Actividades de prevención y factores de riesgo en diabetes mellitus y pie diabético / Prevention activities and risk factors in diabetes mellitus and diabetic foot

RESUMEN

Objetivos: determinar prevalencia actividades de prevención por médicos y pacientes. Identificar factores de riesgo pie, metabólicos, alimentarios y estado nutricional. Métodos: estudio descriptivo, transversal octubre 2009-junio 2011, pacientes hospitalizados con diabetes mellitus, mayores de edad; aprobación comité ética. Encuesta médica, evaluación nutricional,medición A1c y lípidos, educación mediante cartilla autocuidado. Análisis descriptivo variables cuantitativas y cualitativas, coeficientes correlación de Pearson; programas Excel 2007 y SPSS-versión-15.0. Resultados: pacientes encuestados 263; hombres 44.1% y mujeres 55.9%; edad promedio63.6±13.3; tiempo diagnóstico diabetes 11.4 ± 8.5 años. Escolaridad primaria 58.9%, estrato socioeconómico 1-2 (71.3%). Antecedente úlceras 14.8%, amputación 1.9%, disestesias 49.8%, claudicación intermitente 22.7%, examen pies por médico 42.9%. Actividades prevención por médicos son precarias porque no educan 59.5% sobre autocuidado pie, examinan pies 57.1%, preguntan sobre disestesias 68.3%, claudicación intermitente 74.8%. Autocuidado pacientes diario inadecuado porque, no revisan pies 27.4%, interior calzado 28.1%; no realizan secado interdigital 8%, lubricación pies 58.8%; sin automonitoreo 63.2%; corte inadecuado uñas 68.1%; no usan medias 21.7%, calzado terapéutico 98.5%; sin colaboración familiar 55.1%. Descontrol metabólico A1c 9.6% ± 2.7; c-LDL 99.1 mg% ± 31.3; triglicéridos 171.9 mg% ± 97.9. Sin consejería por nutricionista 39.4%; con preobesidad-obesidad 58.9%. Correlación IMC y cintura punto medio (r=0.750, p=0.000); IMC y porcentaje grasa corporal (r=0.586,p=0.000). Hábitos alimentación preferencia alimentos fritos 42.3%; bajo consumo proteína animal (12.7%), lácteos (31.8%), frutas (64.7%) y verduras (57.9%); alto consumo almidones (43.4%). Conclusiones: las actividades de prevención por médicos y pacientes son deficientes. Se evidenciaron factores de riesgo para diabetes mellitus y pie diabético hiperlipidemia, hiperglucemia, obesidad y hábitos alimentarios inadecuados.

ABSTRACT

Objectives: to determine prevalence and prevention activities by physicians and patients. Identify risk factors foot, metabolic, dietary and nutritional status. Methods: a descriptive, cross-sectional study, from October 2009 to June 2011 in adult patients hospitalized with diabetes mellitus. Ethics Committee approval. Medical questionnaire, nutritional assessment, measurement A1c and lipids, education through self care booklet. Descriptive analysis: quantitative and qualitative variables, Pearson correlation coefficients; Excel 2007 and SPSS version-15.0 programs. Results: 263 patients were surveyed; 44.1% men and 55.9% women; mean age 63.6 ± 13.3; time of diabetes diagnosis 11.4 ± 8.5 years. 58.9% had primary schooling, socioeconomic status 1-2 (71.3%). Clinical antecedents ulcers 14.8%, 1.9% amputation, dysesthesias 49.8%, 22.7% intermittent claudication, foot exam by physician 42.9%. Prevention activities by doctors are precarious because 59.5% do not educate about foot self-care, 57.1% examine feet, 68.3% ask about dysesthesias, 74.8% about intermittent claudication. Inadequate daily feet self-care by patients because they don`t inspect their feet 27.4% or the inner shoes 28.1%; 8% do not make interdigital drying; 58.8% do not lubricate their feet; 63.2% make no self-monitoring; 68.1% have inadequate nail cutting; 21.7% do not use stockings, 98.5% do not have therapeutic footwear; 55.1% have no family collaboration. Metabolic dyscontrol A1c 9.6 ± 2.7%; LDL-C 99.1% ± 31.3 mg; triglycerides 171.9 ± 97.9 mg%. 39.4% do not have nutritionist counseling; 58.9% present pre-obesity-obesity. Correlation BMI and waist midpoint circumference (r = 0.750, p = 0.000); BMI and body fat percentage (r = 0.586, p = 0.000). Eating habits fried food preference 42.3%; Low consumption animal protein (12.7%), dairy (31.8%), fruits (64.7%) and vegetables (57.9%); high starch consumption (43.4%). Conclusions: prevention efforts by doctors and patients are deficient. Risk factors for diabetes mellitus and diabetic foot observed were hyperlipidemia, hyperglycemia, obesity and inadequate eating habits.