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Abstract(s)
A diabetes é um distúrbio metabólico complexo caraterizado por hiperglicemia, uma condição fisiologicamente anormal caracterizada níveis elevados de glicose no sangue. A diabetes tem diferentes classificações e a tipo 2 representa 90–95% de todas as diabetes. O risco de ocorrência desta doença aumenta com a idade, com a obesidade, em indivíduos com baixos níveis de atividade física e naqueles que pertencem a certos grupos étnicos, como os africanos. A hiperglicemia a longo prazo leva a várias complicações microvasculares e macrovasculares, principais responsáveis pela morbilidade e mortalidade associada à doença.
A prevalência da diabetes na população mundial adulta é de 10,5%, ou seja, 537 milhões de pessoas de 20 a 79 anos vivem com doença. Prevê-se que esse número aumente para 783 milhões até 2045 em todo o mundo. No entanto, as previsões de aumento da prevalência não são iguais para todas as regiões do globo. O aumento previsto para África é aproximadamente 10 vezes superior ao da Europa. Isto significa que existe atualmente 24 milhões de adultos africanos a viverem com diabetes e estima-se que em 2045 este número aumente para 55 milhões.
Na Guiné-Bissau, país da África Subsariana com uma população estimada em 2022 de 2.105.572 de habitantes, a prevalência de diabetes é desconhecida. Estima-se, no entanto, que em 2021 existiam 18 bissau-guineenses por cada 1000 habitantes com diabetes diagnosticas e outros 10, por cada 1000 habitantes, com diabetes não diagnosticada.
Infelizmente, a Guiné-Bissau, país considerado de baixo rendimento, tem investido poucos recursos no diagnóstico e tratamento de doenças crónicas incluindo a diabetes. No entanto, para que seja possível contrariar as estimativas de aumento exponencial da diabetes na Guiné-Bissau, é necessário tomar medidas de prevenção e tratamento eficazes, é, portanto, essencial conhecer quantos e quem são os bissau-guineses que vivem com diabetes. É necessário também encontrar soluções económica de rastreio da doença, de forma a identificar níveis de risco e canalizar os poucos recursos de diagnóstico para aqueles com maiores riscos.
Neste sentido, o objetivo principal deste estudo foi identificar o risco de desenvolver diabetes em 10 ano e a prevalência da diabetes tipo 2 não diagnosticada numa amostra de polícias do Ministério do Interior da Guiné-Bissau. Este estudo também teve como objetivo avaliar o perfil sociodemográfico, clínico e do estado nutricional destes polícias, bem como caracterizar este perfil de acordo com o risco de diabetes e com a prevalência de diabetes tipo 2 não diagnosticada.
Portanto, realizou-se um estudo observacional transversal descritivo e analítico no Ministério do Interior da Guiné-Bissau, em Bissau, junto dos polícias sem diagnóstico prévio de diabetes, utilizando uma entrevista, uma avaliação física e um teste da glicémia capilar em jejum e de hemoglobina glicada, quando aplicável, por um enfermeiro do departamento do Serviço de Saúde do Ministério do Interior.
Através da entrevista foi possível identificar para cada participante o sexo, a idade, o estado civil, os hábitos e estilos de vida como hábitos tabágicos, alcoólicos, prática de exercício físico, toma de medicação para tensão arterial, glicémia elevada prévia, história familiar de diabetes e o consumo de frutas ou hortícolas.
Na avaliação física, foi possível avaliar o peso, a altura, a percentagem de massa gorda, a circunferência da cintura e a tensão arterial. O índice de massa corporal foi calculado e classificado segundo critérios da Organização Mundial de Saúde. Do mesmo modo, para a circunferência da cintura, para a percentagem de massa gorda e para a tensão arterial, os participantes foram classificados segundo critérios internacionalmente aceites.
