Avaliação do autocuidado com os pés entre pacientes portadores de diabetes melito / Evaluation of self-care with feet among patients with diabetes mellitus

Resumo Contexto O pé diabético é uma complicação do diabetes melito (DM), sendo a maior causa de amputação dos membros inferiores. Objetivos Avaliar a prática de medidas de autocuidado com os pés, segundo sexo e escolaridade, em pacientes portadores de DM na região nordeste no estado da Bahia. Métodos Estudo quantitativo, observacional, analítico, transversal, realizado com 88 pacientes portadores de DM, em consulta de rotina, de fevereiro a março de 2020. A coleta de dados foi executada através da aplicação de questionários socioeconômico e do autocuidado com os pés (conhecimento sobre pé diabético, hábitos de cuidado/inspeção dos pés e procura pela Unidade de Saúde na presença de alterações com a saúde dos pés). Resultados Do total, 58% dos indivíduos desconhecia o termo "pé diabético", porém possuíam cuidados mínimos adequados com os pés, como inspecioná-los (60,2%), hidratá-los (65,9%), não andar descalço (81,8%) e cortar as unhas (92%), apesar de 90,9% não utilizar sapatos considerados adequados. Houve relação entre menor nível de escolaridade e pior desempenho nas questões referentes a andar descalço, hidratar os pés, cortar as unhas, usar calçados adequados e identificar micoses (p < 0,05), porém não houve associação da realização das medidas de autocuidado e sexo. Conclusão Os portadores de DM entrevistados não realizaram todas as medidas de autocuidado com os pés e desconheciam o termo "pé diabético". Houve associação entre menor escolaridade e menor capacidade de realização dessas medidas, o que sugere que o letramento em saúde seria importante para melhoria desse autocuidado, contribuindo para diminuição de complicações e amputações dos pés.

Abstract Background The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. Objectives To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. Methods This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). Results 58% of the sample did not know the term "diabetic foot", but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. Conclusions Interviewed patientswith DM did not perform all foot self-care activities and did not know what the term "diabetic foot" means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

Riesgo cardiovascular en la mujer diabética / Cardiovascular risk in the diabetic woman

Resumen Introducción: La enfermedad cardiovascular en mujeres ha sido un apartado con diversas investigaciones que han intentado llegar a los factores de riesgo más determinantes o las vías moleculares más específicas para explicar el riesgo aumentado que poseen las mujeres respecto a los hombres. Objetivo: Dar una visión global de esta situación al lector, involucrando especialmente aquella población de mujeres que padece diabetes mellitus tipo 2, cuya condición es un factor de riesgo independiente para el desarrollo de enfermedad cardiovascular, de gran costo y morbimortalidad mundiales. Métodos: Se realizó una búsqueda en PubMed y Google Scholar con términos MeSH y términos comunes y se obtuvieron algunas referencias cruzadas a criterio de los autores. Conclusiones: Es necesario implementar en la práctica médica diaria un contexto específico de prevención de riesgo cardiovascular mediante programas de educación continuada o por medio de las entidades prestadoras de servicios de salud para evitar la progresión de enfermedad cardiovascular en las mujeres diabéticas antes de llegar a desenlaces mayores y potencialmente fatales.

Abstract Introduction: Cardiovascular disease in woman has been an issue with plenty of investigations towards the finding of the most determinant risk factors o the specific molecular paths to explain the increased risk in women compared to men. Objective: To give to the reader a global vision of this situation, involving specially the type 2 diabetes mellitus woman population, whose condition is an independent risk factor to the development of the cardiovascular disease with great cost and morbidity and mortality worldwide. Methods: A PUBMED and Google Scholar search was performed with MeSH and common terms and were obtained some cross-references at the discretion of the authors. Conclusions: It is necessary to implement a specific context of cardiovascular risk prevention in daily medical practice through continuing education programs or through health service providers to prevent the progression of cardiovascular disease in diabetic women before reaching major outcomes and potentially fatal.

Asociación entre conocimientos y actitudes preventivas sobre complicaciones crónicas en diabéticos de un policlínico peruano / Association between knowledge and preventive attitudes about chronic complications in diabetics in a Peruvian polyclinic

Introducción: Hay escasos estudios realizados para valorar la asociación entre el nivel de conocimientos sobre la diabetes mellitus tipo 2 y las actitudes que tienen los pacientes para mejorar el control de su enfermedad. Objetivo: Determinar la asociación entre el nivel de conocimientos y las actitudes preventivas sobre las complicaciones crónicas en pacientes con diabetes mellitus tipo 2. Métodos: Estudio transversal analítico en pacientes con diabetes tipo 2 de Chiclayo, Perú. Se indagó la asociación entre actitudes preventivas y nivel de conocimientos, además se exploró asociación con edad, sexo, nivel de instrucción, instrucción diabetológica previa, antecedentes familiares, hospitalizaciones previas, tiempo de enfermedad. Resultados: De 150 pacientes, el 60 por ciento fueron mujeres. El 40,0 por ciento presentó un nivel de conocimientos intermedio y un 84,7 por ciento reportaron actitudes preventivas favorables. Se encontró que los pacientes con nivel de conocimiento adecuado tenían 43 por ciento mayor frecuencia de presentar actitudes preventivas favorables (razón de prevalencia = 1,43). Los pacientes que tenían entre 7 a 15 años de enfermedad resultaron asociados positivamente a tener actitudes preventivas favorables (razón de prevalencia = 1,32). Conclusiones: Los pacientes diabéticos con conocimientos adecuados sobre su enfermedad tienen actitudes preventivas favorables frente a su padecimiento y sus complicaciones crónicas. Adicionalmente, los pacientes diagnosticados entre 7 - 15 años atrás tienen mejores actitudes preventivas(AU)

