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Prevalência da diabetes Mellitus e factores sociodemográficos, clínicos e epidemiológicos em pacientes adultos com tuberculose, no hospital sanatório de Luanda/ Angola
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Introdução: A tuberculose é a enfermidade epidémica mais frequente no mundo e um problema de saúde pública nos países em desenvolvimento (WHO, 2015).
Objectivo: Estimar a prevalência da diabetes mellitus e alguns factores associados em pacientes adultos com tuberculose.
Métodos: Estudo quantitativo, observacional, transversal, analítico, dos pacientes adultos (idade igual ou superior a 18 anos) com diagnóstico de tuberculose, independentemente da sua apresentação, hospitalizados ou atendidos no Hospital Sanatório de Luanda. Foi feita uma amostra sistemática dos participantes elegíveis para o estudo entre 12 de Fevereiro a 22 de Março de 2018. Os dados foram colhidos através da aplicação de um questionário de perguntas de resposta fechada aos participantes, consulta da ficha clínica e medição da glicémia capilar. Os dados do questionário foram inseridos numa base de dados criada no programa IBM (SPSS statistic version 20.0). Foi feita análise estatística descritiva de todas as variáveis e analisada a relação entre as características sociodemográficas, clínicas e epidemiológicas e ter ou não diagnóstico presuntivo de diabetes. Foram, ainda, calculados os odd ratio ajustados para algumas varíaveis sociodemográficas, clínicas e epidemiológicas utilizando a regressão logística.
Resultados: Participaram no estudo 438 pacientes sendo que 16,9% (n=74) tiveram diagnóstico presuntivo de diabetes mellitus com glicémia capilar ≥126 mg/dl. A maioria dos participantes com diagnóstico de diabetes mellitus, era do sexo masculino, estava desempregado, vivia em casa de familiar e tinha frequentado o ensino secundário. Oitenta e seis vírgula cinco por cento era um caso novo de tuberculose, 9,5% tinha tuberculose multidroga resistente, 95,9% tinha tuberculose pulmonar, 21,6% tinha algum tipo de co-morbilidade, 32,4% consumia álcool e 39,2% era ex-fumador.
As características dos doentes com diagnóstico de Diabetes mellitus foram: 40 anos de idade, sexo masculino, ter alguma co-morbilidade, frequentado até o ensino secundário, desempregado, caso novo de tuberculose, tuberculose pulmonar, consumo de álcool , ex-fumador e glicémia capilar ≥126 mg/dl.
De modo a controlar o efeito de potenciais confundimentos, realizou-se análise de regressão logística, usámos como variável dependente ter ou não Diabetes mellitus, de acordo com os valores de glicemia capilar obtidos durante a realização (≥126 mg/dl e < 126mg/dl). Actualmente, são definidos pela Organização Mundial da Saúde (OMS) e pela American Diabetes Association (ADA) para o diagnóstico de Diabetes mellitus glicémia de jejum superior 126mg/dl confirmado em mais de uma ocasião (Diabetologia, S.P.D, 2013).
Foram, ainda, consideradas as seguintes variáveis: sexo, idade, escolaridade, tipo de caso, consumo de álcool, consumo de tabaco e co-morbilidades. Dentre estas variáveis, apenas a idade se revelou estar associada a diabetes mellitus entre os indivíduos com tuberculose. Verificou-se que por cada aumento de um ano na idade dos indivíduos com TB, existia um aumento de 3,4% de desenvolver DM (OR= 1,034; IC95= [1,102; 1,057]).
Discussão: A prevalência da DM em pacientes com TB no Hospital Sanatório de Luanda, foi de 16,9% o que sugere que esta doença pode estar relacionada com a TB.
A prevalência de DM encontrada neste estudo é elevada comparativamente com estudos semelhantes feitos em outros países.
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Ao contrário do que é preconizado pela OMS, verificou-se que existem vários obstáculos no que toca ao estudo da diabetes mellitus em indivíduos com TB, já que a maioria dos participantes do estudo não possuia esta informação na sua ficha clínica.
Conclusão: Assim, é importante haver um investimento no rastreio da diabetes mellitus junto dos doentes com TB de modo a se poder prestar melhores cuidados e a aumentar a eficiência da resposta do programa de luta contra a Tuberculose.
