Aplicativos como ferramenta de educação em saúde para portadores de diabetes mellitus: o que está disponível na língua portuguesa? / Apps as a health education tool for people with diabetes mellitus: what is available in Portuguese?

Resumo Os aplicativos de saúde para dispositivos móveis se revelam como uma ferramenta importante para a educação em saúde para apoiar o tratamento de diferentes doenças, como o diabetes mellitus (DM). Nesse sentido, esta pesquisa analisa as funcionalidades dos aplicativos existentes na língua portuguesa destinados a auxiliar pessoas com DM. Foi realizada uma busca sistemática para identificação dos aplicativos por meio dos indexadores "Controle de diabetes", "Diabetes", "Glicose" e "Insulina" nos sistemas operacionais Android e iOS. Foram encontrados 576 aplicativos, porém, apenas 63 (10,9%) atenderam aos critérios de inclusão. De acordo com sua funcionalidade, os aplicativos apresentaram as seguintes possibilidades de uso: 13 educativos; 12 monitoram atividade física; 18 contêm diário alimentar; 28 contam carboidratos; 34 monitoram a insulina; 49 monitoram a glicemia; 33 apresentam gráficos; 9 alertam sobre a presença de hipo ou hiperglicemia; 17 lembram coleta de glicemia; e 5 apresentaram receitas culinárias. As funcionalidades que auxiliam na mudança de comportamento e individualizam estratégias de tratamento ainda são incipientes. Sugere-se o desenvolvimento de ferramentas auxiliares para interação dos aplicativos com seus usuários e a comprovação da sua eficácia.

Abstract Health applications for mobile devices are an important tool for a health education to support the treatment of different diseases, such as diabetes mellitus (DM). In this sense, this research analyzes the functionalities of existing applications in Portuguese aimed at helping people with DM. A systematic search was performed to identify the applications by the descriptors "Diabetes control," "Diabetes," "Glucose," and "Insulin" in Android and iOS operating systems. A total of 576 applications were found, but only 63 (10.9%) met the inclusion criteria. According to their functionality, the apps presented the following possibilities of use: 13 are educational; 12 monitor physical activity; 18 contain a food diary; 28 count carbohydrates; 34 monitor insulin; 49 monitor blood glucose; 33 present graphs; 9 warn about the presence of hypo or hyperglycemia; 17 recall blood glucose collection; and 5 present culinary recipes. Functionalities that assist in behavior change and that individualize treatment strategies are still incipient. We suggest the development of auxiliary tools for interaction of applications with their users and the proof of their effectiveness.

Low-Load High-Velocity Resistance Exercises Improve Strength and Functional Capacity in Diabetic Patients.

This study investigated the effects of low-load high-velocity resistance exercises on neuromuscular and functional outcomes in patients with Type 2 diabetes (T2D) during the early-phase of resistance training. Thirty participants with T2D performed 18 training sessions (6 weeks - 3x week) in one of two groups: low-load high-velocity exercises (LLHV, n=15, 62.1±10.5 years) or recreational activities (RA, n=15 56.7 ± 19.4 years). LLHV performed resistance exercises with 3x 8reps as fast as possible with 50-60% 1RM. RA performed light activities. Strength, power, and functional tests were assessed. There was significant increasing in the knee extension peak-torque at 60°/s (7.6%) and 180°/s (12.2%), rate of force development in the LLHV group (P<0.05), whereas there were no changes in the RA group. Significant increases in functional test were observed in the LLHV group (P<0.01) with no changes in the RA group. In conclusion, the LLHV induced marked improvements in neuromuscular parameters, as well as in the functional capacity of participants with T2D.

Barreiras e facilitadores da adesão a um programa de educação em diabetes: a visão do usuário / Adherence barriers and facilitators to a diabetes education program: the user's point of view

