Laércio Joel Franco

Tendências do diabetes mellitus no Brasil: o papel da transição nutricional

Prevalence of type 2 diabetes mellitus has increased rapidly and is expected to increase even further. In Latin America countries there is an upward trend among the younger age groups, with a major negative impact on the quality of life and burden of the disease for the health care system. Increasing rates of overweight and obesity associated with lifestyle changes and aging of the population are the main contributing factors to the increasing prevalence of type 2 diabetes. Dietary shifts in the Brazilian population (low frequency of fiber-rich foods and heavy consumption of saturated fatty acids and sugars) and sedentary lifestyle are the main risk factors for obesity, type 2 diabetes, and other chronic diseases. Diabetes prevention programs are being promoted in several countries with results showing improvement in quality of life.

Prevalence and 7-year incidence of Type II diabetes mellitus in a Japanese-Brazilian population: an alarming public health problem

Abstract Aims/hypothesis. In 1993, the prevalence of glucose intolerance was studied in a sample of 647 first-generation and second-generation Japanese-Brazilians. Their cohort was followed until 2000, when a second survey was conducted, this included the first and second generations, aged 30 or more years. The aims were to estimate the prevalence of glucose intolerance and 7-yr incidence of Type II (non-insulin-dependent) diabetes mellitus in this population. Methods. Prevalence rates were obtained for 1330 subjects examined in 2000. The incidence of diabetes mellitus was calculated for those classified as normal glucose tolerant in 1993 (n=253). A Students t test and the Cox proportional hazard model were used in data analysis. Results. In the year 2000, higher proportions of subjects were observed in all categories of glucose intolerance than those found in 1993. The overall incidence of diabetes was 30.9 per 1000 per year. A worse profile was observed among incident cases of diabetes, characterized by higher baseline values of anthropometric and metabolic variables as compared to those who had not developed diabetes. Analysis considering the simultaneous effects of demographic, nutritional and metabolic variables and physical activity levels for the development of diabetes showed that age, sex, waist circumference, fasting and 2-h plasma glucose concentrations were independent predictors. Conclusion/interpretation. Our data point towards a worsening of glucose tolerance status among Japanese-Brazilians, who show one of the highest prevalence rates of diabetes mellitus worldwide. This could reflect their strong genetic susceptibility associated with unfavourable environmental conditions.

Avaliação estratégica de educação em grupo e individual no programa educativo em diabetes

OBJECTIVE To compare the effectiveness of individual and group strategies in a diabetes education program. METHODS A total of 104 type-2 diabetes outpatients enrolled in an education program of a teaching hospital in Belo Horizonte, Southeastern Brazil, were randomly selected and assigned to two different education strategies: group education (54 subjects) and individual education (50 subjects). Group education comprised three monthly sessions, which involved play and interactive dynamics. In parallel, a second group received individual education. Subjects were follow up for six months during 2006 and they were evaluated using specific questionnaires: knowledge of diabetes, psychological attitudes, change in behavior, quality of life. Clinical evaluation was performed at baseline, three and six months of intervention. RESULTS Mean age was 60.6 years. The results of group and individual education were similar in the assessment tests of attitude, change of behavior and quality of life. A reduction in HbA1c levels was seen in both groups, but a statistically significant difference (p=0.012) was found only in the group education. CONCLUSIONS Both strategies of diabetes education were effective, however, group education was more effective than individual education for blood glucose control.OBJETIVO: Comparar a efetividade de estrategias, em grupo e individual, de programa educativo em diabetes. METODOS: Cento e quatro pacientes com diabetes tipo 2, atendidos no ambulatorio e com seguimento em programa educativo de hospital de Belo Horizonte (MG), foram aleatoriamente recrutados e alocados em dois grupos: educacao em grupo (n=54) e individual (n=50). A educacao em grupo consistia de tres encontros mensais, nos quais eram desenvolvidas dinâmicas ludicas e interativas. Simultaneamente, o outro grupo era acompanhado individualmente. O acompanhamento ocorreu por seis meses durante o ano de 2006, sendo avaliados por questionarios especificos: conhecimentos em diabetes, atitudes psicologicas, mudanca de comportamento, qualidade de vida. Foi realizada avaliacao clinica no tempo inicial, depois de tres e seis meses da intervencao. RESULTADOS: A media de idade dos pacientes era de 60,6 anos. Os resultados da educacao em grupo e individual foram semelhantes no teste de atitudes, mudanca de comportamento e qualidade de vida. Observou-se reducao nos niveis de HbA1c nos dois grupos, entretanto apenas no de educacao em grupo a diferenca apresentou significância estatistica (p= 0,012). CONCLUSOES: As duas estrategias do programa educativo em diabetes foram efetivas, porem a educacao em grupo apresentou melhores resultados de controle glicemico do que a individual.

The Costs of Type 2 Diabetes Mellitus Outpatient Care in the Brazilian Public Health System

OBJECTIVE The prevalence of type 2 diabetes has shown a significant increase in parallel with health care costs. The objective of the Brazilian Study on Diabetes Costs (ESCUDI study) was to estimate direct and indirect costs of type 2 diabetes outpatient care in the Brazilian Public Health Care System. METHODS Data were collected from different levels of health care in eight Brazilian cities in 2007. A total of 1000 outpatients were interviewed and had their medical records data analyzed. Direct medical costs included expenses with medications, diagnostic tests, procedures, blood glucose test strips, and office visits. Nonmedical direct costs included expenses with diet products, transportation, and caregivers. Absenteeism, sick leave, and early retirement were classified as indirect costs. RESULTS Total annual cost for outpatient care was US

High intake of fruits and vegetables predicts weight loss in Brazilian overweight adults

2108 per patient, out of which US

Comportamento alimentar em mulheres portadoras de diabetes tipo 2

1335 per patient of direct costs (63.3%) and US

The ROC curve in the evaluation of fasting capillary blood glucose as a screening test for diabetes and IGT

773 per patient of indirect costs (36.7%). Costs escalated as duration of diabetes and level of health care increased. Patients with both microvascular and macrovascular complications had higher costs (US

Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults

3199 per patient) compared to those with either microvascular (US

Prevalência de diabetes mellitus: diferenças de gênero e igualdade entre os sexos

2062 per patient) or macrovascular (US

Metabolic Profile and Cardiovascular Risk Patterns of an Indian Tribe Living in the Amazon Region of Brazil

2517 per patient) complications only. The greatest portion of direct costs was attributed to medication (48.2%). CONCLUSIONS Diabetes treatment leads to elevated costs both to Brazilian Public Health Care System and society. Costs increased along with duration of disease, level of care and presence of chronic complications, which suggested a need to reallocate health resources focusing on primary prevention of diabetes and its complications.