Indicators of the line of care for people with diabetes in Brazil: National Health Survey 2013 and 2019

Malta, Deborah Carvalho; Ribeiro, Edmar Geraldo; Gomes, Crizian Saar; Alves, Francielle Thalita Almeida; Stopa, Sheila Rizzato; Sardinha, Luciana Monteiro Vasconcelos; Pereira, Cimar Azeredo; Duncan, Bruce Bartholow; Schimidt, Maria Inês

Deborah Carvalho Malta

Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil

http://orcid.org/0000-0002-8214-5734

Edmar Geraldo Ribeiro

Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil

http://orcid.org/0000-0002-7201-9566

Crizian Saar Gomes

Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil

http://orcid.org/0000-0001-6586-4561

Francielle Thalita Almeida Alves

Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil

http://orcid.org/0000-0001-8886-8514

Sheila Rizzato Stopa

Ministério da Saúde, Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Brasília, DF, Brazil

http://orcid.org/0000-0001-8847-665X

Luciana Monteiro Vasconcelos Sardinha

Ministério da Saúde, Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Brasília, DF, Brazil

http://orcid.org/0000-0002-3679-3618

Cimar Azeredo Pereira

Instituto Brasileiro de Geografia e Estatística, Diretoria de Pesquisas, Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0001-6183-1607

Bruce Bartholow Duncan

Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Epidemiologia, Porto Alegre, RS, Brazil

http://orcid.org/0000-0002-1365-2222

Maria Inês Schimidt

Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Epidemiologia, Porto Alegre, RS, Brazil

http://orcid.org/0000-0002-9479-3659

Correspondence
Deborah Carvalho Malta. dcmalta@gmail.com

Associate editor

Maryane Oliveira Campos

Authors’ contribution

Malta DC drafted the first version of the manuscript, participated in the design, analysis and interpretation of data. Gomes CS performed the analysis and interpretation of data. Ribeiro EG, Gomes CS, Alves FTA, Stopa SR, Sardinha LMV, Pereira CA, Ducan BB, Schimidt MI contributed to the analysis and interpretation of data, and to the drafting or critical review of the manuscript. All authors have approved the final version and are responsible for all aspects of the work, including ensuring its accuracy and integrity.

Conflicts of interest

The authors declare they have no conflicts of interest.

Indicators	Sex		PR^a (95%CI)^b
	Male (A)	Female (B)	PR^a (95%CI)^b
	% (95%CI)^b	% (95%CI)^b	B/A
Used medication for DM^c or took insulin in the two weeks prior to the date of the interview	88.8 (86.7;90.6)	88.9 (87.1;90.5)	1.00 (0.97;1.03)
Received medical care for diabetes within the past 12 months	76.6 (73.7;79.2)	81.0 (78.7;83.0)	1.06 (1.01;1.10)
Last appointment for DM with the same physician as in previous appointments	60.4 (57.1;63.6)	58.6 (55.7;61.5)	0.97 (0.90;1.04)
Had all appointments with a specialist after referral	82.7 (77.0;87.2)	81.9 (77.6;85.5)	0.99 (0.91;1.07)
Had an eye exam within the past 12 months	36.8 (33.8;39.8)	36.6 (34.1;39.3)	1.00 (0.90;1.11)
Had diabetic foot screening within the past 12 months	30.5 (27.8;33.4)	32.5 (30.1;35.1)	1.07 (0.95;1.20)
Hospitalization due to DM or some sort of complication	16.5 (14.3;19.1)	13.1 (11.5;15.0)	0.80 (0.65;0.97)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	6.1 (4.7;7.9)	5.6 (4.2;7.6)	0.93 (0.62;1.38)
Last appointment for DM was at a Primary Health Care Center	46.4 (43.2;49.6)	51.1 (48.1;54.0)	1.10 (1.01;1.21)
Obtained at least one medication through the Popular Pharmacy Program	49.0 (45.9;52.2)	53.4 (50.6;56.1)	1.09 (1.01;1.18)

