Factors associated with glycemic control in a sample of individuals with Diabetes Mellitus taken from the Longitudinal Study of Adult Health, Brazil, 2008-2010

Moraes, Helaine Aparecida Bonatto de; Mengue, Sotero Serrate; Molina, Maria del Carmem Bisi; Cade, Nágela Valadão

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Epidemiologia e Serviços de Saúde

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Original article • Epidemiol. Serv. Saúde 29 (3) • 2020 • https://doi.org/10.5123/S1679-49742020000300017 copy

Factors associated with glycemic control in a sample of individuals with Diabetes Mellitus taken from the Longitudinal Study of Adult Health, Brazil, 2008-2010^* * Article derived from the Master’s Degree dissertation entitled ‘Non-association between medication adherence and glycemic control in diabetic participants of the ELSA-Brasil study’, defended by Helaine Aparecida Bonatto de Moraes at the Federal University of Espírito Santo (UFES) Public Health Postgraduate Program in 2017.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to investigate factors associated with glycemic control in individuals with diabetes mellitus (DM).

Methods

this was a cross-sectional study, with participants in the Longitudinal Study of Adult Health with self-reported DM; binomial logistic regression was used.

Results

1,242 individuals were included; 54.2% had glycated hemoglobin ≥6.5%, showing inadequate glycemic control; factors associated with inadequate glycemic control were male sex (OR=1.39 – 95%CI 1.05;1.85), black skin color (OR=1.74 – 95%CI 1.22;2.48) or brown skin color (OR=1,57 – 95%CI 1.14;2.16), average occupation level (OR=1.63 – 95%CI 1.02;2.58), not having health insurance (OR=1.47 – 95%CI 1.09;1.96), use of insulin (OR=7.34 – 95%CI 3.56;15.15), increased waist-to-hip ratio (OR=1.87 – 95%CI 1.19;2.93), smoking (OR=1.73 – 95%CI 1.09;2.74), and poor or very poor self-rated health (OR=2.37 – 95%CI 1.17;4.83).

Conclusion

the results reinforce the multicausal context in glycemic control, which was associated with sociodemographic factors, lifestyles and health conditions.

Diabetes Mellitus; Glycated Hemoglobin A; Diabetes Complications; Hyperglycemia

Variable	Categorization	n	%
Sex	Male	659	53.1
Sex	Female	583	46.9
Age range (in years)	35-44	80	6.4
	45-54	354	28.5
	55-64	514	41.4
	≥65	294	23.7
Race/skin color	Black	545	43.9
	Brown	273	22.0
	White	343	27.6
	Yellow/indigenous	61	4.9
	No information	20	1.6
Schooling	Incomplete elementary	143	11.5
	Complete elementary	125	10.1
	Complete high school	464	37.3
	Higher education	510	41.1
Marital status	Married or living with someone	808	65.1
	Divorced. separated or widowed	308	24.8
	Single	125	10.0
	No information	1	0.1
Per capita income (in minimum wages)	<4	760	61.2
	4 to <8	315	25.3
	8 to <12	120	9.7
	12 to <16	11	0.9
	≥16	31	2.5
	No information	5	0.4
Physical activity	Active	42	3.4
Physical activity	Not active	1,200	96.6
Smoking habit	Never	629	50.6
	Former smoker	480	38.6
	Smoker	132	10.7
	No information	1	0.1
Alcohol consumption	Never	176	14.1
	Former user	369	29.7
	User	697	56.2
Medication adherence	Low/medium adherence	748	60.2
Medication adherence	High adherence	494	39.8
Medication type	Oral antidiabetic	1,074	86.5
	Insulin	71	5.7
	Both	97	7.8
Glycemic control	Glycated hemoglobin≥6.5%	673	54.2
Glycemic control	Glycated hemoglobin<6.5%	569	45.8
Total		1,242	100.0

Variable	Categorization	n	%
Body mass index (BMI)	Low/normal weight	214	17.2
	Overweight	518	41.7
	Obesity	510	41.1
Waist circumference (WC)	Ideal	122	9.8
	Changed	1,119	90.1
	No information	1	0.1
Waist-to-hip ratio (WHR)	Ideal	117	9.4
	Changed	1,124	90.5
	No information	1	0.1
Abdominal obesity	No	315	25.4
	Yes	484	39.0
	No information	443	35.6
Total daily diet calories	<2,000	265	21.3
	2,000<3,000	567	45.7
	3,000<4,000	255	20.5
	≥4,000	154	12.4
	No information	1	0.1
Self-rated health (SRH)	Very good	108	8.7
	Good	569	45.8
	Regular	483	38.9
	Poor/very poor	80	6.4
	No information	2	0.2
Private health insurance	No	454	36.5
	Yes	787	63.4
	No information	1	0.1
Occupational history	Working	754	60.7
	Retired	487	39.2
	No information	1	0.1
Job category	Support	404	32.5
	Technical	452	36.4
	Higher/teacher	386	31.1
Religious activity	No	354	28.5
Religious activity	Yes	888	71.5
Total		1,242	100.0