Com base na entrevista e na avaliação física, calculou-se o risco de desenvolver diabetes tipo 2 nos próximos 10 anos, através da ferramenta FINDRISC. Para cada participante foi atribuída uma pontuação de 0 a 26, que corresponde ao risco de diabetes e quanto maior a pontuação, maior o risco. Com base na pontuação, os participantes foram classificados de acordo com o nível de risco em: baixo, ligeiro, moderado, alto ou muito alto. A glicémia em jejum foi avaliada através de teste rápido para determinação da glicémia capilar após jejum de oito horas e a prevalência de diabetes não diagnosticada foi considera para valores superiores a 126 mg/dl. A hemoglobina glicada foi avaliada apenas para os indivíduos que tiveram valores de glicémia em jejum superior ou igual a 110mg/dL, através de um teste rápido com uma amostra de sangue capilar, utilizando- se um aparelho portátil, e a prevalência de diabetes não diagnosticada foi considera para valores superiores a 6,4%.
O risco de diabetes tipo 2 nos próximos 10 anos para os polícias do Ministério do Interior da Guiné-Bissau foi de 7 em 26 pontos, classificado em risco ligeiro, sendo que 17% da amostra foi classificada com um risco moderado ou superior. O risco de desenvolver diabetes tipo 2 nos próximos 10 anos foi maior nas mulheres, nos polícias divorciados, nos que tinham hábitos alcoólicos, nos que apresentaram uma gordura corporal classificada em obesidade e os classificados com tensão arterial alta ou hipertensão.
A prevalência de diabetes tipos 2 não diagnosticada entre os polícias da amostra foi de 6,7% para critérios de glicemia em jejum e de 9% para a hemoglobina glicada. Uma maior glicémia em jejum foi superior para os polícias do sexo masculino, os viúvos(as), para aqueles que tinham uma atividade física inferior a 150 ou superior a 300 minutos por semana, os que tinham hábitos alcoólicos, com uma classificação da gordura corporal em excesso e aqueles classificados com uma tensão arterial classificada em hipertensão.
Encontrou-se também que os valores de glicémia em jejum e de hemoglobina glicada foram superiores nos indivíduos classificados com níveis de risco de diabetes superiores, medidos pelo FINDRISC.
A prevalência de diabetes tipo 2 não diagnosticada nesta amostra foi superior ao estimado para a Guiné-Bissau, pelo que é de extrema importância a realização de um estudo de prevalência de âmbito nacional alargado. O instrumento FINSRISC pode ser uma ferramenta valiosa na predição do risco de bissau-guineenses, podendo ser utilizadas em campanhas de sensibilização para a diabetes tipo 2 e em sessões de educação para saúde sobre os seus fatores de risco.
Diabetes is a complex metabolic disorder characterized by hyperglycemia; a physiologically abnormal condition characterized high blood glucose levels. Diabetes has different classification and type 2 accounts for 90–95% of all diabetes. The risk of this disease increases with age, with obesity, in individuals with low levels of physical activity and those belonging to certain ethnic groups, such as Africans. Long-term hyperglycemia leads to several microvascular and macrovascular complications, which are mainly responsible for the morbidity and mortality associated with the disease. The prevalence of diabetes in the adult world population is 10.5%, that is, 537 million people aged 20 to 79 live with the disease. This number is expected to increase to 783 million by 2045 worldwide. However, predictions of increased prevalence are not the same for all regions of the world. The projection increase for Africa, and it is approximately 10 times greater than that for Europe. This means that there are currently 24 million African adults living with diabetes and it is estimated that by 2045 this number will increase to 55 million. In Guinea-Bissau, a country in Sub-Saharan Africa with an estimated population of 2’105’572 inhabitants in 2022, the prevalence of diabetes is unknown. It is estimated, however, that in 2021 there were 18 Bissau-Guineans for every 1000 inhabitants with diagnosed diabetes and another 10 per 1000 inhabitants with undiagnosed diabetes. Unfortunately, Guinea-Bissau, a low-income country, has invested few resources in the diagnosis and treatment of chronic diseases, including diabetes. However, to