Indicators	Region					PR^a (95%CI)^b
	North (A)	Northeast (B)	Southeast (C)	South (D)	Midwest (E)	B/A	C/A	D/A	E/A
	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	B/A	C/A	D/A	E/A
Used medication for DM^c or took insulin in the two weeks prior to the date of the interview	86.8 (83.5;89.5)	90.2 (88.2;91.8)	88.8 (86.2;90.9)	87.0 (83.3;90.0)	90.1 (86.9;92.6)	1.04 (1.00;1.08)	1.02 (0.98;1.07)	1.00 (0.95;1.05)	1.04 (0.99;1.09)
Received medical care for diabetes within the past 12 months	82.3 (78.5;85.6)	78.4 (75.5;80.9)	80.7 (77.4;83.6)	74.6 (69.6;79.0)	78.5 (74.0;82.5)	0.95 (0.90;1.01)	0.98 (0.93;1.04)	0.91 (0.84;0.98)	0.95 (0.89;1.02)
Last appointment for DM with the same physician as in previous appointments	51.7 (46.3;57.0)	55.5 (52.4;58.7	61.8 (57.8;65.6)	64.7 (60.4;68.8)	51.6 (45.5;57.5)	1.08 (0.96;1.21)	1.20 (1.10;1.35)	1.25 (1.11;1.42)	1.00 (0.85;1.17)
Had all appointments with a specialist after referral	82.7 (75.4;88.2)	75.6 (69.6;80.7)	83.1 (77.3;87.6)	89.3 (83.8;93.1)	80.8 (71.2;87.7)	0.91 (0.82;1.02)	1.00 (0.91;1.11)	1.08 (0.98;1.19)	0.98 (0.86;1.11)
Had an eye exam within the past 12 months	34.2 (29.7;38.9)	32.2 (29.5;35.0)	40.8 (37.3;44.3)	32.1 (28.2;36.3)	36.3 (31.8;41.1)	0.94 (0.80;1.11)	1.20 (1.02;1.40)	0.94 (0.78;1.13)	1.06 (0.88;1.28)
Had diabetic foot screening within the past 12 months	29.9 (25.6;34.7)	29.4 (26.7;32.2)	34.0 (30.6;37.4)	30.5 (26.6;34.8)	28.4 (23.9;33.7)	0.98 (0.82;1.17)	1.13 (0.95;1.36)	1.02 (0.83;1.25)	0.95 (0.76;1.19)
Hospitalization due to DM or some sort of complication	17.4 (13.5;22.2)	17.2 (14.8;20.0)	12.1 (10.1;14.5)	15.9 (12.5;20.1)	16.6 (13.0;20.9)	0.99 (0.74;1.32)	0.70 (0.51;0.95)	0.92 (0.65;1.29)	0.95 (0.67;1.34)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	5.6 (3.8;8.1)	5.9 (4.8;7.1)	6.0 (4.1;8.7)	5.5 (3.7;8.0)	5.7 (4.0;7.1)	1.05 (0.69;1.60)	1.07 (0.63;1.82)	0.98 (0.57;1.67)	1.02 (0.61;1.69)
Last appointment for DM was at a Primary Health Care Center	56.6 (51.2;61.8)	49.6 (46.4;52.8)	46.2 (42.3;50.0)	55.7 (50.7;60.5)	49.5 (43.7;55.3)	0.88 (0.78;0.98)	0.82 (0.72;0.93)	0.98 (0.87;1.12)	0.88 (0.75;1.02)
Obtained at least one medication through the Popular Pharmacy Program	35.6 (30.7;40.9)	39.5 (36.4;42.7)	56.4 (52.8;60.0)	59.1 (54.5;63.6)	56.4 (51.6;61.1)	1.10 (0.94;1.31)	1.59 (1.35;1.86)	1.66 (1.41;1.96)	1.58 (1.34;1.87)

Indicators	Age groups			PR^a (95%CI)^b
	18 to 29 (A)	30 to 59 (B)	≥ 60 (C)	B/A	C/A
	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	B/A	C/A
Used medication for DM^c or took insulin in the two weeks prior to the date of the interview	60.1 (41.8;76.0)	87.0 (84.6;89.0)	91.1 (89.5;92.5)	1.45 (1.07;1.95)	1.52 (1.13;2.03)
Received medical care for diabetes within the past 12 months	57.9 (39.8;74.1)	79.9 (77.1;82.6)	79.2 (77.0;81.2)	1.38 (1.02;1.87)	1.37 (1.01;1.86)
Last appointment for DM with the same physician as in previous appointments	58.3 (39.8;74.7)	57.9 (54.4;61.3)	60.5 (57.8;63.2)	0.99 (0.72;1.37)	1.04 (0.76;1.43)
Had all appointments with a specialist after referral	58.5 (22.6;87.1)	82.3 (77.5;86.2)	83.1 (78.6;86.8)	1.41 (0.73;2.71)	1.42 (0.74;2.74)
Had an eye exam within the past 12 months	30.5 (16.5;49.3)	34.9 (31.7;38.3)	38.2 (35.7;40.7)	1.15 (0.65;2.03)	1.25 (0.72;2.19)
Had diabetic foot screening within the past 12 months	17.8 (9.5;30.9)	26.3 (23.3;29.6)	36.1 (33.7;38.6)	1.48 (0.81;2.70)	2.03 (1.11;3.68)
Hospitalization due to DM or some sort of complication	43.3 (25.6;62.8)	14.4 (12.3;16.7)	13.9 (12.2;15.7)	0.33 (0.21;0.53)	0.32 (0.20;0.51)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	0.4 (0.0;1.7)	7.0 (4.9;9.8)	5.2 (4.3;6.3)	17.20 (3.97;74.42)	12.84 (3.05;53.95)
Last appointment for DM was at a Primary Health Care Center	54.7 (36.4;71.9)	51.6 (48.1;55.1)	47.2 (44.5;49.9)	0.94 (0.67;1.33)	0.86 (0.61;1.22)
Obtained at least one medication through the Popular Pharmacy Program	36.5 (21.6;54.7)	53.2 (49.7;56.8)	50.7 (48.1;53.2)	1.46 (0.91;2.34)	1.39 (0.86;2.22)