Introduction: There are few studies carried out to assess the association between the level of knowledge about type 2 diabetes mellitus and the attitudes that patients have to improve the control of their disease. Objective: To determine the association between the level of knowledge and preventive attitudes about chronic complications in patients with type 2 diabetes mellitus. Methods: Analytical cross-sectional study in patients with type 2 diabetes in Chiclayo, Peru. The association between preventive attitudes and level of knowledge was investigated, as well as the association with age, sex, level of education, previous diabetic education, family history, previous hospitalizations, time of illness. Results: Of 150 patients, 60 percent were women. 40.0 percent presented an intermediate level of knowledge and 84.7 percent reported favorable preventive attitudes. It was found that patients with an adequate level of knowledge had a 43 percent higher frequency of presenting favorable preventive attitudes (Prevalence ratio = 1,43). Patients who had between 7 and 15 years of disease were positively associated with having favorable preventive attitudes (Prevalence ratio = 1,32). Conclusions: Diabetic patients with adequate knowledge about their disease have favorable preventive attitudes towards their condition and its chronic complications. In addition, patients diagnosed between 7 - 15 years ago have better preventive attitudes(AU)

Control glicémico perioperatorio / Perioperatory glycemic control

Diabetes is the most common endocrinopathy, in 2014, 8.6% of the population suffered from diabetes, and it was responsible for at least 3.7 million deaths per year. It is estimated that by that by 2050 more than 30% of the population will have this disease. In cardiovascular surgery, it is described that 5.2% of patients are undiagnosed diabetics and this rises to 10% -28% in non-cardiac surgeries. The adverse results are markedly high in those patients with poor glycemic control including an increase of more than 50% in mortality, as well as an increase in respiratory infections, surgical site infection, urinary infection, heart attack and acute kidney injury among others. During the preoperative period of patients with diabetes, it is important to review glycemic control and its current treatment, in addition to providing the patient instructions on how to adjust medications. Intraoperatively, any condition that leads to an uncontrolled increase in surgical stress must be controlled, since this in turn generates hyperglycemia. Knowledge of insulins, their pharmacology and schedules is essential to maintain blood glucose intraoperatively in normal ranges. Different practical algorithms are proposed for the correct and safe management of hyperglycemia in the perioperative period. All care should be continued in the postoperative period defining the continuity of the insulin therapies established and the postoperative care of the patient.

La diabetes es la endocrinopatía más común, en 2014, el 8,6% de la población padecía diabetes siendo responsable de 3,7 millones de muertes por año. Se estima que para el 2050 más del 30% de la población tendrá diabetes. En cirugía cardiovascular el 5,2% de los pacientes son diabéticos no diagnosticados, cifra que aumenta hasta 10%-28% en cirugías no cardíacas. Los resultados adversos son marcadamente elevados en aquellos pacientes con mal control incluyendo un aumento del 50% en la mortalidad, así mismo, incremento de infecciones respiratorias, infección del sitio quirúrgico, infección urinaria, infarto agudo de miocardio y lesión renal aguda, entre otros. Durante el preoperatorio de pacientes con diabetes, es importante revisar el control glucémico y su tratamiento, además de proporcionar al paciente instrucciones por escrito sobre cómo ajustarlo. En el intraoperatorio se debe controlar cualquier condición que lleve a un aumento del estrés quirúrgico pues este a su vez genera hiperglucemia. Es fundamental el conocimiento de las insulinas, su farmacología y esquemas para mantener glucemias en el intraoperatorio en rangos normales. Se proponen diferentes algoritmos prácticos para el correcto y seguro manejo de la hiperglucemia en el perioperatorio. La atención debe continuarse en el posoperatorio definiendo continuidad de terapias insulínicas instauradas y el adecuado cuidado del paciente.

Avaliação do risco de ulceração nos pés em pessoas com diabetes mellitus na atenção primária / Evaluación del riesgo de ulceración en piesdepersonas con diabetes mellitus en la atención primaria de salud / Risk evaluation of feet ulceration in people with diabetes mellitus in primary care

