Quality of life of people with diabetes mellitus.

OBJECTIVE: To analyze the quality of life of people with type 2 diabetes mellitus in the three levels of the healthcare system. METHOD: A quantitative, cross-sectional and descriptive study carried out in primary, secondary and tertiary healthcare units with individuals in outpatient care. The validated Diabetes-39 instrument was used to evaluate quality of life. RESULTS: The sample consisted of 53 people. There was a decreasing tendency in the quality of life impairment from the primary to the tertiary care levels. In the total sample, there were differences between domains of quality of life with the variables gender, insulin use and occupation, greater perception of quality of life impairment and disease severity in people with higher rates of glycated hemoglobin. CONCLUSION: Quality of life tends to worse as the disease worsens. The results suggest that quality of life is related to sociodemographic and clinical variables, therefore, these should be considered in the care.

Contribution of family social support to the metabolic control of people with diabetes mellitus: A randomized controlled clinical trial.

AIM: This randomized controlled clinical trial aimed to evaluate the contribution of family social support to the clinical/metabolic control of people with type 2 diabetes mellitus. BACKGROUND: Diabetes mellitus is a chronic disease that requires continuous care in order for individuals to reach glycemic control, the primordial goal of treatment. Family social support is essential to the development of care skills and their maintenance. However, there are few studies that investigate the contribution of family social support to diabetes control. METHODS: The study was developed between June 2011 and May 2013, and included 164 people who were randomized using simple randomization. The intervention group differed from the control group in that it included a family caregiver, who was recognized by the patient as a source of social support. The educational interventions received by people with diabetes mellitus were used as the basis of the education provided through telephone calls to patients' family members and caregivers, and their purpose was to encourage dialogue between the patients and their relatives about the topics related to diabetes. RESULTS: Regarding the clinical impact, the results showed that there was a greater reduction in blood pressure and glycated hemoglobin in the intervention group than in the control group, showing a positive effect on the control of the disease. CONCLUSIONS: Families should be incorporated into the care of people with diabetes mellitus and especially in health care programs, in particular those that can promote different forms of social support to strengthen the bond between family members.

Perceived self-efficacy among liver transplant candidates and recipients.

Self-efficacy is defined as one's belief that one can perform the necessary behaviors to achieve one's goals. This belief is one of the most powerful motivational predictors of how well a person will perform at almost any endeavor. Limited information is available, however, about self-efficacy in the organ transplantation population. This study aimed to identify the self-efficacy belief among liver transplant candidates and recipients and compare these results with demographic characteristics. The authors analyzed 100 patients who were candidates and recipients for liver transplantation in a Brazilian center. The average self-efficacy score for the candidates was significantly lower than for the recipients. Future investigation is necessary to explore possible interventions to be taken before and after liver transplantation that could influence self-efficacy of the organ transplantation patients.

[An association between forms of coping and the socio-demographic variables of people on chronic hemodialysis]. / Associação entre os modos de enfrentamento e as variáveis sociodemográficas de pessoas em hemodiálise crônica.

This sectional study was performed with the objective to verify the association between the forms of coping used by people on chronic hemodialysis and their socio-demographic variables. A semi-structured instrument and the Folkman and Lazarus' Coping Strategies Inventory were used. The sample consisted of 107 adults, mostly male (62.4%), on ambulatory hemodialysis for over six months. The most commonly referred forms of coping were related to the positive reevaluation factor (coping centered on emotions); with the highest mean scores among women for all factors and for people who reported having a partner, living with their families and receiving support in their treatment, and the highest scores were common for the factors control, self-control, and social support. Knowing the forms of coping prepares nurses to reinforce or seek, with patients on hemodialysis, choosing positive forms of coping and propose actions that permit patients to develop adaptive mechanisms.

Insulin self-administration technique with disposable syringe among patients with diabetes mellitus followed by the family health strategy.

This cross-sectional study aimed to describe the most common correct and incorrect self-administration techniques for insulin using disposable syringes by patients cared for by the Family Health Strategy (FHS), relate the findings to sociodemographic variables and also identify the professional responsible for teaching this technique. A total of 169 patients were selected by simple random sampling in 37 FHS units in a city in the state of Minas Gerais, Brazil from August to October 2006. The results identified errors in all the steps recommended by the American Diabetes Association and Brazilian Diabetes Association for the safe administration of insulin, from hand washing to compression on the injection site. The FHS favors the development of interventions focused on the needs of the clientele registered at the unit, stimulating self-care. Results from this study can contribute to the planning of these interventions.

Cross-cultural adaptation and validation of the instrument Diabetes - 39 (D-39): brazilian version for type 2 diabetes mellitus patients - stage 1.