Indicators	Education				PR^a (95%CI)^b
	No schooling and incomplete elementary school (A)	Complete elementary school and incomplete high school (B)	Complete high school and incomplete higher education (C)	Complete higher education (D)	B/A	C/A	D/A
	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	B/A	C/A	D/A
Used medication for DM^c or took insulin in the two weeks prior to the date of the interview	89.6 (87.9;91.0)	85.2 (79.2;90.2)	87.9 (84.5;90.7)	91.0 (87.1;93.8)	0.95 (0.88;1.02)	0.98 (0.95;1.02)	1.02 (0.98;1.06)
Received medical care for diabetes within the past 12 months	79.5 (77.2;81.6)	76.2 (69.6;81.7)	79.5 (75.5;82.9)	79.8 (75.1;83.8)	0.96 (0.89;1.04)	1.00 (0.95;1.05)	1.00 (0.94;1.07)
Last appointment for DM with the same physician as in previous appointments	57.0 (54.1;59.8)	61.7 (55.9;67.3)	60.1 (55.5;64.6)	69.5 (63.6;74.9)	1.08 (0.98;1.2)	1.06 (0.96;1.15)	1.22 (1.11;1.34)
Had all appointments with a specialist after referral	80.0 (75.0;84.0)	80.4 (71.7;86.9)	82.3 (75.2;88.3)	95.2 (91.5;97.3)	1.00 (0.9;1.12)	1.03 (0.93;1.14)	1.19 (1.11;1.27)
Had an eye exam within the past 12 months	32.2 (29.7;34.9)	39.1 (33.0;45.6)	41.5 (37.2;45.9)	50.6 (44.5;56.6)	1.21 (1.01;1.46)	1.29 (1.13;1.47)	1.57 (1.36;1.81)
Had diabetic foot screening within the past 12 months	29.0 (26.5;31.5)	33.5 (28.4;39.0)	34.0 (29.7;38.5)	41.2 (35.2;47.4)	1.16 (0.96;1.39)	1.17 (1.0;1.37)	1.42 (1.2;1.69)
Hospitalization due to DM or some sort of complication	15.9 (14.1;17.9)	12.5 (9.1;16.9)	13.3 (10.6;16.6)	11.3 (7.2;17.3)	0.78 (0.56;1.09)	0.84 (0.65;1.08)	0.71 (0.45;1.11)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	7.3 (5.7;9.3)	4.0 (2.5;6.4)	4.5 (2.8;7.1)	2.0 (0.9;4.2)	0.55 (0.32;0.93)	0.61 (0.36;1.05)	0.27 (0.12;0.61)
Last appointment for DM was at a Primary Health Care Center	58.3 (55.5;61.0)	48.7 (42.8;54.7)	38.0 (33.4;42.8)	17.5 (12.9;23.5)	0.84 (0.73;0.95)	0.65 (0.57;0.74)	0.30 (0.22;0.41)
Obtained at least one medication through the Popular Pharmacy Program	52.3 (49.5;55.0)	59.8 (54.2;65.2)	50.1 (45.5;54.7)	40.7 (35.3;46.4)	1.15 (1.03;1.27)	0.96 (0.86;1.07)	0.78 (0.67;0.9)

