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      Qualidade da informação sobre diabéticos e hipertensos registrada no Sistema HIPERDIA em São Carlos-SP, 2002-2005 Translated title: Quality of information on diabetic and hypertensive patients from the HIPERDIA System in the city of São Carlos, São Paulo State, 2002-2005

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          Abstract

          O objetivo deste estudo foi analisar a qualidade da informação sobre diabéticos e hipertensos registrada no Sistema HIPERDIA, na cidade de São Carlos, São Paulo, no período de 2002 a 2005. Foram analisados, descritiva e sequencialmente, todos os 2.662 cadastros, no Sistema HIPERDIA, realizados no período de 1º/6/2002 a 31/12/2005. Sobrepeso/obesidade foi assinalado em 63% dos cadastros, mas quando o índice de massa corporal foi calculado, estava presente em 79,4% deles. Do total, 21% dos cadastros não possuíam registro de medida da cintura. Em 34% dos cadastros havia registro apenas de glicemia capilar de jejum e em 82% destes, os valores eram > 110mg/dl. Em 48% dos cadastros havia registro apenas de glicemia capilar pós-prandial e em 67% destes, os valores eram > 140mg/dl. Doença renal, pé diabético, amputação por diabetes e doenças cardiovasculares foram assinalados em apenas 9,6%, 5,1%, 2,4% e 32,3% dos formulários, respectivamente. Não há informações relativas à retinopatia e neuropatia diabéticas, como exames de fundo de olho e de sensibilidade de membros inferiores. Adicionalmente, não há registros de hemoglobina glicosilada, excreção urinária de albumina ou eletrocardiograma. Os dados sugerem ausência, imprecisão e contradição de importantes informações sobre diabéticos e hipertensos e apontam a necessidade de capacitação profissional e de utilização de critérios clínico-laboratoriais para a caracterização das complicações crônicas decorrentes do DM e hipertensão arterial registradas no Sistema HIPERDIA. As deficiências encontradas podem levar ao subdimensionamento epidemiológico dessas doenças na população brasileira e comprometer o planejamento de estratégias destinadas à prevenção e controle dessas doenças.

          Translated abstract

          This paper aimed to analyze the quality of information on diabetic and hypertensive patients registered in HIPERDIA System in the city of São Carlos, São Paulo State, from 2002 to 2005. Data were surveyed descriptively and sequentially from 2.662 forms, in the HIPERDIA System from June 1st, 2002 to December 31st, 2005. Overweight/obesity was reported in 63% of formularies, however, this number increased to 79.4% when the body mass index was calculated. In 21% of formularies there was no waist measure. In 34% of forms only fasting glycemia was informed and in 82% of them glycemia was > 110 mg/dl. In 48% of formularies only postprandial glycemia was informed and in 67% of them glycemia was > 140 mg/dl. Renal disease, diabetic foot, amputation from diabetes, and cardiovascular diseases were reported in only 9.6%, 5.1%, 2.4% and 32.3% of forms, respectively. There is no information regarding diabetic retinopathy and neuropathy. In addition, there is no information on glycate hemoglobin, urinary albumin excretion or electrocardiogram. Data suggest absence, inaccuracy and contradiction of information on diabetic and hypertensive patients, and the need of professional training and use of clinical and laboratory criteria to characterize diabetic and hypertensive chronic complications registered in the HIPERDIA System. The deficiencies found may compromise the evaluation of the impact of these diseases in Brazilian population and the health planning to control and prevent such diseases.

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          Most cited references22

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          Diabetes and Cardiovascular Disease: A Statement for Healthcare Professionals From the American Heart Association

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            Diabetic nephropathy: diagnosis, prevention, and treatment.

            Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects approximately 40% of type 1 and type 2 diabetic patients. It increases the risk of death, mainly from cardiovascular causes, and is defined by increased urinary albumin excretion (UAE) in the absence of other renal diseases. Diabetic nephropathy is categorized into stages: microalbuminuria (UAE >20 microg/min and or =200 microg/min). Hyperglycemia, increased blood pressure levels, and genetic predisposition are the main risk factors for the development of diabetic nephropathy. Elevated serum lipids, smoking habits, and the amount and origin of dietary protein also seem to play a role as risk factors. Screening for microalbuminuria should be performed yearly, starting 5 years after diagnosis in type 1 diabetes or earlier in the presence of puberty or poor metabolic control. In patients with type 2 diabetes, screening should be performed at diagnosis and yearly thereafter. Patients with micro- and macroalbuminuria should undergo an evaluation regarding the presence of comorbid associations, especially retinopathy and macrovascular disease. Achieving the best metabolic control (A1c 1.0 g/24 h and increased serum creatinine), using drugs with blockade effect on the renin-angiotensin-aldosterone system, and treating dyslipidemia (LDL cholesterol <100 mg/dl) are effective strategies for preventing the development of microalbuminuria, in delaying the progression to more advanced stages of nephropathy and in reducing cardiovascular mortality in patients with type 1 and type 2 diabetes.
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              Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study.

              The EURODIAB IDDM Complications Study involved the examination of 3250 randomly selected insulin-dependent diabetic patients, from 31 centres in 16 European countries. Part of the examination included an assessment of neurological function including neuropathic symptoms and physical signs, vibration perception threshold, tests of autonomic function and the prevalence of impotence. The prevalence of diabetic neuropathy across Europe was 28% with no significant geographical differences. Significant correlations were observed between the presence of diabetic peripheral neuropathy with age (p < 0.05), duration of diabetes (p < 0.001), quality of metabolic control (p < 0.001), height (p < 0.01), the presence of background or proliferative diabetic retinopathy (p < 0.01), cigarette smoking (p < 0.001), high-density lipoprotein cholesterol (p < 0.001) and the presence of cardiovascular disease (p < 0.05), thus confirming previous associations. New associations have been identified from this study - namely with elevated diastolic blood pressure (p < 0.05), the presence of severe ketoacidosis (p < 0.001), an increase in the levels of fasting triglyceride (p < 0.001), and the presence of microalbuminuria (p < 0.01). All the data were adjusted for age, duration of diabetes and HbA1c. Although alcohol intake correlated with absence of leg reflexes and autonomic dysfunction, there was no overall association of alcohol consumption and neuropathy. The reported problems of impotence were extremely variable between centres, suggesting many cultural and attitudinal differences in the collection of such information in different European countries. In conclusion, this study has identified previously known and new potential risk factors for the development of diabetic peripheral neuropathy.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                physis
                Physis: Revista de Saúde Coletiva
                Physis
                IMS-UERJ
                1809-4481
                2009
                : 19
                : 2
                : 405-417
                Affiliations
                [1 ] Universidade Federal de São Carlos
                Article
                S0103-73312009000200009
                060980a0-a069-4081-8c46-8a8f4e4a7721

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0103-7331&lng=en

                Diabetes mellitus,hypertension,HIPERDIA Information System,hipertensão,sistema de informação HIPERDIA

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