Controlling glycemia is the biggest difficulty for people with diabetes in Brazil. More than 13 million Brazilians between the ages of 20 and 79 suffer from diabetes.
The data comes from the Brazilian Diabetes Society (SBD), which estimates that by 2045 the disease will affect 24 million people and most patients will not be able to control the disease.
There are two types of diabetes. Type 1, of genetic origin, that begins to manifest in childhood or adolescence; and type 2, which can be developed in adulthood and is influenced by the lifestyle of the person. In this case, habits such as smoking, sedentary lifestyle and poor nutrition contribute to the onset of the disease.
A study conducted by researchers from the federal universities of Rio Grande do Sul, Amazonas, Pará and São Paulo in 28 public health centers in 20 Brazilian cities concluded that only 23% of children and adolescents and 9% of adults with diabetes had the glycemic check index and keep the disease under control.
The study also pointed out that the difficulty of control is greater in the northern region of the country, followed by the region's Northeast, Southeast, South and Midwest. According to endocrinologist Denise Franco, director of ADJ (Brazilian Diabetes Association), the figures show the relationship between the difficulty of managing diabetes and the quality of public health services.
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The specialist explains that SUS offers treatment for diabetes, but health departments do not always have a doctor available and it is common practice to miss medication. "In a region of the country, monitoring can be easier because the patient has access to 200 bands per month, but in another region these bands can be missing and without them the patient can not perform the test to see the glucose index." , explains the doctor.
The study also concluded that the difficulty of controlling the disease is higher in patients with low incomes. This is because these patients have more difficult access to medical specialists, in this case endocrinologists, and therefore receive more detailed information about the treatment and consequences of having the disease uncontrolled.
In patients with a low income 65% can make agreements with an endocrinologist. Among patients of the middle class, the percentage was more than 75% and in the patients in the higher classes 78%.
The study also points out that the number of specialists in Brazil is insufficient, both in the public network and in the private network. According to the CFM (Federal Council of Medicine), there are 5,200 endocrinologists in the country. According to the latest IBGE estimate, the country has 208 million inhabitants, which is on average one endocrinologist for every 40 thousand inhabitants.
Managing diabetes requires a new lifestyle
Controlling blood glucose is a big challenge because it involves a number of changes in the patient's habits and lifestyle.
According to Denise, the patient must understand that he has a chronic illness that has no cure but can be controlled. "This control depends on lifestyle changes, including accepting the need to use medication and following treatment correctly," she said.
These changes are part of what diabetes education is called – it is the set of information that the patient and the people who live with him must assimilate to control the disease. "Diabetes is not like a disease you take antibiotics and has been healed in seven days, the patient needs to know if he cares, needs information and must be willing to accept the changes," says the endocrinologist.
Control reduces public health expenditure
The lack of glycemic control is responsible for various complications caused by diabetes, including eye diseases, cardiovascular diseases, kidney damage, nervous system problems, infections and amputations.
"Maintaining high blood glucose means maintaining a chronic inflammatory process, increasing the risk of complications, increasing the risk of hospitalization, and reducing the risk of hospitalization if the patient is under control. ", explains Denise.
The study also looked at the average value and total costs of hospitalizations caused by complications of diabetes. The average cost of adult hospitalization with diabetes is US $ 845 (equivalent to R $ 3,434), or 19% higher than the hospitalization of a patient without the disease.
The endocrinologist explains the difference with the help of an infarct case as an example. "When a heart attack occurs, it does not only go to the hospital, which are days of intensive care, surgical procedures and other treatments.If it could be a hospitalization of 3 or 4 days, in the patient with diabetes, the risk of complications and more time in the hospital are needed. "
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