Indicator	Questions used in the construction of the indicator	Calculation method
Used medication for diabetes mellitus (DM) or took insulin in the two weeks prior to the date of the interview	PNS 2013	(number of individuals who have taken diabetes medication or insulin within the two weeks prior to the survey date/number of individuals who have reported a medical diagnosis of diabetes) x 100
	In the past two weeks, because of diabetes have you:
	Taken any oral medication to lower your blood sugar? (yes; no)
	Taken insulin? (yes; no)
	PNS 2019
	In the past two weeks, because of diabetes have you:
	Taken any oral medication to lower your blood sugar? (yes; all of them; yes, some; no)
	Has any doctor ever prescribed insulin to you to control diabetes? (yes; no)
Received medical care for diabetes within the past 12 months	PNS 2013 and 2019	(number of individuals who have received medical care for diabetes within the past 12 months/number of individuals who have reported a medical diagnosis of diabetes) x 100
	When was the last time you received medical care due to diabetes? (less than 6 months ago; 6 months ago to less than 1 year; 1 year ago to less than 2 years; 2 years ago to less than 3 years; 3 years ago or over; never did)
Last appointment for DM with the same physician as in previous appointments	PNS 2013 and 2019	(number of individuals who have reported that the doctor who they visited in the last appointment was the same as in previous appointments/number of individuals who have reported a medical diagnosis of diabetes and received medical care less than 3 years ago) x 100
	In the last appointment, was the doctor who saw you the same as in previous consultations? (yes; no)
Had all appointments with a specialist after referral	PNS 2013	(number of people who have reported getting all appointments with a specialist doctor/number of individuals who have reported a medical diagnosis of diabetes and have been referred to an appointment with a specialist doctor) x 100
	In any of the appointments for diabetes, was there a referral to a specialist doctor, such as a cardiologist, endocrinologist, nephrologist or ophthalmologist? (yes; no; there was no referral, as all appointments for diabetes were with a specialist doctor)
	Did you go to all the appointments with the specialist doctor? (yes; no)
	PNS 2019
	In any of the appointments for diabetes, was there a referral to a specialist doctor, such as a cardiologist, endocrinologist, nephrologist or ophthalmologist? (yes; no; there was no referral, as all appointments for diabetes were with a specialist doctor)
	Did you go to the appointments with the specialist doctor? (yes, all of them; yes, some of them; no)
Had an eye exam within the past 12 months	PNS 2013 and 2019	(number of individuals who have reported having an eye exam less than 1 year ago/number of individuals who have reported a medical diagnosis of diabetes) x 100
Had an eye exam within the past 12 months	When was the last time you had an eye exam or ophthalmoscopy in which your pupil was dilated? (less than 6 months ago; 6 months ago to less than 1 year; 1 year ago to less than 2 years; 2 years ago to less than 3 years; 3 years ago or over; never did)
Had diabetic foot screening within the past 12 months	PNS 2013 and 2019	(number of individuals who have reported having had their feet examined less than 1 year ago/number of individuals who have reported a medical diagnosis of diabetes) x 100
Had diabetic foot screening within the past 12 months	When was the last time a doctor or healthcare professional examined your feet for sensitivity or the presence of wounds or irritations? (less than 6 months ago; 6 months ago to less than 1 year; 1 year ago to less than 2 years; 2 years ago to less than 3 years; 3 years ago or over; never did)
Hospitalization due to DM or some sort of complication	PNS 2013 and 2019	(number of individuals who have been hospitalized due to diabetes or some sort of complication/number of individuals who have reported a medical diagnosis of diabetes and received medical care less than 3 years ago) x 100
Hospitalization due to DM or some sort of complication	Have you ever been hospitalized because of diabetes or any complications? (yes; no)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	PNS 2013 and 2019	(number of individuals who have reported severe/very severe degree of limitations in usual activities due to diabetes or some sort of complication/number of individuals who have reported a medical diagnosis of diabetes) x 100
	In general, to what extent does diabetes or a diabetes complication limit your usual activities (such as working, doing housework, etc.)?(does not limit; a little; moderately; severely; very severely)
Last appointment for DM was at a Primary Health Care Center	PNS 2013	(number of individuals who have had their last appointment at a Primary Health Care Center/number of individuals who have reported a medical diagnosis of diabetes and received medical care less than 3 years ago) x 100
	The last time you received medical care for diabetes, where did you receive care? [PHC center (public health post or center or family health unit); specialty center, public polyclinic, or public medical assistance center (PAM); public emergency care center (UPA); another type of public emergency care center (24/7); public emergency room or the emergency department of a public hospital; public hospital/outpatient clinic; private doctor’s office or private clinic; Outpatient clinic provided by the company/business or the Union; private emergency room ou private hospital emergency department; At home, with a doctor from the family health team; At home, with a private practice doctor; other (specify)]
	PNS 2019
	The last time you received medical care for diabetes, where were you seen? [pharmacy; PHC center (public health post or center or family health unit); specialty center, public polyclinic, or public medical assistance center (PAM); public emergency care center (UPA); another type of public emergency care center (24/7); public emergency room or the emergency department of a public hospital; public hospital/outpatient clinic; private office, private clinic or private hospital outpatient clinic; private emergency room or private hospital emergency department; at home]
Obtained at least one medication through the Popular Pharmacy Program	PNS 2013	(number of individuals who have obtained at least one medication or insulin via the Popular Pharmacy Program/number of individuals who have taken medication to control diabetes) x 100
	Was any of the diabetes medications or insulin obtained from the Popular Pharmacy Program (PFP)? (yes; all of them; yes, some; no)
	PNS 2019
	Was any of the oral diabetes medications obtained from the “There is a Popular Pharmacy Here Program” (PFP) (“Aqui Tem Farmácia Popular”)? (yes; all of them; yes, some; no)
	Was insulin obtained from the “There is a Popular Pharmacy Here Program” (PFP)? (yes; no)