counter estimates of the exponential increase in diabetes in Guinea-Bissau, it is necessary to take effective prevention and treatment measures. It is, therefore, essential to know how many and who Bissau Guineans are living with diabetes. It is also necessary to find economical solutions for tracking the disease, to identify risk levels and then drive the scarce resources in diagnostic to those at greater risk. In this sense, the main objective of this study was to identify the type 2 diabetes risk and undiagnosed prevalence of type 2 diabetes in a sample of police officers from the Ministry of the Interior of Guinea-Bissau. This study also aimed to evaluate the sociodemographic, clinical and nutritional status profile of these police officers, as well as characterize this profile according to the risk and prevalence of type 2 diabetes. Therefore, a descriptive and analytical cross-sectional observational study was carried out at the Ministry of the Interior of Guinea-Bissau, in Bissau, among police officers without a previous diagnosis of diabetes, using an interview, a physical assessment and a fasting blood glucose test, and glycated hemoglobin, when applicable, by a nurse from the Health Service department of the Ministry of the Interior. Through the interview, it was possible to identify for each participant the sex, age, marital status, habits and lifestyles such as smoking and alcohol habits, physical exercise, taking medication for blood pressure, previous high blood sugar levels, family history of diabetes and consumption of fruits or vegetables. In the physical assessment, it was possible to evaluate weight, height, percentage of fat mass, waist circumference and blood pressure. Body mass index was calculated and classified according to World Health Organization criteria. Likewise, for waist circumference, fat mass percentage and blood pressure, participants were classified according to internationally accepted criteria. Based on the interview and physical evaluation, the risk of developing type 2 diabetes in the next 10 years was calculated using the FINDRISC tool. Each participant was assigned a score from 0 to 26, which corresponds to the risk of diabetes and the higher the number, the greater the risk. Based on the score, participants were classified according to their risk level as: low, mild, moderate, high or very high. Fasting blood glucose was assessed using a rapid test to determine capillary blood glucose after an eight-hour fasting and the undiagnosed prevalence of diabetes was considered for values greater than 126 mg/dl. Glycated hemoglobin was assessed only for individuals who had fasting blood glucose values greater than or equal to 110 mg/dL, through a rapid test with a capillary blood sample, using a portable device, and the prevalence of diabetes was considered for values above 6.4%. The risk of type 2 diabetes in police officers from the Ministry of the Interior of Guinea- Bissau was 7 out of 26 points, classified as mild risk and 17% of the sample was classified as moderate or greater risk. The risk of developing type 2 diabetes in the next 10 years was higher in women, divorced police officers, those with alcoholic habits, those with body fat classified as obesity and those classified as having high blood pressure or hypertension. The prevalence of undiagnosed type 2 diabetes among police officers in the sample was 6.7% for fasting blood glucose criteria and 9% for glycated hemoglobin. Fasting blood glucose was higher for male, widowers, those who had physical activity less than 150 or more than 300 minutes per week, those who had alcoholic habits, with body fat classification in excessive and those classified with blood pressure as hypertension. It was also found that fasting blood glucose and glycated hemoglobin values were higher in individuals classified as having higher diabetes risk levels, measured by FINDRISC. The prevalence of type 2 diabetes in this sample was higher than estimated for Guinea- Bissau, which is why it is extremely important to carry out a broad national prevalence study. The FINSRISC can be a valuable tool in predicting the risk of Bissau-Guineans and can be used in awareness campaigns about type 2 diabetes and in health education sessions about its risk factors.