Variable	Categorization	Inadequate glycemic control (HbA1c ≥6.5%)		p-value^a
Variable	Categorization	n	%	p-value^a
Sex	Male	377	57.2	0.023
Sex	Female	296	50.8	0.023
Age range (in years)	35-44	46	57.5	0.080
	45-54	210	59.3
	55-64	270	52.5
	≥65	147	50.0
Race/skin color	Black	244	44.8	<0.001
	Brown	177	64.8
	White	209	60.9
	Yellow/indigenous	35	57.4
Schooling	Incomplete elementary	101	70.6	<0.001
	Complete elementary	89	71.2
	Complete high school	274	59.1
	Higher education	209	40.9
Per capita income (in minimum wages)	<4	470	61.8	<0.001
	4 a <8	138	43.8
	8 a <12	48	40.0
	12 a <16	6	54.5
	≥16	9	29.0
Marital status	Married/living with someone	437	54.0	0.587
	Divorced or separated	172	55.8
	Single	63	50.4
Type of medication	Oral antidiabetic	528	49.2	<0.001
	Insulin	61	85.9
	Both	85	87.6
Medication adherence	Low/medium	426	56.9	0.016
Medication adherence	High	247	50.0	0.016

Variable	Categorization	Inadequate glycemic control (HbA1c >6.5%)		p-value^a
Variable	Categorization	n	%	p-value^a
Body mass index (BMI)	Low/normal weight	117	54.7
	Overweight	273	52.7	0.661
	Obesity	283	55.5
Waist circumference (WC)	Ideal	65	53.3	0.839
Waist circumference (WC)	Changed	607	54.2
Waist-to-hip ratio (WHR)	Ideal	50	42.7	0.009
Waist-to-hip ratio (WHR)	Changed	622	55.3
Religious activity	No	176	49.7	0.046
Religious activity	Yes	497	55.9	0.046
Job category	Support	273	67.6	<0.001
	Technical	260	57.5
	Higher/teacher	140	36.3
Private health insurance	No	300	66.1	<0.001
Private health insurance	Yes	373	47.4	<0.001
Occupational history	Working	417	55.3	0.310
Occupational history	Retired	255	52.4	0.310
Self-rated health (SRH)	Very good	44	40.7	<0.001
	Good	278	48.8
	Regular	292	60.4
	Poor/very poor	58	72.5
Physical activity	Active	25	59.5	0.480
Physical activity	Not active	648	54.0	0.480
Smoking habit	Never	320	50.9	0.001
	Former smoker	262	54.6
	Smoker	90	68.2
Alcohol consumption	Never	102	57.9	0.039
	Former user	214	58.0
	User	355	50.9
Total daily diet calories	<2,000	138	52.1	<0.001
	2,000<3,000	281	49.5
	3,000<4,000	148	58.0
	≥4,000	105	68.2

Variable	Categorization	Adjusted analysis	p-value^c
Variable	Categorization	Adjusted (95%CI)^b	p-value^c
Sex	Female	–	–
Sex	Male	1.39 (1.05;1.85)	0.021
Age range (in years)	35-44	–	–
	45-54	1.05 (0.60;1.81)	0.856
	55-64	0.90 (0.52;1.54)	0.700
	≥65	0.98 (0.54;1.76)	0.954
Schooling	Incomplete elementary	1.03 (0.55;1.96)	0.905
	Complete elementary	1.38 (0.74;2.57)	0.300
	Complete high school	0.95 (0.62;1.46)	0.832
	Higher education	–	–
Per capita income (in minimum wages)	<4	1.55 (0.59;4.06)	0.370
	4 to <8	1.25 (0.48;3.23)	0.633
	8 to <12	1.562 (0.58;4.18)	0.375
	12 to <16	3.02 (0.59;15.43)	0.184
	≥16	–	–
Religious activity	Yes	–	–
Religious activity	No	0.87 (0.64;1.18)	0.379
Race/skin color	White	–	–
	Black	1.74 (1.22;2.48)	0.002
	Brown	1.57 (1.14;2.16)	0.006
	Yellow/indigenous	1.65 (0.91;2.99)	0.098
Job category	Support	1.67 (0.94;2.96)	0.078
	Technical	1.63 (1.02;2.58)	0.039
	Higher/teacher	–	–
Health insurance	Yes	–	–
Health insurance	No	1.47 (1.09;1.96)	0.010
Type of medication	Oral antidiabetic	–	–
	Insulin	7.34 (3.56;15.15)	<0.001
	Both	7.58 (3.96;14.52)	<0.001
Waist-to-hip ratio (WHR)	Ideal	–	–
Waist-to-hip ratio (WHR)	Changed	1.87 (1.19;2.93)	0.007
Smoking habit	Never	–	–
	Former smoker	0.97 (0.73;1.28)	0.817
	Smoker	1.73 (1.09;2.74)	0.019
Self-rated health (SRH)	Very good	–	–
	Good	1.29 (0.80;2.09)	0.290
	Regular	1.53 (0.93;2.52)	0.092
	Poor/very poor	2.37 (1.17;4.83)	0.017
Total daily diet calories	<2,000	–	–
	2,000<3,000	0.89 (0.64;1.25)	0.530
	3,000<4,000	1.17 (0.78;1.73)	0.433
	≥4,000	1.53 (0.95;2.45)	0.075
Alcohol consumption	Never	–	–
	Former user	0.92 (0.60;1.40)	0.709
	User	0.97 (0.64;1.46)	0.894
Medication adherence	Low/medium adherence	1.20 (0.92;1.56)	0.166
Medication adherence	High adherence	–	–

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Helaine Aparecida Bonatto de Moraes – Rua João Benedito, No. 21, Colatina, Espírito Santo, Brazil. Postcode: 29707-082 E-mail: habonatto@yahoo.com.br