Indicators	Race/skin color			PR^a (95%CI)^b
	White (A)	Black (B)	Brown (C)	B/A	C/A
	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	B/A	C/A
Used medication for DM^c or took insulin in the two weeks prior to the date of the interview	88.3 (85.8;90.4)	88.8 (84.8;91.8)	89.1 (87.2;90.0)	1.00 (0.96;1.00)	1.00 (0.97;1.00)
Received medical care for diabetes within the past 12 months	77.8 (74.6;80.7)	77.9 (73.1;82.51)	80.5 (78.0;82.7)	1.00 (0.93;1.00)	1.00 (0.98;1.10)
Last appointment for DM with the same physician as in previous appointments	63.2 (59.6;66.6)	55.1 (49.0;61.3)	56.9 (53.7;60.0)	0.87 (0.77;0.98)	0.90 (0.83;0.97)
Had all appointments with a specialist after referral	85.1 (80.4;88.9)	83.2 (73.4;89.9)	78.3 (72.4;83.2)	0.97 (0.87;1.10)	0.92 (0.84;1.00)
Had an eye exam within the past 12 months	40.3 (37.3;43.45)	34.1 (29.1;39.4)	33.8 (30.9;36.9)	0.84 (0.71;1.00)	0.84 (0.74;0.94)
Had diabetic foot screening within the past 12 months	34.9 (32.0;38.0)	24.7 (20.7;29.2)	29.5 (26.7;32.5)	0.70 (0.58;0.85)	0.84 (0.74;0.96)
Hospitalization due to DM or some sort of complication	13.3 (11.2;15.6)	14.7 (11.5;18.7)	15.8 (13.8;18.1)	1.10 (0.82;1.49)	1.20 (0.96;1.40)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	4.6 (3.5;6.0)	5.4 (3.9;7.4)	6.9 (4.9;9.5)	1.10 (0.77;1.80)	1.50 (0.96;2.30)
Last appointment for DM was at a Primary Health Care Center	41.5 (38.2;44.8)	55.7 (49.7;61.6)	54.8 (51.6;57.9)	1.30 (1.10;1.50)	1.30 (1.20;1.40)
Obtained at least one medication through the Popular Pharmacy Program	53.6 (50.5;56.6)	53.8 (48.0;59.5)	49.3 (46.1;52.5)	1.00 (0.89;1.10)	0.92 (0.84;1.00)

Indicators	Household income per capita			PR^a (95%CI)^b
	Up to 1 MW^d (A)	1 to 3 MWs^d (B)	3 MWs^d or more (C)	B/A	C/A
	% (95%CI)^b	% (95%CI)^b	% (95%CI)^b	B/A	C/A
Used medication for DM^c or took insulin in the two weeks prior to the date of the interview	88.6 (86.6;90.4)	89.0 (86.8;90.9)	89.2 (84.7;92.5)	1.00 (0.97;1.04)	1.01 (0.96;1.05)
Received medical care for diabetes within the past 12 months	79.2 (76.7;81.5)	79.2 (76.4;81.8)	78.6 (74.0;82.6)	1.00 (0.96;1.04)	0.99 (0.94;1.05)
Last appointment for DM with the same physician as in previous appointments	55.1 (52.1;58.0)	60.9 (57.2;64.4)	72.2 (67.0;76.9)	1.11 (1.02;1.19)	1.31 (1.20;1.43)
Had all appointments with a specialist after referral	75.7 (70.0;80.6)	87.6 (83.8;90.6)	91.6 (86.8;94.8)	1.16 (1.07;1.25)	1.21 (1.12;1.31)
Had an eye exam within the past 12 months	30.9 (28.3;33.6)	39.1 (35.8;42.5)	51.9 (46.6;57.1)	1.27 (1.12;1.43)	1.68 (1.47;1.92)
Had diabetic foot screening within the past 12 months	27.3 (24.9;29.8)	33.3 (30.0;36.7)	43.9 (38.5;49.5)	1.22 (1.07;1.40)	1.61 (1.38;1.88)
Hospitalization due to DM or some sort of complication	18.5 (16.3;20.9)	11.8 (9.9;13.9)	7.5 (5.4;10.5)	0.64 (0.51;0.79)	0.41 (0.29;0.58)
Severe or very severe degree of limitation in usual activities due to DM or some sort of complication	7.9 (6.4;9.7)	4.3 (2.6;7.1)	2.6 (1.4;4.8)	0.55 (0.32;0.94)	0.33 (0.17;0.63)
Last appointment for DM was at a Primary Health Care Center	61.3 (58.4;64.1)	45.0 (41.3;48.6)	13.3 (10.2;17.3)	0.73 (0.67;0.80)	0.22 (0.17;0.29)
Obtained at least one medication through the Popular Pharmacy Program	53.6 (50.6;56.5)	53.1 (49.6;56.7)	38.4 (33.5;43.6)	0.99 (0.91;1.08)	0.72 (0.62;0.83)

