Characteristics of carbohydrate counting practice associated with adequacy of glycated hemoglobin in adults with type 1 diabetes mellitus in Brazil.

Background: The Carbohydrate Counting (CC) is directly associated with achieving glycemic control by people with Type 1 Diabetes Mellitus (T1DM). Therefore, this study aims to analyze characteristics of the CC practice associated with the adequacy of glycated hemoglobin (HbA1c) in adults with T1DM in Brazil. Methods: The study was cross-sectional, carried out using an online form with questions about knowledge of CC, clinical, anthropometric, sociodemographic data, follow-up with health professionals and understanding of the concepts of CC. Pearson's chi-square test and binomial logistic regression analysis (p<0.05) were applied. Results: 173 adults participated, of which 57.2% had increased HbA1c (≥7%). Having the diabetes duration <10 years (p=0.006), performing the CC at lunch (p=0.040) and dinner (p=0.018), using specific applications to perform the CC (p=0.001), having learned to perform CC with a nutritionist (p=0.037) and knowing how to correctly define the concepts of food bolus (p=0.001), correction bolus (p<0.001) and insulin/carbohydrate ratio (p<0.001) was associated with having adequate HbA1c (<7%). Participants who were undergoing CC practice were 3.273 times more likely to have adequate HbA1c and participants with diabetes duration <10 years were 2.686 times more likely to have adequate HbA1c. Conclusion: It was concluded that variables transversal to CC favor adequate HbA1c values in adults with T1DM and that practicing CC and having a diabetes duration of less than 10 years are predictive factors of having adequate HbA1c.

Adherence to Online Nutritional Monitoring Was Associated with Better Food Habits in People with T1DM during the COVID-19 Pandemic in Brazil.

Until this moment, no research has been found that has assessed adherence to online nutritional monitoring by adults with Diabetes Mellitus Type 1 (T1DM) during the pandemic. This article aims to analyze the association between eating habits and adherence to nutritional online care by adults with T1DM during social distancing because of the COVID-19 pandemic in Brazil. A cross-sectional study was carried out in July 2020. An online form was used to collect sociodemographic data, financial status, eating habits, carrying out online nutritional monitoring, and adherence to social distancing. Pearson's chi-squared test was performed with adjusted residual analysis and binomial logistic regression analysis (p < 0.05). Out of the 472 adults, only 8.9% had consulted with a nutritionist. Doing nutritional monitoring online during social distancing was associated with a reduction in the consumption of ultra-processed foods (p = 0.021), eating more servings of fruit (p = 0.036), and doing carbohydrate counting (CC) more frequently (p = 0.000). Doing nutritional monitoring online increased adherence to carbohydrate counting by 2.57 times and increased the consumption of fruits by 0.423 times. Therefore, nutritional monitoring, even if performed remotely, can influence the acquisition and maintenance of healthier eating habits, in addition to assisting adherence to the practice of CC.

Changes in Physical Activity Associated with Mental Health in People with Type 1 Diabetes during the COVID-19 Pandemic.

The social isolation carried out during the COVID-19 pandemic contributed to physical inactivity and impacted people's mental health, with physical activity being an important pillar in the treatment of Type 1 Diabetes Mellitus (T1DM). Thus, this study aims to verify whether there is an association between the perception of mental health and the practice of physical activity in individuals with T1DM during social isolation in the COVID-19 pandemic in Brazil. This was a cross-sectional study conducted in July 2020, with 472 adults with T1DM, using an online form to collect sociodemographic, mental health and physical activity data during social isolation. The Chi-Square test of independence was performed with adjusted residuals analysis (p < 0.05). A total of 51.3% of the participants remained sedentary or stopped doing physical activity during the period of social isolation. There was an association between being interested in performing daily activities (p = 0.003), not feeling depressed (p = 0.001), feeling slightly irritated (p = 0.006), having slight problems with sleep (p = 0.012) and practicing physical activity. There was also an association between maintaining physical activity and not feeling depressed (p = 0.017) and feeling very slightly irritated (p = 0.040). Adults with T1DM who practiced physical activity during the period of social isolation due to the COVID-19 pandemic showed better aspects of mental health.

Adherence to Carbohydrate Counting Improved Diet Quality of Adults with Type 1 Diabetes Mellitus during Social Distancing Due to COVID-19.

To control glycemic variability in people with Type 1 diabetes mellitus (T1DM), it is essential to perform carbohydrate counting (CC), a strategy that ensures better quality of life for these patients. Thus, this study aims to analyze potential factors associated with adherence to CC in adults with T1DM during social distancing due to COVID-19 in Brazil. This was a single cross-sectional study carried out in July 2020. An online form was used to collect sociodemographic and economic data on the purchasing of supplies and food, as well as social distancing. The Chi-square test was performed with adjusted residuals analysis and a binomial logistic regression analysis (p < 0.05). Of 472 adults, 37.71% reported performing CC in the same frequency as before social distancing. There was an association between performance of CC and the type of city (p = 0.027), family income (p = 0.000), use of financial emergency aid (p = 0.045), type of insulin administration and glycemic monitoring (p < 0.000), and cooking more (p = 0.012). Participants who maintained or reduced consumption of ultra-processed foods were 0.62 times more likely to adhere to CC (OR 0.626, 95% IC: 0.419−0.935) and participants who cooked more were 1.67 times more likely to adhere to CC (OR 1.67, 95% CI: 1.146−2.447). There are still people with T1DM who did not know about and did not use CC method, which highlights the need for diabetes education.

