Self-reported diabetes in older people: comparison of prevalences and control measures

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1 Rev Súde Púlic 2014;48(4): Originl Articles DOI: /S Sheil Rizzto Stop I Chester Luiz Glvão Césr II Neuer José Segri III Moisés Goldum IV Vness Mrtins Vlente Guimrães V Mri Cecíli Goi Porto Alves VI Mrilis Berti de Azevedo Brros VII Self-reported dietes in older people: comprison of prevlences nd control mesures Dietes utorreferido em idosos: comprção ds prevlêncis e medids de controle ABSTRACT OBJECTIVE: The ojective of this study ws to nlyze the prevlence of dietes in older people nd the dopted control mesures. I Progrm de Pós-grdução em Súde Púlic. Fculdde de Súde Púlic. Universidde de São Pulo. São Pulo, SP, Brsil II Deprtmento de Epidemiologi. Fculdde de Súde Púlic, Universidde de São Pulo. São Pulo, SP, Brsil III Deprtmento de Súde Coletiv. Universidde Federl de Mto Grosso. Cuiá, MT, Brsil IV Deprtmento de Medicin Preventiv. Fculdde de Medicin. Universidde de São Pulo. São Pulo, SP, Brsil V Escol de Artes, Ciêncis e Humniddes. Universidde de São Pulo. São Pulo, SP, Brsil VI Instituto de Súde. Secretri de Estdo d Súde. São Pulo, SP, Brsil VII Deprtmento de Medicin Preventiv e Socil. Fculdde de Ciêncis Médics, Universidde Estdul de Cmpins. Cmpins, SP, Brsil Correspondence: Sheil Rizzto Stop Deprtmento de Epidemiologi FSP-USP Av. Dr. Arnldo, 715 Cerqueir Césr São Pulo, SP, Brsil E-mil: sheilrizzto@usp.r METHODS: Dt regrding older dietic individuls who prticipted in the Helth Surveys conducted in the Municiplity of So Pulo, SP, ISA-Cpitl, in 2003 nd 2008, which were cross-sectionl studies, were nlyzed. Prevlences nd confidence intervls were compred etween 2003 nd 2008, ccording to sociodemogrphic vriles. The comintion of the dtses ws performed when the confidence intervls overlpped. The Chi-squre (level of significnce of 5%) nd the Person s Chi-squre (Ro-Scott) tests were performed. The vriles without overlp etween the confidence intervls were not tested. RESULTS: The ge of the older dults ws yers. The mjority were women, Cucsin, with n income of etween > 0.5 nd 2.5 times the minimum slry nd low levels of schooling. The prevlence of dietes ws 17.6% (95%CI 14.9;20.6) in 2003 nd 20.1% (95%CI 17.3;23.1) in 2008, which indictes growth over this period (p t the limit of significnce). The most prevlent mesure dopted y the older dults to control dietes ws hypoglycemic gents, followed y diet. Physicl ctivity ws not frequent, despite the significnt differences oserved etween 2003 nd 2008 results. The use of pulic helth services to control dietes ws significntly higher in older individuls with lower income nd lower levels of eduction. CONCLUSIONS: Dietes is complex nd chllenging disese for ptients nd the helth systems. Mesures tht encourge helth promotion prctices re necessry ecuse they presented smller proportion thn the use of hypoglycemic gents. Pulic helth policies should e implemented, nd imed minly t older individuls with low income nd schooling levels. These chnges re essentil to improve the helth condition of older dietic ptients. Received: 11/3/2013 Approved: 3/2/2014 Article ville from: DESCRIPTORS: Aged. Dietes Mellitus, Epidemiology. Hypoglycemic Agents. Self Cre. Life Style. Helth Behvior. Helth Services Accessiility. Helth Surveys.

