Type 2 diabetes, healthcare expenditures and its correlation with anthropometric factors and physical activity: 18-month follow-up in a Brazilian city

Abstract AIMS To compare the profile of adults attended at primary care level of the Brazilian National Health System according to occurrence of T2DM during 18 months of follow-up. METHOD Longitudinal study carried out with 316 adults. T2DM and PA were assessed by questionnaires. Measurements of weight, height and waist circumference (WC) were also performed. Healthcare expenditures were based on the demand of services registered in medical records. Analysis of variance (ANOVA) with Tukey’s post hoc test was used, as well as their similar for non-parametric variables. Spearman’s correlation coefficient analyzed the relationship between variables. All analyzes were performed using the statistical software BioEstat (release 5.0) and the significance level was set at p-value <0.05. RESULTS Patients with T2DM at baseline showed higher values of WC, BMI, nursing appointments, customer services, medication, total cost and lower values of PA when compared to patients T2DM-free. Patients who developed T2DM during the follow-up presented higher values of WC, screening, pharmacy frequency, medications and total cost when compared to individuals without T2DM. Being in the highest quartile of PA did not change the costs of health services among patients T2DM-free. Healthcare expenditures were positively correlated to BMI among participants T2DM-free and with T2DM at baseline. CONCLUSION Participants with T2DM and participants who developed T2DM during the follow-up showed higher values of BMI, WC, healthcare expenditures and were less active when compared to participants T2DM-free. Healthcare expenditures were positively correlated with BMI among participants with T2DM at baseline and T2DM-free.

摘要
研究目的：本研究旨在对比巴西国家卫生系统基层医疗就诊的成人受试者，在18个月随访期间2型糖尿病（Type 2 Diabetes Mellitus, T2DM）的发生情况及其临床特征差异。
方法：本研究为纳入316名成人的纵向队列研究。通过问卷评估受试者的2型糖尿病与体力活动（Physical Activity, PA）情况；同时测量体重、身高及腰围（Waist Circumference, WC）。医疗支出数据基于病历记录的服务需求信息。统计分析采用方差分析（Analysis of Variance, ANOVA）及Tukey事后检验，非参数变量则采用对应非参数检验方法；采用斯皮尔曼相关系数分析变量间的关联。所有统计分析均使用统计软件BioEstat（5.0版本）完成，检验水准设定为p值<0.05。
结果：基线已确诊2型糖尿病的受试者，其腰围、体重指数（Body Mass Index, BMI）、护理门诊就诊次数、门诊服务量、用药情况及总医疗支出均高于无2型糖尿病受试者，而体力活动水平更低。随访期间新发2型糖尿病的受试者，其腰围、筛查项目频次、药房取药频率、用药情况及总医疗支出均高于未发生2型糖尿病的个体。处于体力活动最高四分位组的无2型糖尿病受试者，其医疗服务支出未发生显著变化。在无2型糖尿病及基线确诊2型糖尿病的受试者中，医疗支出与体重指数均呈正相关。
结论：与未发生2型糖尿病的受试者相比，基线确诊2型糖尿病者及随访期间新发2型糖尿病者的体重指数、腰围及医疗支出均更高，且体力活动水平更低。在基线确诊2型糖尿病及无2型糖尿病的受试者中，医疗支出与体重指数均呈正相关。