Este estudo objetivou identificar barreiras e facilitadores da adesão a um programa para o tratamento da Diabetes Mellitus tipo 2 (DM2). O Programa Doce Desafio (PDD) é contínuo, de base anual; regular, oferecido desde 2001; multidisciplinar, com exercícios físicos supervisionados, alimentação, autocuidado, uso de medicamentos e aspectos psicossociais; multiprofissional, com profissionais da farmácia, nutrição, educação física, medicina e enfermagem; multiestratégico, com palestras, debates, jogos, oficinas, discussões e práticas de exercício físico supervisionado; comunitário, incluindo a atenção básica; intersetorial, entre Universidade e Serviço; e realiza sessões de 120 minutos duas vezes por semana, em três locais do Distrito Federal. A pesquisa foi qualitativa, exploratória e baseada na técnica "roda de conversa". Todos os 132 frequentadores do programa foram convidados e 55 sujeitos aceitaram participar da pesquisa. Cada unidade de atendimento sediou um encontro mediado pelo pesquisador, que utilizou roteiro semiestruturado para estabelecer um diálogo sobre as barreiras e facilitadores da adesão ao PDD. Todas as falas foram gravadas, transcritas e submetidas à análise de conteúdo. Das falas emergiram seis facilitadores à adesão: motivação para aprender; incentivo familiar; interação afetiva; melhoria da saúde e qualidade de vida; prazer da atividade física; e orientação profissional. E, quatro barreiras: desgaste no preenchimento de formulários; complicações de saúde; dificuldades financeiras; e problemas familiares. Educação multidisciplinar, exercícios físicos orientados e acompanhamento humanizado foram diferenciais do PDD em relação a outras vivências no tratamento da DM2. Falta avançar na capacitação profissional e sensibilização dos participantes para que as avaliações clínicas se tornem menos exaustivas e mais acessíveis.

This study aims to identify barriers and facilitators of adherence to a program for the treatment of type 2 diabetes mellitus (DM2). The Sweet Challenge Program (PDD) is continuous, in annual basis; regular, offered since 2001; multidisciplinary, with supervised exercise, nutrition, self-care, use of medication and psychosocial aspects; multiprofessional, with pharmacy, nutrition, physical education, medicine and nursing professionals; multistrategic, with lectures, debates, games, workshops, discussions, and supervised exercise practices; community-based, including primary care; intersectoral, among University and Service; and offers 120 minutes sessions twice a week, in three places of the Federal District. The research was qualitative, exploratory and based on "conversation circle" technic. All 132 program attendees were invited and 55 accepted to participate. Each local hosted a meeting mediated by the researcher, using semi-structured script, to establish a dialogue about barriers and facilitators of adherence to PDD. All speeches were recorded, transcribed and subjected to content analysis. From speech emerged six facilitators to adherence: motivation to learn; family encouragement; affective interaction; health and quality of life improvement, physical activity enjoyment, and professional guidance. And, four barriers: form fillings; health complications, financial difficulties, and family problems. Multidisciplinary education, guided physical exercises and humanized follow-up were PDD's differential in relation to other experiences in the treatment of DM2. There is need to progress in professional training and participants sensitization so that clinical evaluations become less exhausting and more accessible.

Diabetes education program with emphasis on physical exercise in subjects with type 2 diabetes: a community-based quasi-experimental study.

BACKGROUND: Diabetes mellitus (DM) requires permanent multidisciplinary treatment. This study investigated the effects of an educational program with emphasis on physical exercise on biological health markers of subjects with type 2 DM (T2DM). METHODS: This was a quasi-experimental study with subjects who attended a diabetes education program over one year. At the beginning, middle and end of the annual cycle, glycated hemoglobin (HbA1c), lipid profile and anthropometry were measured. The program offered two hours of educational and exercise interventions twice a week. Before and after each session capillary blood glucose (BG) was measured. Statistical analysis used Pearson's χ2, paired t, ANOVA-RM and MANOVA tests to compare results with significance levels set at P<0.05. RESULTS: Data of 103 subjects (73% women) were analyzed. Mean age was 64.1±10.8 years and 23% of participants were on insulin therapy. As an acute effect mean BG decreased significantly (P<0.001) from 157.5±61.5 mg/dL to 128.5±47.5 mg/dL after the intervention sessions, also resulting in increased prevalence of normoglycemic BG (from 44.0% to 68.6%). Chronic effects of participation in the program could be perceived through significant reduction (P<0.05) from beginning to end of the study of mean BG (from 144.8±5.0 mg/dL to 135.3±3.1 mg/dL), HbA1c (from 7.3±1.3% to 7.1±1.0%) and triglycerides (from 177.9±121.3 mg/dL to 150.5±130.9 mg/dL). There were no significant changes in anthropometric variables. CONCLUSIONS: A diabetes education program with emphasis on supervised physical exercise improved triglycerides and glycemic control in subjects with T2DM.