RESUMO Objetivo: avaliar o risco de ulceração nos pés de pessoas com diabetes mellitus atendidas na atenção primária. Método: estudo transversal analítico realizado em Teresina, Piauí, com 308 pacientes, sendo incluídos maiores de 18 anos diagnosticados com diabetes mellitus e excluídos aqueles com ulceração ativa e/ou neuropatia atribuída a outros agravos. Os dados foram coletados mediante formulário sociodemográfico, clínico e de classificação do risco de ulceração nos pés, no período de fevereiro a agosto de 2019. A análise ocorreu a partir de estatísticas descritiva e inferencial. Resultados: dos participantes, 56,5% tinham mais de 60 anos, 59,7% não realizavam o controle da glicemia, 56,2% não praticavam atividade física, 51,3% estavam com sobrepeso e 54,2% apresentaram grau de risco 1 para ulceração nos pés. A situação conjugal, ocupação e diabetes mellitus há mais de 10 anos, controle glicêmico inadequado, hipertensão arterial, dislipidemia e obesidade tiveram associação estatisticamente significativa com o risco de ulceração. Aqueles com pele seca, deformidades, reflexo do tornozelo e percepção de vibração no hálux alterados apresentaram mais probabilidade de ulceração nos pés. Constatou-se que o exame clínico dos pés e a sensibilidade preservada ao monofilamento foram fatores de proteção. Conclusão: observouse que os aspectos sociodemográficos e clínicos interferem na probabilidade de ulceração, sendo que a maioria apresentou risco baixo. Além disso, no exame clínico dos pés, as alterações na sensibilidade vibratória e no reflexo do tornozelo aumentaram a probabilidade de ulceração, destacando-se que a classificação do risco de ulceração é imprescindível na assistência às pessoas com diabetes mellitus.

RESUMEN Objetivo: evaluar el riesgo de ulceración del pie en personas con diabetes mellitus tratadas en atención primaria. Método: estudio analítico transversal realizado en Teresina, Piauí, con 308 pacientes, incluidos los mayores de 18 años diagnosticados de diabetes mellitus y excluidos aquéllos con ulceración activa y / o neuropatía atribuida a otras condiciones. Los datos se recogieronde febrero a agosto de 2019 por medio de un formulario sociodemográfico, clínico y de clasificación de riesgo para la ulceración en el pie. El análisis se realizó a través de estadística descriptiva e inferencial. Resultados: el 56,5% de los participantes tenía más de 60 años, el 59,7% no realizaba control glucémico, el 56,2% no practicaba actividad física, el 51,3% tenía sobrepeso y el 54,2% tenía un grado de riesgo 1 de ulceración del pie. La situación conjugal, ocupación, diabetes mellitus durante más de 10 años, el inadecuado control glucémico, la hipertensión arterial, la dislipidemia y la obesidad tuvieron una asociación estadísticamente significativa con el riesgo de ulceración. Aquéllos con piel seca, deformidades, reflejo del tendón de Aquiles alterado y percepción alterada de la vibración del hallux tenían más probabilidades de ulceración de pies. Se encontró que el examen clínico de los pies y la sensibilidad conservada al monofilamento eran factores protectores. Conclusión: se observó que los aspectos sociodemográficos y clínicos interfieren con la probabilidad de ulceración, siendo la mayoría de bajo riesgo. Además, en el examen clínico de los pies, los cambios en la sensibilidad vibratoria y en el reflejo del tendón de Aquiles aumentaron la probabilidad de ulceración, destacando que la clasificación del riesgo de ulceración es esencial en la atención de las personas con diabetes mellitus.

ABSTRACT Objective: to evaluate the risk of foot ulceration in people with diabetes mellitus treated in primary care. Method: this is a cross-sectional analytical study carried out in Teresina, Piauí, with 308 patients, including those over 18 years old diagnosed with diabetes mellitus and excluding those with active ulceration and/ or neuropathy attributed to other conditions. The data were collected using a sociodemographic, clinical, and risk classification form for the foot ulceration, from February to August 2019. The analysis was based on descriptive and inferential statistics. Results: in the study, 56.5% of the participants were over 60 years old, 59.7% did not perform glycemic control, 56.2% did not practice physical activity, 51.3% were overweight and 54.2% had a degree of risk 1 for foot ulceration. Marital status, occupation, and diabetes mellitus for more than 10 years, inadequate glycemic control, arterial hypertension, dyslipidemia, and obesity had a statistically significant association with the risk of ulceration. Those with dry skin, deformities, ankle reflexes, and altered perception of hallux vibration were more likely to have foot ulcers. We found that the clinical examination of the feet and the preserved sensitivity to the monofilament were protective factors. Conclusion: we observed that the sociodemographic and clinical aspects interfere with the probability of ulceration and most of them present a low risk. Also, in the clinical examination of the feet, changes in vibratory sensitivity and ankle reflex increased the likelihood of ulceration, noting that the classification of the risk of ulceration is essential in assisting people with diabetes mellitus.

Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network - VICTIM Register / Disparidades no Uso de Stents Farmacológicos para Pacientes Diabéticos com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Assistidos na Rede Pública versus Privada - Registro VICTIM

Abstract Background: Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives: To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods: This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results: A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions: The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

