Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus / Influência dos fatores socioeconômicos e psicológicos no controle glicêmico em crianças jovens com diabetes mellitus tipo 1

Abstract Objective: To evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. Methods: This was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. Results: A total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n = 50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. Conclusions: The socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.

Resumo Objetivo: Avaliar a influência dos fatores socioeconômicos e psicológicos no controle glicêmico de crianças pequenas portadoras de diabetes mellitus tipo 1. Métodos: Estudo de corte transversal, avaliou crianças pré-púberes, com diabetes mellitus tipo 1. Foram analisados os fatores socioeconômicos com o Critério de Classificação Econômica Brasil e as condições psicológicas através da versão brasileira do Problem Areas in Diabetes (B-Paid), associado ao controle glicêmico, mensurado pela hemoglobina glicada. Foi utilizada análise descritiva. As variáveis foram avaliadas bivariada e multivariantemente pelo modelo de regressão de Poisson robusto, os testes Exato de Fisher e Qui-Quadrado de Pearson para as razões de prevalência bruta e ajustada, sendo o intervalo de confiança estimado em 95%. Resultados: Foram incluídas no estudo 68 crianças com diabetes mellitus tipo 1. Foi observada uma associação negativa entre controle glicêmico (níveis de hemoglobina glicada), status socioeconômico (Critério de Classificação Econômica Brasil) e condição psicológica (versão brasileira do Problem Areas in Diabetes). Entre os participantes do estudo, 73,5% (n = 50) das crianças apresentaram status socioeconômico desfavorável, esses participantes apresentaram 1,4 vezes mais chances de apresentar valores alterados de hemoglobina glicada. Em relação a indivíduos com estado psicológico comprometido, houve uma prevalência de 26 (38,2%) apresentou uma pontuação acima de 70, sendo assim classificada com estresse psicológico, essas crianças foram 1,68 vezes mais prováveis (intervalo de confiança 95%: 1,101, 1,301) de apresentar níveis mais elevados de hemoglobina glicada. Conclusão: As condições socioeconômicas e as características psicológicas dos participantes do estudo foram negativamente associadas aos resultados da hemoglobina glicada. Esses dados reforçam a importância das variáveis estudadas como preditores de controle glicêmico.

Psychiatric disorders in adolescents with type 1 diabetes: a case-control study

Objectives: To study the prevalence of psychiatric disorders in adolescents with and without type 1 diabetes, the factors associated with its presence, and to test the reliability of a screening tool for use in clinical settings. Methods: Eighty-one adolescents were enrolled in this case-control study, including 36 diabetic participants and 45 controls. Clinical and sociodemographic data were collected and psychiatric symptoms and diagnoses were obtained from adolescents and their parents using a screening tool (Strengths & Difficulties Questionnaire) and a semi-structured interview (Development and Well-Being Assessment). Results: Psychiatric disorders were identified in 22.2% of the sample (30.56% among diabetic adolescents vs. 15.56% of controls: OR = 2.39, 95%CI 0.82-6.99; p = 0.11). Overweight (body mass index percentile ≥ 85) was the only factor associated with psychiatric disorder (OR = 3.07; 95%CI 1.03-9.14; p = 0.04). Compared to the semi-structured interview, the screening instrument showed 80% sensitivity, 96% specificity, 88.9% positive predictive value and 92.3% negative predictive value for the presence of psychiatric diagnoses in adolescents. Conclusion: Psychiatric morbidity was high in this sample of adolescents, especially among those with diabetes. Routine use of the Strengths and Difficulties Questionnaire can help with early detection of psychiatric disorders in this at-risk group.

