Nível de ativação e fatores associados em pessoas vivendo com diabetes cadastradas na atenção primária à saúde

Abstract

Considering the magnitude of diabetes mellitus as a chronic non-communicable disease, self-management of the disease by the individual is essential for successful treatment. Primary Health Care represents a scenario for investigating factors related to complications of chronic diseases and for providing guidance that generates greater autonomy for the individual. Objective: To evaluate the level of activation in people with diabetes registered in Primary Health Care and associated factors in a city from the Mata Mineira Zone. Methodology: Crosssectional study with people with diabetes in Primary Health Care. A questionnaire was applied for identification, sociodemographic data, lifestyle, health conditions and glycated hemoglobin recorded in the electronic medical record. Dietary characteristics were obtained using the SISVAN food consumption marker and the level of activation was assessed using the 13-item Patient Activation Measure® scale. Data analysis was performed using descriptive statistics, Pearson's chi-square test and Poisson regression. Results: A total of 120 people with diabetes participated in this stud, the majority of whom were female (72.5%; n=87) and the average age was 54.63 ± 11.22 years. The average time since diabetes diagnosis was 8.21 ± 6.77 years, with 92.5% being type 2 diabetes. The average activation score was 50.62±6.07 points and a higher prevalence of individuals with a level 1 activation. There was an association between a higher prevalence of high activation and paid work, monitoring blood glucose levels at home and having a history of acute myocardial infarction (AMI). Belonging to socioeconomic classification B1 and B2 and having obesity were associated with a lower level of activation. Regarding food consumption markers, it was observed that the highest activation score was associated with a higher prevalence of consumption of six meals the previous day and consumption of two or more healthy eating markers regardless of age, sex, race, socioeconomic classification, marital status, physical exercise, smoking, alcohol consumption, however these associations were not maintained after adjustment for obesity. Fruit intake the day before was also associated with a higher level of activation, regardless of the sex and age of the participants, this association was not maintained after all adjustments. The highest activation score was associated with the lowest consumption of hamburgers and sausages on the previous day, independent of all adjustment variables. Conclusion: The findings of this study reveal associations between activation and paid work, glycemic monitoring, history of AMI, consumption the day before the interview of six meals, two or more markers of healthy eating, fruit and lower consumption of hamburgers and sausages presented a higher level activation. However, a lower level of activation was found among people who belonged to a better socioeconomic classification (B1 and B2) and who were obese. Furthermore, the average activation score found in this study can be improved, reinforcing the importance of multidisciplinary monitoring of these individuals in the SUS and carrying out health interventions in order to increase the activation levels of this population and improve glycemic control.