Resumo Fundamento: A angioplastia primária (AP) com colocação de stent, seja ele convencional ou farmacológico, representa a principal estratégia no tratamento do infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Os pacientes diabéticos, entretanto, representam população especial no IAMCSST, com altas taxas de reestenose e desfechos clínicos desfavoráveis, devendo-se indicar o uso de stents farmacológicos (SF), nível de evidência A e classe de indicação II, para redução destes danos. Objetivo: Avaliar a taxa de uso de SF em pacientes com IAMCSST e no subgrupo dos diabéticos assistidos na rede pública versus privada de saúde em Sergipe. Métodos: Trata-se de um estudo populacional, transversal, com abordagem quantitativa, que utilizou os dados do Registro VICTIM. Estes foram coletados nos quatro únicos hospitais com capacidade para realizar AP em Sergipe, no período de dezembro de 2014 a março de 2017. Em todas as hipóteses testadas, o nível de significância adotado foi de 5% (p < 0,05). Resultados: Foram avaliados 707 pacientes diagnosticados com IAMCSST, dos quais 589 foram atendidos pelo SUS e 118 pela rede privada. O uso de SF na AP foi menor no SUS em comparação com a rede privada, tanto no total da amostra (10,5% vs 82,4%; p < 0,001) quanto no subgrupo dos pacientes diabéticos (8,7% vs 90,6%; p < 0,001), respectivamente. Conclusões: O estudo revela disparidade no uso de SF durante a realização de AP entre a rede pública e privada, tanto na amostra total quanto no subgrupo dos diabéticos, com menores taxas para usuários do SUS, demonstrando os desafios que necessitam ser vencidos para se atingir melhorias na qualidade dos serviços prestados.

Variables psicológicas asociadas a adherencia, cronicidad y complicaciones en pacientes con diabetes mellitus tipo 2 / Psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus

Background:: Lack of adherence to treatment may hamper the management of type 2 Diabetes Mellitus. Aim To identify if there is a profile of psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus. Material and Methods: The psychometric instruments Multidimensional Scale of Locus of Control in Health, Locus of Control of Rotter and Inventory of Temporary Orientation of Zimbardo & Boyd were applied to 192 patients aged 64 ± 10 years (78% women) with type 2 diabetes attending public primary health clinics. Adherence to treatment was assessed using glycosylated hemoglobin levels. Results: There was an inverse association between glycosylated hemoglobin and adherence to treatment (p < 0.01). Adherence in patients with renal damage and diabetic foot was associated with the psychological variables Negative Time Perspective Profile (p < 0.05) and External Locus of Control Powerful Other (p < 0.05). Conclusions: A psychological profile associated with adherence was observed in the presence of kidney damage and diabetic foot. A fatalistic present and a negative past are the outstanding features of a negative temporal profile.

Health education to prevent chronic diabetes mellitus complications in primary care / Educación en salud para la prevención de las complicaciones crónicas de diabetes mellitus en la atención primaria / Educação em saúde para prevenção das complicações crônicas do diabetes mellitus na atenção primária

ABSTRACT Objective: Understand how Family Health Strategy members organize themselves for health education, on the management and prevention of chronic complications of diabetes mellitus in primary health care. Method: Qualitative study that used complex thought as the theoretical framework and evaluative research as the methodological framework. Thirty-eight healthcare professionals took part in the study. Data was gathered using the following techniques: interview, observation, and analysis of medical records. The data analysis, which was supported by triangulation, used ATLAS.ti software. Results: Shortcomings in health education were identified, such as insufficient infrastructure, poor interpersonal relationships among health professionals, and lack of planning for carrying out this activity. However, there is room for potential improvement in this situation. Conclusion: Health education for people with diabetes mellitus in primary health care is set within a multifaceted context, with multiple barriers to its implementation.

RESUMEN Objetivo: Comprender cómo los participantes del Programa Estrategia Salud de la Familia se organizan en relación con la educación en salud, en la gestión y prevención de las complicaciones crónicas de la diabetes mellitus en la Atención Primaria a la Salud. Método: Estudio cualitativo que utilizó Pensamiento Complejo como marco teórico y investigación evaluativa como marco metodológico. Participaron 38 profesionales de salud. Los datos se obtuvieran mediante: entrevista; observación; análisis de los registros médicos. El análisis de datos se apoyó en la triangulación, con el software ATLAS.ti. Resultados: Se identificaron debilidades relativas a la educación en salud, como falta de estructura física, relaciones interpersonales entre profesionales y ausencia de una planificación para ejecutar esta actividad. Sin embargo, hay espacio para una mejora potencial de esta situación. Conclusión: La práctica de la educación para la salud de personas con diabetes en Atención Primaria constituye un contexto de múltiples facetasy obstáculos.

RESUMO Objetivo: Compreender como os integrantes da Estratégia Saúde da Família se auto-organizam para a educação em saúde, no manejo e prevenção das complicações crônicas do diabetes mellitus na Atenção Primária à Saúde. Método: Estudo qualitativo, que utilizou o Pensamento Complexo como referencial teórico e a pesquisa avaliativa como referencial metodológico. Participaram da pesquisa 38 profissionais de saúde. Para a coleta de dados utilizou-se: entrevista, observação e análise de prontuários. A triangulação subsidiou a análise dos dados e empregou-se o software ATLAS.ti. Resultados: Foram identificadas fragilidades na realização da educação em saúde referentes à estrutura física, nos relacionamentos interpessoais entre os profissionais e ausência de planejamento para implementação dessa atividade. Entretanto, apontaram espaços considerados potenciais para a melhoria dessa realidade. Conclusão: Considera-se que a prática da educação em saúde para as pessoas com diabetes mellitus na Atenção Primária à Saúde compõe um contexto multifacetado, com múltiplas barreiras para sua execução.