Safety in the hypertriglyceridemia treatment with n-3 polyunsaturated fatty acids on glucose metabolism in subjects with type 2 diabetes mellitus / Seguridad en el tratamiento de la hipertrigliceridemia con n-3 ácidos grasos poliinsaturados en el metabolismo de la glucosa en pacientes con diabetes mellitus tipo 2

Introduction: Type 2 diabetes mellitus increases the risk of hypertriglyceridemia and is an independent risk factor for cardiovascular diseases. Current literature reveals the beneficial effects of n-3 polyunsaturated fatty acids (n-3 PUFA) in hypertriglyceridemia treatment, however the safety for type 2 diabetic subjects are still debatable. This literature review discusses the safety on glucose metabolism of n-3 PUFA supplementation in the treatment of hypertriglyceridemia in subjects with type 2 diabetes mellitus. Methods: A literature review was conducted on EMBASE and MEDLINE database to investigate clinical trials published since 1990 until June 2014 that investigated the effects of dietary/supplementation n-3 PUFA intake in hypertriglyceridemia treatment in subjects with type 2 diabetes mellitus.Results and Discussion: Fourteen clinical trials (n = 2,105) were included in this review. All trials reported areduction in triglycerides levels between 12 - 34% in intra- group and 15 - 36% in between-groups analysis. Four trials showed a significant increase in LDL-c (6 - 18%) and another four in HDL-c levels (4 - 15%). No significantchanges were found to total cholesterol, VLDL-c, fasting glucose, HbA1C, and insulin sensitivity index. Conclusions: The n-3 PUFA supplementation leads animprovement on TG levels and did not result in any impairment on glucose metabolism in hypertriglyceridemic patients with type 2 diabetes mellitus being a safe option to treat the diabetic population (AU)

Introducción: Diabetes mellitus tipo 2 aumenta el riesgo de hipertrigliceridemia y es un factor de riesgo independiente para las enfermedades cardiovasculares. La literatura actual revela efectos beneficiosos de n-3 ácidos grasos poliinsaturados (n-3 AGPI) en el tratamiento de la hipertrigliceridemia, sin embargo, la seguridad de este tratamento en los sujetos diabéticos tipo 2 es discutible. Esta revisión de la literatura discute la seguridad del n-3 PUFA la suplementación sobre el metabolismo de la glucosa en el tratamiento de la hipertrigliceridemia en pacientes con diabetes mellitus tipo 2. Métodos: Se ha realizado una revisión de la literatura en la base de datos MEDLINE y EMBASE del los ensayos clínicos publicados con fecha posterior al 1990 hasta Junio de 2014 sobre los efectos de la ingesta / suplementos del n-3 AGPI en el tratamiento de la hipertrigliceridemia en pacientes con diabetes mellitus tipo 2. Resultados y Discusión: Catorce estudios clínicos (n = 2105) se incluyeron en esta revisión. Del estudios informaron una reducción en los niveles de triglicéridos entre 12 a 34% en interior del grupo comparación y de 15 a 36% en entre grupos análisis. Cuatro estudios mostraron un aumento significativo en el LDL-c (6-18%) y otros cuatro en los niveles de HDL-c (4 - 15%). No se encontraron cambios significativos en el colesterol total, VLDL-c, la glucosa, HbA1c y el índice de sensibilidad a la insulina. Conclusión: El n-3 AGPI suplementación lleva una mejora en los niveles de triglicéridos y no arrojaron deterioro en el metabolismo de la glucosa en pacientes con hipertrigliceridemia con diabetes mellitus tipo 2 siendo una opción segura para el tratamiento de la población diabética (AU)

Safety in the hypertriglyceridemia treatment with N-3 polyunsaturated fatty acids on glucose metabolism in subjects with type 2 diabetes mellitus.

INTRODUCTION: Type 2 diabetes mellitus increases the risk of hypertriglyceridemia and is an independent risk factor for cardiovascular diseases. Current literature reveals the beneficial effects of n-3 polyunsaturated fatty acids (n-3 PUFA) in hypertriglyceridemia treatment, however the safety for type 2 diabetic subjects are still debatable. This literature review discusses the safety on glucose metabolism of n-3 PUFA supplementation in the treatment of hypertriglyceridemia in subjects with type 2 diabetes mellitus. METHODS: A literature review was conducted on EMBASE and MEDLINE database to investigate clinical trials published since 1990 until June 2014 that investigated the effects of dietary/supplementation n-3 PUFA intake in hypertriglyceridemia treatment in subjects with type 2 diabetes mellitus. RESULTS AND DISCUSSION: Fourteen clinical trials (n = 2,105) were included in this review. All trials reported a reduction in triglycerides levels between 12 - 34% in intra- group and 15 - 36% in between-groups analysis. Four trials showed a significant increase in LDL-c (6 - 18%) and another four in HDL-c levels (4 - 15%). No significant changes were found to total cholesterol, VLDL-c, fasting glucose, HbA1C, and insulin sensitivity index. CONCLUSIONS: The n-3 PUFA supplementation leads an improvement on TG levels and did not result in any impairment on glucose metabolism in hypertriglyceridemic patients with type 2 diabetes mellitus being a safe option to treat the diabetic population.

