Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

Lima, Rodrigo Fonseca; Fontbonne, Annick; Carvalho, Eduardo Maia Freese de; Montarroyos, Ulisses Ramos; Barreto, Maria Nelly Sobreira de Carvalho; Cesse, Eduarda Ângela Pessoa

doi:10.1590/S0080-623420160000700009

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 50 (06) • Nov-Dec 2016 • https://doi.org/10.1590/S0080-623420160000700009 copy

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco^* * Extracted from the dissertation "Fatores associados ao controle glicêmico inadequado em diabéticos tipo 2 cadastrados na Estratégia Saúde da Família em Pernambuco", Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, 2013.

Factores asociados con el control glucémico en personas con diabetes en la Estrategia Salud de la Familia en Pernambuco

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

Identifying factors associated with glycemic control in people with type 2 Diabetes Mellitus (DM) registered in the Family Health Strategy (FHS) in Pernambuco, Brazil.

METHOD

Associations between glycemic control (glycosylated hemoglobin A lower or equal to 7%) presented by people with DM and variables related to sociodemographic conditions, lifestyle, characteristics of diabetes, treatment and follow-up of patients by health services were investigated by multiple regression.

RESULTS

More than 65% of the participants presented inadequate glycemic control, especially those with lower age, longer illness duration, more annual contacts with FHS and complex therapeutic regimen. People with DM without referrals to specialists presented greater glycemic control. Associations with education level and obesity did not remain significant in the multivariate model.

CONCLUSION

The evolution of diabetes hinders adequate control, however, attention to younger people with DM and referrals to specialists are factors that can improve glycemic control.

Descriptors
Diabetes Mellitus Type 2; Primary Health Care; Hemoglobin A, Glycosylated; Family Health Strategy

Characteristics	Total sample	Glycemic Control		OR (CI 95%):	p-value
Characteristics	Total sample	Inadequate (A1c > 7%)	Adequate (A1c < 7%)	OR (CI 95%):	p-value
Duration of illness	8.6 ± 7.5	9.5 ± 7.8	6.5 ± 6.3	1.37^* * Increased chance at every increase of 5 years. (1.20 - 1.56)	< 0.001
Duration of illness
< 5 years	286 (38.3%)	171 (59.8%)	115 (40.2%)	Reference	-
From 5 to 9 years	174 (23.3%)	128 (73.6%)	46 (26.4%)	1.87 (1.23 - 2.86)	0.003
10 years or longer	286 (38.3%)	221 (77.3%)	65 (22.7%)	2.27(1.45 - 3.33)	< 0.001
Sociodemographic
Gender
Male	250 (31.8%)	169 (67.6%)	81 (32.4%)	Reference	-
Female	537 (68.2%)	376 (70.0%)	161 (30.0%)	1.12 (0.80 - 1.54)	0.494
Age (in years)	61.1 ± 13.1	60.4 ± 12.8	62.6 ± 13.6	0.93^* * Increased chance at every increase of 5 years. (0.88 - 0.99)	0.029
Age group
< 45	83 (10.6%)	58 (69.9%)	25 (30.1%)	Reference	-
45- 59	263 (33.4%)	191 (72.6%)	72 (27.4%)	1.15 (0.67 - 1.96)	0.628
60- 74	333 (42.3%)	231 (69.4%)	102 (30.6%)	0.98 (0.58 - 1.64)	0.928
≥ 75	108 (13.7%)	65 (60.2%)	43 (39.8%)	0.65 (0.36 - 1.19)	0.167
Education level
Illiterate	300 (38.1%)	218 (72.7%)	82 (27.3%)	Reference	-
Incomplete primary education	373 (47.4%)	254 (68.1%)	119 (31.9%)	0.80 (0.57 - 1.12)	0.198
Complete primary education	52 (6.6%)	36 (69.2%)	16 (30.8%)	0.85 (0.45 - 1.61)	0.610
Secondary education or higher	62 (7.9%)	37 (59.7%)	25 (40.3%)	0.55 (0.31 - 0.98)	0.043
Occupation
Retired/Pensioner/Disabled assistance	468 (59.8%)	312 (66.7%)	156 (33.3%)	Reference	-
Working	157 (20.0%)	113 (72.0%)	44 (28.0%)	1.28 (0.86 - 1.91)	0.218
Unemployed	30 (3.8%)	21 (70.0%)	9 (30.0%)	1.17 (0.52 - 2.61)	0.707
Housewife/student	128 (16.4%)	98 (76.6%)	30 (23.4%)	1.63 (1.03 - 2.57)	0.033
Family income
< 1 MW	233 (31.9%)	162 (69.5%)	71 (30.5%)	Reference	-
> 1 MW	497 (68.1%)	342 (68.8%)	155 (31.2%)	0.97 (0.69 - 1.35)	0.846
Lifestyle
Practices leisurely physical activity
Yes	231 (29.7%)	153 (66.2%)	78 (33.8%)	Reference	-
No	546 (70.7%)	383 (70.1%)	163 (29.9%)	1.20 (0.86 - 1.67)	0.281
Adopts a healthy diet
Yes	538 (69.4%)	368 (68.4%)	170 (31.6%)	Reference	-
No	237 (30.6%)	169 (71.3%)	68 (28.7%)	1.15 (0.82 - 1.61)	0.419
Smokes
Currently a smoker	101 (12.8%)	73 (62.3%)	28 (37.7%)	Reference	-
Quit smoking	322 (40.9%)	218 (67.7%)	104 (32.3%)	0.81 (0.49 - 1.31)	0.387
Never smoked	364 (46.2%)	254 (69.8%)	110 (30.2%)	0.88 (0.54 - 1.45)	0.627

