Perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19: resultados da DIABETES / Profile of people with diabetes who used telepharmacy during the covid-19 pandemic: results from DIABETES / Perfil de personas con diabetes que usaron telefarmacia durante la pandemia de covid-19: resultados de DIABETES

O objetivo foi analisar o perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19. Trata-se de um estudo transversal com dados oriundos da websurvey DIABETESvid que ocorreu nos meses de setembro e outubro de 2020. Verificou-se que 45 participantes recorreram à telefarmácia, sendo que 55,6% eram do sexo masculino, 42,2% tinham idade compreendida entre 18 e 34 anos e 46,7% estudaram 12 ou mais anos. Além disso, 48,9% autorreferiram diabetes mellitus tipo 1. A maioria usava insulina (55,6%) e obteve os medicamentos para o diabetes em farmácias do sistema público de saúde (60%). Ademais, as pessoas que tiveram o diagnóstico de covid-19 buscaram mais pela telefarmácia (RP=2,20; IC95% 1,23­3,94). Sabe-se que os medicamentos são essenciais para o tratamento do diabetes. Logo, no período estudado em que se preconizava o distanciamento físico, os participantes apropriaram-se da telefarmácia a fim de obter a integralidade do cuidado

The objective was to analyze the profile of people with diabetes who used telepharmacy during the covid-19 pandemic. This is a cross-sectional study with data from the DIABETESvid websurvey that took place in September and October 2020. It was found that 45 participants used telepharmacy, 55.6% of whom were male, 42.2% were between 18 and 34 years-old and 46.7% studied 12 or more years. In addition, 48.9% self-reported type 1 diabetes mellitus. Most used insulin (55.6%) and obtained their diabetes medication from pharmacies in the public health system (60%). Also, people diagnosed with covid-19 used telephar-macy more often (PR=2.20; 95%CI 1.23­3.94). It is known that drugs are essential for the treatment of diabetes. Therefore, in the period studied in which physical distancing was advocated, the participants used telepharmacy to obtain comprehensive care

El objetivo fue analizar el perfil de las personas con diabetes que utilizaron la telefarmacia durante la pandemia del covid-19. Estudio transversal con datos de la encuesta por internet DIABETESvid realizada en septiembre y octubre de 2020. Se encontró que 45 participantes recurrieron a la telefarmacia, de los cuales el 55,6% eran hombres, el 42,2% tenían entre 18 y 34 años y el 46,7% estudiaban 12 o más años. Además, el 48,9% se autorrefirió diabetes mellitus tipo 1. La mayoría utilizaba insulina (55,6%) y recibía su medicación antidiabética en farmacias del sistema público (60%). Además, las personas diagnosticadas con covid-19 buscaron telefarmacia con más frecuencia (RP = 2,20; IC 95% 1,23­3,94). Los medicamentos son esenciales para el tratamiento de la diabetes. Por lo tanto, en el período estudiado en el que se propugnaba el distanciamiento físico, los participantes se apropiaron de la telefarmacia para la atención integral

Self-Care and Resilience in People with Diabetes Mellitus in the COVID-19 Pandemic / Autocuidado e Resiliência em Pessoas com Diabetes Mellitus na Pandemia da COVID-19 / Autocuidado y Resiliencia en Personas con Diabetes Mellitus en la Pandemia del COVID-19

Abstract Isolation and social distancing imposed adjustments in the lifestyle of people with diabetes mellitus (DM), who are more likely to develop more severe forms of COVID-19. This study aimed to analyze the relationship between self-care and resilience in people with DM during the COVID-19 pandemic. This is an observational-cross-sectional web survey with 1,475 Brazilian adults with DM. An instrument of sociodemographic and clinical variables and the DSC and CD-RISC 10 scales were used from March to October 2020. An increase in average resilience was observed with increasing age and that it was higher among proper self-care behaviors. The highest averages of resilience were found for men, with T2DM, under oral medication, no change in DM control during the pandemic, those who had telemedicine consultations, and were isolated. The development of resilience is suggested as a protective factor in clinical practice in DM.