Prevention of chronic complications of diabetes mellitus according to complexity / Prevención de las complicaciones crónicas de la diabetes mellitus a la luz de la complejidad / Prevenção das complicações crônicas do diabetes mellitus à luz da complexidade

ABSTRACT Objective: To assess the prevention by primary health care providers of chronic complications of diabetes mellitus according to the complex thinking theoretical approach. Method: Evaluative research based on the complex thinking theoretical approach. The following techniques for data collection were used: interviews with 38 participants; observation in collective and individual appointments; and analysis of medical records of people with diabetes. The triangulation applied for data analysis was the ATLAS.ti software. Results: The prevention and management of chronic complications of diabetes did not meet the requirements set forth by ministerial public policies aimed at this population. Systematic monitoring to prevention of chronic complications showed significant gaps. Final considerations: Primary health care did not consider preventive actions for diabetes mellitus complications. This context was marked by disjunctive, fragmented, and dissociated practices types of care targeted to the totality of the assisted people.

RESUMEN Objetivo: Evaluar la prevención de complicaciones crónicas en diabetes mellitus a la luz del referencial teórico del Pensamiento Complejo en actuantes de atención primaria de salud. Método: Investigación evaluativa con Pensamiento Complejo como referencial teórico. Datos recolectados mediante entrevista con 38 participantes; observación de atenciones colectivas e individuales; y análisis de 25 historias clínicas de personas con diabetes. La triangulación facilitó el análisis de datos, realizado con software ATLAS.ti. Resultados: La prevención y el manejo de las complicaciones crónicas de la diabetes no atendían lo establecido en las políticas públicas ministeriales dirigidas a tal público. El seguimiento sistematizado para control de prevención de complicaciones crónicas mostró importantes fallas. Consideraciones finales: La asistencia en atención primaria no contemplaba acciones de prevención de complicaciones de la diabetes mellitus. El contexto estaba cargado de prácticas disyuntivas, fragmentadas y disociadas de una atención que apunta a la totalidad de las personas atendidas.

RESUMO Objetivo: Avaliar a prevenção de complicações crônicas do diabetes mellitus a luz do referencial teórico do Pensamento Complexo por integrantes da atenção primária à saúde. Método: Pesquisa avaliativa, que teve como referencial teórico o Pensamento Complexo. Como técnicas de coleta de dados foram utilizadas: entrevista com 38 participantes; observação nos atendimentos coletivos e individuais;e análise em 25 prontuários de pessoas com diabetes. A triangulação subsidiou a análise de dados que teve auxílio do software ATLAS.ti. Resultados: A prevenção e o manejo das complicações crônicas do diabetes não atendiam ao estabelecido nas políticas públicas ministeriais destinadas a esse público. O acompanhamento sistematizado para controle da prevenção das complicações crônicas apresentou importantes lacunas. Considerações finais: A assistência na atenção primária não contemplava ações de prevenção de complicação do diabetes mellitus. Esse contexto era por marcado por práticas disjuntivas, fragmentadas e dissociadas de uma assistência que visa a totalidade das pessoas assistidas.

Influencia de la Diabetes mellitus en la salud bucal del adulto mayor / Influence of the Diabetes mellitus in the buccal health care

Introducción: Debido al rápido crecimiento del grupo de adultos mayores y diabéticos en la población cubana, es posible predecir que los requerimientos en la atención odontológica serán mayores en los próximos años, por lo que la prevención y atención en Odontogeriatria se considera una necesidad del presente y futuro inmediatos. Objetivo: Determinar la influencia de la Diabetes mellitus en el estado de salud bucal del adulto mayor. Material y Métodos: Se realizó un estudio descriptivo de corte transversal en la clínica estomatológica del policlínico universitario Dr. Mario Muñoz Monroy del Wajay, en el período de 2015 a 2016. La muestra fue de 634 adultos mayores de los tres consultorios seleccionados por un sistema de conglomerado monoetápico. Se realizó examen bucal y se completó un formulario para la recolección de la información. Las variables estudiadas fueron:Diabetes mellitus, edad, sexo, factores de riesgos y enfermedades bucales. Resultados: En la población diabética, predominó el grupo de 60-74 años y sexo femenino; los factores de riesgo que prevalecieron fueron las prótesis desajustadas (60 por ciento), la xerostomía (58 por ciento) (p=0,001) y el hábito de fumar (32 por ciento); las enfemedades más frecuentes, la periodontal (58,3 por ciento), las úlceras traumáticas (13,3 por ciento) y la queilitis angular (7.9 por ciento); solo existió significación en las dos últimas. Conclusiones: En la población diabética prevaleció el grupo de 60 a 74 años y sexo femenino. Las prótesis desajustadas fue el factor de riesgo más representado; seguido por la xerostomía, el hábito de fumar y la enfermedad periodontal y las úlceras traumáticas las enfermedades bucales que predominaron(AU)

