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Revista Brasileira de Epidemiologia

Print version ISSN 1415-790XOn-line version ISSN 1980-5497

Rev. bras. epidemiol. vol.22  São Paulo  2019  Epub Dec 05, 2019

http://dx.doi.org/10.1590/1980-549720190061 

NOTES AND INFORMATION

Prevalence of diabetes in adults and the elderly, medication use and sources of acquisition: a comparative analysis of 2012 and 2016

Priscila Maria Stolses Bergamo FranciscoI 
http://orcid.org/0000-0001-7361-9961

Patrícia Silveira RodriguesI 
http://orcid.org/0000-0002-1313-2403

Karen Sarmento CostaI 
http://orcid.org/0000-0002-2218-6024

Noemia Urruth Leão TavaresII 
http://orcid.org/0000-0001-6180-7527

Vera Lúcia TierlingI  III 
http://orcid.org/0000-0001-9856-2017

Marilisa Berti de Azevedo BarrosI 
http://orcid.org/0000-0003-3974-195X

Deborah Carvalho MaltaIV 
http://orcid.org/0000-0002-8214-5734

IFaculty of Medical Sciences, Universidade Estadual de Campinas - Campinas (SP), Brazil.

IIFaculty of Health Sciences, Universidade de Brasília - Brasília (DF), Brazil.

IIISecretariat of Science and Technology and Strategic Inputs, Ministério da Saúde - Brasília (DF), Brazil.

IVSchool of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.


Among chronic noncommunicable diseases (NCDs), diabetes mellitus (DM) is distinguished in a heterogeneous group of metabolic disorders characterized by hyperglycemia due to defects in insulin action and/or secretion1. The persistent increase in blood glucose is related to acute or chronic complications in the cardiovascular, renal and neurological system, with high rates of hospitalization and mortality1,2.

Estimates show that between 2010 and 2030 there will be a 69% increase in the number of adults with DM in developing countries and 20% in developed countries3. In Brazil, data from the National Health Survey (PNS) estimate that about 9.2 million Brazilians are diagnosed with DM, with prevalence increasing with increasing age4.

The importance of the disease is highlighted as the main cause of mortality and premature disability in affected individuals in most developing countries, including Brazil5. Its prolonged course is reflected in the increased demand for services6, the high use of medicines, especially in the elderly6,7, its restriction of daily activities6 and significant social impact. Several factors are associated with the disease4,7 and health promotion measures have been implemented in the country in recent years to contain the progression of this NCD as well as others8.

In Brazil, medication for the treatment of DM are freely available in the National Public Health System(SUS), including primary care and, as a complementary strategy, through the Brazilian Popular Pharmacy Program (PFPB). The purpose of this brief communication was to estimate the prevalence of DM in adult and elderly individuals living in the capitals of the Brazilian states and the Federal District, to verify the percentage of diabetics on medication (oral and insulin), to describe the distribution of users according to sources of acquisition and to evaluate the percentages obtained in SUS between 2012 and 2016, from a comparative perspective.

We used data from individuals aged ≥ 18 years from the risk factor surveillance system for chronic noncommunicable diseases via telephone survey(Vigitel), conducted annually by the Ministry of Health since 2006, for the years 2012 (n = 45,448) and 2016 (n = 53,210)9.10. Vigitel has been approved by the National Commission of Ethics in Research on Human Beings (processes nº 13081/2008 and 355.590 / 2013). All individuals were consulted and informed and agreed to participate in the research.

Prevalence of diabetes was estimated for all respondents (age ≥ 18 years), for adults (between 18 and 59 years) and elderly (age ≥ 60 years), as well as the percentage of medication use (oral or insulin). among diabetics. For those who reported tablet or insulin use, the percentages and respective confidence intervals of 95% (95%CI) were also estimated, according to sources. Comparisons were performed using Pearson’s c2 test (Rao-Scott) with a significance level of 5%. All analyzes took into account the weights of the inquiry’s complex sample design. The medicines were obtaining for free in SUS / PFPB pharmacies.

The prevalences of DM were 7.4% (95%CI 6.9 - 7.8) and 8.9% (95%CI 8.5 - 9.4) in 2012 and 2016, consecutively. In men the prevalence was 6.5% (95%CI 5.8 - 7.2) and 7.8% (95%CI 7.2 -8.6) and in women, 8.1% (95%CI 7.5 - 8.9) and 9.9% (95%CI 9.2 - 10.5) in those years. In adults and the elderly, a significant increase was observed, from 4.6 to 5.4% (p = 0.014), and from 22.2 to 25.9% (p = 0.001), respectively, during the study period.

For the group of diabetics aged ≥ 18 years, regarding the exclusive use of oral medication, the percentages observed were 76.8 and 76.4% and, for insulin, 17.6 and 19.7% in 2012 and 2016, relatively, without statistically significant differences for the subgroups analyzed (p> 0.05).