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias: revisión de la literatura / Psychosocial impact of type 1 diabetes mellitus in children, adolescents and their families: literature review

La diabetes mellitus tipo 1 es la patología endocrina crónica más común en niños. El tratamiento incluye dieta, actividad física, medicación con insulina y un autocontrol adecuado. Este autocontrol puede ser dificultoso, provocando que niños, adolescentes y sus familias sufran diversas complica ciones psicosociales. Existe una relación inversa entre autocontrol y presencia de complicaciones psicosociales, siendo los principales problemas ansiedad y depresión, donde los adolescentes llegan a ser 2,3 veces más propensos a presentar problemas de salud mental. Las familias se ven afectadas inicialmente en el período de debut por un estado de shock, con sentimientos de angustia e ira. Los necesarios cambios de hábitos y estilos de vida pueden generar problemas psicosociales entre los que destacan trastornos ansiosos, depresivos y alimenticios. Posteriormente, el niño o adolescente y su grupo familiar pueden transitar a un nuevo equilibrio caracterizado por un buen autocontrol y adherencia al tratamiento o profundizar los trastornos individuales y grupales, trastornos que pue den reaparecer, especialmente en la adolescencia. El tratamiento integral de la diabetes mellitus tipo 1 requiere atender estos aspectos mediante equipos multidisciplinarios que incluyen profesionales médicos y del ámbito psicosocial. En esta revisión se analizan los principales aspectos relacionados al impacto psicosocial en niños y adolescentes con diabetes mellitus tipo 1 y sus familias.

Type 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental health problems. Families are initially affected, in the debut period by a state of shock, with feelings of distress and anger. The necesary changes in habits and lifestyles can lead to psychosocial problems, including anxiety, depression and eating disorders. Subsequently, the child or adolescent and his or her family group may move into new balance characterized by good self-control and adherence to tratment, or deepen individual and group disorders which may reappear, especially in adolescence. The comprehensive treatment of type 1 diabetes mellitus requires addressing these aspects through multidisciplinary teams which include medical and phychosocial professionals. This review analyses the main aspects related to the psychosocial impact of diabetes mellitus type 1 among children, adolescents and their families.

Impacto de la diabetes tipo 1 en el desarrollo neurocognitivo de niños entre 5 y 18 años / Impact of type-1 diabetes on neurocognitive development in children between 5 and 18 years of age

Introducción: la diabetes tipo 1 es la segunda enfermedad crónica más frecuente de la infancia. Dentro de sus comorbilidades de la diabetes tipo 1, los efectos sobre el riñón, la retina, los nervios, los vasos sanguíneos y el sistema cardiovascular son ampliamente conocidos, sin embargo y a pesar de su importancia, en los niños, aún se conoce poco acerca del impacto de la diabetes tipo 1 sobre el sistema nervioso central en desarrollo. Objetivo: estudiar el desarrollo neurocognitivo alcanzado por nuestros pacientes con diabetes tipo 1 de comienzo temprano, analizando su relación con el control metabólico de la enfermedad y con factores socio-ambientales. Material y Métodos: se realizó un estudio descriptivo, observacional y transversal, con análisis retrospectivo. Fueron incluidos los niños atendidos en el Hospital de Pediatría Garrahan, con diabetes tipo 1, con comienzo de la enfermedad antes de los 7 años de vida. Se evaluó perfil neurocognitivo incluyendo capacidad cognitiva general, razonamiento verbal y perceptivo motor, velocidad de procesamiento y memoria operativa. Las variables metabólicas analizadas fueron mal control por hiperglucemia o por hipoglucemia y grado de descompensación al debut. Resultados: El coeficiente intelectual total se relacionó significativamente con educación secundaria materna. (R2 0.56 F= 5.21, p= 0.01). El índice de comprensión verbal se relacionó significativamente tanto con el escore de hiperglucemia como con educación secundaria materna. (R2 0.56 F= 5.16, p= 0.01). El índice de velocidad de procesamiento presentó relación significativa solo con el valor de bicarbonato al debut. (R2 0.39 F= 3.72, p= 0.03) y el índice de memoria operativa presentó relación significativa con vivienda propia y valor de bicarbonato al debut. (R2 0.50 F= 5.32, p= 0.009). Los pacientes con mayores eventos de hipoglucemias no presentaron diferencias significativas en ninguna variable neurocognitiva con respecto a los demás. Conclusión: hemos hallado alteraciones neurocognitivas leves asociadas principalmente a hiperglucemia, grado de descompensación al debut y a causas socioambientales. Resulta clara la necesidad de alcanzar objetivos de control glucémico con el fin de evitar o retrasar la posible aparición de complicaciones crónicas entre las cuales deben incluirse las que afectan al sistema nervioso central en desarrollo (AU)

