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Controlo de doentes diabéticos na Cidade da Praia em Cabo Verde estudo de caso
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Resumo(s)
Resumo: Em Cabo Verde como em toda a África, a Diabetes mellitus tem sido considerada uma epidemia crescente.
Objetivos: Neste estudo pretende-se determinar a proporção de doentes controlados e fatores relacionados com o controlo da doença em diabéticos seguidos em duas Instituições prestadoras de cuidados de saúde da cidade da Praia.
Métodos: Trata-se de um estudo de caso comparativo em que a população de estudo é constituída por doentes diabéticos tipo 1 e 2 de ambos os sexos com idade superior a 10 anos, utilizadores em 2010 e 2011 das consultas do Centro de Saúde de Achada de Santo António (CSASA) e do Centro Social da Cruz Vermelha da cidade da Praia (CCV) e cujo diagnóstico foi feito há, pelo menos, 1 ano. Para a recolha de dados procedeu-se ao preenchimento de uma ficha elaborada para o efeito contendo dados sociodemográficos e clínicos recolhidos dos processos clínicos. Foram construídos modelos de regressão logística para cada uma das variáveis dependentes selecionadas: controlo dos doentes diabéticos, a presença de complicações de entre as quais a presença de neuropatia e presença de retinopatia.
Resultados: Foram estudados 327 doentes diabéticos, sendo 80,7% (n=264) do CCV e 19,3% (n=63) do CSASA. Dos 264 doentes que eram seguidos no CCV, 29,5 % (n=78) eram do sexo masculino e 70,5 % (n=186) do sexo feminino. No CSASA também se observou um predomínio de indivíduos do sexo feminino constituindo 74,6 % (n=47) contra 25,4% (n=16) do sexo masculino. A diabetes do tipo 2 predominou em ambas as instituições. A presença de comorbilidade verificada foi maior no CSASA do que na Cruz Vermelha (87,3% no CSASA e 74,6 % na CCV). Relativamente às complicações crónicas foram verificadas em 38,3% (n=101) no CCV e 25,4% (n=16) no CSASA.
A proporção de doentes diabéticos controlados foi, no CSASA de 29,1% (n=16) e na CCV de 15,1% (n=32). Na análise de regressão logística verificou-se que o controlo da Diabetes mellitus (DM) é explicado pelo facto de o diabético pertencer ao CSASA e estar a ser tratado com fármacos antidiabéticos orais como a metformina e a glibenclamida isolados ou com dieta e exercício físico; que a presença de complicações está relacionada o facto de os doentes estarem a ser seguidos no CCV, doentes com idade mais avançada, doentes que apresentam a doença há mais tempo e que têm hipertensão arterial; que a presença de neuropatia está mais relacionada com a duração da doença e com o mau controlo da glicémia; e que a presença deretinopatia está relacionada com o facto de o doente ter mais idade, ter a doença há mais tempo e estar a ser tratado com a associação glibenclamida + metformina.
Conclusões: Os resultados deste estudo mostram que, não obstante esses resultados estarem relacionados com populações específicas, podendo não ser representativa da população diabética cabo-verdiana, é evidente que é urgente a implementação de medidas eficazes para melhorar o controlo e a qualidade de vida dos doentes diabéticos no país. Os dados reforçaram necessidade de atendimento primário com ênfase na avaliação de riscos e educação do paciente.
