Nesse período, o modelo de financiamento da APS não sofreu alterações metodológicas importantes. Neste artigo, descreve-se os resultados do novo modelo de financiamento para APS aprovado de forma tripartite em 2019, o “Previne Brasil”, que é composto por (i) capitação ponderada, (ii) incentivos a ações específicas e estratégicas e (iii) pagamento por desempenho. Esses primeiros resultados revelam o incremento de mais de 50 milhões de pessoas com cadastro qualificado e único, associado ao número recorde de mais de 52 mil equipes de Saúde da Família/Equipe de Atenção Primária (EAP) financiadas pelo Ministério da Saúde, sendo mais de 35 mil (67%) com uso de prontuário eletrônico. Além disso, o cadastro das pessoas e dos profissionais da APS brasileira junto ao Sistema de Informação em Atenção Básica (SISAB) se configura como o maior conjunto de dados demográficos e clínicos de saúde do mundo. Esses avanços favorecem a superação das dificuldades para o alcance de maior acesso, longitudinalidade e coordenação do cuidado, qualificando a APS brasileira em busca de melhores resultados em saúde.