Introduction: Due to the fast growth of the group of elderly and diabetics in the Cuban population, it is possible to predict that the requirements in the odontology attention will be greater in the next years. For that reason the prevention and attention in the Odontogeriatry is considered a necessity of the present and future Immediate. Objective: To determine the influence of the Diabetes mellitus in the state of the buccal health care of the senior citizens in the dentistry clinic in Wajay through 2015 to 2016. Material and Methods: A cross-sectional descriptive study was carried out in the stomatology clinic of the Polyclinic Dr. Mario Muñoz Monroy in the period from 2015 to 2016. The sample was 634 older adults from the three clinics selected by a single-stage conglomerate system. A mouth exam was performed and a form for collecting the information was completed. The variables studied were: Diabetes mellitus, age, sex, risk factors and oral diseases. Results: In the diabetic population, the group of 60-74 years and female gender predominated. The risk factors that prevailed were maladaptive prostheses (60 percent), xerostomia (58 percent) (p = 0.001) and smoking (32 percent); Periodontal disease (58.3 percent), traumatic ulcers (13.3 percent) and angular cheilitis (7.9 percent); There was only meaning in the last two. Conclusions: In the population studied prevailed the group of 60 to 74 years and female sex. The maladaptive prostheses were the most represented risk factor; Followed by xerostomia, smoking and periodontal disease and traumatic ulcers predominant oral diseases(AU)

Elaboração e desenvolvimento de aplicativo móvel para autocuidado e automonitoramento do pé diabético / Development of a mobile application for self-care and self-monitoring of diabetic foot

Diabetes mellitus é uma síndrome crônica complexa, que exige assistência contínua e uso de estratégias que visem à redução de suas complicações. É reconhecido como um severo problema de saúde pública e configura-se como uma epidemia em todo o mundo. Embora existam sérias complicações decorrentes da doença as que acometem os pés representam a maior parte. Nesse contexto o pé diabético representa um problema de saúde pública relevante já que 40 a 70% de todas as amputações de extremidades inferiores estão relacionadas a essa doença. Acrescido a esses números alarmantes é reconhecido que ainda é insignificante o número de pacientes que recebe regularmente cuidados em seus pés por profissionais de saúde, além de ser baixa a adesão às atividades de autocuidado por esses pacientes, indicando tais fatos como possíveis fatores responsáveis pelo grande número de complicações e mortes. Dessa forma é de suma importância o desenvolvimento e a implementação de estratégias que aprimorem o manejo do pé diabético, buscando sua prevenção e a promoção do autocuidado, já que este é responsável por 95% do sucesso do tratamento das doenças crônicas. Desse modo frente à presença do diabetes, do potencial de risco para o desenvolvimento do pé diabético e do fato deste ser uma complicação incapacitante, porém prevenível, e ainda, entendendo a importância e necessidade de um olhar mais atento aos pés e como as ferramentas computacionais podem oportunizar um melhor cuidado em saúde, auxiliando o autocuidado, acreditamos que o desenvolvimento de um aplicativo para dispositivos móveis seja uma estratégia para auxiliar na prevenção e promoção à saúde das pessoas com diabetes. Para tal o presente estudo descritivo e de desenvolvimento experimental, teve como objetivo a elaboração do aplicativo móvel “Pé Diabético” visando oferecer subsídios as pessoas com diabetes para o autocuidado e automonitoramento de seus pés. Assim, o estudo foi conduzido em 3 etapas: revisão sistemática ...

Diabetes mellitus is a complex chronic syndrome that requires a lot of time and strategy use aimed at reducing its complications. It is recognized as a public health problem and is set up as an epidemic around the world. Although there are serious for a majority of parties. In this context, diabetic foot represents a relevant public health problem since 40 to 70% of all lower extremity amputations are related to this disease. In addition to these alarming and recognized numbers, the number of patients receiving health care at their feet by health professionals is still insignificant, as well as being low adherence to self-care activities by these patients, indicating such facts as please number complications and deaths. Thus, it is of paramount importance to develop and implement strategies that improve the management of diabetic foot, seeking its prevention and a promotion of self-care, since it is responsible for 95% of the success of the treatment of chronic diseases. Thus, in the presence of diabetes, the potential risk for the development of diabetic foot and the fact that this is a disabling but preventable complication, and also understanding the importance and necessity of a closer look at the feet and how the tools The best health care, helping self care, we believe in all the development of a mobile application is a strategy to assist in prevention and health in people with diabetes. For the present descriptive study and experimental development, the objective was the elaboration of the mobile application "Diabetic Foot" aiming to offer subsidies such as people with diabetes for self-care and self-monitoring of their feet. Thus, the study was conducted in three stages: systematic review of the literature, elaboration of the prototype and pre-test. A systematic review was developed according to Cochrane methodology, and the prototype was constructed using a software programming methodology Extreme Programming, JavaScript language ...

association between fruits and vegetables intake and prevention of diabetes complications in patients with type2 diabetes

Background and Objectives: Because few studies about lie effects of fruit and vegetable consumption in the reduction of diabetic complications. The aim of this investigation was to determine the association between diabetes complications and fruits and vegetables intake in patients with type 2 diabetes

Methods and Materials: In this case-control study, 150 diabetic patients with complications during a visit to the health centers of malekan with 150 diabetic patients without complications after matched for age, sex and duration of diabetes, were selected. Diabetic patients with a histoiy of smoking, hypertension, heart disease, and kidney were excluded and data were collected with interview and refer to die medical records by food frequency questionnaires [FFQ]