Introducción: Diabetes mellitus tipo 2 aumenta el riesgo de hipertrigliceridemia y es un factor de riesgo independiente para las enfermedades cardiovasculares. La literatura actual revela efectos beneficiosos de n-3 ácidos grasos poliinsaturados (n-3 AGPI) en el tratamiento de la hipertrigliceridemia, sin embargo, la seguridad de este tratamento en los sujetos diabéticos tipo 2 es discutible. Esta revisión de la literatura discute la seguridad del n-3 PUFA la suplementación sobre el metabolismo de la glucosa en el tratamiento de la hipertrigliceridemia en pacientes con diabetes mellitus tipo 2. Métodos: Se ha realizado una revisión de la literatura en la base de datos MEDLINE y EMBASE del los ensayos clínicos publicados con fecha posterior al 1990 hasta Junio de 2014 sobre los efectos de la ingesta / suplementos del n-3 AGPI en el tratamiento de la hipertrigliceridemia en pacientes con diabetes mellitus tipo 2. Resultados y Discusión: Catorce estudios clínicos (n = 2105) se incluyeron en esta revisión. Del estudios informaron una reducción en los niveles de triglicéridos entre 12 a 34% en interior del grupo comparación y de 15 a 36% en entre grupos análisis. Cuatro estudios mostraron un aumento significativo en el LDL-c (6-18%) y otros cuatro en los niveles de HDL-c (4 - 15%). No se encontraron cambios significativos en el colesterol total, VLDL-c, la glucosa, HbA1c y el índice de sensibilidad a la insulina. Conclusión: El n-3 AGPI suplementación lleva una mejora en los niveles de triglicéridos y no arrojaron deterioro en el metabolismo de la glucosa en pacientes con hipertrigliceridemia con diabetes mellitus tipo 2 siendo una opción segura para el tratamiento de la población diabética.

Evidências sobre efeitos da atividade física no controle glicêmico: importância da adesão a programas de atenção em diabetes / Evidence of physical activity effects on glycemic control: importance of adherence to diabetes care programs

O Diabetes Mellitus (DM) tipo 2 (DM2) é um problema de saúde pública que requer cuidados contínuos e multidisciplinares. A presente revisão tem por objetivo destacar a importância da inclusão de atividades físicas em programas de atenção em DM2, salientando seu efeito no controle glicêmico e aspectos que influenciam a adesão de usuários, bem como associar a temática às atuais políticas públicas de atenção básica em saúde no Brasil. Artigos originais, revisões sistemáticas e de meta-análise que continham os termos DM2, adesão, exercício físico, atividade física e programa de educação em DM (em português e inglês) encontrados nos bancos de dados PubMed, Scopus e BioMed Central foram incluídos. Políticas públicas e diretrizes (guidelines) também foram utilizadas para contextualização e discussão. Evidências indicam que a participação em programas de atenção à DM2 se associa a um melhor prognóstico da doença; indivíduos mais aderentes apresentam melhores resultados no controle glicêmico e redução da massa corporal que os menos aderentes. Fatores como supervisão profissional, envolvimento em grupos, apoio familiar, tipo de exercício e frequência de encontros podem influenciar diretamente a adesão a esses programas. Educação em DM, atividades físicas e terapia nutricional são importantes no tratamento da DM2, porém, há escassez de programas públicos de saúde que, de forma multidisciplinar e contínua, contemplem estas ações terapêuticas.

