RESUMO
AIMS/HYPOTHESIS: We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. METHODS: The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005-2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. RESULTS: A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal-bolus regimen. An increasing proportion of participants had ≥2 HbA1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. CONCLUSIONS: In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.
Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobinas Glicadas/metabolismo , Controle Glicêmico , Adulto , Idoso , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hemoglobinas Glicadas/efeitos dos fármacos , Controle Glicêmico/estatística & dados numéricos , Controle Glicêmico/tendências , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Autogestão/estatística & dados numéricos , Autogestão/tendênciasRESUMO
PURPOSE: The purpose of this study was to evaluate bladder self-management in transition to adult care for patients with spina bifida (SB) in 3 countries with similar clinical practice and different social, cultural, and economic milieu. STUDY DESIGN: Cross-sectional study. SUBJECTS AND SETTING: The sample comprised 90 participants: 27 reside in Brazil, 36 reside in Germany, and 27 reside in the United States. Demographic characteristics of the sample are based on country. The distribution of sex in the Brazilian sample was 18 males and 9 females, the German group had 11 males and 25 females, and the United States group had 8 males and 19 females. The age range of the cumulative sample was 13 to 29 years. The age of the German sample (mean 23.56, standard deviation [SD] 4.60 years) was significantly higher (analysis of variance, F(2, 87) = 13.62, P < .001) than the other 2 groups (Brazil mean 20.56 years, SD 5.24; US mean 19.44 years, SD 4.70). METHODS: Demographic, clinical, and social variable data were collected via an online questionnaire distributed to multiple regions of Germany and a multidisciplinary myelomeningocele clinic at the University of Michigan in the Midwestern United States. In Brazil, participants completed a printed version of the survey. In Germany and the United States, an electronic version of the survey was made available online. German and English versions of the survey, originally developed in Portuguese for persons residing in Brazil, were translated and validated. RESULTS: The majority of participants (94.4%) performed intermittent catheterization (IC), 76.5% performed IC independently, whereas 23.5% required assistance with IC or catheterized with aids (handles, leg spreaders, and penis or labia holder). There were no statistically significant group differences in independent self-catheterization by gender. There were significant national group differences in level of lesion (P = .016), use of shunt (P = .012), and medication for bladder management (P < .001). Among participants 18 years and older, there were significantly higher levels of education in the German and the US samples than in the Brazilian sample (P < .001). CONCLUSIONS: Although there were national group differences in medical characteristics and management of SB, differences in independent self-catheterization were not significant. Findings suggest that support from family/caregivers and health care providers appears to facilitate transition to independent self-care, regardless of national context.
Assuntos
Transferência de Pacientes/métodos , Autogestão/métodos , Disrafismo Espinal/complicações , Bexiga Urinária/fisiopatologia , Adolescente , Adulto , Análise de Variância , Brasil , Estudos Transversais , Feminino , Alemanha , Humanos , Cateterismo Uretral Intermitente/métodos , Cateterismo Uretral Intermitente/tendências , Masculino , Michigan , Transferência de Pacientes/tendências , Autogestão/tendências , Disrafismo Espinal/psicologia , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To report the participatory management experience of a Family Health Strategy by means of community assemblies. METHODS: Community assemblies were performed with the population of a Family Health Strategy center in the city of Criciúma/SC. The meetings occurred between 2016 and 2017, including health care professionals, managers, members of the organized civil society and the healthcare system clients. RESULTS: The activity enable us to rethink the teamwork process regarding the system of health appointment scheduling and the replication of this process for all the family health teams of the municipality. FINAL REMARKS: Participatory management provided opportunities for new collective spaces that facilitate the democratization of healthcare in order to mobilize the role of the health system client in the development of more welcoming, resolute and integral health practices.
Assuntos
Participação da Comunidade/métodos , Participação do Paciente/métodos , Autogestão/métodos , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Autogestão/tendênciasRESUMO
ABSTRACT Objective: To report the participatory management experience of a Family Health Strategy by means of community assemblies. Methods: Community assemblies were performed with the population of a Family Health Strategy center in the city of Criciúma/SC. The meetings occurred between 2016 and 2017, including health care professionals, managers, members of the organized civil society and the healthcare system clients. Results: The activity enable us to rethink the teamwork process regarding the system of health appointment scheduling and the replication of this process for all the family health teams of the municipality. Final remarks: Participatory management provided opportunities for new collective spaces that facilitate the democratization of healthcare in order to mobilize the role of the health system client in the development of more welcoming, resolute and integral health practices.
RESUMEN Objetivo: Relatar la experiencia de gestión participativa de una Estrategia de Salud de la Familia (ESF) a través de las asambleas comunitarias. Método: Se realizaron asambleas comunitarias con la población adscrita de una Estrategia Salud de la Familia en el municipio de Criciúma / SC. Los encuentros ocurrieron entre los años 2016 y 2017 con la participación de profesionales de salud, gestores, representantes de la sociedad civil organizada y clientes. Resultados: La actividad permitió repensar el proceso de trabajo del equipo en cuanto a la forma de programación de consultas y la replicación de esta iniciativa en todos los equipos de Salud de la Familia del municipio. Consideraciones finales: La gestión participativa oportunizó nuevos espacios colectivos que posibilitaron la democratización de la salud para movilizar el protagonismo del cliente en la construcción de prácticas más acogedoras, resolutivas e integrales para la salud.
RESUMO Objetivo: Relatar a experiência de gestão participativa de uma Estratégia de Saúde da Família (ESF) por meio das assembleias comunitárias. Método: Foram realizadas assembleias comunitárias com a população adstrita de uma Estratégia Saúde da Família no município de Criciúma/SC. Os encontros aconteceram entre os anos de 2016 e 2017 envolvendo a participação de profissionais de saúde, gestores, representantes da sociedade civil organizada e usuários. Resultados: A atividade permitiu repensar o processo de trabalho da equipe no tocante a forma de agendamento de consultas e a replicação desta iniciativa em todas as equipes de Saúde da Família do município. Considerações finais: A gestão participativa oportunizou novos espaços coletivos que possibilitaram a democratização da saúde de forma a mobilizar o protagonismo do usuário na construção de práticas mais acolhedoras, resolutivas e integrais para a saúde.