2 Rev Súde Púlic 2014;48(4): RESUMO OBJETIVO: O ojetivo deste trlho foi nlisr prevlênci de dietes em idosos e s medids de controle dotds. MÉTODOS: Form nlisdos ddos de idosos diéticos prticipntes dos Inquéritos de Súde no Município de São Pulo, SP, ISA-Cpitl, 2003 e 2008, estudos de se trnsversl. Comprrm-se s prevlêncis e seus intervlos de confinç entre os dois nos de estudo, segundo vriáveis sociodemográfics. Relizou-se junção dos ncos de ddos qundo ocorreu soreposição dos intervlos de confinç. Relizou-se teste Qui-qudrdo com nível de significânci de 5% e o Qui-qudrdo de Person (Ro-Scott). Vriáveis sem soreposições entre os intervlos de confinç não form testds. RESULTADOS: Os idosos tinhm predominntemente de nos, erm do sexo feminino, de cor rnc, com rend > 0,5 té 2,5 slários mínimos e ix escolridde. A prevlênci de dietes foi de 17,6% (IC95% 14,9;20,6) em 2003 e 20,1% (IC95% 17,3;23,1) em 2008, sugerindo crescimento no período (p no limite d significânci). O uso de hipoglicemintes presentou miores prevlêncis, seguido por diet limentr, entre os meios dotdos pr controlr o dietes. Houve ix frequênci ds prátics de tividde físic, pesr d diferenç significtiv encontrd no período. Ocorrerm diferençs significtivs relcionds o cesso e o uso de serviço púlico de súde pr controle do dietes, mior em idosos com menor rend e menor escolridde nos dois nos nlisdos. CONCLUSÕES: O dietes é um doenç complex e desfidor pr o portdor e pr os sistems de súde. São necessáris inicitivs que encorjem prátics de promoção de súde, um vez que ests presentrm percentuis inferiores o uso de hipoglicemintes. Deve-se investir em polítics púlics de súde, principlmente direcionds os idosos de ix rend e escolridde. Tis mudnçs são essenciis pr melhori ds condições de súde dos idosos portdores de dietes. DESCRITORES: Idoso. Dietes Mellitus, Epidemiologi. Hipoglicemintes. Autocuiddo. Estilo de Vid. Comportmentos Sudáveis. Acesso os Serviços de Súde. Inquéritos Epidemiológicos. INTRODUCTION Popultion ging is one of the gretest chllenges in pulic helth, prticulrly in medium-income countries. There hs een significnt increse in the older popultion ( 60 yers) in Brzil over the lst decdes: from 1.7 million in 1940 to 20.5 million in 2010 (10.8% of the Brzilin popultion)., Moreover, Brzil is going through process of epidemiologicl trnsition. Chronic diseses, which re typicl of ging, re in focus in the context of pulic helth. Dietes mellitus is one of the min diseses tht ffect the older popultion. Its incresing prevlence nd high moridity nd mortlity mke it glol epidemic. 10,23 Dietes is chllenging for the helth systems worldwide. Popultion ging, growing urniztion, nd intensifiction of gloliztion s well s the doption of unhelthy lifestyles nd industrilized diets re the min cuses for the incresed incidence nd prevlence of the disese. 10 The numer of ptients with dietes worldwide exceeds 180 million nd is estimted to rech 350 million in According to the Ministry of Helth, Cmrno AA, Knso S. Perspectivs de crescimento pr populção rsileir: velhos e novos resultdos. Brsíli (DF): Instituto de Pesquis Econômic Aplicd; Instituto Brsileiro de Geogrfi e Esttístic. Censo Brsíli (DF); 2010 [cited 2014 Fe 28]. Aville from: ige.g.,ov.r/sinopse/weservice

3 556 Dietes in older people: comprison of prevlences Stop SR et l over 10 million individuls in Brzil hve dietes, of which pproximtely 33.0% re etween 60 nd 79 yers of ge. c The im of this study ws to nlyze the prevlence of dietes mong older people nd the dopted control mesures. METHODS This cross-sectionl study used dt from Helth Surveys in the Municiplity of So Pulo, SP, Southestern Brzil, ISA-Cpitl 2003, nd ISA-Cpitl The ddressed topics were relted the individul s overll helth (lifestyle, living conditions, stte of helth, nd use of helth services). In the ISA-Cpitl 2003, 3,357 individuls (872 older dults) were interviewed. The smple ws strtified y groups in two