Characteristic	Total sample	Glycemic Control		OR (CI 95%):	p-value
Characteristic	Total sample	Inadequate (A1c > 7%)	Adequate (A1c < 7%)
Anthropometric and clinical aspects
BMI (Kg/m²⁾	28.4 ± 5.3	28.2 ± 5.3	29.0 ± 5.2	0.97 (0.94 - 1.00)	0.084
Nutritional state
Normal	188 (26.4%)	142 (75.5%)	46 (24.5%)	Reference	-
Overweight	282 (39.6%)	191 (67.7%)	91 (32.3%)	0.68 (0.45 - 1.03)	0.069
Obese	242 (34.0%)	160 (66.1%)	82 (33.9%)	0.63 (0.41 - 0.97)	0.035
Complications due to DM
None	149 (21.2%)	103 (69.1%)	46 (30.9%)	Reference	-
1	279 (39.6%)	182 (65.2%)	97 (34.8%)	0.84 (0.55 - 1.28)	0.416
2	182 (25.8%)	126 (69.2%)	56 (30.8%)	1.00 (0.63 - 1.61)	0.984
≥ 3	94 (13.3%)	76 (80.9%)	18 (19.1%)	1.87 (1.02 - 3.57)	0.045
Characteristics of monitoring^* * During the 12 months prior to the interview.
Number of contacts with the FHS
≥ 4 times	281 (37.7%)	206 (73.3%)	75 (26.7%)	Reference	-
1 - 3 times	262 (35.1%)	183 (69.9%)	79 (30.1%)	0.84 (0.58 - 1.22)	0.371
None	203 (27.2%)	125 (61.6%)	78 (38.4%)	0.58 (0.39 - 0.86)	0.006
Referral to endocrinologists
Yes	133 (17.0%)	81 (60.9%)	52(39.1%)	Reference	-
No	649 (83.0%)	460 (70.9%)	189 (29.1%)	1.56 (1.06 - 2.32)	0.024
Referral to cardiologists
Yes	258 (33.0%)	167 (64.7%)	91 (35.3%)	Reference	-
No	524 (67.0%)	374 (71.4%)	150 (28.6%)	1.35 (0.99 - 1.87)	0.059
Participated in educational activities
Yes	167 (21.5%)	122 (73.0%)	45 (27.0%)	Reference	-
No	608 (78.5%)	415 (68.3%)	193 (31.7%)	0.79 (0.54 - 1.16)	0.235
Drug treatment
Without medications and/or insulin	57 (7.3%)	27 (47.3%)	30 (52.7%)	Reference	-
Oral monotherapy	420 (54.0%)	273 (65.0%)	147 (35.0%)	2.06 (1.18 - 3.60)	0.011
Combined oral therapy	249 (32.0%)	197 (79.1%)	52 (20.9%)	4.21 (2.30 - 7.69)	< 0.001
Insulin therapy with or without OAD	52 (6.7%)	44 (84.6%)	8 (15.4%)	6.11 (2.45 - 15.3)	< 0.001

Variables	OR (CI 95%):	p-value
Age (in years)	0.91 (0.86 - 0.97)	0.006
Duration of illness
< 5 years	Reference	-
From 5 to 9 years	1.90 (1.23 - 2.92)	0.004
10 years and longer	2.32 (1.56 - 3.45)	< 0.001
Referral to endocrinologists^* * In the 12 months prior to the interview.
Yes	Reference	-
No	1.97 (1.30 - 3.00)	0.001
Drug treatment
Without medication and/or insulin	Reference	-
Oral monotherapy	2.01 (1.11 - 3.62)	0.020
Combined oral therapy	3.60 (1.89 - 6.84)	<0.001
Insulin therapy with or without OAD	5.12 (1.93 - 13.6)	0.001
Number of contacts with the FHS^* * In the 12 months prior to the interview.
≥ 4 times	Reference	-
1- 3 times	0.95 (0.64 - 1.40)	0.790
None	0.69 (0.45 - 1.04)	0.074

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E-mail: reeusp@usp.br

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[1] Corresponding author: Eduarda Ângela Pessoa Cesse. Av. Moraes Rego s/n - Cidade Universitaria, CEP 50670-420 Recife, PE, Brazil. educesse@cpqam.fiocruz.br