Introduction: Type-1 diabetes is the second-most common chronic disease in childhood. Among the co-morbidities of type-1 diabetes, kidney, retina, nerve, blood-vessel, and cardiovascular involvement is widely known; however, in spite of its importance in children little is known about the impact of type-1 diabetes on the developing central nervous system. Aim: To study neurocognitive development in our patients with early-onset type-1 diabetes, with a focus on the association with metabolic control of the disease. Material and Methods: A descriptive, observational, and transsectional study was conducted using retrospective data analysis. Children with type-1 diabetes with a disease onset before 7 years of age seen at the pediatric Hospital Garrahan were included in the study. The neurocognitive profile was assessed, including general cognitive abilities, verbal and perceptive motor reasoning, processing speed, and working memory. Metabolic variables evaluated were poor hyperglycemia control or hypoglycemia and degree of decompensation at onset. Results: Total intellectual quotient was significantly related to maternal secondary education (R2 0.56 F= 5.21, p= 0.01). Verbal comprehension index score was significantly associated both with hyperglycemia score and maternal secondary education (R2 0.56 F= 5.16, p= 0.01). Processing speed index was significantly related only to bicarbonate levels at onset (R2 0.39 F= 3.72, p= 0.03) and working memory index was significantly related to family homeownership and bicarbonate levels at onset (R2 0.50 F= 5.32, p=0.009). Patients with a greater number of hypoglycemia events did not have significant differences in any of the neurocognitive variables compared to the other children. Conclusion: We found that mild neurocognitive impairment was mainly associated with hyperglycemia, degree of decompensation at onset, and environmental causes. There is a clear need to achieve the goal of glycemia control so as to avoid or delay possible chronic complications including those that affect the developing central nervous system (AU)

Quality of life of adolescents with type 1 diabetes

INTRODUCTION: Diabetes mellitus is a highly prevalent chronic disease. Type 1 diabetes mellitus usually develops during infancy and adolescence and may affect the quality of life of adolescents. OBJECTIVE: To evaluate the quality of life of adolescents with type 1 diabetes mellitus in a metropolitan region of western central Brazil. METHODS: Adolescents aged 10-19 years who had been diagnosed with type 1 diabetes mellitus at least 1 year previously were included. Patients with verbal communication difficulties, severe disease, and symptomatic hypo- or hyperglycemic crisis as well as those without an adult companion and who were <18 years of age were excluded. The self-administered Diabetes Quality of Life for Youths instrument was applied. RESULTS: Among 96 adolescents (57% females; 47% white, and 53% nonwhite), 81% had an HbA1c level of >7%. In general, the adolescents consistently reported having a good quality of life. The median scores for the domains of the instrument were as follows: “satisfaction”: 35; “impact”: 51; and “worries“: 26. The total score for all domains was 112. Bivariate analysis showed significant associations among a lower family income, public health assistance, and insulin type in the “satisfaction” domain; and a lower family income, public health assistance, public school attendance, and a low parental education level in the “worries“ domain and for the total score. A longer time since diagnosis was associated with a lower total score. Multivariable analysis confirmed the association of a worse quality of life with public health assistance, time since diagnosis, and sedentary lifestyle in the “satisfaction” domain; female gender in the “worries” domain; and public health assistance for the total score. CONCLUSIONS: Overall, the adolescents evaluated in this study viewed their quality of life as good. Specific factors that ...