stges: census nd households. Sixty census sectors were drwn sed on the PNAD-2002 smple (Ntionl Household Smple Survey). The sectors were drwn into three strt, ccording to level of schooling of the hed of the fmily, mesured y the percentge of those who hd university degree: < 5.0%, 5.0%-24.99%, nd 25.0%. The plnned minimum smple size ws 420 individuls for ech domin, i.e., sex nd ge: < 1 yer, 1-11 yers; yers (mles nd femles); yers (mles nd femles); nd 60 yers (mles nd femles). This ws sed on n estimted prevlence of 50%, confidence level of 95% (95%CI), smpling error of 0.06, nd design effect of 1.5. In the ISA-Cpitl 2008, 3,271 individuls (924 older dults) were interviewed, nd the strtified smpling ws performed y groups in two stges: census sectors (70 sectors) nd households. The smple ws formed y eight demogrphic domins, s in the survey of The smple size vried etween 300 nd 780 domins. These were clculted considering n estimted prevlence of 50.0%, 95%CI, smpling error etween 0.04 nd 0.07, nd design effect of 1.5. We used the smpling domins of 60 yers for oth the mle nd femle sexes from the two surveys. Dt were otined y mens of questionnire composed of groups of topics with specific questions minly closed questions with pre-estlished lterntives. The questionnires were dministered y trined interviewers nd nswered y the older individuls themselves. The dependent vrile ws the presence of selfreported dietes. The independent vriles were demogrphic nd socioeconomic chrcteristics, such s sex (mle nd femle), ge (60-69 yers, yers, nd 80 yers), ethnicity (Cucsin nd non-cucsin), mritl sttus (mrried, stle reltionship, single, seprted/divorced, widower), level of schooling (yers of study: 0-3, 4-7, 8), occuption (with n ctivity, without n ctivity, unemployed), per cpit income (minimum slry: 0.5, > , 2.5). The following prmeters were lso nlyzed: knowledge nd prctice of mesures of dietes control (diet, regime to lose/mintin weight, physicl ctivity, routine use of insulin, use of insulin on need sis, routine use of orl hypoglycemic gents, use of orl hypoglycemic gents on need sis, no mesures, nd others), complictions (vision prolems, kidney prolems, nd circultory prolems), nd the use of helth services to control dietes (flu nd pneumoni immuniztion, proximity of the vccintion center to the older person s home, nd type of service: pulic or privte). Assocition etween demogrphic/socioeconomic vriles nd the presence of dietes ws estimted using the Chi-squre test, nd the level of significnce ws set s 5%. Prevlences nd 95%CI were compred to evlute the control prctices nd use of helth services y dietic ptients. The overlp etween the confidence intervls ws determined for the two distinct groups. The difference etween the two yers ws considered significnt when there ws no overlp etween the confidence intervls. Otherwise, the dtses from 2003 nd 2008 were comined (comined dtse) using the sttisticl softwre Stt 11.0 nd the ppend commnd. The comintion of the dtses ws necessry to determine if smll overlps etween confidence intervls were sttisticlly significnt. To ssemle the informtion contined in oth dtses in single dtse, ll the vriles kept the sme nme nd nswer ctegory nd new vrile ws creted to identify from which dtse the oservtion originted. 17 The ssocition ws performed using Person s Chi-squre (Ro-Scott). The vriles without overlp etween the confidence intervls were not tested. The dt nlysis ws performed using the sttisticl softwre Stt 11.0 nd the survey module, which tkes into considertion the effects of complex smpling. The present study ws pproved y the Ethics Committee of the Fculdde de Súde Púlic of the Universidde de São Pulo (Opinion , de 2012). c Portl Brsil. Súde do Idoso. Brsíli (DF); 2012 [cited 2014 Fe 28]. Aville from:

4 Rev Súde Púlic 2014;48(4): RESULTS Dietes mellitus ws reported y 17.6% (95%CI 14.9;20.6) of the older individuls who nswered the 2003 survey nd y 20.1% (95%CI 17.3;23.1) of those who nswered the 2008 survey. This increse tended to e significnt. There ws significnt ssocition etween self-reported dietes nd low income (in 2003) nd etween self-reported dietes nd low levels of schooling (in 2008) (Tle 1). In 2003, 52.1% of the older dults with dietes mentioned following diet. These individuls were minly women (73.8%; p = 0.029). The percentge of older individuls with dietes following diet in 2008 ws 61.0%. In oth yers, > 90.0% of the older dults stted not following regime to lose/ mintin their weight. There ws low frequency of physicl ctivity, with > 85.0% of the older people stting tht they did not perform ny physicl ctivities (p = 0.029), in oth yers (Tle 2). The prevlence of routine use of insulin ws similr in oth yers; it ws more prevlent in women: 88.2% (p = 0.010) of the older women with dietes in 2003 nd 81.4% (p = 0.016) in Hrdly ny older individuls (< 1%) used insulin on need sis. The prevlence of routine use of orl hypoglycemic gents ws 61.0% in 2003 nd 71.8% in 2008, which represented significnt increse during this period. In oth yers, hrdly ny older individuls (< 3%) used orl hypoglycemic gents on need sis. The Tle 1. Prevlence of dietes mellitus ccording to demogrphic nd socioeconomic chrcteristics in older dults. ISA- Cpitl, So Pulo, SP, Southestern Brzil, 2003 nd Vrile n Prevlence (%) p n c Prevlence (%) p Age group (yers) to to Sex Femle Mle Ethnicity Cucsin Non-cucsin Mritl sttus Mrried Stle reltionship Single Seprted/Divorced Widower Level of schooling (yers) to to Occuption With n ctivity Without n ctivity Unemployed Income (in minimum slries) > 0.5 to > Smple weightings were tken into considertion. Person s Chi-squre test. c Numers in the weighted smple. Significnt differences shown in old.

5 558 Dietes in older people: comprison of prevlences Stop SR et l Tle 2. Hits dopted y dietic older individuls to control dietes. ISA-Cpitl, So Pulo, SP, Southestern Brzil, 2003 nd p % 95%CI n % 95%CI n Diet No ; ; Yes ; ; Regimen to lose or mintin weight No ; ; Yes ; ; Physicl ctivity No ; ; Yes ; ; Routine use of insulin No ; ; Yes ; ; Use of insulin when there is prolem No ; ; Yes ; ; Routine use of orl hypoglycemic gents No ; ; Yes ; ; Use of hypoglycemic gents when there is prolem No ; ; Yes ; ; No mesures No ; ; Yes ; ; Others No ; ; Yes ; ; Prevlence in the weighted smple. Asolute numers in the smple. Significnt differences re shown in old. options no mesures nd other showed prevlences of < 10.0% in oth yers (Tle 2). In 2003, 23.5% of the older dults sid tht they hd some form of compliction from dietes; nd in 2008, this percentge ws 28.9%. Vision prolems were more prevlent thn kidney prolems (63.6% in 2003 nd 72.3% in 2008). In 2003, the prevlence of vision prolems in older dietic ptients ws higher in mrried individuls (72.5%; p = 0.002) nd in retired individuls (78.2%; p = 0.038). In 2008, the prevlence of vision prolems ws higher in non-cucsin individuls (35.8%; p = 0.027). The prevlence of kidney prolems ws 15.4% in 2003 nd 38.5% in 2008 (this difference ws sttisticlly significnt (p = 0.046)) (Tle 3) nd ws ssocited with low schooling levels in 2003 (p = 0.048) nd in 2008 with the mle sex (56.5%) (p = 0.004). The prevlence of circultory prolems ws 34.4% in 2003 nd 52.3% in 2008 nd ws higher in the mle older individuls (50.0%) in 2008 (p = 0.012). Approximtely 70.7% of the older dults were vccinted ginst the flu in 2003 nd 66.9% in 2008 (Tle 4). The mjority used the pulic helth service to receive the vccine (> 95.0% in oth yers), nd in 2008, pulic helth service ws the most used y the older individuls with low income (p = 0.008). Most stted hving received the vccine t the helth center closest to their home. The proximity of the vccintion center to the ptients homes ws ssocited with low income (p < nd p = 0.002, in 2003 nd 2008, respectively) nd with low schooling levels (p = in 2003).

6 Rev Súde Púlic 2014;48(4): In 2003, 28.9% of the older dults with dietes reported hving received the vccine ginst pneumoni; nd in 2008, this percentge ws 24.3%. In oth yers, > 95.0% of individuls stted tht they received this vccine t pulic helth centers nd t the center tht ws closest to home (Tle 4). In 2008, this fct ws ssocited with the level of schooling: it ws higher in individuls with 8 yers of study (p = 0.032). DISCUSSION The prevlence of self-reported dietes in the older dults ws 17.6% in 2003 nd 20.1% in The prevlence of dietes ws 17.9% in So Pulo, ccording to the SABE Project 8 (Helth, Well-eing nd Aging) nd 14.6% in Bmuí, SP, ccording to the Project Bmuí 16 (popultion-sed cohort study on the helth of the older people, which used lortory tests to determine the presence of the disese, conducted in 1997). The increse in the prevlence of dietes from 2003 to 2008 my e due to the higher numer of dignosed cses of dietes or to the ctul expnsion of the disese. The higher numer of dignosed cses my e the result of the introduction of HiperDi, 22 which llows to monitor ptients with dietes registered in sic helth units. HiperDi ws estlished etween 2001 nd 2003 nd involved cmpigns of dietes screening, dignosis confirmtion, nd tretment initition. The expnsion of the disese results from the increse in the prevlence of oesity in the older popultion. Oesity is the risk fctor for dietes incidence nd hinders its tretment when the disese is lredy estlished. The prevlence of oesity is higher in the dietic popultion. 4,7 Income (in 2003) nd level of schooling (in 2008) were significntly ssocited with dietes, which indictes tht the prevlence of dietes mong the older people ws ffected y socioeconomic fctors. The Project Bmuí 16 nd the study conducted in the city of Arrqur, SP, Southestern Brzil, 20 lso found significnt ssocitions etween dietes nd low-income levels. Lim-Cost 9 (2004) suggests tht schooling ffects ehviors prejudicil to the helth of older dults nd tht low levels of schooling re ssocited with the occurrence of chronic diseses nd other dysfunctions. The numer of older individuls who followed diet did not increse significntly. There ws significnt difference etween the sexes in 2003 with regrd to diet, with higher percentge of women following diet. The results re in line with dt from VIGITEL, 12 in which women showed higher intke of fruits, legumes, nd vegetles nd less intke of met with excess ft. Moreover, the routine use of insulin ws ssocited with the vrile sex in oth yers. These results re similr to those otined in other studies nd suggest tht women re more willing to undergo insulin tretment thn men. 4 The routine use of n orl hypoglycemic gent tended to e significnt in the period under study, nd it ws the most frequent hit of the older dietic popultion. The prevlence of the use of hypoglycemic gents y the older popultion ws 64.7% in survey conducted in Mins Geris 5 in Only one hit, mong the most reported y the older dietic ptients (diet, use of orl hypoglycemic gents, nd use of insulin), ws relted to helth promotion nd prevention of chronic diseses. Physicl ctivity ws not Tle 3. Complictions from dietes in older individuls. ISA-Cpitl, So Pulo, SP, Southestern Brzil, 2003 nd % 95%CI n % 95%CI n p Presence of complictions No ; ; Yes ; ; Vision prolems c No ; ; Yes ; ; Kidney prolems c No ; ; Yes ; ; Circultory prolems c No ; ; Yes ; ; Prevlence in the weighted smple. Asolute numers in the smple. c Among the older dults who reported hving some compliction. Significnt differences shown in old.

7 560 Dietes in older people: comprison of prevlences Stop SR et l Tle 4. Use of vccintion helth centers y self-reported dietic older individuls. ISA-Cpitl, So Pulo, SP, Southestern Brzil, 2003 nd % 95%CI n % 95%CI n p Received flu vccine No ; ; Yes ; ; Type of service c Pulic ; ; Privte ; ; Ws it the closest center to home? c No ; ; Yes ; ; Received pneumoni vccine No ; ; Yes ; ; Type of service d Pulic ; ; Privte ; ; Ws it the closest center to home? d No ; ; Yes ; ; Prevlence in the weighted smple. Asolute numers in the smple. c Among the older dults who reported hving received the flu vccine. d Among the older dults who reported hving received pneumoni vccine. frequent prctice, lthough it incresed over the period under nlysis nd despite the significnt difference etween 2003 nd Physicl exercise is essentil for the control of the disese nd is prt of its tretment. 19 A study conducted in Mins Geris showed similr results with regrd to complictions from dietes, i.e., higher prevlence of vision prolems in the older dults who lived with prtner, who were retired, nd who were housewives. 21 This compliction ws predominnt in non-cucsin individuls, which is in line with the results presented in the interntionl literture. 6 Non- Cucsin individuls hve higher lood pressure levels thn Cucsin individuls, which is risk fctor for the development of the vision prolems. According to dt from the NHANES, the prevlence of vision prolems in the non-cucsin popultion is 46.0% higher thn in the Cucsin popultion. 6 Differences with regrd to kidney complictions were oserved etween 2003 nd 2008, which is in greement with the Brzilin literture. A Brzilin study with dt regrding the period etween 2000 nd 2004 demonstrted prevlence of dietic nephropthy of 15.0%, 1 wheres in 2009, it ws 27.0% s per The Brzilin Dilysis Census of the Brzilin Nephrology Assocition. 18 Dietes increses the risk of developing crdiovsculr disorders. These conditions hve negtive effect on the qulity of life of older people with dietes nd cn led to deth. A study conducted in Mringá, PR, over four 3-yer periods ( , , , nd ) indictes diseses of the circultory system s the principl cuse of mortlity in older individuls with dietes. 13 In 2003, 70.7% of older people with dietes were vccinted ginst the flu; in 2008 this percentge ws 66.9%. The immuniztion progrm in the older popultion ws initited in the 1960s nd ws recommended y the World Helth Orgniztion. The minimum vccintion coverge gol estlished y the Ntionl Immuniztion Progrm ws 70.0% until 2007 nd ws incresed to 80.0% in the following yer. d More thn 95.0% of the vccinted older dults used the pulic helth services to receive the vccine, in oth yers. This fct ws ssocited with low income. A study tht used dt from the SABE project 11 suggested significnt ssocition etween the use of pulic services nd low income. d Portl Súde. Súde lnç nest 3ª feir Cmpnh Ncionl de Vcinção contr gripe de Brsíli (DF); 2012 [cited 28 Fe 2014]. Aville from:

8 Rev Súde Púlic 2014;48(4): The centers where the ptients received the flu vccine were those closest to their homes. This result ws sttisticlly ssocited with low income nd low schooling levels; moreover, it ws similr to dt otined in study 2 conducted in Pelots, RS, Southern Brzil. The individuls who lived nerest to the helth centers were those with lower incomes nd lower eduction levels. Vccintion ginst pneumoni ws 28.9% in 2003 nd 24.3% in Older dietic ptients re more susceptile to pneumoni ecuse they re t greter risk for hyperglycemi, low immunity, reduced lung function, nd other co-moridities. 3 The mjority of the older dults stted tht they received the vccine in the centers closest to their homes. Proximity of the vccintion centers to home ws ssocited with the individuls level of schooling nd the vccintion coverge ws lower in those with low levels of eduction. The older ptients with higher schooling levels showed etter helth sttus, etter lifestyles, higher level of informtion, nd etter socioeconomic conditions, when compred to those with lower schooling levels. 14 The informtion used to estimte the prevlences were self-reported, i.e., lortory tests were not used to confirm the dignosis of dietes. Previous studies hve indicted tht the vlidity of self-reported informtion vries ccording to the disese, the impirments nd comoridities, nd the sociodemogrphic chrcteristics. 15 It is estimted tht 50.0% of individuls with dietes re not wre they hve the disese, which remins symptomtic until screening tests re performed or until disese-relted complictions occur. e The nlysis period ws restricted to 5 yers, ccording to the periodicity of the survey tht ws used. Dietes mellitus is common nd serious disese tht cuses finncil urden to the ptients s well s helth services. Dietes deserves specil ttention mong the complex nd chllenging disorders tht currently ffect the society nd the helth systems; it is pulic helth prolem. Progrms to encourge prctices of helth promotion nd helthy lifestyles should e implemented, ecuse these hve positive effect on the qulity of life of older individuls with dietes. A reflection on the policies nd mesures imed t this prticulr popultion re necessry to improve the cre given to dietic ptients. Such ctions re indispensile for the promotion of etter living conditions nd helth mong this popultion. REFERENCES 1. Cherchigli ML, Mchdo EL, Szuster DAC, Andrde EIG, Acurcio FA, Ciff WT, et l. Epidemiologicl profile of ptients on renl replcement therpy in Brzil, Rev Sude Pulic. 2010;44(4):1-10. DOI: /S Cost JSD, Fcchini LA. Utilizção de serviços multoriis em Pelots: onde populção consult e com que frequênci. Rev Sude Pulic. 1997;31(4): DOI: /S Flguer M, Pifrre R, Mrtin A, Sheiks A, Moreno A. Etiology nd outcome of communitycquired pneumoni in ptients with dietes mellitus. Chest. 2005;128(5): DOI: /MD.0013e31827f Gomes MB, Ginnell Neto DG, Mendonç E, Tmsci MA, Fonsec RM, Ré RR, et l. Prevlênci de sorepeso e oesidde em pcientes com dietes mellitus tipo 2 no Brsil: estudo multicêntrico ncionl. Arq Brs Endocrinol Met. 2006;50(1): DOI: /S Gontijo MF, Rieiro AQ, Klein CH, Rozenfeld S, Acurcio FA. Uso de nti-hipertensivos e ntidiéticos por idosos: inquérito em Belo Horizonte, Mins Geris, Brsil. Cd Sude Pulic. 2012;28(7): DOI: /S X Hrris MI, Klein R, Cowie CC, Rowlnd M, Byrd- Holt DD. Is the risk of dietic retinopthy greter in non-hispnic lcks nd Mexicn Americns thn in non-hispnic whites with type 2 dietes? A US popultion study. Dietes Cre. 1998;21(8): DOI: /dicre Hippisley-Cox J, Pringle M. Prevlence, cre nd outcomes for ptients with diet-controlled dietes in generl prctice: Cross-sectionl survey. Lncet. 2004;364(9432): DOI: /S (04) Lerão ML. Condições de súde. In: Lerão ML, Lurenti R. SABE Súde, Bem-estr e Envelhecimento. O Projeto Se no Município de São Pulo: um ordgem inicil. Brsíli (DF): Orgnizção Pn-Americn d Súde; p Lim-Cost MF. Influence of the ge nd eductionl level on the use of preventive helth cre services: Helth survey in the Metropolitn Are of Belo Horizonte, Mins Geris Stte, Brzil. Epidemiol Serv Sude. 2004;13(4): Lim-Cost MF, Filho AIL, Mtos DL. Tendêncis ns condições de súde e uso de serviços de súde entre idosos rsileiros: um estudo sedo n Pesquis Ncionl por Amostr de Domicílios (1998, 2003). Cd Sude Pulic. 2007;23(10): DOI: /S X e Ministério d Súde. Dietes Mellitus. Brsíli (DF); 2006.

9 562 Dietes in older people: comprison of prevlences Stop SR et l 11. Louvison MCP, Lerão ML, Durte YAO, Sntos JLF, Mlik AM, Almeid ES. Desigulddes no uso e cesso os serviços de súde entre idosos do Município de São Pulo. Rev Sude Pulic. 2008;42(4): DOI: /S Mlt DC, Silv SA, Oliveir PPV, Iser BPM, Bernl RTI, Srdinh LMV, et l. Resultdos do monitormento dos Ftores de risco e Proteção pr Doençs Crônics Não Trnsmissíveis ns cpitis rsileirs por inquérito telefônico, Rev Brs Epidemiol. 2012;15(3): DOI: /S X Mthis TAF, Jorge MHPM. Dietes Mellitus n populção idos em Município d região Sul do Brsil: um estudo de mortlidde e moridde hospitlr. Arq Brs Endocrinol Met. 2004;48(4): DOI: /S Noronh KV, Andrde MV. Desigulddes sociis em súde e n utilizção dos serviços de súde entre os idosos n Améric Ltin. Rev Pnm Slud Pulic. 2005;17(5/6): DOI: /S Okur Y, Urn LH, Mhoney DW, Jcosen SJ, Rodeheffer RJ. Agreement etween selfreported questionnires nd medicl record dt ws sustntil for dietes, hypertension, myocrdil infrction nd stroke ut not for hert filure. J Clin Epidemiol. 2004;57(10): DOI: /j.jclinepi Pssos VMA, Brreto SM, Diniz LM, Lim-Cost MF. Type 2 dietes: prevlence nd ssocited fctors in Brzilin community the Bmuí helth nd ging study. So Pulo Med J. 2005;123(2): DOI: /S Segri NJ, Frncisco PMSB, Alvez MCGP, Brros MBA, Cesr CLG, Goldum M, et l. Prátics preventivs de detecção de câncer em mulheres: comprção ds estimtivs dos inquéritos de súde (ISA - Cpitl) e vigilânci de ftores de risco e proteção pr doençs crônics por inquérito telefônico (VIGITEL - São Pulo). Rev Brs Epidemiol. 2011;14Suppl 1: DOI: /S X Sesso RCC, Lopes AA, Thomé FS, Lugon JR, Burdmnn EA. Censo Brsileiro de Diálise, J Brs Nefrol. 2010;32(4): DOI: /S Sigl RJ, Kenny GP, Wssermn DH, Cstned- Scepp C, White RD. Physicl ctivity/exercise nd type 2 dietes: consensus sttement from the Americn Dietes Assocition. Dietes Cre. 2006;29(6): DOI: /dc Silv RC, Simões MJ, Leite AA. Ftores de risco pr doençs crdiovsculres em idosos com dietes mellitus tipo 2. Rev Cienc Frm Bsic Apl. 2007;28(1): Tvres DMS, Rodrigues FR, Silv CGC, Mirnzi SSC. Crcterizção de idosos diéticos tendidos n tenção secundári. Cienc Sude Coletiv. 2007;12(5): DOI: /S Toscno CM. As cmpnhs ncionis pr detecção ds doençs crônics nãotrnsmissíveis: dietes e hipertensão rteril. Cienc Sude Coletiv. 2004;9(4): DOI: /S Vinicor F. Is dietes pulic helth disorder? Dietes Cre. 1994;17(Suppl 1):22-7. Article sed on the mster s disserttion of Stop SR, titled: Condição de súde de idosos com dietes mellitus no Município de São Pulo, nos nos de 2003 e 2008: um estudo de se populcionl, presented to the Progrm de Pós- Grdução em Súde Púlic of the Fculdde de Súde Púlic of the Universidde de São Pulo, in The uthors declre no conflict of interest.