Results: Average intake of fruit and vegetables in the patients case group was 1.28 and 1.82 serve per day and in control group respectively, 2.8 and 2.7 serve per day was reported. So that intake less than two serves per day of fruit and vegetables were associated with increased risk of developing complications. [Fruits OR:2.23 ,%95 CI: 1.59-3.1, P=0.001, and vegetables OR: 1.71 ,%95 CI: 1.2-2.4, P=0.002]

Conclusions: Our findings indicate that less than 2 servings of fruit and vegetables daily intake can increase the possible risk of diabetes complications

Assessment of quality of life in type II diabetic patients using the modified diabetes quality of life (MDQoL)-17 questionnaire

ABSTRACT Diabetic complications, comorbidities, and cost of treatment affect the quality of life (QoL) of an individual. The QoL assessment is considered an important measure of outcome in chronic disease management. The objective of our study was to assess the quality of life in Type II diabetes mellitus patients with and without complications using the modified diabetes quality of life (MDQoL)-17. A prospective descriptive study was conducted over 6 months, after taking ethical committee approval. As per the inclusion criteria from medicine wards of tertiary care hospital, 250 patients were selected. Demographic characteristics were documented in the data collection form and the patients were administered with the MDQoL questionnaire in different languages. The data was analyzed using IBM SPSS version 20. Majority of the patients were male (64.4%). The average age of the study population was 60.34±12.04 years. Most of the patients had a diabetes history of more than 10 years and HbA1c > 8%. The average QoL score was 65.47±15.07. Majority of the diabetic patients had the QoL score between 70 and 50. Patients without complication had a better QoL. As the number of complications increased, there was a decrease in the QoL. The presence of comorbidity also decreased the QoL. There was a statistically significant correlation with various parameters such as age, duration of diabetes history, HbA1c, number of complications and type of complication verses QoL of diabetic patients (p<0.05). The overall QoL in diabetic patients is reduced. Thus, proper management and strict glycemic control is necessary to prevent progression and occurrence of complications to maintain a better QoL in diabetes patients.

Green banana pasta diet prevents oxidative damage in liver and kidney and improves biochemical parameters in type 1 diabetic rats

ABSTRACT Objective In this study, the effects of a green banana pasta diet on the oxidative damage from type 1 diabetes mellitus (DM) were investigated. Materials and methods Formulations containing 25 (F25), 50 (F50), and 75% (F75) of green banana pasta were prepared and included in a 12-week diet of Wistar rats with alloxan-induced type 1 DM. The effects of these formulations in preventing oxidative damage in kidneys and liver homogenates of rats were evaluated using the TBARS assay (lipid peroxidation in liver) and the DNPH assay (protein oxidation in liver and kidneys). Furthermore, the effects of the formulations on the fasting glycemia, fructosamine levels, renal function (creatinine), liver function (enzymes aspartate aminotransferase [AST] and alanine aminotransferase [ALT]), and lipid profile (total cholesterol and fractions) in the serum of rats were evaluated in addition to the evaluation of the centesimal composition and microbiological analysis of the produced green banana pasta. Results An F75 diet prevented hyperglycemia in diabetic rats (p < 0.05) compared to the diabetic rats fed a standard diet (commercial feed). Notably, the protein oxidation in both the liver and kidneys were prevented in diabetic rats on the F50 or F75 diets compared to the control group, whereas the lipid peroxidation was only prevented in the liver (p < 0.05). Moreover, all formulations prevented an increase in the amount of triglycerides in the serum of the rats. The F25 and F50 diet prevented the increase of cholesterol, and the F75-based diet of ALT and fructosamine (p < 0.05) supported the anti-hyperglycemic effects and the protection against oxidative damage. Conclusion The green banana pasta (F75) diet showed great potential for preventing complications associated with diabetes.

Impacto de intervenções educativas na redução das complicações diabéticas: revisão sistemática / Impacto de intervenciones educativas en la reducción de las complicaciones diabéticas: revisión sistemática / Impact of educational interventions in reducing diabetic complications: a systematic review

RESUMO Objetivo: identificar na literatura evidências da efetividade e eficácia de intervenções educativas na redução de complicações metabólicas e/ou vasculares em adultos com diabetes mellitus. Método: revisão sistemática realizada nas bases de dados LILACS, IBECS, CUMED, CINAHL e Medline e na biblioteca on-line SciELO com estudos de 2004 a 2014. Resultados: incluídos 11 estudos (5 ensaios clínicos randomizados e 6 quase experimentais). Apenas pesquisas que analisaram complicações vasculares foram identificadas. Conclusão: dois ensaios clínicos mostraram eficácia na redução de complicações cardiovasculares, da catarata ou retinopatia e nefropatia e todos os estudos quase experimentais revelaram efetividade na redução das úlceras nos pés, da vasculopatia e da neuropatia periféricas e manutenção da função renal.

RESUMEN Objetivo: identificar en la literatura evidencias de la efectividad y eficacia de intervenciones educativas en la reducción de complicaciones metabólicas y/o vasculares en adultos con diabetes mellitus. Método: revisión sistemática realizada en las bases de datos LILACS, IBECS, CUMED, CINAHL y Medline, y en la biblioteca online SciELO, consultado estudios de entre 2004 y 2014. Resultados: fueron incluidos 11 estudios (5 ensayos clínicos randomizados y 6 cuasiexperimentales). Solamente fueron identificadas investigaciones que analizaron complicaciones vasculares. Conclusión: dos ensayos clínicos mostraron eficacia en la reducción de complicaciones vasculares, de la catarata o retinopatía y de la nefropatía; y todos los estudios cuasiexperimentales revelaron efectividad en la reducción de las úlceras de pie, la vasculopatía y la neuropatía periféricas, y en el mantenimiento de la función renal.

