Among chronic noncommunicable diseases (NCDs), diabetes mellitus (DM) is distinguished in a heterogeneous group of metabolic disorders characterized by hyperglycemia due to defects in insulin action and/or secretion¹1. Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2017-2018. São Paulo: Clannad; 2017 [acessado em 10 mar. 2018]. Disponível em: Disponível em: http://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
http://www.diabetes.org.br/profissionais... . The persistent increase in blood glucose is related to acute or chronic complications in the cardiovascular, renal and neurological system, with high rates of hospitalization and mortality¹1. Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2017-2018. São Paulo: Clannad; 2017 [acessado em 10 mar. 2018]. Disponível em: Disponível em: http://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
http://www.diabetes.org.br/profissionais... ^,22. American Diabetes Association. Classification and Diagnosis of Diabetes. Diabetes Care 2015; 38(Supl. 1): S8-S16. https://doi.org/10.2337/dc15-S005
https://doi.org/10.2337/dc15-S005... .

Estimates show that between 2010 and 2030 there will be a 69% increase in the number of adults with DM in developing countries and 20% in developed countries³3. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87(1): 4-14. https://doi.org/10.1016/j.diabres.2009.10.007
https://doi.org/10.1016/j.diabres.2009.1... . In Brazil, data from the National Health Survey (PNS) estimate that about 9.2 million Brazilians are diagnosed with DM, with prevalence increasing with increasing age⁴4. Iser BPM, Stopa SR, Chueiri PS, Szwarcwald CL, Malta DC, Monteiro HOC, et al. Prevalência de diabetes autorreferido no Brasil: resultados da Pesquisa Nacional de Saúde 2013. Epidemiol Serv Saúde 2015; 24(2): 305-14. http://dx.doi.org/10.5123/S1679-49742015000200013
http://dx.doi.org/10.5123/S1679-49742015... .

The importance of the disease is highlighted as the main cause of mortality and premature disability in affected individuals in most developing countries, including Brazil⁵5. World Health Organization. Global report on diabetes. Genebra: WHO; 2016.. Its prolonged course is reflected in the increased demand for services⁶6. Malta DC, Iser BPM, Chueiri PS, Stopa SR, Szwarcwald CL, Schmidt MI, et al. Cuidados em saúde entre portadores de diabetes mellitus autorreferido no Brasil, Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol 2015; 18(Supl. 2): 17-32. http://dx.doi.org/10.1590/1980-5497201500060003
http://dx.doi.org/10.1590/1980-549720150... , the high use of medicines, especially in the elderly⁶6. Malta DC, Iser BPM, Chueiri PS, Stopa SR, Szwarcwald CL, Schmidt MI, et al. Cuidados em saúde entre portadores de diabetes mellitus autorreferido no Brasil, Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol 2015; 18(Supl. 2): 17-32. http://dx.doi.org/10.1590/1980-5497201500060003
http://dx.doi.org/10.1590/1980-549720150... ^,77. Prado MAMP, Francisco PMSB, Barros MBA. Diabetes em idosos: uso de medicamentos e risco de interação medicamentosa. Ciênc Saúde Coletiva 2016; 21(11): 3447-58. http://dx.doi.org/10.1590/1413-812320152111.24462015
http://dx.doi.org/10.1590/1413-812320152... , its restriction of daily activities⁶6. Malta DC, Iser BPM, Chueiri PS, Stopa SR, Szwarcwald CL, Schmidt MI, et al. Cuidados em saúde entre portadores de diabetes mellitus autorreferido no Brasil, Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol 2015; 18(Supl. 2): 17-32. http://dx.doi.org/10.1590/1980-5497201500060003
http://dx.doi.org/10.1590/1980-549720150... and significant social impact. Several factors are associated with the disease⁴4. Iser BPM, Stopa SR, Chueiri PS, Szwarcwald CL, Malta DC, Monteiro HOC, et al. Prevalência de diabetes autorreferido no Brasil: resultados da Pesquisa Nacional de Saúde 2013. Epidemiol Serv Saúde 2015; 24(2): 305-14. http://dx.doi.org/10.5123/S1679-49742015000200013
http://dx.doi.org/10.5123/S1679-49742015... ^,77. Prado MAMP, Francisco PMSB, Barros MBA. Diabetes em idosos: uso de medicamentos e risco de interação medicamentosa. Ciênc Saúde Coletiva 2016; 21(11): 3447-58. http://dx.doi.org/10.1590/1413-812320152111.24462015
http://dx.doi.org/10.1590/1413-812320152... and health promotion measures have been implemented in the country in recent years to contain the progression of this NCD as well as others⁸8. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Coordenação Geral de Doenças e Agravos Não Transmissíveis. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022 [Internet]. Brasília: Ministério da Saúde; 2011 [acessado em 10 mar. 2018]. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/plano_acoes_enfrent_dcnt_2011.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... .