Insumos para manejo do Diabetes Tipo 1 durante o distanciamento social por COVID-19 no Brasil / Supplies for Type 1 Diabetes management during COVID-19 social distancing in Brazil

O estudo analisou fatores socioeconômicos associados à aquisição de insumos para manejo da glicemia por pessoas com Diabetes Mellitus tipo 1 durante o distanciamento social pela Pandemia de COVID-19 no Brasil. Pesquisa transversal com coleta de dados realizada durante 21 dias do mês de julho de 2020, com um formulário online sobre dados socioeconômicos e aquisição de insumos para monitorização glicêmica. Foi aplicado o teste Qui-Quadrado de Pearson com análise de resíduos ajustados (p<0,05). Participaram 472 adultos de ambos os sexos. Foram encontradas associações entre o tipo de aparelho utilizado para monitorização glicêmica (glicosímetro ou sistema Flash) e renda (p<0,000), escolaridade (p=0,007), macrorregiões (p=0,049) e tipo de cidade (p=0,043); entre aquisição de insulinas e renda (p<0,000), macrorregião (p=0,027) e tipo de bairro (p=0,003); entre aquisição de fitas reagentes e renda (p<0,000); entre aquisição de lancetas e renda (p=0,001), tipo de cidade (p=0,035) e de bairro (p=0,010); entre o uso de Sistema Flash e renda (p<0,000) e tipo de bairro (p=0,006). Os resultados expõem as desigualdades sociais na aquisição de insumos para manejo da glicemia por pessoas com Diabetes Tipo 1 durante a Pandemia no Brasil.

This study analyzed socioeconomic factors related with the acquisition of supplies for blood glucose management by people with Type 1 Diabetes Mellitus during social distancing due to the COVID-19 Pandemic in Brazil. This was a cross-sectional study with data collected during 21 days in July 2020, by an online form on socioeconomic data and acquisition of supplies for glycemic monitoring. This research applied Pearson's Chi-Squared test with adjusted residual analysis (p<0.05). 472 adults of both sexes participated. Relationships were found between the type of device used for blood glucose monitoring (glucometer or Flash system) and income (p<0.000), education (p=0.007), macro-regions (p=0.049), and type of city (p=0.043); between insulin acquisition and income (p<0.000), macro-region (p=0.027) and type of neighborhood (p=0.003); between acquisition of reagent strips and income (p<0.000); between acquisition of lancets and income (p=0.001), type of city (p=0.035) and neighborhood (p=0.010); between the use of Flash System and income (p<0.000) and type of neighborhood (p=0.006). The results expose the social inequalities in the acquisition of supplies for blood glucose management by people with Type 1 Diabetes during the Pandemic in Brazil.

Cooking habits and food choices of individuals with Type 1 Diabetes Mellitus during the pandemic of COVID-19 / Hábito de cozinhar e escolhas alimentares de indivíduos com Diabetes Mellitus Tipo 1 durante a pandemia de COVID-19

ABSTRACT Objective To verify the association between cooking habits, socioeconomic data, and food choices of individuals with Type 1 Diabetes Mellitus during the pandemic of COVID-19. Methods Transversal study with individuals with Type 1 Diabetes Mellitus carried out in July 2020. Socioeconomic data and information about social distancing and food practices were collected with an online form. The research was approved by the university's Ethics and Research Committee (Process number 4.147.663). Results Out of the 472 participants, 50.9% reported that they have been cooking more during the pandemic. An association between cooking more and having a university degree (p<0.000) was observed. Not being able to comply with social distancing rules because of work necessities was associated with not cooking (p=0.006). Cooking more during the quarantine was associated with eating less than five meals per day (p=0.04), having an appropriate consumption of fruits (p=0.02) and vegetables (p=0.04), and increased water intake (p=0.01). Conclusion In Brazil, the habit of cooking during the pandemic may represent an increase in domestic work, reinforced by social inequalities. Therefore, comprehending the cooking habits and food choices of people with diabetes may widen the perspectives of health professionals involved in the treatment of the disease and contribute to the elaboration of public policies that take the country's inequalities into account. We emphasize the importance of investing in policies that encourage the development of culinary skills, as well as the habit of cooking as part of the actions of Food and Nutrition Education.

RESUMO Objetivo Verificar associação entre o hábito de cozinhar, dados socioeconômicos e escolhas alimentares de indivíduos com Diabetes Mellitus tipo 1 durante a pandemia de COVID-19. Método Estudo transversal realizado com indivíduos com Diabetes Mellitus tipo 1 durante julho de 2020. A partir de um formulário on-line foram coletados dados socioeconômicos, demográficos, informações sobre o distanciamento social e práticas alimentares durante a quarentena. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa (parecer 4.147.663). Resultados Dos 472 participantes, 50,9% relataram estar cozinhando mais durante a quarentena. Observou-se uma associação entre cozinhar mais e ter ensino superior (p<0,000). Não estar realizando distanciamento social porque precisava trabalhar esteve associado a não cozinhar (p=0,006). Quanto à alimentação, cozinhar mais durante a quarentena estava associado a consumir menos de cinco refeições ao dia (p=0,04), ter consumo adequado de frutas (p=0,02) e hortaliças (p=0,04) e ter aumentado a ingestão de água (p=0,01). Conclusão No Brasil, o hábito de cozinhar durante a pandemia pode representar um aumento do trabalho doméstico, ocasionado pelas desigualdades sociais. Portanto, compreender esse hábito e as escolhas alimentares de pessoas com diabetes, pode ampliar a visão dos profissionais de saúde envolvidos no tratamento e contribuir com a elaboração de políticas públicas que levem em consideração as desigualdades do país. Ressaltamos a importância do investimento em políticas que estimulem o desenvolvimento das habilidades culinárias, bem como do hábito de cozinhar no âmbito das ações de Educação Alimentar e Nutricional.