Introduction: Tuberculosis is the most common epidemic disease in the world with public health concern in developing countries (WHO, 2015). Objective: To estimate the prevalence of diabetes mellitus and associated factors in adult patients with tuberculosis. Methods: Quantitative Study, observational and cross sectional analytical, of adult patients (aged less than 18 years) with tuberculosis, regardless of their presentation, either hospitalized or taking medication at Luanda centre hospital. A systematic sample was taken from eligible participants from 12 February to 22 March 2018. Data were collected through close-ended questionnaire, the medical records consultation and measurement of capillary blood glucose. Data was coded into a database created in the IBM program (SPSS statistic version 20.0). A descriptive statistical analysis of all variables was performed and the relationship between sociodemographic, clinical and epidemiological characteristics and the presence or not presumptive diagnosis of diabetes was analysed. We also adjusted the odds ratio for some sociodemographic, clinical and epidemiological variables using logistic regression. Results: A total of 438 patients were sampled in the study, of those, 16.9% (n = 74) had a presumptive diagnosis of Diabetes Mellitus with capillary glycemia ≥126 mg / dl, being the majority male, unemployed, living with family and had attended secondary school. Eighty-five percent was a new case of TB. of those, 9.5% had resistant multidrug tuberculosis, 95.9% had pulmonary tuberculosis, 21.6% had some type of co-morbidity, 32.4% had alcohol and 39.2% were former smokers. The characteristics of patients diagnosed with Diabetes Mellitus were: 40 years of age, male, have some co-morbidity, unemployed and held secondary school, new TB case, pulmonary tuberculosis, was alcohol consumption, ex-smoker, and capillary glycemia ≥126 mg/dl. A logistic regression analysis was performed, Diabetes Mellitus was used as dependent variable based on the capillary glycemia values obtained during the test (≥126 mg / dl and <126mg/dl). Currently, the World Health Organization (WHO) and the American Diabetes Association (ADA) for the diagnosis of Diabetes mellitus, fasting plasma glucose 126mg / dl, confirmed on more than one occasion (Diabetologia, S.P.D, 2013). While socio-demographic characteristic, including type of case, alcohol consumption, smoking and comorbidities were plotted as independent variables. Among the independent variables, only age was found to be associated with Diabetes Mellitus among individuals with tuberculosis. It was found that for each one-year increase in the age of TB individuals, there was a 3.4% increase in Diabetes Mellitus (OR = 1.034, CI 95 = [1.102, 1.057]). Discussion: The prevalence of Diabetes Mellitus in patients with tuberculosis at Luanda Centre Hospital was 16.9%, suggesting that this disease may be related to tuberculosis. The prevalence of Diabetes Mellitus found in this study is high compared to similar studies done in other countries.Contrary to what is advocated by the WHO, it has been found that there are several challenges to study Diabetes Mellitus in individuals with tuberculosis, since most of the study participants did not have this information in their clinical file. Conclusion: It is therefore important to invest in Diabetes Mellitus screening of tuberculosis patients in order to provide better care and to increase the effectiveness of TB program response.
Introduction: Tuberculosis is the most common epidemic disease in the world with public health concern in developing countries (WHO, 2015). Objective: To estimate the prevalence of diabetes mellitus and associated factors in adult patients with tuberculosis. Methods: Quantitative Study, observational and cross sectional analytical, of adult patients (aged less than 18 years) with tuberculosis, regardless of their presentation, either hospitalized or taking medication at Luanda centre hospital. A systematic sample was taken from eligible participants from 12 February to 22 March 2018. Data were collected through close-ended questionnaire, the medical records consultation and measurement of capillary blood glucose. Data was coded into a database created in the IBM program (SPSS statistic version 20.0). A descriptive statistical analysis of all variables was performed and the relationship between sociodemographic, clinical and epidemiological characteristics and the presence or not presumptive diagnosis of diabetes was analysed. We also adjusted the odds ratio for some sociodemographic, clinical and epidemiological variables using logistic regression. Results: A total of 438 patients were sampled in the study, of those, 16.9% (n = 74) had a presumptive diagnosis of Diabetes Mellitus with capillary glycemia ≥126 mg / dl, being the majority male, unemployed, living with family and had attended secondary school. Eighty-five percent was a new case of TB. of those, 9.5% had resistant multidrug tuberculosis, 95.9% had pulmonary tuberculosis, 21.6% had some type of co-morbidity, 32.4% had alcohol and 39.2% were former smokers. The characteristics of patients diagnosed with Diabetes Mellitus were: 40 years of age, male, have some co-morbidity, unemployed and held secondary school, new TB case, pulmonary tuberculosis, was alcohol consumption, ex-smoker, and capillary glycemia ≥126 mg/dl. A logistic regression analysis was performed, Diabetes Mellitus was used as dependent variable based on the capillary glycemia values obtained during the test (≥126 mg / dl and <126mg/dl). Currently, the World Health Organization (WHO) and the American Diabetes Association (ADA) for the diagnosis of Diabetes mellitus, fasting plasma glucose 126mg / dl, confirmed on more than one occasion (Diabetologia, S.P.D, 2013). While socio-demographic characteristic, including type of case, alcohol consumption, smoking and comorbidities were plotted as independent variables. Among the independent variables, only age was found to be associated with Diabetes Mellitus among individuals with tuberculosis. It was found that for each one-year increase in the age of TB individuals, there was a 3.4% increase in Diabetes Mellitus (OR = 1.034, CI 95 = [1.102, 1.057]). Discussion: The prevalence of Diabetes Mellitus in patients with tuberculosis at Luanda Centre Hospital was 16.9%, suggesting that this disease may be related to tuberculosis. The prevalence of Diabetes Mellitus found in this study is high compared to similar studies done in other countries.Contrary to what is advocated by the WHO, it has been found that there are several challenges to study Diabetes Mellitus in individuals with tuberculosis, since most of the study participants did not have this information in their clinical file. Conclusion: It is therefore important to invest in Diabetes Mellitus screening of tuberculosis patients in order to provide better care and to increase the effectiveness of TB program response.
Descrição
Palavras-chave
Saúde pública Tuberculose Diabetes Mellius Prevalência Epidemiologia
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical