Self-reported diabetes in older people: comparison of prevalences and control measures

Stopa, Sheila Rizzato; César, Chester Luiz Galvão; Segri, Neuber José; Goldbaum, Moisés; Guimarães, Vanessa Martins Valente; Alves, Maria Cecília Goi Porto; Barros, Marilisa Berti de Azevedo

doi:10.1590/S0034-8910.2014048005219

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Original Articles • Rev. Saúde Pública 48 (4) • Aug 2014 • https://doi.org/10.1590/S0034-8910.2014048005219 copy

Self-reported diabetes in older people: comparison of prevalences and control measures

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

The objective of this study was to analyze the prevalence of diabetes in older people and the adopted control measures.

METHODS

Data regarding older diabetic individuals who participated in the Health Surveys conducted in the Municipality of Sao Paulo, SP, ISA-Capital, in 2003 and 2008, which were cross-sectional studies, were analyzed. Prevalences and confidence intervals were compared between 2003 and 2008, according to sociodemographic variables. The combination of the databases was performed when the confidence intervals overlapped. The Chi-square (level of significance of 5%) and the Pearson’s Chi-square (Rao-Scott) tests were performed. The variables without overlap between the confidence intervals were not tested.

RESULTS

The age of the older adults was 60-69 years. The majority were women, Caucasian, with an income of between > 0.5 and 2.5 times the minimum salary and low levels of schooling. The prevalence of diabetes was 17.6% (95%CI 14.9;20.6) in 2003 and 20.1% (95%CI 17.3;23.1) in 2008, which indicates a growth over this period (p at the limit of significance). The most prevalent measure adopted by the older adults to control diabetes was hypoglycemic agents, followed by diet. Physical activity was not frequent, despite the significant differences observed between 2003 and 2008 results. The use of public health services to control diabetes was significantly higher in older individuals with lower income and lower levels of education.

CONCLUSIONS

Diabetes is a complex and challenging disease for patients and the health systems. Measures that encourage health promotion practices are necessary because they presented a smaller proportion than the use of hypoglycemic agents. Public health policies should be implemented, and aimed mainly at older individuals with low income and schooling levels. These changes are essential to improve the health condition of older diabetic patients.

Aged; Diabetes Mellitus, Epidemiology; Hypoglycemic Agents; Self Care; Life Style; Health Behavior; Health Services Accessibility; Health Surveys

Variable	2003			2008

	n	Prevalence (%)^a	p^b	n^c	Prevalence (%)	p^b
Age group (years)			0.15			0.81
60 to 69	474	16.5		443	18.7
70 to 79	307	20.5		323	21.5
≥ 80	91	11.9		158	20.8
Sex			0.51			0.34
Female	451	18.7		568	20.5
Male	421	15.4		356	19.3
Ethnicity			0.80			0.09
Caucasian	589	17.3		655	18.8
Non-caucasian	261	17.5		267	22.8
Marital status			0.40			0.63
Married	496	14.4		488	18.4
Stable relationship	62	18.9		35	16.6
Single	57	20.0		74	23.1
Separated/Divorced	58	17.2		85	18.6
Widower	179	23.9		235	24.2
Level of schooling (years)			0.09			0.03
0 to 3	362	20.2		314	22.0
4 to 7	313	18.4		349	23.6
≥ 8	181	12.5		259	14.9
Occupation			0.43			0.24
With an activity	312	18.3		284	16.9
Without an activity	494	17.1		606	32.9
Unemployed	46	17.1		22	21.2
Income (in minimum salaries)			0.04			0.57
≤ 0.5	181	21.2		201	22.3
> 0.5 to 2.5	488	18.2		564	20.8
> 2.5	203	13.9		159	16.1

