Determinantes sociais da saúde, autocuidado e controle glicêmico de pessoas com diabetes tipo 2 da atenção secundária à saúde de Leopoldina, Minas Gerais

Abstract

Type 2 diabetes mellitus was considered a major public health problem due to its high prevalence and chronicity. Recent studies investigate an association between diabetes and the social determinants of health. Thus, the objective of this study was to evaluate the individual, proximal and intermediates social determinants of health that affect adherence to self-care activities and those that affect glycated hemoglobin in individuals with type 2 diabetes mellitus. A cross-sectional study was conducted in the Hiperdia program of secondary health care in Leopoldina, in the interior of the Zona da Mata region of Minas Gerais, with 203 adult and elderly individuals, of both sexes, diagnosed with type 2 diabetes mellitus, carried out between the months from December 2018 and October 2019. Data collection took place through a structured interview to investigate social determinants, the analysis of medical records to obtain glycated hemoglobin levels for assessment of glycemic control and a questionnaire to assess adherence to self-care, food intake and anthropometry. The main results are the predominance of females (73.3%), elderly (58.9%) with midian age of 62 years (38 - 86 years), a high proportion of individuals with low adherence to self-care activities (87.6%) and inadequate glycemic control (72.7%). The associations between social determinants and adherence to selfcare activities and adherence to feeding food were performed based on the determination of Odds Ratio (OR) and on 95% confidence interval (95% CI), it was considered statistical significance level p <0.05. Employed or retiredu individuals (OR=0.11; 95% CI 0.01 - 0.82; p=0.032) and individuals with monthly family income above three minimum wages (OR = 0.19; 95% CI 0, 06 - 0.63; p = 0.007) had less chance of low adherence to self-care activities. On the other side, the longer the time of diagnosis, the lower the chance of low adherence to feeding food (OR=0.96; 95% CI 0.93 - 0.99; p=0.037) and the greater the number of children, the greater the chance of low adherence to feeding food (OR=1.20; 95% CI 1.01 - 1.43; p=0.035). Through the hierarchical multiple linear regression, the association between glycated hemoglobin and the social determinants of health was evaluated. Eight or less years of study (β=0.680, p=0.040), unemployment (β=0.321, p=0.035), treatment with oral hypoglycemic associated with insulin (β=0.628, p<0.001), female (β=0.569, p=0.049) and having a family history of diabetes mellitus (β=0.516, p=0.044) were statiscally significant associated with a tendency to increase glycated hemoglobin levels. However, living on dirt or gravel streets with a tendency to decrease glycated hemoglobin levels (β=-1.261, p<0.001). In conclusion, the importance of identifying social determinants capable of interfering in adherence to self-care and glycemic control is emphasized by the possibility to develop and implement effective and humanized health actions that consider the influence of non-modifiable and modifiable determinants.