Controle glicêmico e estilo de vida em indivíduos com diabetes usuários da atenção primária à saúde no município de Juiz de Fora - MG

Abstract

The incidence of type 2 diabetes (T2DM) has exponentially increased in recent years as a consequence of the contemporary social context, with Brazil being one of the countries with the highest prevalence and consequent impact on morbimortality. The care of individuals living with diabetes encompasses a set of factors, with primary health care (PHC) playing a crucial role as a coordinator and promoter of measures for better living conditions. It is known that there is still a gap between the implementation of scientific knowledge and the promotion of metabolic control through healthy habits, and understanding the local context allows for the development of effective actions to achieve this. The objective is to describe and evaluate glycemic control and lifestyle, related to diet and physical exercise, in individuals with T2DM treated in the PHC of Juiz de Fora between 2022 and 2023. A cross-sectional descriptive-exploratory study was conducted with patients aged ≥18 years, randomly selected from one to two Basic Health Units (BHU) in the 13 municipal health regions, according to the percentage distribution of coverage. Sociodemographic and clinical data were collected, and the following instruments were applied: Diabetes Education Questionnaire (DATE-Q), food intake questionnaire used in Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL), International Physical Activity Questionnaire (IPAQ), Bandura Exercise Self-Efficacy Scale (BESES), Diabetes Management Self-Efficacy Scale (DMSES), Medication Adherence Measure (MAT), and Brazilian Problem Areas in Diabetes Scale (B-PAID). Data distribution was analyzed using the Shapiro-Wilk test. Variables with normal distribution are presented as mean ± standard deviation, and those without normal distribution as median [Quartile1-Quartile3]. Total scores were correlated with glycated hemoglobin (HbA1c) values using the Spearman test, considering a significance level of 5%. Eighty individuals with T2DM from 12 health regions participated, in average elderly (61.2 ± 12.3 years), mostly with overweight or obesity (87,5), and with low household income (60% receiving ≤ 2 minimum wages monthly). The annual median HbA1c showed inadequate glycemic control (7.8% [6.4-9.9%]) between the participants. Additionally, moderate level of disease related knowledge was observed (total DATE-Q score: 13.0 ± 2.9), along with adequate consumption of beans, vegetables, legumes, and fruits, and reduced consumption of processed beverages. There was low exercise selfefficacy (total BESES score: 28.3 [6.1-57.2]), high self-efficacy for diabetes control (total DMSES score: 76.5 [64.3-84.8]), high adherence to medication treatment (total MAT score: 5.6 [5.1-5.9]), and little suffering associated with living with diabetes (total B-PAID score: 31.3 [14.0-51.3]). There was no significant correlation between HbA1c and physical activity level, measured in Metabolic Equivalent of Tasks (MET), and between HbA1c and the number of natural/processed foods consumed on the day before the assessment. A significant correlation was found between HbA1c and the following variables: household income (negative and weak ρ=-0.232; P=0.038), years of insulin use (negative and moderate ρ=-0.314; P=0.036), medication adherence (negative and weak ρ=-0.278; P=0.015), and suffering associated with living with diabetes (positive and weak ρ=0.228; P=0.042). Although the relationship found between the variables of interest was moderate or weak, it is reasonable to assume that comprehensive, multifactorial strategies aimed at promoting income equality, appropriate use of medications, and improvement in quality of life can contribute to better glycemic control.