Resumo O isolamento e o distanciamento social impuseram ajustes no estilo de vida de pessoas com diabetes mellitus (DM), que têm maiores chances de desenvolverem formas mais graves de COVID-19. Este estudo teve por objetivo analisar a relação entre autocuidado e resiliência em pessoas com Diabetes Mellitus (DM) durante a pandemia da COVID-19. Realizou-se um websurvey observacional-transversal com 1.475 brasileiros adultos com DM. Utilizou-se um instrumento de variáveis sociodemográficas e clínicas e as escalas QAD e CD-RISC 10 entre março-outubro de 2020. Observou-se aumento na média de resiliência com o aumento da idade e que ela foi maior entre os comportamentos de autocuidado realizados de forma adequada. As maiores médias de resiliência foram para homens, com DM2, medicação via oral, sem mudança no controle do DM durante a pandemia, que tiveram contato com profissional de saúde por telemedicina e que ficaram isolados. Sugere-se o desenvolvimento da resiliência como fator de proteção na prática clínica em DM.

Resumen El aislamiento y distanciamiento social han definido el estilo de vida de las personas con diabetes mellitus (DM), quienes tienen más probabilidades de desarrollar una forma más grave de COVID-19. Este estudio tuvo como objetivo analizar la relación entre el autocuidado y la resiliencia en personas con Diabetes Mellitus (DM) durante la pandemia de COVID-19. Encuesta web observacional-transversal con 1475 adultos brasileños con DM. Se utilizó un instrumento de variables sociodemográficas-clínicas y las escalas QAD, CD-RISC 10 entre marzo-octubre 2020. Hubo un aumento de la resiliencia media con el aumento de la edad y que fue mayor entre las conductas de autocuidado adecuada. Los promedios de resiliencia más altos fueron, con DM2, medicación oral, sin control de DM durante una pandemia, tuvieron contacto con un profesional de salud a través de telemedicina y fueron aislados. El desarrollo de la resiliencia se sugiere como factor protector en la práctica clínica en DM.

Onde os brasileiros obtiveram os medicamentos para o diabetes na pandemia de COVID-19? Resultados da DIABETESvid / Where did Brazilians get their diabetes drugs during the COVID-19 pandemic? DIABETESvid results

O acesso aos medicamentos para o diabetes é fundamental para o controle da doença. Contudo, o distanciamento social na pandemia de COVID-19 pode ter limitado a provisão de medicamentos e insumos. Assim, o objetivo deste estudo foi analisar as fontes de obtenção dos medicamentos para o diabetes na pandemia de COVID-19 no Brasil. Os dados são oriundos da pesquisa DIABETESvid e nesta análise considerou-se a amostra de conveniência de 1608 participantes que responderam ao questionário divulgado em mídias sociais de sociedades científicas relacionadas ao diabetes. Trata-se de um estudo transversal, conduzido na forma de websurvey, no período de 1 de setembro a 19 de outubro de 2020. O desfecho analisado foi as fontes de obtenção dos medicamentos para o diabetes categorizadas em farmácias do Sistema Único de Saúde, farmácias do programa "Aqui Tem Farmácia Popular", bem como, farmácias e drogarias privadas e outras fontes. A maioria dos participantes autorreferiu diagnóstico de diabetes mellitus tipo 1 (49,8%), usava insulina (61,9%) e possuía plano privado de saúde (68,7%). As farmácias e drogarias privadas e outras fontes foram os principais locais de provisão dos medicamentos para o diabetes (47,5%). Os participantes que residiam na região Centro-Oeste do país apresentaram menor frequência de provisão em farmácias do programa "Aqui tem Farmácia Popular" (0,57; IC95% 0,36-0,92). Verificou-se, na amostra estudada, maior frequência de provisão dos medicamentos para o diabetes em farmácias e drogarias privadas e outras fontes com redução na frequência em farmácias públicas na pandemia de COVID-19 no Brasil.