Indicador	Perguntas utilizadas na construção do indicador	Método de cálculo
Uso de medicamento para diabetes mellitus (DM) ou insulina nas duas últimas semanas anteriores à data da pesquisa	PNS 2013	(número de pessoas que tomaram medicamento para diabetes ou usaram insulina nas duas últimas semanas anteriores à data da pesquisa/número de indivíduos que referem diagnóstico médico de diabetes) x 100
	Nas duas últimas semanas, por causa do diabetes, o(a) Sr.(a):
	Tomou medicamentos orais para baixar o açúcar? (sim; não)
	Usou insulina? (sim; não)
	PNS 2019
	Nas duas últimas semanas, por causa do diabetes, o(a) Sr.(a):
	Tomou os medicamentos orais para baixar o açúcar? (sim, todos; sim, alguns; não)
	Algum médico já lhe receitou insulina para controlar o diabetes? (sim; não)
Assistência médica para diabetes nos últimos 12 meses	PNS 2013 e 2019	(número de indivíduos que receberam assistência médica para diabetes há menos de 1 ano/número de indivíduos que referem diagnóstico médico de diabetes) x 100
Assistência médica para diabetes nos últimos 12 meses	Quando foi a última vez que o(a) Sr.(a) recebeu atendimento médico por causa do diabetes? (há menos de 6 meses; de 6 meses a menos de 1 ano; de 1 ano a menos de 2 anos; de 2 anos a menos de 3 anos; há 3 anos ou mais; nunca fez)
Realização da última consulta para DM com o mesmo médico das consultas anteriores	PNS 2013 e 2019	(número de indivíduos que referem que o médico que atendeu na última consulta era o mesmo das consultas anteriores/número de indivíduos que referem diagnóstico médico de diabetes e que receberam atendimento médico há menos de 3 anos) x 100
	Na última consulta, o médico que o(a) atendeu era o mesmo das consultas anteriores? (sim; não)
Realização de todas as consultas com médico especialista após ser encaminhado	PNS 2013	(número de pessoas que referiu conseguir todas as consultas com médico especialista/número de indivíduos que referem diagnóstico médico de diabetes e que foram encaminhados para alguma consulta com médico especialista) x 100
	Em algum dos atendimentos para diabetes, houve encaminhamento para alguma consulta com médico especialista, tal como cardiologista, endocrinologista, nefrologista ou oftalmologista? (sim; não; não houve encaminhamento, pois todas as consultas para diabetes foram com médico especialista)
	O(a) Sr.(a) foi a todas as consultas com médico especialista? (sim; não)
	PNS 2019
	Em algum dos atendimentos para diabetes, houve encaminhamento para alguma consulta com médico especialista, tal como cardiologista, endocrinologista, nefrologista ou oftalmologista? (sim; não; não houve encaminhamento, pois todas as consultas para diabetes foram com médico especialista)
	O(a) Sr.(a) foi às consultas com médico especialista? (sim, todas; sim, algumas; não)
Realização de exame de vista nos últimos 12 meses	PNS 2013 e 2019	(número de indivíduos que referem realizar exame de vista há menos de 1 ano/número de indivíduos que referem diagnóstico médico de diabetes) x 100
Realização de exame de vista nos últimos 12 meses	Quando foi a última vez que realizaram um exame de vista ou fundo de olho em que dilataram sua pupila? (há menos de 6 meses; de 6 meses a menos de 1 ano; de 1 ano a menos de 2 anos; de 2 anos a menos de 3 anos; há 3 anos ou mais; nunca fez)
Realização de exame dos pés nos últimos 12 meses	PNS 2013 e 2019	(número de indivíduos que referem ter seus pés examinados há menos de 1 ano/número de indivíduos que referem diagnóstico médico de diabetes) x 100
Realização de exame dos pés nos últimos 12 meses	Quando foi a última vez que um médico ou profissional de saúde examinou seus pés para verificar sensibilidade ou presença de feridas ou irritações? (há menos de 6 meses; de 6 meses a menos de 1 ano; de 1 ano a menos de 2 anos; de 2 anos a menos de 3 anos; há 3 anos ou mais; nunca fez)
Internação por causa da DM ou de alguma complicação	PNS 2013 e 2019	(número de indivíduos que foram internados por causa da diabetes ou de alguma complicação/número de indivíduos que referem diagnóstico médico de diabetes e que receberam atendimento médico há menos de 3 anos) x 100
Internação por causa da DM ou de alguma complicação	Alguma vez o(a) Sr.(a) se internou por causa do diabetes ou de alguma complicação? (sim; não)
Limitação de grau intenso ou muito intenso nas atividades habituais devido a DM ou alguma complicação	PNS 2013 e 2019	(número de indivíduos que referem grau muito intenso/intenso de limitações nas atividades habituais devido ao diabetes ou a alguma complicação/número de indivíduos que referem diagnóstico médico de diabetes) x 100
	Em geral, em que grau o diabetes ou alguma complicação do diabetes limita as suas atividades habituais (tais como trabalhar, realizar afazeres domésticos etc.)? (não limita; um pouco; moderadamente; intensamente; muito intensamente)
Realização da última consulta para diabetes em unidade básica de saúde (UBS)	PNS 2013	(número de indivíduos que realizaram a última consulta em unidade básica de saúde/número de indivíduos que referem diagnóstico médico de diabetes e que receberam atendimento médico há menos de 3 anos) x 100
	Na última vez que recebeu assistência médica para diabetes, onde o(a) Sr.(a) foi atendido?
	PNS 2019
	Na última vez que recebeu atendimento médico para diabetes, onde o(a) Sr.(a) foi atendido?
Aquisição de pelo menos um medicamento no programa “Aqui Tem Farmácia Popular”	PNS 2013	(número de pessoas que obtiveram pelo menos um medicamento ou insulina no programa “Aqui Tem Farmácia Popular”/número de indivíduos que tomaram medicamento para controlar a diabetes) x 100
	Algum dos medicamentos para diabetes ou insulina foi obtido no Programa Farmácia Popular (PFP)? (sim, todos; sim, alguns; não, nenhum)
	PNS 2019
	Algum dos medicamentos orais para diabetes foi obtido no “Aqui Tem Farmácia Popular”? (sim, todos; sim, alguns; não, nenhum)
	A insulina foi obtida no “Aqui Tem Farmácia Popular”? (sim; não)

