Glycemic outcomes of people with diabetes mellitus in Brazilian primary health care.

Background: The capillary blood glucose monitoring program at home a challenge in primary health care. Therefore, it is fundamental to identify the glycemic control of people with diabetes mellitus through HBA1c and to analyze its associated factors. Objective: To identify the glycemic profile of people with Diabetes Mellitus (DM) through HbA1c and analyze factors associated. Materials & methods: Cross-sectional study developed in Ribeirão Preto, São Paulo, Brazil. Secondary data from the electronic health record of people registered in the Primary Health Care system were used. A sample of 3181 participants was obtained. People with HbA1c < 7.0% (53 mmol/mol) were considered to have adequate glycemic control. For people aged ≥ 55 years, a less stringent target, < 8.0% (64 mmol/mol), was also considered. The odds ratio was the measure of effect analyzed with their respective 95% Confidence Intervals (95% CI). Results: Adequate glycemic control with HbA1c < 7.0% (53 mmol/mol) was found in 44.8% of people and, when using the less rigid target, HbA1c < 8.0% (64 mmol/mol) for people aged ≥ 55 years-old, 70.6% had adequate glycemic control. Age and drug therapy were associated with adequate glycemic control (p < 0.001), which was more frequent among older people and those who used only metformin. Conclusion: The study shows that the achievement of adequate glycemic control is still a challenge, especially with regard to younger people and those who use insulin.

Leisure physical activity of people with and without chronic non-communicable diseases.

OBJECTIVES: to analyze the leisure physical activity of people with and without chronic non-communicable diseases by the single health system of the city of Ribeirão Preto - São Paulo. METHODS: observational cross-sectional study, data were collected by means of interviews in a sample for convenience and random of adults. RESULTS: there were 719 people, where 70.1% had chronic non-communicable diseases, being 68.1% inactive. Physical inactivity presents a similar distribution between the groups with and without disease and a national average in leisure physical activity. CONCLUSIONS: these data are aimed at health services that do not encourage physical and auditory leisure activities, such as multiprofessional activities in the health area.

Controle glicêmico de pessoas com diabetes mellitus na atenção primária à saúde em Ribeirão Preto / Glycemic control of people with diabetes mellitus in primary health care in Ribeirão Preto - SP

Estudo observacional transversal com o objetivo de analisar o controle glicêmico de pessoas com diabetes mellitus por meio dos valores de HbA1c na atenção primária à saúde de um município do interior paulista. Participaram do estudo as pessoas que utilizaram medicamentos para o tratamento do diabetes mellitus adquiridos na rede de atenção primária à saúde no ano de 2018. O estudo foi aprovado pelo comitê de ética em pesquisa. Foram utilizados dados secundários obtidos por meio do prontuário de saúde eletrônico. Os dados foram analisados no software SPSS 20.0 por meio de estatística descritiva, teste Qui-quadrado de Pearson, com nível de significância de 0,05 e regressão logística binária para obtenção da odds ratio e seus respectivos intervalos de confiança de 95%. A amostra foi constituída de 3181 pessoas, com predomínio de mulheres e média de idade de 62,8 anos (desvio padrão = 12,3). A metformina foi o medicamento mais utilizado, sendo que, 27,5% das pessoas utilizaram apenas a metformina, 19,7% utilizaram apenas sulfonilureia, 21,1% utilizaram metformina + sulfonilureia, 18,3% utilizaram antidiabético oral + insulina e 13,4% utilizaram apenas insulina. O controle glicêmico adequado (HbA1c <7,0%) foi encontrado em 44,8% das pessoas com DM e, quando utilizado a meta menos rígida (HbA1c <8,0%) para as pessoas com idade ≥55 anos, 70,6% apresentaram controle glicêmico adequado. A idade e a terapia medicamentosa estiveram associadas ao controle glicêmico adequado (p<0,001). O controle glicêmico adequado (HbA1c <7,0%) foi mais frequente entre pessoas de maior idade, sendo de apenas 30,4% entre as pessoas de 25 a 34 anos, 35,4% entre as de 35 a 44 anos, 37,1% entre as de 45 a 54 anos, 45,1% entre as de 55 a 64 anos, 45,2% entre as de 65 a 74 anos, alcançando o seu máximo, 55,8%, entre as pessoas com idade ≥75 anos. Quanto à terapia medicamentosa, as pessoas que utilizaram insulina ou antidiabético oral + insulina apresentaram menor frequência de controle glicêmico adequado, 27,1% e 20,9%, respectivamente. Por outro lado, 78,4% das pessoas que utilizaram apenas metformina, 45,1% das que utilizaram apenas sulfonilureia e 38,2% das que utilizaram metformina + sulfonilureia, apresentaram controle glicêmico adequado (HbA1c <7,0%). O estudo mostra que o alcance do controle glicêmico adequado é ainda um desafio, o que aumenta a necessidade de ampliação nas ações de atenção à saúde das pessoas com DM, especialmente no que tange às pessoas mais jovens e em uso de terapias medicamentosas intensas.

This is a cross-sectional observational study that aims to analyze the glycemic control of people with diabetes mellitus by HbA1c values in primary health care in a city in the countryside of São Paulo. People who used drugs for the treatment of diabetes mellitus, acquired in the primary health care network in 2018, participated in the study. The study was approved by the research ethics committee. The secondary data obtained from the electronic health record were used. The data were analyzed using the SPSS 20.0 software with descriptive statistics, Pearson's Chi-square test, with a significance level of 0.05 and binary logistic regression, to obtain the odds ratio and their respective 95% confidence intervals. The sample consisted of 3,181 people, with a predominance of women and a mean age of 62.8 years-old (standard deviation = 12.3). Metformin was the most widely used drug, with 27.5% of people using only metformin, 19.7% use only sulfonylurea, 21.1% use metformin + sulfonylurea, 18.3% use oral antidiabetic + insulin and 13.4% use only insulin. Adequate glycemic control (HbA1c <7.0%) was found in 44.8% of people with DM and, when using the less rigid target (HbA1c <8.0%) for people aged ≥55 years-old, 70.6% had adequate glycemic control. Age and drug therapy were associated with adequate glycemic control (p <0.001). Adequate glycemic control (HbA1c <7.0%) was more frequent among older people, being only 30.4% among people who are 25 to 34 years-old, 35.4% among those who are 35 to 44 years-old, 37.1% between 45 and 54 years-old, 45.1% between 55 and 64 years-old, 45.2% between 65 and 74 years-old, reaching its maximum, 55.8%, among people aged ≥75 years-old. As for drug therapy, people who used insulin or oral antidiabetic + insulin had a lower frequency of adequate glycemic control, 27.1% and 20.9%, respectively. On the other hand, 78.4% of people who used only metformin, 45.1% of those who used only sulfonylurea and 38.2% of those who used metformin + sulfonylurea, have presented adequate glycemic control (HbA1c <7.0%). The study shows that the achievement of adequate glycemic control is still a challenge, what increases the need to expand health care actions for people with DM, especially with regard to younger people and those ones who use intense drug therapies.

Leisure physical activity of people with and without chronic non-communicable diseases / Actividad física de esparcimiento de personas con y sin enfermedades crónicas no transmisibles / Atividade física de lazer de pessoas com e sem doenças crônicas não transmissíveis

ABSTRACT Objectives: to analyze the leisure physical activity of people with and without chronic non-communicable diseases by the single health system of the city of Ribeirão Preto - São Paulo. Methods: observational cross-sectional study, data were collected by means of interviews in a sample for convenience and random of adults. Results: there were 719 people, where 70.1% had chronic non-communicable diseases, being 68.1% inactive. Physical inactivity presents a similar distribution between the groups with and without disease and a national average in leisure physical activity. Conclusions: these data are aimed at health services that do not encourage physical and auditory leisure activities, such as multiprofessional activities in the health area.

RESUMEN Objetivos: analizar la práctica de actividad física de ocio de personas con enfermedades crónicas no transmisibles por el sistema único de salud del municipio de Ribeirão Preto - São Paulo. Métodos: estudio observacional transversal, los datos fueron recolectados por medio de entrevistas en una muestra por conveniencia y aleatoria de adultos. Resultados: fueron 719 personas, donde el 70,1% poseía enfermedades crónicas no transmisibles, siendo el 68,1% inactivo. La inactividad física presenta una distribución similar entre los grupos con y sin enfermedad y una media nacional en la actividad física de ocio. Conclusiones: estos datos se dirigen a los servicios de salud que no incentivan la realización de actividades físicas y auditivas de ocio, como las actividades multiprofesionales en el espacio de salud.

RESUMO Objetivos: analisar a prática de atividade física de lazer de pessoas com e sem doenças crônicas não transmissíveis usuárias do sistema único de saúde do município de Ribeirão Preto - São Paulo. Métodos: trata-se de estudo observacional transversal. Os dados foram coletados por meio de entrevistas em uma amostra por conveniência e aleatória de adultos. Resultados: foram 719 pessoas, dentre as quais 70,1% possuíam doenças crônicas não transmissíveis, sendo 68,1% inativos. A inatividade física apresenta uma distribuição semelhante entre os grupos com e sem doença, e a média nacional na atividade física de lazer. Conclusões: esses dados podem direcionar ações junto aos serviços de saúde no que tange ao incentivo à realização de atividade física e ao estímulo de práticas saudáveis de lazer, como estratégias multiprofissionais no âmbito político de saúde.