Needed Improvements in Diabetes Prevention and Management in Brazil

Abstract

IntroductionDiabetes mellitus is one of the most common chronic diseases worldwide and its prevalence continues to increase. Adherence to good health behaviors provides better control of the disease. This study analyzed trends in the prevalence of diabetes among Brazilian adults between 2006 and 2016 and compared the frequency of key health behaviors between people with and without diabetes. MethodsWe analyzed data from 572,437 Brazilian adults interviewed between 2006 and 2016 by using the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel). We used regression models to investigate significant trends in the prevalence of diabetes and differences in adherence to health behaviors between people with and without diabetes.ResultsThe prevalence of diabetes increased significantly from 5.5% to 8.9% (P <.001), being higher among women, older adults, and those with less than a high school education. The greatest increase was observed among these groups with higher prevalence. People with diabetes had a lower frequency of risk behaviors and a higher frequency of protective behaviors when compared to people without diabetes. The greatest differences were observed in the consumption of soft drinks and sugar-sweetened beverages (9.5% vs 25.0%) and alcoholic beverages (9.0% vs 17.9%), and the smallest differences were related to regular consumption of fruits and vegetables (40.7% vs 34.0%) and meats with excess fat (24.3% vs 32.2%). People with diabetes reported less leisure-time physical activity (PRa, 0.92 [P < .001]) and less transport-related physical activity (PRa, 0.84 [P <.001]) than those without diabetes.ConclusionDiabetes prevalence increased between 2006 and 2016. People with diabetes had better dietary habits than those without diabetes, but still had risk behaviors such as insufficient physical activity.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…Although the differences in the methodology described above limit the ability to perform cross-sectional or trend comparisons among countries, we note several commonalities. During 2005–2020, some countries reported an increase in the prevalence of diabetes [ 33 , 36 , 38 – 40 , 66 , 70 – 72 , 79 , 85 , 86 ], consistent with previously published reviews [ 5 , 15 , 32 , 116 – 123 ]. Compared with the rest of the region, and as previously reported [ 5 , 15 , 32 , 124 , 125 ], diabetes prevalence varies across the region, with higher prevalence in Mexico (13.7%), Haiti (14.1% in women and 8.2% in men), and Puerto Rico (12.5–12.7% in the population aged 18 ≥ years and 26.8% in the population aged ≥ 45 years), and lower in Colombia (3.0% in the population aged 18 ≥ years, but 11.2% in age group ≥ 60 years), Dominican Republic (3.5%), Ecuador (2.7%), Peru (3.7%), and Uruguay (5.5–6.0%) (Fig.…”

“…Multiple studies in our review reported a higher prevalence of diabetes among women [ 36 , 38 , 40 , 42 , 44 , 47 , 49 – 52 , 57 , 60 , 62 , 63 , 65 , 70 , 72 , 75 , 78 , 79 , 83 – 86 , 90 , 95 , 96 , 110 , 113 ]. While the mediating factors for this sex difference need further study (e.g., history of GDM, which was outside of the scope of this review), the increased prevalence of diabetes among women in some LatAm countries would be expected to have implications for health and health care, and potentially future generations [ 267 – 269 ].…”

“…In addition, the growing prevalence of diabetes mellitus across LatAm and the complexity of the disease suggest opportunities to create or strengthen collaborations towards its prevention and early detection [141][142][143][144]. For example, multinational and multidisciplinary researchpublic health-health care policy-clinical care partnerships which already exist in formal or informal platforms may be well-positioned to evaluate the impact of nutrition, health insurance, housing, and other public policies [79,141,143,[145][146][147][148][149][150][151][152][153][154] on health outcomes and assess their potential translation into preventive strategies at the public health and clinical care levels. At the same time, the eventual implementation of such strategies will be strengthened by local governments' commitment to prioritize the prevention and treatment of NCDs, in this case, diabetes, as previously voiced by experts and advocates in the region [79,141,[155][156][157][158].…”

“… Dal Fabbro, 2014 [ 77 ] 2008–2012 Brazil Descriptive study on health of Xavante Indians from Mato Grosso N = 948 (463 men; 485 women) Age ≥ 20 years Capillary sample, although venous samples were obtained for other biomarkers; HbA1c Total age-adjusted: 28.3% (18.4% in men, 40.6% in women) Ministerio do Planejamento, Orçamento e Gestão, 2014 [ 78 ] 2013 Brazil (Pesquisa Nacional de Saúde -PNS 2013) Brazilian National Health Survey Random, clustered, three-stage sampling N = 62,986 households (no sex breakdown) Age ≥ 18 years Self-report; HbA1c was tested, but results not presented in this report Prevalence based on self-report = 6.2% (7.0% in women, 5.4% in men) Prevalence increased with age and with lower educational attainment. de Oliveira, 2018 [ 79 ] 2006–2016 Brazil [Surveillance Systems of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel)] Secondary analysis National Telephone Survey Quantitative review N = 572,437 adults (sum of all years) (no sex breakdown) Age ≥ 18 years Self-report Prevalence (2016): 8.9% Increased from 5.5% in 2006 Higher prevalence among women, with lower income, and with lower education. Ministério da Saúde do Brasil, 2019 [ 80 ] 2018 Brazil Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL BRASIL 2018) National Telephone Survey Capital cities of each of the 26 states and the Federal District, land lines Random, stratified N = 52,395 19,039 men, 33,356 women Age ≥ 18 years Self-report only Prevalence self-reported: 7.7% (8.1% in women, 7.1% in men) Diabetes prevalence Increased with age.…”

“…Multiple studies reported a greater prevalence of diabetes among women [ 36 , 38 , 40 , 42 , 44 , 47 , 49 – 52 , 57 , 60 , 62 , 63 , 65 , 70 , 72 , 75 , 78 , 79 , 83 – 86 , 90 , 95 , 96 , 110 , 113 ], and with increasing age, especially over age 60 years [ 33 , 36 , 44 , 47 , 50 , 55 , 69 – 72 , 78 , 80 , 81 , 86 , 91 , 93 , 110 ]. Some studies reported an inverse relationship between diabetes and socioeconomic status (SES) [ 33 , 79 , 103 ] or educational attainment [ 33 , 44 , 62 , 63 , 70 , 72 , 73 , 75 , 76 , 78 , 79 , 86 , 101 ]. Other studies reported a direct relationship between having health insurance and self-reported diabetes [ 42 , 70 , 97 , 100 ], implying that persons who have health insurance—proxy of access to health care services—would be aware of their health issues and report them accordingly.…”