Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola

<p>Abstract</p> <p>Background</p> <p>To determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a rural community (Bengo) of Angola.</p> <p>Methods</p> <p>A random sample of 421 subjects aged 30 to 69 years (30% men and 70% women) was selected from three villages of Bengo province. This cross-sectional home survey was conducted using a sampling design of stage conglomerates. First, clinical and anthropometric data were obtained and fasting capillary glucose level was determined. Subjects who screened positive (fasting capillary glucose ≥ 100 mg/dl and < 200 mg/dl) and each sixth consecutive subject who screened negative (fasting capillary glucose < 100 mg/dl) were submitted to the second phase of survey, consisting of the 75-g oral glucose tolerance test. Data was analyzed by the use of SAS statistical software.</p> <p>Results</p> <p>The prevalence rates of diabetes mellitus and IGT were 2.8% and 8.1%, respectively. The age group with the highest prevalence of diabetes was 60 to 69 years (42%). Impaired glucose tolerance prevalence was 38% in the 40 to 49 year age group and it increased with age, considering that the 50 to 59 and 60 to 69 year age groups as a whole represent 50% of all subjects with impaired glucose tolerance. The prevalence of diabetes mellitus did not differ significantly between men (3.2%) and women (2.7%) (p = 0.47). On the other hand, the prevalence of impaired glucose tolerance among women showed almost twice that found in men (9.1% vs. 5.6%, respectively). Overweight was present in 66.7% of the individuals with diabetes mellitus and 26.5% of individuals with impaired glucose tolerance showed overweight or obesity.</p> <p>Conclusions</p> <p>Although the prevalence of diabetes mellitus was low, the prevalence of impaired glucose tolerance is considered to be within an intermediary range, suggesting a future increase in the frequency of diabetes in this population.</p

Estimating cardiovascular risk in patients with type 2 diabetes: a national multicenter study in Brazil

<p>Abstract</p> <p>According to Brazilian National Data Survey diabetes is the fifth cause for hospitalization and is one of the ten major causes of mortality in this country.</p> <p>Aims</p> <p>to stratify the estimated cardiovascular risk (eCVR) in a population of type 2 diabetics (T2DM) according to the Framingham prediction equations as well as to determine the association between eCVR with metabolic and clinical control of the disease.</p> <p>Methods</p> <p>From 2000 to 2001 a cross-sectional multicenter study was conducted in 13 public out-patients diabetes/endocrinology clinics from 8 Brazilian cities. The 10-year risk of developing coronary heart disease (CHD) was estimated by the prediction equations described by Wilson et al (Circulation 1998). LDL equations were preferably used; when patients missed LDL data we used total cholesterol equations instead.</p> <p>Results</p> <p>Data from 1382 patients (59.0% female) were analyzed. Median and inter-quartile range (IQ) of age and duration of diabetes were 57.4 (51-65) and 8.8 (3-13) years, respectively without differences according to the gender. Forty-two percent of these patients were overweight and 35.4% were obese (the prevalence of higher BMI and obesity in this T2DM group was significantly higher in women than in men; p < 0.001). The overall estimated eCVR in T2DM patients was 21.4 (13.5-31.3). The eCVR was high (> 20%) in 738 (53.4%), intermediate in 202 (14.6%) and low in 442 (32%) patients. Men [25.1(15.4-37.3)] showed a higher eCVR than women [18.8 (12.4-27.9) p < 0.001]. The most common risk factor was high LDL-cholesterol (80.8%), most frequently found in women than in men (p = 0.01). The median of risk factors present was three (2-4) without gender differences. Overall we observed that 60 (4.3%) of our patients had none, 154(11.1%) one, 310 (22.4%) two, 385 (27.9%) three, 300 (21.7%) four, 149 (10.5%) five and six, (2%) six risk factors. A higher eCVR was noted in overweight or obese patients (p = 0.01 for both groups). No association was found between eCVR with age or a specific type of diabetes treatment. A correlation was found between eCVR and duration of diabetes (p < 0.001), BMI (p < 0.001), creatinine (p < 0.001) and triglycerides levels (p < 0.001) but it was not found with HbA1c, fasting blood glucose and post-prandial glucose. A higher eCVR was observed in patients with retinopathy (p < 0.001) and a tendency in patients with microalbuminuria (p = 0.06). Conclusion: our study showed that in this group of Brazilian T2DM the eCVR was correlated with the lipid profile and it was higher in patients with microvascular chronic complications. No correlation was found with glycemic control parameters. These data could explain the failure of intensive glycemic control programs aiming to reduce cardiovascular events observed in some studies.</p

Portador de hipertensão arterial: atitudes, crenças, percepções, pensamentos e práticas Arterial hypertension patients: attitudes, beliefs, perceptions, thoughts and practices