Diabetes is a complex metabolic disorder characterized by hyperglycemia; a physiologically abnormal condition characterized high blood glucose levels. Diabetes has different classification and type 2 accounts for 90–95% of all diabetes. The risk of this disease increases with age, with obesity, in individuals with low levels of physical activity and those belonging to certain ethnic groups, such as Africans. Long-term hyperglycemia leads to several microvascular and macrovascular complications, which are mainly responsible for the morbidity and mortality associated with the disease. The prevalence of diabetes in the adult world population is 10.5%, that is, 537 million people aged 20 to 79 live with the disease. This number is expected to increase to 783 million by 2045 worldwide. However, predictions of increased prevalence are not the same for all regions of the world. The projection increase for Africa, and it is approximately 10 times greater than that for Europe. This means that there are currently 24 million African adults living with diabetes and it is estimated that by 2045 this number will increase to 55 million. In Guinea-Bissau, a country in Sub-Saharan Africa with an estimated population of 2’105’572 inhabitants in 2022, the prevalence of diabetes is unknown. It is estimated, however, that in 2021 there were 18 Bissau-Guineans for every 1000 inhabitants with diagnosed diabetes and another 10 per 1000 inhabitants with undiagnosed diabetes. Unfortunately, Guinea-Bissau, a low-income country, has invested few resources in the diagnosis and treatment of chronic diseases, including diabetes. However, to counter estimates of the exponential increase in diabetes in Guinea-Bissau, it is necessary to take effective prevention and treatment measures. It is, therefore, essential to know how many and who Bissau Guineans are living with diabetes. It is also necessary to find economical solutions for tracking the disease, to identify risk levels and then drive the scarce resources in diagnostic to those at greater risk. In this sense, the main objective of this study was to identify the type 2 diabetes risk and undiagnosed prevalence of type 2 diabetes in a sample of police officers from the Ministry of the Interior of Guinea-Bissau. This study also aimed to evaluate the sociodemographic, clinical and nutritional status profile of these police officers, as well as characterize this profile according to the risk and prevalence of type 2 diabetes. Therefore, a descriptive and analytical cross-sectional observational study was carried out at the Ministry of the Interior of Guinea-Bissau, in Bissau, among police officers without a previous diagnosis of diabetes, using an interview, a physical assessment and a fasting blood glucose test, and glycated hemoglobin, when applicable, by a nurse from the Health Service department of the Ministry of the Interior. Through the interview, it was possible to identify for each participant the sex, age, marital status, habits and lifestyles such as smoking and alcohol habits, physical exercise, taking medication for blood pressure, previous high blood sugar levels, family history of diabetes and consumption of fruits or vegetables. In the physical assessment, it was possible to evaluate weight, height, percentage of fat mass, waist circumference and blood pressure. Body mass index was calculated and classified according to World Health Organization criteria. Likewise, for waist circumference, fat mass percentage and blood pressure, participants were classified according to internationally accepted criteria. Based on the interview and physical evaluation, the risk of developing type 2 diabetes in the next 10 years was calculated using the FINDRISC tool. Each participant was assigned a score from 0 to 26, which corresponds to the risk of diabetes and the higher the number, the greater the risk. Based on the score, participants were classified according to their risk level as: low, mild, moderate, high or very high. Fasting blood glucose was assessed using a rapid test to determine capillary blood glucose after an eight-hour fasting and the undiagnosed prevalence of diabetes was considered for values greater than 126 mg/dl. Glycated hemoglobin was assessed only for individuals who had fasting blood glucose values greater than or equal to 110 mg/dL, through a rapid test with a capillary blood sample, using a portable device, and the prevalence of diabetes was considered for values above 6.4%. The risk of type 2 diabetes in police officers from the Ministry of the Interior of Guinea- Bissau was 7 out of 26 points, classified as mild risk and 17% of the sample was classified as moderate or greater risk. The risk of developing type 2 diabetes in the next 10 years was higher in women, divorced police officers, those with alcoholic habits, those with body fat classified as obesity and those classified as having high blood pressure or hypertension. The prevalence of undiagnosed type 2 diabetes among police officers in the sample was 6.7% for fasting blood glucose criteria and 9% for glycated hemoglobin. Fasting blood glucose was higher for male, widowers, those who had physical activity less than 150 or more than 300 minutes per week, those who had alcoholic habits, with body fat classification in excessive and those classified with blood pressure as hypertension. It was also found that fasting blood glucose and glycated hemoglobin values were higher in individuals classified as having higher diabetes risk levels, measured by FINDRISC. The prevalence of type 2 diabetes in this sample was higher than estimated for Guinea- Bissau, which is why it is extremely important to carry out a broad national prevalence study. The FINSRISC can be a valuable tool in predicting the risk of Bissau-Guineans and can be used in awareness campaigns about type 2 diabetes and in health education sessions about its risk factors.
Description
Mestrado em parceria com a Escola Superior de Saúde do Instituto Politécnico da Guarda
Keywords
Diabetes Mellitus Diabetes Tipo 2 FINDRISC Guiné-Bissau Africa