The study aimed to accomplish a cross-cultural adaptation of the 'Diabetes - 39 - D-39' instrument for Brazil, to test the validity of the adapted version in a sample of type 2 diabetes mellitus patients and to describe the participants of the study, according to the scores obtained on the Likert-type scale. The instrument adaptation process followed several steps: instrument translation; achievement of the consensus in Portuguese; evaluation by an expert committee; back-translation; achievement of the consensus in English; comparison of the original and consensus versions in English; semantic analysis and pre-test of the Portuguese version. Results showed that the instrument items, in the first stage of cultural adaptation to Portuguese, presented high internal consistency levels.

[The relationship between social support and the social demographic characteristics of people with diabetes mellitus]. / A relação entre o apoio social e as características sociodemográficas das pessoas com diabetes mellitus.

This cross-sectional study aimed at associating the perceived social support with the social demographic characteristics of people with diabetes mellitus, between May and November 2008. The sample consisted of 161 patients with diabetes mellitus and the Social Support Network Inventory was used. High perception of social support was observed in the studied sample, the main source of support were the family members, followed by health professionals. Social support was directly correlated with age and inversely correlated with educational level, both of weak magnitude. The assessment of social support will permit interventions to promote the adaptation of people to the health demands.

Education in Diabetes Mellitus for blood glucose self-monitoring: a quasi-experimental study.

OBJECTIVE: to evaluate the contributions of an educational program for capillary blood glucose self-monitoring. METHOD: a quasi-experimental study performed in an outpatient unit of a tertiary health care service in a sample of 25 people with Type 2 Diabetes Mellitus, from July 2016 to December 2017, developed through interactive tools for care with capillary blood glucose self-monitoring. RESULTS: among the items of capillary blood glucose self-monitoring that showed improvement after participation in the educational program, the most noteworthy are the "postprandial blood glucose values" (p=0.0039), "Interpretation of capillary blood glucose results with meals and medications" (p=0.0156), "recognition of the 'weakness' symptom for hyperglycemia" (p=0.0386) and "administration of medications correctly" for hyperglycemia prevention (p=0.0063). CONCLUSION: the study made it possible to recognize the main characteristics of blood glucose self-monitoring that may contribute to the care for the person with diabetes.

[Factors associated with insulin self-administration by diabetes mellitus patients in the Family Health Strategy]. / Fatores associados à auto-aplicação da insulina nos usuários com diabetes mellitus acompanhados pela Estratégia Saúde da Família.

This cross-sectional study aimed to compare two groups of patients with diabetes mellitus treated under the Family Health Strategy, with insulin self-administration versus non-self-administration, in relation to socio-demographic variables, perceived difficulties, and the person responsible for the self-application. A total of 269 patients participated, included through simple random sampling, from 37 Family Health Strategy units in the urban area of a municipality in the State of Minas Gerais, Brazil. The self-administration group consisted of 169 individuals (62.8%), as compared to 100 (37.2%) in the non-self-administration group. Comparing the two groups, schooling was statistically significant; 45% of those who did not self-administer reported absence of physical or cognitive difficulties that might prevent them from conducting the procedure, demonstrating the potential for adherence; 90% reported needing assistance in the insulin administration process at home, and of these, 75% reported receiving assistance from family members. The Family Health Strategy favors the development of interventions centered on users' needs, encouraging them to adopt and develop self-care skills, and the results of the present study can contribute to the planning of such interventions.

Evaluation of the effects of a diabetes educational program: a randomized clinical trial.

OBJECTIVE: Evaluate the effectiveness of a diabetes mellitus educational program in primary health care. METHODS: This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T0), three (T3), six (T6) and nine (T9) months after the beginning of the intervention. RESULTS: After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T3, T6 and T9 times were significantly lower among the people in the intervention group (p < 0.05). CONCLUSIONS: The educational program model developed was effective to improve the glycemic control of the intervention group participants.

Confirmatory factor analysis of the Appraisal of Self-Care Agency Scale - Revised.

Objective: to analyze the factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R), adapted for Brazil. Method: methodological study conducted with 150 individuals with diabetes mellitus cared for by the Family Health Strategy, most of whom are elderly with low educational levels. The test of the hypothesis concerning the confirmatory factor composition of the ASAS-R was performed using latent variables structural equations. Results: the model's goodness-of-fit indexes were satisfactory (χ2 = 259.19; χ2/g.l = 2.97, p < 0.001; GFI = 0.85; RMR = 0.07; RMSEA = 0.09); the factor loads were greater than 0.40; and most item-to-factor-correlations presented moderate to strong magnitude (0.34 to 0.58); total alpha value was 0.74, while the alpha of the three factors were 0.69, 0.38 and 0.69, respectively. Conclusion: the scale's factor structure presented satisfactory validity and reliability results, with the exception of one factor. Application of this scale to samples of the general population is desirable in order to strengthen analyses of internal consistency and the dimensionality of the factor structure. This study is expected to contribute to further studies addressing the self-care agency construct and the development of the ASAS-R.