Comportamiento sanitario de pacientes con diabetes tipo I. Hospital de Niños de Santísima Trinidad de Córdoba. enero 2010-diciembre 2011

El presente trabajo de investigación tiene por objeto analizar elcomportamiento sanitario de pacientes que padecen patologías crónicas enel Hospital de Niños de la Santísima Trinidad de la Ciudad de Córdoba, y seelige entre estas patologías los pacientes con Diabetes Tipo 1. Para elestudio se utiliza la base de datos proporcionada por el Servicio de Diabetesdel Hospital. Se analiza la composición del grupo etario, la localizacióngeográfica de los pacientes, la asistencia a los controles correspondientes, ylas internaciones en relación al grado de cumplimiento de dichos controles.Además, y en función de los actores directos intervinientes en la atención delos pacientes internados, se determina el costo de la internación, ya seatanto en camas críticas como en sala, estableciendo una comparación con elcosto del paciente que se atiende por consultorio sin necesitar internaciónalguna.El procesamiento de los datos reveló la existencia, en general, de una buenaadhesión al tratamiento terapéutico por parte de los pacientes. Ello permiteinferir que el vínculo médico-paciente ha sido logrado, dado que, un grannúmero de ellos a pesar de haber superado la edad pediátrica, continúanasistiendo al Hospital para ser atendidos.Además, se infiere en la trascendencia de la tarea docente que imparte elequipo de salud a los padres y pacientes, por un lado, y la importancia de lacapacidad de captar el mensaje por parte del adulto que acompaña almenor, ya que existe una total dependencia del niño al momento de concurrira la consulta, y ser consecuente con el tratamiento terapéutico.En este último caso, se observa una adecuada disposición de las familias enacompañar y contener a los niños que transitan en esta patología...

This research aims to analyze health outcomes of hospitalized patients withchronic pathologies in the Hospital de Niños de la Santísima Trinidad de laProvincia of Córdoba. For the completion of this study the Diabetes Servicehas provided the database. Composition of the age group, geographicallocation of patients, attendance to the corresponding controls, and hospitaladmissions in relation to the degree of compliance with the controls areanalyzed.Depending on the participants in the care of inpatients, the cost ofhospitalization both in critical cases, and in general wards is determined, andit is compared to the cases of outpatients.Data processing revealed the existence of a good therapy compliance, whichallows to infer that physician-patient relationship has been successful, sincea large number of patients, despite having surpassed pediatric age, continueto attend the Hospital.The importance of the teaching task to parents and patients carried forwardby the health team, and the importance of the ability to grasp the message bythe adult accompanying the child, can also be inferred, especially bearing inmind the total reliance of the child at the time of going to consultation and thefact of being consistent with therapeutic treatment.In this latter case, a suitable family predisposition is observed whenaccompanying and holding children under this pathology...

Anxiety disorders are associated with quality of life impairment in patients with insulin-dependent type 2 diabetes: a case-control study

Objective: To assess the presence of anxiety disorders and quality of life in patients with insulin-dependent type 2 diabetes. Methods: Case-control study of 996 patients with type 2 diabetes and 2,145 individuals without diabetes. The sole inclusion criterion for the case group was insulin-dependent type 2 diabetes. We compared the case and control groups for sociodemographic variables, laboratory and clinical data, and presence of anxiety disorders. Quality of life was evaluated using the WHOQOL-BREF instrument, and the prevalence of anxiety disorder was evaluated by the Mini International Neuropsychiatric Interview (MINI). Results: Patients with diabetes had a higher prevalence of generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder. The presence of these disorders in combination with type 2 diabetes was associated with worse quality of life in the physical, social, psychological, and environmental domains. Conclusions: This study demonstrates the importance of diagnosing and treating anxiety disorders in patients with diabetes, so as to prevent more serious complications associated with these comorbidities. .

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study / Comorbidade psiquiátrica no diabetes tipo 1: um estudo transversal observacional

Objective This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. Methods A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). Results With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). Conclusion The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident. .