Access to diabetes medications is critical to disease control. However, social distancing in the COVID-19 pandemic may have limited the provision of medicines and supplies. Thus, the objective of this study was to analyze the sources of obtaining diabetes drugs in the COVID-19 pandemic in Brazil. The data came from the DIABETESvid survey, and this analysis considered a convenience sample of 1608 participants who responded to the questionnaire published on social media of scientific societies related to diabetes. This is a cross-sectional study, conducted in the form of a web survey, from September 1 to October 19, 2020. The outcome analyzed was the sources for obtaining diabetes drugs categorized in pharmacies of the "Sistema Único de Saúde", pharmacies of the "Aqui tem Farmácia Popular" program, as well as private pharmacies and drugstores and other sources. Most participants self-reported a diagnosis of type 1 diabetes mellitus (49.8%), used insulin (61.9%), and had a private health plan (68.7%). Private pharmacies and drugstores and other sources were the main places where medicines for diabetes were supplied (47.5%). Participants residing in the Midwest region of the country had a lower frequency of supply in pharmacies in the "Aqui tem Farmácia Popular" program (0.57; 95%CI 0.36-0.92). In the studied sample, there was a higher frequency of supply of diabetes drugs in private pharmacies and drugstores and other sources with a reduction in frequency in public pharmacies during the COVID-19 pandemic in Brazil.

Resiliência e autocuidado em diabetes na pandemia de COVID-19 no Brasil / Resilience and self care in the COVID-19 pandemic in Brazil

As pessoas com diabetes mellitus, que convivem com uma doença crônica não transmissível, têm maiores chances de serem atingidas fatalmente pela COVID-19, necessitando de maior atenção nesse período pandêmico. O isolamento e distanciamento social, impuseram ajustes no estilo de vida e nos comportamentos de autocuidado para o enfrentamento e o seu sucesso está intimamente ligado aos níveis de resiliência. Este estudo buscou analisar a resiliência e autocuidado de brasileiros com diabetes mellitus na pandemia por COVID-19. Realizou-se uma web survey exploratória no Brasil, denominada DIABETESvid de setembro a outubro de 2020, período em que as restrições sociais estavam sendo flexibilizadas em algumas regiões do Brasil, sem previsão de disponibilidade de vacinas para toda a população brasileira. Participaram do estudo 1475 adultos que responderam o questionário completo por meio de um link, residentes no Brasil com o diagnóstico de DM. O questionário foi elaborado por especialistas com as variáveis sociodemograficas, clínicas, resiliência avaliada pelo CD-RISC 10 e autocuidado pelo QAD. O estudo foi aprovado pelo comitê de ética em pesquisa. Os dados foram coletados pelo REDCap e foram importados para o Excel e analisados no software Statistics versão 13.0 por meio de estatística descritiva, teste ANOVA, com nível de significância de 0,05. A maioria dos adultos era da região Sudeste do país (67,25%), do sexo feminino (67,66%), com pós-graduação (31,39%) e plano de saúde (70,44%). A média de idade foi de 43,02 anos (DP=15,90), variando entre 18 a 87 anos, em que 42,92% ficaram alocados na faixa de 35 a 59 anos. A média de resiliência encontrada foi de 25,40 (DP=7,66), e a maior média de resiliência entre homens (27,36, DP=27,36). A região do país que apresentou maior média de resiliência foi a Norte (26,95, DP=7,98) e a menor média, a Sul (24,14, DP=7,65). A maioria possuía DM1 (50,92%), recebeu o diagnóstico de COVID-19 (8,75%), com 1 a 10 anos de diagnóstico de DM (41,83%), não perceberam mudanças no controle do DM (44,47%), não consumiam bebida alcoólica (53,83%) e seguiram medidas de restrição de contato, saindo de casa apenas para compras no supermercado e na farmácia (45,02%). Apenas 32,75% das pessoas com DM tiveram acesso a algum profissional da saúde por meio da Telemedicina e 98,71% das pessoas afirmaram fazer uso de medicamento para o tratamento de DM. A adesão ao autocuidado do diabetes foi maior para uso de medicamentos e consumo de dieta saudável, mas foi menor para monitoramento glicêmico, atividade física e exame dos pés, achados frequentemente relatados antes da pandemia. No entanto, obtivemos uma média menor de resiliência quando comparada a estudos realizados no Brasil antes da pandemia semelhantes a pacientes psiquiátricos ambulatoriais. Desta forma, a resiliência e autocuidado podem variar pelo contexto da coleta, se considerarmos as respostas dadas durante a pandemia, em que muitos fatores adversos estavam presentes. Assim, a resiliência é pensada como uma lacuna de conhecimento a ser explorada, pois mesmo após a vacinação, os indivíduos diabéticos ainda podem enfrentar muitas dificuldades que necessitam ser investigadas