Abstract: In Cape Verde like in all others countries of Africa, Diabetes mellitus has been considered a growing epidemic. Objectives: This study aims to determine the proportion of patients controlled and factors related to disease control in diabetics followed at two institutions providing health care of Praia. Methods: This is a comparative case study in which the study population consists of patients with diabetes type 1 and 2 of both sexes aged over 10 years, in 2010 and 2011 users consultations Health Center Achada Santo António (CSASA) and Social Centre Red Cross City of Praia (CCV) and whose the diagnosis was confirmed for at least 1 year. For data collection proceeded to fill in a form designed for this purpose containing demographic and clinical data collected from clinical files. We constructed logistic regression models for each of the dependent variables selected: control of diabetic patients, the presence of complications, neuropathy and presence of retinopathy. Results: We studied 327 diabetic patients, and 80.7% (n=264) of the CCV and 19.3% (n=63) of CSASA. Of the 264 patients who were followed in the CCV, 29.5% (n=78) were male and 70.5% (n=186) were female. In CSASA also observed a predominance of females constituting about 74.6% (n=47) versus 25.4% (n=16) male. Diabetes type 2 predominated in both institutions. The presence of comorbidity was observed in greater in CSASA than the Red Cross (CSASA in 87.3% and 74.6% in the CCV). With regard to chronic complications, it was found in 38,3% (n=101) in CCV and 25,4% (n=16) in CSASA. . The proportion of diabetic patients was controlled at CSASA 29.1% (n=16) and the CCV 15.1% (n=32). In logistic regression analysis showed that the control of Diabetes mellitus (DM) is explained by the fact that the diabetic belong to CSASA and be treated with oral antidiabetic agents such as metformin and glibenclamide alone or with diet and exercise, the presence of complications is related to the fact that patients are being followed in the CCV, older patients, patients with diabetes for longer and who have high blood pressure, the presence of neuropathy is more related to the duration of the disease and the poor glycemic control, and presence of retinopathy associated relates to the fact that the patient is older, have the disease for a longer period and be treated with the combination metformin + glibenclamide.Conclusions: The results of this study show that, despite these results are related to specific populations and may not be representative of the diabetic population of Cape Verde, it is evident that it is urgent to implement effective measures to improve the control and quality of life of patients diabetics in the country. The data reinforced the need for primary care with emphasis on risk assessment and patient education.
Abstract: In Cape Verde like in all others countries of Africa, Diabetes mellitus has been considered a growing epidemic. Objectives: This study aims to determine the proportion of patients controlled and factors related to disease control in diabetics followed at two institutions providing health care of Praia. Methods: This is a comparative case study in which the study population consists of patients with diabetes type 1 and 2 of both sexes aged over 10 years, in 2010 and 2011 users consultations Health Center Achada Santo António (CSASA) and Social Centre Red Cross City of Praia (CCV) and whose the diagnosis was confirmed for at least 1 year. For data collection proceeded to fill in a form designed for this purpose containing demographic and clinical data collected from clinical files. We constructed logistic regression models for each of the dependent variables selected: control of diabetic patients, the presence of complications, neuropathy and presence of retinopathy. Results: We studied 327 diabetic patients, and 80.7% (n=264) of the CCV and 19.3% (n=63) of CSASA. Of the 264 patients who were followed in the CCV, 29.5% (n=78) were male and 70.5% (n=186) were female. In CSASA also observed a predominance of females constituting about 74.6% (n=47) versus 25.4% (n=16) male. Diabetes type 2 predominated in both institutions. The presence of comorbidity was observed in greater in CSASA than the Red Cross (CSASA in 87.3% and 74.6% in the CCV). With regard to chronic complications, it was found in 38,3% (n=101) in CCV and 25,4% (n=16) in CSASA. . The proportion of diabetic patients was controlled at CSASA 29.1% (n=16) and the CCV 15.1% (n=32). In logistic regression analysis showed that the control of Diabetes mellitus (DM) is explained by the fact that the diabetic belong to CSASA and be treated with oral antidiabetic agents such as metformin and glibenclamide alone or with diet and exercise, the presence of complications is related to the fact that patients are being followed in the CCV, older patients, patients with diabetes for longer and who have high blood pressure, the presence of neuropathy is more related to the duration of the disease and the poor glycemic control, and presence of retinopathy associated relates to the fact that the patient is older, have the disease for a longer period and be treated with the combination metformin + glibenclamide.Conclusions: The results of this study show that, despite these results are related to specific populations and may not be representative of the diabetic population of Cape Verde, it is evident that it is urgent to implement effective measures to improve the control and quality of life of patients diabetics in the country. The data reinforced the need for primary care with emphasis on risk assessment and patient education.
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Palavras-chave
Saúde pública Diabetes Controlo glicémico Cabo Verde