Muzy Jéssica, Campos Mônica Rodrigues, Emmerick Isabel, Silva Raulino Sabino da, Schramm Joyce Mendes de Andrade
Escola Nacional de Sáude Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
University of Massachusetts Medical School, Worcester, U.S.A.
Cad Saude Publica. 2021 May 28;37(5):e00076120. doi: 10.1590/0102-311X00076120. eCollection 2021.
Diabetes mellitus is one of the most prevalent diseases worldwide and is among the leading causes of loss of healthy years of life, which is aggravated in Brazil by accelerated population aging. This study aims to measure the problem of diabetes mellitus and its complications and characterize healthcare for diabetics in Brazil, according to regions. Prevalence rates were estimated using a multinomial regression model, and characterization of healthcare was based on triangulation between the Brazilian National Health Survey (PNS), the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), and data from the Popular Pharmacy program. Diabetes prevalence in Brazil was 9.2%, according to the multinomial model, and prevalence in the corrected PNS (self-report + altered glycated hemoglobin - HbA1c ≥ 6.5) was 9.4%. The proportion of diabetes mellitus underreporting in the country was 42.5%, reaching 72.8% in the North. Among individuals diagnosed with diabetes mellitus, half presented HbA1c ≥ 6.5. Insufficient fundus eye examination (only 40% on average), with major regional variation (North 25% - Southeast 52%), is reflected in the high prevalence of retinopathy. Insufficient examination of feet (only 30%), can lead to more amputations. About 80% of diabetics used medications, indicating a persistently high proportion still without treatment. Healthcare deficiencies for diabetics lead to greater morbidity, hospitalizations (15%), and visits to emergency departments (27%, PMAQ). The scenario in 2012, although not ideal, occurred in a context of strengthening of the Brazilian Unified National Health System (SUS). The growing prevalence of diabetes mellitus and cutbacks in public health budgeting call for serious reflection on control of the disease in the coming years.
糖尿病是全球最普遍的疾病之一，也是导致健康寿命损失的主要原因之一，在巴西，人口加速老龄化使这一问题更加严重。本研究旨在衡量糖尿病及其并发症问题，并按地区描述巴西糖尿病患者的医疗保健情况。患病率采用多项回归模型进行估计，医疗保健情况的描述基于巴西国家卫生调查（PNS）、国家改善初级保健可及性和质量计划（PMAQ-AB）以及大众药房计划的数据进行三角测量。根据多项模型，巴西的糖尿病患病率为9.2%，经校正的PNS（自我报告+糖化血红蛋白改变-HbA1c≥6.5）中的患病率为9.4%。该国糖尿病漏报比例为42.5%，在北部地区达到72.8%。在被诊断患有糖尿病的个体中，一半的人HbA1c≥6.5。眼底检查不足（平均仅40%），且存在较大的地区差异（北部25%-东南部52%），这反映在视网膜病变的高患病率上。足部检查不足（仅30%），可能导致更多截肢。约80%的糖尿病患者使用药物，这表明仍有持续高比例的患者未得到治疗。糖尿病患者的医疗保健不足导致更高的发病率、住院率（15%）和急诊就诊率（27%，PMAQ）。2012年的情况虽然不理想，但却是在巴西统一国家卫生系统（SUS）得到加强的背景下发生的。糖尿病患病率的不断上升以及公共卫生预算的削减，要求我们在未来几年认真思考对该疾病的控制。
