Custos e mortalidades por diabetes mellitus no Brasil e prevenção das doenças dos pés relacionadas ao diabetes na atenção primária à saúde

Abstract

Introduction. With the ageing of the population, Brazil has been experiencing a process of demographic transition which has led to an increase in chronic non-communicable diseases, among which Diabetes Mellitus stands out. The increase in the number of people with the disease is considered a serious public health problem, given the need for high investment in both outpatient and inpatient treatment, as well as in the promotion and prevention of the disease. The latter is a challenge for the promoters of social public policies: government officials, researchers and society in general as co-responsible for self-care. According to the Brazilian Diabetes Society, around 8.8% of the world's population lives with the disease and by 2045 the number of diabetics is expected to rise to more than 628.6 million people worldwide. Objective. To analyze the mortality and costs of diabetes mellitus in Brazil and identify actions to prevent diabetic foot within the scope of Primary Health Care. Methodology. Article 1: Ecological study of spatial analysis of mortality from diabetes, with a quantitative and descriptive approach, using the specific mortality rate per 100,000 inhabitants; Article 2: Integrative literature review study, to survey publications on virtual platforms, PubMed, Virtual Health Library and Scielo. Results. Article 1 and 2: The highest mortality rates occurred in the states of Roraima (4.74), Acre (3.18), Alagoas (3.12), Amapá (3.02). The state of Amazonas was in 8th place (2.48), with the lowest rates in the Federal District (0.98) and Paraná (0.85). Article 2: Thirteen studies were selected and the main actions for preventing diabetic foot within the scope of PHC were those related to adequate foot care, including nail and skin care, and the importance of daily foot monitoring. Patients with sensory loss should be educated on how to use other sensory modalities (palpation, visual inspection with an unbreakable mirror) to detect possible foot problems early. Article 3: When analyzing the total costs of the gross domestic product of each state, the scenario indicates that the Northeast and North regions stand out. The costs of hospital services are higher than the costs of professional services. Conclusion. Although morbidity from Diabetes Mellitus is on the rise in Brazil, there has been a reduction in mortality between 2012 and 2022, except in some specific regions in the North and Northeast. When analyzing the total costs of the gross domestic product of each state, the scenario indicates that the Northeast and North regions stand out. The costs of hospital services are higher than the costs of professional services. According to the studies analyzed, the occurrence of foot damage is an avoidable complication of diabetes, but it remains a frequent condition and this leads to complex situations such as lower limb amputations and death. The studies point to the need to control diabetes complications, with emphasis on expanding the care network; implementing practice protocols in the routines of care at basic health units; health education for both professionals and patients; and guidance on self-care and regular foot assessment.