Type 2 Diabetes Mellitus (DM2) is a public health issue that requires continuous and multidisciplinary care. This review aims to present the importance of including physical activities in DM2 care programs, highlighting the effect on glycemic control and the aspects that influence user?s adherence, as well as linking this issue to current public policies on primary health care in Brazil. Original articles, systematic reviews and meta-analyzes that contained the words DM2, adherence, exercise, physical activity and diabetic education program (in Portuguese and English) found on PubMed, Scopus and BioMed Central databases were included. Public policies and guidelines were also used for contextualization and discussion. Evidences indicate that attending a DM2 care program is associated with a better prognosis; individuals with greater adherence have better results on glycemic control and weight reduction then the lesser adherents. Factors like professional supervision, group involvement, family support, type of physical activity and frequency of meetings may directly influence the adherence to the programs. DM education, physical activities and nutritional therapy are important to the DM2 treatment; however, there is a lack of programs that support these therapeutic actions in a multidisciplinary and continuous way.

Pé de Charcot: relato de caso antes e após participação em programa de educação em diabetes (doce desafio) / Charcot’s foot: reported case of a diagnosed diabetic person and result safter participation oriented program of physical activities to diabetic people(doce desafio/sweet-challenge)

Pé de Charcot é uma complicação rara que pode acometer diabéticos, em especial se mal controlados,sendo de alta morbidade. Estudo de caso de diabético, feminino, 44 anos de idade, ensino médio, 11anos de diagnóstico de DM, em insulinoterapia, com quadro de Pé de Charcot há 3 anos. Relacionou-sedados acerca de seu modo de vida e como ele se comporta em relação à patologia pré e pós Charcot.Informações foram coletadas através de entrevista e dados coletados nos prontuários do Doce DESAFIO.O sujeito relatou dificuldades, no princípio, para que o diagnóstico fosse estabelecido, referindo inclusiveter sido solicitado vários exames radiológicos após descrição de quadro álgico e edema, onde não foidetectado o desabamento do pé, característico do Pé de Charcot. Após aproximadamente 2 mesesdiagnosticou-se Charcot e foi prescrita palmilha e tala, que diminuíram os sintomas. Ao ingressar noDoce DESAFIO, 16 meses após, suas glicemias eram usualmente maiores que 500mg/dl. Apresentavamedo de episódios hipoglicêmicos, às vezes evitando aplicar insulina diária caso não tivesse certezaquanto às atividades e refeições ao longo do dia. Buscava corrigir hiperglicemias maiores que 250mg/dlcom valor fixo de 5u de insulina regular, independente da medida suposta ou aferida. A partir dasorientações de educação em diabetes, a monitorização foi iniciada, obteve mais informações sobre apatologia, especialmente sobre ação das insulinas e ajustes seguindo adaptações relacionando asmedidas da glicemia aferida com a insulina exógena a ser aplicada e, junto ao médico, a insulinização foimelhor distribuída e adequada, para a melhora da sua qualidade de vida. Também no Doce DESAFIO,além de orientação de atividade física para melhora da circulação periférica, houve fortalecimento damusculatura e tendões adjacentes para que fossem minimizadas as conseqüências do quadro. Atualmente,segundo a própria sua glicemia tem se mantido em torno de 96-125mg/dl...

Charcot’s Foot: a rare and high morbidity diabetic complication, especially in those with poor glycemiccontrol. Case study of a diabetic woman, age 44, high school; diabetes diagnosed 11 years ago, ininsulin therapy, 3 years since Charcot’s Foot diagnosis. Lifestyle and behavior information related tothe pathology pre and post-Charcot were collected through interview and from Sweet-Challenge (DoceDESAFIO) records. RESULTS: Diagnosis difficulties were refereed, even after various radiological examsfollowing pain and edema descriptions. Approximately 2 months after Charcot’s diagnosis, splint andfeet cast were prescript. Before joining Sweet-Challenge (16 months after), the glycemic values wereusually >500 mg/dl. There was apprehension of hypoglycemic episodes, sometimes avoiding insulinadministration when there wasn’t certainty about the activities and meals of the day. Hyperglycemiawas usually corrected with a fixed amount of 5U of regular insulin, not taking the measure onconsideration. With orientation from Sweet-Challenge, self-monitoring of blood glucose (SMBG) began.The information received was especially about insulin and its adjustments. With a physician, the insulintherapy improved. Oriented exercises for improvement of peripheral circulation and muscularstrengthening were initiated, thus, optimizing the prognostics; aiming the improvement of her quality oflife. She said that her glycemic values ranged 96-125 mg/dl after attending the Sweet-Challenge. Herattendance was about 1 time/month or a bit more. At the end of the classes her blood glucose was about168±65mg/dl. CONCLUSION: Self-confidence and consciousness of her diabetes control from theinstructions received was related, and also a better disposition and self-control was observed.