Clinical Validation of the Indicators and Definitions of the Nursing Outcome "Tissue Integrity: Skin and Mucous Membranes" in People With Diabetes Mellitus.

PURPOSE: The study aimed to validate clinically the indicators of the nursing outcome "Tissue Integrity: Skin and Mucous Membranes" and its conceptual and operational definitions in people with diabetes mellitus. METHODS: A methodological study was conducted with an evaluation of 100 participants for two pairs: one of these pairs used the indicators without the definitions and the other used the indicators with their definitions. FINDINGS: The pair who used the definitions presented greater concordance and similarity in the ratings. CONCLUSIONS: The indicators and their definitions have been validated clinically. IMPLICATIONS FOR NURSING PRACTICE: The use of indicators with definitions can contribute to reliable and accurate evaluation of the tissue integrity of the feet in people with diabetes mellitus and, thus, assist in the measurement of the effectiveness of the nursing care provided. OBJETIVO: Validar clinicamente os indicadores do resultado de enfermagem "Integridade Tissular: pele e mucosas" e suas definições conceituais e operacionais em pessoas com diabetes mellitus. MÉTODOS: Estudo metodológico que consistiu na avaliação de 100 participantes por duas duplas de avaliadores: uma dupla utilizou os indicadores sem as definições e, a outra dupla, os indicadores com suas definições. RESULTADOS: A dupla que utilizou as definições apresentou maior concordância e similaridade nas avaliações. CONCLUSÃO: Os indicadores e suas definições foram validados clinicamente. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A utilização de indicadores com suas respectivas definições pode contribuir para a avaliação confiável e precisa da integridade tissular dos pés de pessoas com diabetes mellitus e, assim, auxiliar na mensuração da eficácia da assistência de enfermagem.

Adaptation and validation of the Diabetes Management Self-Efficacy Scale to Brazilian Portuguese.

OBJECTIVE:: to perform the cultural adaptation and validation of the Diabetes Management Self-efficacy Scale for Patients with Type 2 Diabetes Mellitus with a Brazilian population sample. METHOD:: cross-sectional methodological study in which the adaptation and validation process included the stages recommended in the literature. Construct validity and reliability were assessed with 200 adults with type 2 diabetes mellitus. RESULTS:: the items indicated by the panel of judges and by the target population were adjusted in the cultural adaptation to improve clarity and understanding. The instrument's four factors remained in the confirmatory factor analysis with factor loadings of items greater than 0.30, except for factor 4; convergent validity, verified by the multitrait-multimethod analysis, presented inter-item correlations from 0.37 to 0.92, while for discriminant validity, 100% of the items presented greater correlation in their own factors. Cronbach's coefficient alpha for the total scale was 0.78, ranging from 0.57 to 0.86 among factors. CONCLUSION:: semantic, cultural, conceptual and idiomatic equivalences were achieved and the instrument's Brazilian version also presented psychometric properties that showed evidence of reliability and validity. Thus, it can be applied both in clinical practice and research. Self-efficacy is useful for planning and assessing educational interventions, as well as predicting behavior modification in self-care.

Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus.

OBJECTIVE: to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. METHOD: evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A), the Measure of Adherence to Treatments and the electronic system at the place of study were used. The data were collected before and after the end of the educational interventions. The educational activities were developed within 12 months, mediated by the Diabetes Conversation Maps, using the Cognitive Social Theory to conduct the interventions. RESULTS: the knowledge on the disease (p<0.001), the medication treatment (oral antidiabetics) (p=0.0318) and the glycated hemoglobin rates (p=0.0321) improved significantly. CONCLUSION: the educational interventions seem to have positively contributed to the participants' knowledge about diabetes mellitus, the medication treatment adherence and the glycated hemoglobin rates.

Effects of supportive telephone counseling in the metabolic control of elderly people with diabetes mellitus.

Objective: the purpose of this study was to evaluate the efficacy of telephone-based support for the metabolic control of elderly patients with diabetes mellitus. Method: a pragmatic study was conducted in two groups, called G1 (n=36) and G2 (n=27), at a health unit from the countryside of São Paulo state. Patients in G1 group received telephone support over four months, through 16 telephone contacts with educational material; for the G2 group the educational material was mailed. Results: significant differences were found. The G1 group showed a reduction of the parameters of fasting glucose, as well as systolic and diastolic blood pressure. In G2 group a modest reduction was noted in some parameters, with no significant difference. Conclusion: telephone support was effective to deliver patient education to the diabetic elderly, leading to the reduction of fasting blood glucose. This, combined with other strategies, can contribute to reduce glycated hemoglobin (NCT 01972412).