ABSTRACT Objective: To identify in the literature evidence of the effectiveness and efficacy of educational interventions in reducing metabolic and/or vascular complications in adults with diabetes mellitus. Method: A systematic review performed in LILACS, IBECS, CUMED, CINAHL and Medline databases and in the online library SciELO with studies published from 2004 to 2014. Results: Eleven studies were included (5 randomized clinical trials and 6 quasi-experimental). We only identified studies that analyzed vascular complications. Conclusion: Two clinical trials demonstrated efficacy in reducing cardiovascular complications, of cataract or retinopathy and nephropathy and all the quasi-experimental studies showed effectiveness in reducing feet ulcers, peripheral neuropathy and vasculopathy, and maintenance of kidney function.

Hepatitis B vaccination coverage in patients with diabetes mellitus / Cobertura vacunal contra hepatitis B en pacientes con diabetes mellitus / Cobertura vacinal contra hepatite B em pacientes com diabetes mellitus

Abstract OBJECTIVE Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus. METHOD Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis. RESULTS Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89). CONCLUSION Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage.

Resumen OBJETIVO Analizar los factores asociados con la vacunación completa contra hepatitis B (3 dosis) en pacientes con diabetes mellitus. MÉTODO Estudios transversal, llevado a cabo en una Unidad de Salud de una ciudad del interior paulista, con 255 pacientes en seguimiento ambulatorio, en 2014. Los datos fueron obtenidos en el sistema informatizado de la Secretaría Municipal de Salud y mediante un cuestionario estructurado y, para el análisis, un modelo de regresión logística. RESULTADOS Vacunación completa contra hepatitis B fue observada en el 13,7% de los pacientes y se mostró directamente asociada con el nivel de escolaridad (OR=1,30; IC: 1,07-1,57) y con el trabajo actual o anterior como profesional sanitario (OR=3,21; IC: 1,16-8,89). CONCLUSIÓN La cobertura vacunal contra hepatitis B se mostró baja en pacientes con diabetes mellitus, evidenciándose la vulnerabilidad a esa enfermedad severa y potencialmente fatal. Mayor escolaridad y el trabajo en el área sanitaria estuvieron asociados con la mejor cobertura vacunal.

Resumo OBJETIVO Analisar os fatores associados à vacinação completa contra hepatite B (3 doses) em pacientes com diabetes mellitus. MÉTODO Estudo transversal, realizado em uma Unidade de Saúde, de uma cidade do interior paulista, com 255 pacientes em seguimento ambulatorial, em 2014. Os dados foram obtidos no sistema informatizado da Secretaria Municipal de Saúde e por meio de um questionário estruturado e, para análise, modelo de regressão logística. RESULTADOS Vacinação completa contra hepatite B foi observada em 13,7% dos pacientes e mostrou-se diretamente associada ao nível de escolaridade (OR=1,30; IC: 1,07-1,57) e ao trabalho atual ou pregresso como profissional da saúde (OR=3,21; IC: 1,16-8,89). CONCLUSÃO A cobertura vacinal contra hepatite B mostrou-se baixa em pacientes com diabetes mellitus, evidenciando a vulnerabilidade a essa doença grave e potencialmente fatal. Maior escolaridade e o trabalho na área da saúde foram associados a melhor cobertura vacinal.

Effects of ursolic acid on glucose metabolism, the polyol pathway and dyslipidemia in non-obese type 2 diabetic mice.

Ursolic acid (UA) is a pentacyclic triterpenoid compound that naturally occurs in fruits, leaves and flowers of medicinal herbs. This study investigated the dose-response efficacy of UA (0.01 and 0.05%) on glucose metabolism, the polyol pathway and dyslipidemia in streptozotocin/nicotinamide-induced diabetic mice. Supplement with both UA doses reduced fasting blood glucose and plasma triglyceride levels in non-obese type 2 diabetic mice. High-dose UA significantly lowered plasma free fatty acid, total cholesterol and VLDL-cholesterol levels compared with the diabetic control mice, while LDL-cholesterol levels were reduced with both doses. UA supplement effectively decreased hepatic glucose-6-phosphatase activity and increased glucokinase activity, the glucokinase/glucose-6-phosphatase ratio, GLUT2 mRNA levels and glycogen content compared with the diabetic control mice. UA supplement attenuated hyperglycemia-induced renal hypertrophy and histological changes. Renal aldose reductase activity was higher, whereas sorbitol dehydrogenase activity was lower in the diabetic control group than in the non-diabetic group. However, UA supplement reversed the biochemical changes in polyol pathway to normal values. These results demonstrated that low-dose UA had preventive potency for diabetic renal complications, which could be mediated by changes in hepatic glucose metabolism and the renal polyol pathway. High-dose UA was more effective anti-dyslipidemia therapy in non-obese type 2 diabetic mice.