People with diabetes mellitus, who live with a chronic non-communicable disease, are more likely to be fatally affected by COVID-19, requiring greater attention in this pandemic period. Isolation and social distancing have imposed adjustments in lifestyle and self-care behaviors for coping, and their success is closely linked to levels of resilience. This study sought to analyze the resilience and self-care of Brazilians with diabetes mellitus in the COVID-19 pandemic. An exploratory web survey was carried out in Brazil, called DIABETESvid, from September to October 2020, a period in which social restrictions were being relaxed in some regions of Brazil, with no forecast of vaccine available for the entire Brazilian population. A total of 1475 adults living in Brazil with a diagnosis of DM participated in the study, answering the complete questionnaire using a link. The questionnaire was prepared by specialists based on the following variables: sociodemographic; clinics; resilience assessed by CD-RISC 10; and self-care by the QAD. The study was approved by the research ethics committee. Data were collected by REDCap and imported into Excel and analyzed using Statistics software version 13.0 using descriptive statistics, ANOVA test, with a significance level of 0.05. Most adults were from the Southeast region of the country (67.25%), female (67.66%), with graduate degrees (31.39%) and health insurance (70.44%). The mean age was 43.02 years (MD=15.90), ranging from 18 to 87 years, in which 42.92% were allocated in the range of 35 to 59 years. The mean of resilience found was 25.40 (MD=7.66), and the highest mean of resilience among men (27.36, MD=27.36). The region of the country that presented the highest average of resilience was the North (26.95, MD=7.98) and the lowest average was the South region (24.14, MD=7.65). Most had DM1 (50.92%), received the diagnosis of COVID-19 (8.75%), with 1 to 10 years of DM diagnosis (41.83%), did not notice changes in DM control (44 .47%), did not consume alcoholic beverages (53.83%) and followed measures to restrict contact, leaving home only to shop at the supermarket and pharmacy (45.02%). Only 32.75% of people with DM had access to a health professional through Telemedicine and 98.71% of people claimed to use medication for the treatment of DM. Adherence to diabetes self-care was higher for medication use and healthy diet consumption, but lower for glycemic monitoring, physical activity, and foot examination, findings often reported even before the pandemic. However, we obtained a lower average of resilience when compared to studies carried out in Brazil before the pandemic similar to psychiatric outpatients. In this way, resilience and self-care may vary by the context of the collection, if we consider the responses given during the pandemic, in which many adverse factors were present. Thus, resilience is thought of as a knowledge gap to be explored, because even after vaccination, diabetic individuals may still face many difficulties that need to be investigated

Diabetes self-care practices and resilience in the Brazilian COVID-19 pandemic: results of a web survey: DIABETESvid.

BACKGROUND: The world guidance on the measures of social distancing for prevention of COVID-19 has changed the daily habits of great part of the population, and this could influence the care and resilience with diabetes during situations of adversity. This study aimed at assessing the characteristics of diabetic individuals and self-care practices and resilience with diabetes in the context of the COVID-19 pandemic in Brazil. METHODS: This is a cross-sectional web survey study carried out among adults with diabetes, in which a structured 43-item questionnaire was conducted on the REDCap plataform, including the Diabetes Self-Care Activities Questionnaire and Connor-Davidson Resilience Scale, to measure socio-demographic and clinical characteristics. The web survey was disseminated through the main social media and data were collected from September 1st to October 19th, 2020. Data analysis was performed according to type of diabetes mellitus (DM) and at a significance level of 5% (p < 0.05). RESULTS: Of the 1633 participants, 67.5% were women, 43.2% aged between 35 and 59 years old, 68.0% lived in the south-eastern region of Brazil, 57.1% had a high education level, 49% reported to have DM1 and 140 participants reported to have had COVID-19. Diabetes care mostly involved the use of medications (93%), whereas the least used ones were physical activity (24.6%) and examination of the shoes (35.7%). About 40% of the participants reported to be followed up by telemedicine, 61.5% monitored the glycaemic levels, 61.2% followed a healthy diet and 43.4% left home only to go to the supermarket and drugstore. The mean resilience was 25.4 (SD = 7.7). CONCLUSIONS: In Brazil, individuals with diabetes followed social distancing and maintained their medication treatment for DM. However, practice of physical activity and foot examination was little followed by the participants, who also had a low level of resilience. These findings showed the importance of patient follow-up in the healthcare services, meaning that telemedicine should be improved and support provided for adaptation in view of the therapeutic setbacks.