OBJETIVO: Conhecer o portador de hipertensão arterial, da rede pública de saúde, por meio da análise de suas atitudes, percepções, crenças, pensamentos e práticas, com o propósito de aperfeiçoar os programas de atendimento para essa categoria de doença. MÉTODOS: Foi realizado estudo exploratório com 32 pacientes hipertensos atendidos em duas unidades de saúde do Município de Ribeirão Preto, SP. Os sujeitos foram entrevistados em uma única sessão e os dados foram analisados pelo método "análise de conteúdo", por meio de categorias não definidas a priori. RESULTADOS: Quase a metade dos pacientes estudados (41%) não soube definir o que é hipertensão arterial. Mencionaram como principal sintoma dor de cabeça e na nuca (18%), sendo as possíveis conseqüências o derrame e o infarto (39%). Os fatores emocionais foram os mais referidos como os que dificultam o controle da pressão alta. Para este controle, 40% indicaram mudanças de hábitos alimentares e de vida. Dentro deste total, a caminhada e a ginástica foram os mais referidos. Quanto ao comportamento adotado pelos pacientes, os mais mencionados foram o uso de medicamentos e tratamento por profissional de saúde. CONCLUSÕES: Os aspectos psicossociais e as crenças de saúde parecem interferir diretamente no conhecimento que o paciente tem sobre a doença hipertensiva e nas práticas de saúde adotadas. Considera-se importante propor novas formas de orientação aos pacientes com hipertensão arterial.<br>OBJECTIVE: To get to know arterial hypertension patients through their attitudes, beliefs, perceptions, thoughts, and practices related to the disease. METHODS: An exploratory study was carried out in 32 hypertensive patients seen at 2 health care units in the municipal district of Ribeirão Preto, Brazil. Subjects were interviewed in a single session and data were analyzed using the Content Analysis method through categories not defined a priori. RESULTS: About half the patients (41%) were not able to define hypertension. They believed the main symptoms were headaches and neck pain (18%) and the possible consequences of the disease were stroke and heart attack (39%). Emotional factors were mentioned as the ones that mostly impair hypertension control. To accomplish that, 40% said there should be changes in the diet and life style, such as walking and exercising. Regarding patients' practices, drug treatment and management by a health provider were most often referred. CONCLUSIONS: Psychosocial aspects and health beliefs seem to affect directly with patients' knowledge on hypertensive disease and their health practices. Given that all patients had already received some kind of information about arterial hypertension before the beginning of the study, it would be important to propose new forms of educating these patients

Comportamento e conhecimento: fundamentos para prevenção do pé diabético Comportamiento y conocimiento: fundamentos para la prevención del pié diabético Behavior and knowlege: basis for prevention of diabetic foot

OBJETIVO: Identificar o conhecimento e comportamento de pessoas diabéticas em relação aos cuidados com os pés. MÉTODOS: Estudo descritivo e transversal realizado em um centro de pesquisa e extensão universitária do interior paulista, em 2005. Foram entrevistados 55 pacientes diabéticos. Para a obtenção dos dados utilizamos um formulário, dois questionários e exame físico dos pés. RESULTADOS: As pessoas diabéticas não reconhecem a dimensão do risco real com relação aos pés. O conhecimento referido nem sempre se traduz na adoção de ações de autocuidado para a prevenção de problemas relacionados aos pés. Esta realidade aponta para a necessidade de considerarmos as particularidades de cada sujeito e sua interação com o ambiente, para delineamento das intervenções educativas. CONCLUSÕES: É preciso que os profissionais de saúde compreendam que o descompasso entre conhecimento e comportamento dos diabéticos não deve ser interpretado como um obstáculo intransponível, mas como um dos desafios fundamentais que precisam ser enfrentados.<br>OBJETIVO: Identificar el conocimiento y comportamiento de personas diabéticas en relación a los cuidados de los piés. MÉTODOS: Estudio descriptivo y transversal realizado en un centro de investigación y extensión universitaria del interior paulista, en el 2005. Fueron entrevistados 55 pacientes diabéticos. Para la obtención de los datos utilizamos un formulario, dos cuestionarios y examen físico de los piés. RESULTADOS: Las personas diabéticas no reconocen la dimensión del riesgo real en relación a los piés. El conocimiento referido no siempre se traduce en la adopción de acciones de autocuidado para la prevención de problemas relacionados a los piés. Esta realidad apunta hacia la necesidad de considerar las particularidades de cada sujeto y su interacción con el ambiente, para el delineamento de las intervenciones educativas. CONCLUSIONES: Es preciso que los profesionales de salud comprendan que el descompás entre conocimiento y comportamiento de los diabéticos no debe ser interpretado como un obstáculo intransferible, sino como uno de los desafíos fundamentales que precisan ser enfrentados.<br>OBJECTIVE: To describe the knowledge and behaviors of patients with diabetes towards foot care. METHODS: A cross-sectional descriptive study was conducted at a university research and intervention center in the interior of the state of São Paulo. Data were collected through interviews, two specific questionnaires, and physical examination of the foot in 55 patients in 2005. RESULTS: The participants did not recognize the dimension of the true risks regarding lack of foot care. The participant knowledge of diabetes did not translate into actions to prevent foot problems. These results suggest the need to take into consideration specific individual characteristics and the individual's interactions with the environment in designing educational interventions. CONCLUSIONS: Health care professionals need to understand that discrepancy between knowledge and behaviors of patients with diabetes is not an obstacle impossible to cross, but a challenging issue that needs to be addressed