Objetivo Elementos relacionados à saúde mental do paciente diabético tipo 1 são encontrados em várias pesquisas. O objetivo desse estudo é avaliar sinais e sintomas depressivos nesse grupo de pacientes, como também investigar as principais prevalências psiquiátricas que os acometem. Métodos Pesquisa realizada em 110 pacientes diabéticos atendidos em ambulatórios (média = 58.3, D = 14.5; 50 masculinos e 60 femininos) conduzida em Postos de Saúde Pública nos momentos de consulta médica com endocrinologista. A avaliação transcorreu com as escalas Mini International Neuropsychiatric Interview and Hospital Anxiety and Depression Scale (HADS). Resultados Os sintomas de ansiedade tiveram prevalência de 60% (n = 66), enquanto para depressão encontramos resultados de 53.6% (n = 59), considerando que 110 pacientes foram avaliados. Mais especificamente, nós encontramos 28,2 (n. 31) pacientes sem depressão ou ansiedade, 13,6 (n. 15) pacientes com depressão, 16,4 pacientes (n. 18) com ansiedade e 41,8 (n. 46) pacientes com depressão combinada com ansiedade. Outros transtornos comórbidos tiveram prevalência de ansiedade generalizada (22,7%), distimia (18,2%), pânico (8,2%) e fobia social (5,5%). Conclusão Sintomas ansiosos e depressivos são comuns em pacientes diabéticos do tipo 1, porém há prevalência de psicopatologias diversas nesse grupo de pacientes, levando em conta novas necessidades de pesquisas futuras para validar protocolos de tratamentos mais adequados para diabéticos do tipo 1. .

Acampamento de férias para jovens com Diabetes Mellitus Tipo I: achados da abordagem psicológica / Vacation camp for children and adolescents with Type 1 Diabetes Mellitus: findings of the psychological approach

Diabetes Mellitus Tipo 1 requer tratamento intensivo no sentido de reduzir o aparecimento e a progressão das suas complicações. Abordagens educacionais são fundamentais para se alcançar o melhor controle metabólico possível. Visando descrever como crianças e adolescentes, participantes de um Acampamento de Férias, percebem sua condição diabética e o tratamento, foram realizadas 98 entrevistas semidirigidas. Os resultados mostraram que o diagnóstico é sempre um fator impactante, difícil de ser aceito pelo jovem e seus familiares. O suporte da família e amigos, quando excessivo, prejudica a qualidade da adaptação. Eles consideram suas vidas sociais restritas e sofrem com o controle imposto pelo tratamento. Consideraram o ambiente do Acampamento de Férias propício para aprender sobre a doença, promover sua independência afetiva e autonomia na auto-monitorização.

Type 1 Diabetes Mellitus requires intensive treatment in order to reduce the incidence and progression of complications. Educational measures are fundamental to reach the best metabolic control possible. This study realized 98 semi-structured interviews aimed to describe how children and adolescents, participants in a Vacation Camp, perceive their diabetic condition and treatment. The results revealed that the diagnosis is always an impacting factor, difficult to be accepted by the young ones and their families. The support from family and friends when excessive impairs their adaptation. They consider their social lives very restricted and suffer with the control imposed by the treatment. They consider the environment of the vacation camp appropriate to learn about their illness and to promote affective independence and autonomy into self-monitoring.

Vivendo com o diabetes: a experiência contada pela criança / Living with diabetes: the experience as it is told by children

O diabetes mellitus como uma doença crônica exige adaptação nos âmbitos psicológico, social e físico. Este estudo tem por objetivo compreender a experiência da criança na vivência com a doença. Os referenciais teórico e metodológico utilizados foram o Interacionismo Simbólico e a Teoria Fundamentada nos Dados, respectivamente. Entrevistou-se 12 crianças na faixa etária entre 7 e 14 anos. Um total de 7 temas foram identificados nos dados coletados, sendo eles: Vivendo algo inesperado, Enfrentando uma dura realidade, Tendo medo do que está acontecendo, Vivendo sob controle, Tentando adaptar-se à nova realidade", Amadurecendo com a convivência, Olhando para a doença de um jeito diferente. A vivência com o diabetes é algo que a criança enfrenta a cada dia, desde o momento do diagnóstico, tendo limitações na dieta, a inserção da insulinoterapia, a mudança no estilo de vida, fatos esses que desencadeiam sentimentos que oscilam entre medo, insegurança, revolta, aceitação e adaptação

Reflexões sobre o diabetes tipo 1 e sua relação com o emocional / Reflections on the diabetes type 1 and its relation to the emotional aspect

Este artigo tem como tema central o diabetes tipo 1 ou infanto-juvenil. Tendo em vista as repercussões que esta doença crônica traz, este trabalho levantou dados bibliográficos que subsidiassem reflexões sobre os aspectos emocionais vivenciados pelas crianças diabéticas. O resultado mostrou que o emocional influi na etiologia do diabetes e que o diabetes também influi no emocional desta criança. Isso ocorre devido aos cuidados incessantes para controle da doença, medo das possíveis complicações, mal-estar provocado pelos sintomas de hiper e hipoglicemia, o fato de ser "diferente". Sendo assim, é necessário um acompanhamento desta criança não só por médicos, mas também por outros profissionais da saúde, entre eles o psicólogo, objetivando elaboração dos aspectos referentes à doença e suas repercussões emocionais.

Adherencia al tratamiento en adolescentes diabéticos tipo 1 chilenos: una aproximación psicológica / Psychological factors associated to patient's treatment compliance in Chilean diabetic teenagers

Background: Treatment compliance among patients with type 1 diabetes mellitus, is low in 50percent of diabetic teenagers, becoming a social and medical problem. Aim: To determine psycho-social factors associated to treatment compliance among Chilean diabetic type 1 teenagers. Patients and methods: A non experimental study of 61 diabetic teenagers (age 14.9±1.9 years, 37 male). The number of blood glucose determinations, socioeconomic level and practice of sports was measured. Psychological tests were applied to analyze self-efficiency, motivation of achievement, self-esteem and knowledge of the illness and its treatment. As a measure of patient compliance, glycosilated hemoglobin (HB1Ac) was measured. Results: Six patients had a good control of diabetes (HB1Ac <7percent), 24 had HB1Ac values between 7 and 8.9, and 31 (51percent) had values of 9percent or more, considered as a poor diabetes control. The intensified insulin treatment scheme, the knowledge of the illness and its treatment and the sense of self-efficiency, were the factors associated with a better compliance with treatment. Teenagers of higher socio-economical levels had a better compliance with treatment. Conclusions: Fifty percent of Chilean diabetic teenagers in this sample had a poor control of the disease and the variable knowledge about the disease is the better predictor of patient compliance.

Adolescentes com Diabetes mellitus tipo 1: seu cotidiano e enfrentamento da doença / Adolescents with Diabetes mellitus type 1: daily routine and coping

Diabetes mellitus Tipo 1 é uma doença crônica com incidência de 2/1000 adolescentes, que podem ter seu cotidiano alterado. Visando a descrever e analisar como esses adolescentes organizam suas atividades diárias e enfrentam a condiçäo de apresentarem uma doença crônica, foram entrevistados 15 adolescentes que freqüentavam programas de saúde pública para portadores de diabetes em Vitória, ES, que responderam também ao Mapeamento de Atividades Cotidianas-MAC. Este questionário foi aplicado também em 224 estudantes de escolas públicas sem diabetes. Foram feitas análises quantitativas do MAC e análise de conteúdo das entrevistas. Os dados revelaram que os adolescentes, em geral, relataram fazer mais atividades dirigidas para si e que säo realizadas dentro de casa, como assistir televisäo. Os adolescentes com diabetes indicaram algumas dificuldades com a doença, como faltas à escola para ir a consultas médicas, mas näo consideraram ter seu cotidiano modificado, näo havendo diferenças significativas entre os dois grupos