Type 2 diabetes is a chronic, progressive condition that can lead to a variety of complications if not managed properly. The prevalence of this disease is rising worldwide and considered a major public health issue. Although many treatments are available, a lack of patient education and healthcare access can provide an obstacle to patients receiving proper disease management, particularly in countries such as Brazil.
We assessed data from the 2011 National Health and Wellness Survey (NHWS), a cross-sectional, representative, self-administered survey of adults in urban Brazil. Four per cent of respondents reported having been diagnosed with type 2 diabetes. Of these, 86 per cent did not know their glycosylated haemoglobin (HbA1c) level, which is the average level of blood sugar (glucose), over the previous three months. Of the respondents who were aware of their HbA1c levels, 60 per cent reported their levels were above 7 per cent, which means their diabetes was uncontrolled.
Whether a patient has had his HbA1c tested did not vary by insurance status. Brazil’s public healthcare system (Sistema Unico de Saude, SUS) offers full coverage for every citizen. However, the quality of care is not high, so people in middle to high socioeconomic groups purchase private health insurance. The broad private health network that complements the public services represents approximately 25 to 30 per cent of the population. Almost 40 per cent of respondents who reported a diagnosis of type 2 diabetes claimed to have private insurance, and the rest have public insurance. Respondents who did not know their HbA1c level were significantly less likely to have reported having been tested in the past three months and were significantly more likely to not know when they received their last test.
Respondents with public insurance were older and more likely to be unemployed, have lower socioeconomic status, and have less education.
Brazil’s government has developed a system of classifying its citizens by socioeconomic level—A1, A2, B1, B2, C1, C2, D and E—with A1 being the highest and E being the lowest based on education and ownership of consumer durable goods. Similarly, respondents with HbA1c level of less than 7 per cent were generally the most educated and had the highest socioeconomic status. Not knowing one’s HbA1c was associated with the lowest level of education and socioeconomic status.
Few significant differences were observed with respect to health status between diabetics with private insurance and those with public insurance. Respondents with private insurance reported significantly higher physical health status (44.5 per cent) than those with public insurance (44.1 per cent). Although not statistically significant, health status was lower for those with HbA1c of 7 per cent or higher (34.9 per cent) and for those who did not know their HbA1c level (42.6 per cent) compared with those whose HbA1c was less than 7 per cent (46.7 per cent).
The lack of awareness of HbA1c levels suggests a significant gap in patient education. Given the high probability of being uncontrolled, this lack of patient education may have significant humanistic and economic consequences for Brazil from a societal perspective. Improvement in access and education may help improve overall type 2 diabetes management.
See infographic for key facts about type 2 diabetes in Brazil