Objetivo: avaliar a efetividade do suporte telefônico no controle metabólico de idosos com diabetes mellitus. Método: estudo pragmático com 63 participantes, alocados em dois grupos, denominados G1(n=36) e G2(n=27), em uma unidade de saúde do interior paulista. O suporte telefônico foi oferecido, durante quatro meses, para o G1, por meio de 16 ligações telefônicas com conteúdo educativo, e, para o G2, foram enviadas correspondências por via postal. Resultados: no G1 houve significância estatística na redução dos parâmetros das variáveis glicemia de jejum, pressão arterial sistólica e diastólica. No G2, houve redução discreta de algumas variáveis, mas sem significância estatística. Conclusão: o suporte telefônico foi considerado uma estratégia educativa efetiva para idosos com diabetes mellitus e favoreceu a redução da glicemia de jejum e, em conjunto com outras estratégias, pode agregar valor na redução da hemoglobina glicada (NCT 01972412).

Knowledge on diabetes mellitus in the self care process.

This descriptive study in the interior of São Paulo aimed to verify diabetes mellitus patients' knowledge about the disease, causes and complications, highlighting its importance in self care. Data were collected through interviews with 84 persons and analyzed through descriptive statistics. Average age was 53.3 +/- 13 years, time of disease 12.9 +/- 9 years and 58% of the participants did not finish basic education. Only 28.6% of the participants gave correct answers to "what is diabetes" and "what are its causes"; 71% were diagnosed without presenting classic symptoms and 64% had already been hospitalized due to an acute or chronic complication. We indicated aspects that turn the learning process more difficult; little knowledge about the disease, its causes and symptoms, thus affecting the prevention and early diagnosis and entailing predisposition towards complications. Furthermore, the interference of biopsychosocial factors in the self care process is highlighted.

A intervenção "Ensino do cuidado com os pés" para pessoas com diabetes: ensaio clínico randomizado

Introdução: pessoas com diabetes possuem risco aumentado para o desenvolvimento de morbidades nos membros inferiores, o que está relacionado a amputações. Objetivo: analisar o efeito da intervenção "Ensino do Cuidado com os Pés", realizada por meio de visitas domiciliares, na integridade tissular, no conhecimento sobre as atividades de autocuidado e na intenção de cuidar dos pés. Método: ensaio clínico paralelo, de mascaramento único e randomizado com taxa de alocação de 1:1, desenvolvido com pessoas com Diabetes tipo 2. O desfecho primário está relacionado a avaliação da integridade tissular e o secundário, ao conhecimento sobre as atividades de autocuidado e à intenção em realizar cuidados com os pés. Resultados: Participaram do estudo 72 pessoas, divididas em grupo controle e tratado. O grupo controle apresentou diferença significativa (p=<0,05) nos indicadores de pele e anexo, circulação, sensibilidade, conhecimento e intenção de cuidar dos pés. Conclusão: "Ensino do Cuidado com os Pés" é uma estratégia que pode influenciar os indicadores de comprometimento dos pés. nº 20376013.2.0000.5142

Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study.

BACKGROUND: Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. METHODS: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. RESULTS: Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. CONCLUSIONS: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.

[Immunogenetic factors associated with type 1 diabetes mellitus]. / Fatores imunogenéticos associados ao diabetes mellitus do tipo 1.

Type 1 diabetes mellitus has been considered an organ-specific autoimmune disease derived from the selective destruction of pancreatic beta cells. It presents a complex pathogenesis, involving the participation of several factors, including the immunogenetic susceptibility with strong association to histocompatibility genes (HLA), environmental events and autoimmune response with the presence of autoantibodies and/or autoreactive lymphocytes, culminating in metabolic abnormalities. In this study, the literature review describes mechanisms through which some factors cause susceptibility to its appearance and, additionally, prediction innovations regarding this disorder, which will certainly contribute to nursing care for patients with type 1 diabetes.

[Retrospective analysis of nursing records at a specialized unit]. / Análise retrospectiva dos registros de enfermagem em uma unidade especializada.

This is a retrospective longitudinal study conducted in a Specialized Unit in the interior of Brazil. It aimed at verifying differences in nursing records with regard to how to document the care provided to patients in three periods related to the implementation of the Nursing process. Data were collected from 20% of the records of patients aged over 15 years who were randomly selected according to proportional distribution. Such data were fully transcribed in an instrument constructed for this purpose and classified according to the proposals of the referential. The Binomial Test was used for analysis with a significance level of 0.05%. The results showed a tendency to improvement of the records as to writing intellection and complete description of the signs/symptoms in the second period. It was concluded that there was a difference between the initial and the pre-implementation periods, which expresses the need to review the way the Nursing Process must be developed as a responsibility of the whole nursing team.