In Brazil, medication for the treatment of DM are freely available in the National Public Health System(SUS), including primary care and, as a complementary strategy, through the Brazilian Popular Pharmacy Program (PFPB). The purpose of this brief communication was to estimate the prevalence of DM in adult and elderly individuals living in the capitals of the Brazilian states and the Federal District, to verify the percentage of diabetics on medication (oral and insulin), to describe the distribution of users according to sources of acquisition and to evaluate the percentages obtained in SUS between 2012 and 2016, from a comparative perspective.

We used data from individuals aged ≥ 18 years from the risk factor surveillance system for chronic noncommunicable diseases via telephone survey(Vigitel), conducted annually by the Ministry of Health since 2006, for the years 2012 (n = 45,448) and 2016 (n = 53,210)⁹9. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção de Saúde. Vigitel Brasil 2012: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde ; 2013. 136p.^.1010. Brasil. Ministério da Saúde. Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2016. Brasília: Ministério da Saúde ; 2017. 160p.. Vigitel has been approved by the National Commission of Ethics in Research on Human Beings (processes nº 13081/2008 and 355.590 / 2013). All individuals were consulted and informed and agreed to participate in the research.

Prevalence of diabetes was estimated for all respondents (age ≥ 18 years), for adults (between 18 and 59 years) and elderly (age ≥ 60 years), as well as the percentage of medication use (oral or insulin). among diabetics. For those who reported tablet or insulin use, the percentages and respective confidence intervals of 95% (95%CI) were also estimated, according to sources. Comparisons were performed using Pearson’s c2 test (Rao-Scott) with a significance level of 5%. All analyzes took into account the weights of the inquiry’s complex sample design. The medicines were obtaining for free in SUS / PFPB pharmacies.

The prevalences of DM were 7.4% (95%CI 6.9 - 7.8) and 8.9% (95%CI 8.5 - 9.4) in 2012 and 2016, consecutively. In men the prevalence was 6.5% (95%CI 5.8 - 7.2) and 7.8% (95%CI 7.2 -8.6) and in women, 8.1% (95%CI 7.5 - 8.9) and 9.9% (95%CI 9.2 - 10.5) in those years. In adults and the elderly, a significant increase was observed, from 4.6 to 5.4% (p = 0.014), and from 22.2 to 25.9% (p = 0.001), respectively, during the study period.

For the group of diabetics aged ≥ 18 years, regarding the exclusive use of oral medication, the percentages observed were 76.8 and 76.4% and, for insulin, 17.6 and 19.7% in 2012 and 2016, relatively, without statistically significant differences for the subgroups analyzed (p> 0.05).

Regarding the sources considered, there was an increase in oral medication among adults and insulin in the elderly in PFPB. Among all diabetics, there was a reduction in obtaining oral medications in SUS pharmacies and an increase in obtaining them in PFPB. An increased in obtaining insulin in PFPB insulin also observed (Figure 1).

It is important to mention that 69.7 and 70.3% of diabetics obtained free oral medications (SUS/PFPB pharmacies) in 2012 and 2016, respectively. The percentages for obtaining insulin free of charge were 88.9 and 90.0% in the years considered.

The results revealed an increased prevalence of DM in the period studied, especially among the elderly. They also showed, for the group of diabetic adults, a reduction in obtaining oral medicine in public pharmacies of primary care and an increase in obtaining both (oral and insulin) through the PFPB, without changes in obtaining them via private pharmacies in the analyzed period.

In secondary prevention, strict metabolic control plays an important role in combating the onset or progression of chronic complications arising from type 1¹¹11. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977-86. https://doi.org/10.1056/NEJM199309303291401
https://doi.org/10.1056/NEJM199309303291... and type 2¹1. Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2017-2018. São Paulo: Clannad; 2017 [acessado em 10 mar. 2018]. Disponível em: Disponível em: http://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
http://www.diabetes.org.br/profissionais... DM. Although SUS remains a priority source for obtaining drugs to treat DM in the country, it is important to highlight the importance of the three managing bodies in providing treatment to patients with DM, including access to medicines and necessary supplies with guidance directed to rational use, reinforcing the role of primary care as coordinator of care of the Health Care Network.

References

Publication Dates

History