	2003			2008			p

	%^a	95%CI	n^b	%^a	95%CI	n^b
Diet
No	47.9	37.7;58.2	76	39.0	31.3;47.4	78
Yes	52.1	41.8;62.4	74	61.0	52.6;68.9	121	0.188
Regimen to lose or maintain weight
No	96.7	90.8;98.9	145	90.6	82.6;95.1	179
Yes	3.3	1.1;9.2	5	9.4	4.9;17.4	20	0.078
Physical activity
No	98.0	86.8;99.7	149	86.6	77.6;92.3	175
Yes	2.0	0.3;13.2	1	13.4	7.7;22.4	24	0.029
Routine use of insulin
No	84.9	76.3;90.7	129	84.2	78.0;88.9	165
Yes	15.1	9.3;23.7	21	15.8	11.1;22.1	34	0.877
Use of insulin when there is a problem
No	99.3	95.2;99.9	149	99.6	97.1;99.9	198
Yes	0.7	0.1;4.8	1	0.4	0.1;2.9	1	0.716
Routine use of oral hypoglycemic agents
No	39.0	30.2;48.6	61	28.2	22.3;34.9	58
Yes	61.0	51.4;69.8	89	71.8	65.1;77.7	141	0.053
Use of hypoglycemic agents when there is a problem
No	97.1	93.2;98.8	145	98.1	94.8;99.3	195
Yes	2.9	1.3;6.8	5	1.9	0.7;5.2	4	0.523
No measures
No	94.3	89.9;96.9	139	97.0	93.6;98.7	193
Yes	5.7	3.1;10.1	11	3.0	1.3;6.4	6	0.188
Others
No	90.4	84.5;94.1	136	94.9	90.3;97.4	188
Yes	9.6	5.9;15.5	14	5.1	2.6;9.7	11	0.119

	2003			2008			p

	%^a	95%CI	n^b	%^a	95%CI	n^b
Presence of complications
No	76.5	66.8;84.0	112	71.1	62.5;78.4	138
Yes	23.5	16.2;33.2	38	28.9	21.6;37.5	61	0.370
Vision problems^c
No	36.4	20.7;55.8	14	27.7	16.3;42.9	15
Yes	63.6	44.2;79.4	23	72.3	57.1;83.7	46	0.440
Kidney problems^c
No	84.6	65.4;94.1	32	61.5	45.3;75.5	37
Yes	15.4	5.9;34.6	5	38.5	24.5;54.7	24	0.046
Circulatory problems^c
No	65.6	40.9;84.1	26	47.7	32.0;63.9	29
Yes	34.4	15.9;59.1	11	52.3	36.1;68.4	32	0.223

		2003			2008		p

	%^a	95%CI	n^b	%^a	95%CI	n^b
Received flu vaccine
No	29.3	21.9;38.1	42	33.1	26.1;40.8	60
Yes	70.7	61.9;78.1	106	66.9	59.2;73.9	138	0.505
Type of service^c
Public	95.1	86.9;98.3	98	96.6	89.5;99.0	133
Private	4.9	1.7;13.1	4	3.4	1.0;10.5	3	0.640
Was it the closest center to home?^c
No	19.2	10.8;31.8	17	20.9	14.5;29.2	28
Yes	80.8	68.2;89.2	85	79.1	70.8;85.5	110	0.797
Received pneumonia vaccine
No	71.1	60.5;79.9	97	75.7	67.9;82.1	145
Yes	28.9	20.1;39.5	36	24.3	17.9;32.1	46	0.456
Type of service^d
Public	95.9	75.5;99.5	35	95.7	73.5;99.5	44
Private	4.1	0.5;24.5	1	4.3	0.6;26.5	1	0.970
Was it the closest center to home?^d
No	21.3	10.1;39.5	6	15.4	7.6;28.7	8
Yes	78.7	60.5;89.9	29	84.6	71.3;92.4	36	0.502

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Sheila Rizzato Stopa. Departamento de Epidemiologia – FSP-USP. Av. Dr. Arnaldo, 715 Cerqueira César. 01246-904 São Paulo, SP, Brasil. E-mail: sheilarizzato@usp.br