Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
School of Medicine, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Brazil.
Front Endocrinol (Lausanne). 2023 Mar 22;14:1122164. doi: 10.3389/fendo.2023.1122164. eCollection 2023.
Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults.
The PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals.
Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86).
Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.
全球范围内建议使用葡萄糖检测对未确诊的糖尿病进行筛查，以便在检测到的人群中采取预防措施。我们的目的是评估巴西通过全国成年人调查中自我报告的近期检测和医疗咨询来进行葡萄糖检测以筛查糖尿病的情况。
这项研究于 2013 年和 2019 年进行，对年龄在 18 岁及以上的巴西人进行了概率抽样。为了评估未确诊人群中的葡萄糖检测情况，我们排除了那些自我报告有糖尿病既往诊断的人群。然后，我们根据前两年的情况定义了最近的糖尿病诊断途径，并选择了最近的血糖检测和最近的医疗咨询。我们使用具有稳健方差的泊松回归来评估获得途径的相关性，并用调整后的流行率比（PR）及其 95%置信区间表示。
最近葡萄糖检测的获得情况表明，超过 70%的人报告了最近的血糖检测，2013 年为 71%，2019 年为 77%。这些发现与广泛的近期医疗咨询获得情况一致，2013 年和 2019 年分别为 86%和 89%。报告最近的葡萄糖检测和医疗咨询可能更能反映实际的医疗诊断检测的获得情况。当分析这个联合结果时，诊断途径的获得仍然很广泛，分别为 67%和 74%。女性（PR=1.16；1.15-1.17）、年龄较大的个体（PR=1.25；1.22-1.28）和受教育程度较高的个体（PR=1.17；1.15-1.18）、肥胖（PR=1.06；1.05-1.08）和高血压（PR=1.12；1.11-1.13）的人更容易获得（p<0.001）。相反，自我报告为黑人（PR=0.97；0.95-0.99）或混血儿（PR=0.97；0.96-0.98）、居住在农村地区（PR=0.89；0.87-0.90）和没有私人医疗保险计划的人（PR=0.85；0.84-0.86）获得途径较低（p<0.001）。
尽管巴西的糖尿病诊断检测获得途径很高，部分原因是其全民健康保险制度，但社会不平等仍然存在，需要采取具体行动，特别是在农村地区和自我报告为黑人或混血儿的人群中。