Indicadores	Raça/cor da pele			RP^a (IC_95%)^b
	Branca (A)	Preta (B)	Parda (C)	B/A	C/A
	% (IC_95%)^b	% (IC_95%)^b	% (IC_95%)^b	B/A	C/A
Uso de medicamento para DM^c ou insulina nas duas últimas semanas anteriores à data da pesquisa	88,3 (85,8;90,4)	88,8 (84,8;91,8)	89,1 (87,2;90,0)	1,00 (0,96;1,00)	1,00 (0,97;1,00)
Assistência médica para diabetes nos últimos 12 meses	77,8 (74,6;80,7)	77,9 (73,1;82,51)	80,5 (78,0;82,7)	1,00 (0,93;1,00)	1,00 (0,98;1,10)
Realização da última consulta para DM com o mesmo médico das consultas anteriores	63,2 (59,6;66,6)	55,1 (49,0;61,3)	56,9 (53,7;60,0)	0,87 (0,77;0,98)	0,90 (0,83;0,97)
Realização de todas as consultas com o médico especialista após ser encaminhado	85,1 (80,4;88,9)	83,2 (73,4;89,9)	78,3 (72,4;83,2)	0,97 (0,87;1,10)	0,92 (0,84;1,00)
Realização de exame de vista nos últimos 12 meses	40,3 (37,3;43,45)	34,1 (29,1;39,4)	33,8 (30,9;36,9)	0,84 (0,71;1,00)	0,84 (0,74;0,94)
Realização de exame dos pés nos últimos 12 meses	34,9 (32,0;38,0)	24,7 (20,7;29,2)	29,5 (26,7;32,5)	0,70 (0,58;0,85)	0,84 (0,74;0,96)
Internação por causa da DM ou de alguma complicação	13,3 (11,2;15,6)	14,7 (11,5;18,7)	15,8 (13,8;18,1)	1,10 (0,82;1,49)	1,20 (0,96;1,40)
Limitação de grau intenso ou muito intenso nas atividades habituais devido a DM ou alguma complicação	4,6 (3,5;6,0)	5,4 (3,9;7,4)	6,9 (4,9;9,5)	1,10 (0,77;1,80)	1,50 (0,96;2,30)
Realização da última consulta para DM em unidade básica de saúde	41,5 (38,2;44,8)	55,7 (49,7;61,6)	54,8 (51,6;57,9)	1,30 (1,10;1,50)	1,30 (1,20;1,40)
Aquisição de pelo menos um medicamento no programa “Aqui Tem Farmácia Popular”	53,6 (50,5;56,6)	53,8 (48,0;59,5)	49,3 (46,1;52,5)	1,00 (0,89;1,10)	0,92 (0,84;1,00)

Indicadores	Rendimento domiciliar per capita			RP^a (IC_95%)^b
	Até 1 SM^d (A)	1 até 3 SMs^d (B)	3 ou mais SMs^d (C)	B/A	C/A
	% (IC_95%)^b	% (IC_95%)^b	% (IC_95%)^b	B/A	C/A
Uso de medicamento para DM^c ou insulina nas duas últimas semanas anteriores à data da pesquisa	88,6 (86,6;90,4)	89,0 (86,8;90,9)	89,2 (84,7;92,5)	1,00 (0,97;1,04)	1,01 (0,96;1,05)
Assistência médica para diabetes nos últimos 12 meses	79,2 (76,7;81,5)	79,2 (76,4;81,8)	78,6 (74,0;82,6)	1,00 (0,96;1,04)	0,99 (0,94;1,05)
Realização da última consulta para DM com o mesmo médico das consultas anteriores	55,1 (52,1;58,0)	60,9 (57,2;64,4)	72,2 (67,0;76,9)	1,11 (1,02;1,19)	1,31 (1,20;1,43)
Realização de todas as consultas com o médico especialista após ser encaminhado	75,7 (70,0;80,6)	87,6 (83,8;90,6)	91,6 (86,8;94,8)	1,16 (1,07;1,25)	1,21 (1,12;1,31)
Realização de exame de vista nos últimos 12 meses	30,9 (28,3;33,6)	39,1 (35,8;42,5)	51,9 (46,6;57,1)	1,27 (1,12;1,43)	1,68 (1,47;1,92)
Realização de exame dos pés nos últimos 12 meses	27,3 (24,9;29,8)	33,3 (30,0;36,7)	43,9 (38,5;49,5)	1,22 (1,07;1,40)	1,61 (1,38;1,88)
Internação por causa da DM ou de alguma complicação	18,5 (16,3;20,9)	11,8 (9,9;13,9)	7,5 (5,4;10,5)	0,64 (0,51;0,79)	0,41 (0,29;0,58)
Limitação de grau intenso ou muito intenso nas atividades habituais devido a DM ou alguma complicação	7,9 (6,4;9,7)	4,3 (2,6;7,1)	2,6 (1,4;4,8)	0,55 (0,32;0,94)	0,33 (0,17;0,63)
Realização da última consulta para DM em unidade básica de saúde	61,3 (58,4;64,1)	45,0 (41,3;48,6)	13,3 (10,2;17,3)	0,73 (0,67;0,80)	0,22 (0,17;0,29)
Aquisição de pelo menos um medicamento no programa “Aqui Tem Farmácia Popular”	53,6 (50,6;56,5)	53,1 (49,6;56,7)	38,4 (33,5;43,6)	0,99 (0,91;1,08)	0,72 (0,62;0,83)

[1] Correspondence
Deborah Carvalho Malta. dcmalta@gmail.com

Brasil

Brasil

Indicators of the line of care for people with diabetes in Brazil: National Health Survey 2013 and 2019

Abstract

Objective:

Methods:

Results:

Conclusion: