title: Trends in the prevalence of self-reported diabetes in Brazilian capital cities and the Federal District, 2006-2014.
abstract: BACKGROUND
  Diabetes is increasing globally, particularly in low and middle income countries, posing a great challenge to health systems. Brazil is currently ranked 4th in the world in terms of the absolute number of persons with diabetes. Our aim was to analyze the trend in self-reported diabetes prevalence between 2006 and 2014 in Brazilian adults.
  
  
  METHODS
  We used data from the national telephone survey-VIGITEL. Over 40,000 individuals from probabilistic sample of subjects ≥18 years old residing in 26 state capitals and the Federal District were interviewed per year in each location. Estimates were weighted to represent the surveyed population. We analyzed trends with a linear regression model. We adjusted prevalence with a probability predictive margins model, using as reference categories: men, 18-24 years, ≥12 years of schooling and lean/normal weight.
  
  
  RESULTS
  From 2006 to 2014, the overall prevalence increased from 5.5 to 8.0 %, a net rise of 0.26 %/year (P = 0.001). After adjustment for sex, age, schooling and BMI categories, the trend decreased only slightly to 0.25 %/year. Relatively greater adjusted increases were present in men (0.28 %/year), in those ≥65 years (0.52 %/year), with ≤8 years of schooling (0.33 %/year) and in those overweight (0.24 %/year). The most consistent upward trends were observed among men (coefficient of determination, R2= 0.93), those with educational attainment of 0-8 years (R2= 0.81), those > 65 years (R2= 0.79) and those who were overweight (R2= 0.75). There was no significant trend in diabetes prevalence for the obese. As expected, the prevalence of self-reported diabetes was always higher among those with greater age, less schooling, in women, and in those with obesity. Being obese was associated with having more than twice the prevalence of diabetes of those normal/underweight.
  
  
  CONCLUSIONS
  Prevalence of self-reported diabetes in Brazilian adults has risen between 2006 and 2014, especially among those 65 years or older, even after taking into account the sociodemographic and nutritional changes during the period. Regardless of possible causes (higher incidence, increased diagnosis or decreased mortality), this increase in prevalence has enormous implications for the health system, representing >300,000 newly diagnosed cases of diabetes yearly requiring health care.
authors.affiliation: Post Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600/414, Porto Alegre, RS 90035-003 Brazil ; Faculty of Medicine, Universidade do Sul de Santa Catarina, Tubarão, Brazil.
authors.forename: Betine Pinto Moehlecke
authors.initials: BP
authors.lastname: Iser
authors.affiliation: Post Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600/414, Porto Alegre, RS 90035-003 Brazil.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Vigo
authors.affiliation: Post Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600/414, Porto Alegre, RS 90035-003 Brazil.
authors.forename: Bruce Bartholow
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Post Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600/414, Porto Alegre, RS 90035-003 Brazil.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
keywords: Behavioral Risk Factor Surveillance System; Diabetes trends; Health surveys; Linear models; Self-report