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Master's Dissertation
DOI
https://doi.org/10.11606/D.22.2020.tde-10032021-100142
Document
Author
Full name
Adrielen Aparecida Silva Calixto
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Teixeira, Carla Regina de Souza (President)
Banca, Rebecca Ortiz La
Franco, Laercio Joel
Torquato, Maria Teresa da Costa Gonçalves
Title in Portuguese
Controle glicêmico de pessoas com diabetes mellitus na atenção primária à saúde em Ribeirão Preto
Keywords in Portuguese
Atenção primária à saúde
Controle glicêmico
Diabetes mellitus
Hemoglobina A glicada
Abstract in Portuguese
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.
Title in English
Glycemic control of people with diabetes mellitus in primary health care in Ribeirão Preto - SP
Keywords in English
Diabetes mellitus
Glycated hemoglobin A
Glycemic control
Primary health care
Abstract in English
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.
 
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Publishing Date
2021-04-13
 
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