Regarding the sources considered, there was an increase in oral medication among adults and insulin in the elderly in PFPB. Among all diabetics, there was a reduction in obtaining oral medications in SUS pharmacies and an increase in obtaining them in PFPB. An increased in obtaining insulin in PFPB insulin also observed (Figure 1).

Figure 1. Point estimates and 95% confidence interval of the percentage of diabetics undergoing treatment, according to sources. Vigitel, 2012 and 2016. 

It is important to mention that 69.7 and 70.3% of diabetics obtained free oral medications (SUS/PFPB pharmacies) in 2012 and 2016, respectively. The percentages for obtaining insulin free of charge were 88.9 and 90.0% in the years considered.

The results revealed an increased prevalence of DM in the period studied, especially among the elderly. They also showed, for the group of diabetic adults, a reduction in obtaining oral medicine in public pharmacies of primary care and an increase in obtaining both (oral and insulin) through the PFPB, without changes in obtaining them via private pharmacies in the analyzed period.

In secondary prevention, strict metabolic control plays an important role in combating the onset or progression of chronic complications arising from type 111 and type 21 DM. Although SUS remains a priority source for obtaining drugs to treat DM in the country, it is important to highlight the importance of the three managing bodies in providing treatment to patients with DM, including access to medicines and necessary supplies with guidance directed to rational use, reinforcing the role of primary care as coordinator of care of the Health Care Network.

REFERENCES

1. Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2017-2018. São Paulo: Clannad; 2017 [acessado em 10 mar. 2018]. Disponível em: Disponível em: http://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdfLinks ]

2. American Diabetes Association. Classification and Diagnosis of Diabetes. Diabetes Care 2015; 38(Supl. 1): S8-S16. https://doi.org/10.2337/dc15-S005Links ]

3. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87(1): 4-14. https://doi.org/10.1016/j.diabres.2009.10.007Links ]

4. Iser BPM, Stopa SR, Chueiri PS, Szwarcwald CL, Malta DC, Monteiro HOC, et al. Prevalência de diabetes autorreferido no Brasil: resultados da Pesquisa Nacional de Saúde 2013. Epidemiol Serv Saúde 2015; 24(2): 305-14. http://dx.doi.org/10.5123/S1679-49742015000200013Links ]

5. World Health Organization. Global report on diabetes. Genebra: WHO; 2016. [ Links ]

6. Malta DC, Iser BPM, Chueiri PS, Stopa SR, Szwarcwald CL, Schmidt MI, et al. Cuidados em saúde entre portadores de diabetes mellitus autorreferido no Brasil, Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol 2015; 18(Supl. 2): 17-32. http://dx.doi.org/10.1590/1980-5497201500060003Links ]

7. Prado MAMP, Francisco PMSB, Barros MBA. Diabetes em idosos: uso de medicamentos e risco de interação medicamentosa. Ciênc Saúde Coletiva 2016; 21(11): 3447-58. http://dx.doi.org/10.1590/1413-812320152111.24462015Links ]

8. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Coordenação Geral de Doenças e Agravos Não Transmissíveis. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022 [Internet]. Brasília: Ministério da Saúde; 2011 [acessado em 10 mar. 2018]. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/plano_acoes_enfrent_dcnt_2011.pdfLinks ]

9. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção de Saúde. Vigitel Brasil 2012: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde ; 2013. 136p. [ Links ]

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11. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977-86. https://doi.org/10.1056/NEJM199309303291401Links ]

12. K Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352(9131): 837-53. [ Links ]

Financial support: none.

Received: June 16, 2018; Revised: October 22, 2018; Accepted: October 30, 2018

Corresponding author: Priscila Maria Stolses Bergamo Francisco. Department of Public Health, Faculty of Medical Sciences, Universidade Estadual de Campinas. Rua Tessália Vieira de Camargo, 126, Cidade Universitária, CEP: 13083-887, Campinas (SP), Brazil. E-mail: primaria@unicamp.br

Conflict of interests: nothing to declare

Author’s contributions: Priscila Maria Stolses Bergamo Francisco prepared the proposal and writing of the manuscript, planned, programmed and performed the statistical analyzes. Patrícia Silveira Rodrigues collaborated in the planning, writing of the manuscript and literature review. Karen Sarmento Costa collaborated in the writing and critical revision of the content. Noemia Urruth Leão Tavares collaborated in the writing and critical review of the content. Vera Lúcia Tierling collaborated in the writing and review of the literature. Marilisa Berti de Azevedo Barros reviewed the data analysis and critically reviewed the content. Deborah Carvalho Malta reviewed the data analysis, critically reviewed the content, and approved the final manuscript version.

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