Associação entre a adesão terapêutica e o controle glicêmico de pacientes com Diabetes Mellitus tipo 2 / Association between therapeutic adherence and glycemic control in patients with type 2 diabetes mellitus

Introdução: A adesão ao tratamento no diabetes mellitus é fundamental para o controle metabólico, prevenção de complicações, melhoria e manutenção da qualidade de vida. Objetivo: Avaliar a associação entre a adesão ao tratamento farmacológico e o controle glicêmico de pacientes diabéticos tipo 2 e investigar fatores associados a essas condições. Método: Estudo transversal com pacientes ≥ 18 anos com diabetes mellitus tipo 2, atendidos em um serviço privado de endocrinologia, em uso de antidiabéticos orais há pelo menos 6 meses e com dosagem de hemoglobina glicada (HbA1c) de no máximo 12 meses. Foram utilizados a MMAS-8 (Morisky Medication Adherence Scale) e um questionário com dados sociodemográficos e clínicos. Resultados apresentados em razão de prevalência (RP) e intervalo de confiança (IC) 95%, ajustados por regressão logística pelo método enter. O nível de significância estatística adotado foi de 5%. Resultados: Participaram do estudo 134 pacientes, com média de 56,7 ± 12,9 anos, sendo 58,2% mulheres. A adesão terapêutica foi demonstrada por 78,4% dos pacientes, havendo associação positiva com a escolaridade e negativa em relação à idade e ao tempo de diagnóstico. O controle glicêmico foi verificado por 68,7%, não havendo diferença estatisticamente significativa em relação a sexo, idade, raça, escolaridade e tempo de diagnóstico. Entre os pacientes considerados aderentes, 77,1% apresentaram controle adequado da glicemia, enquanto entre pacientes considerados não aderentes, 37,9% foram considerados controlados (p<0,001). Conclusão: A adesão ao tratamento farmacológico esteve associada ao controle glicêmico em pacientes com diabetes tipo 2, acompanhados em consultório privado de endocrinologia.

Introduction: Treatment adherence in diabetes mellitus is essential for metabolic control, complication prevention, quality of life improvement and maintenance. Objective: To assess the association between adherence with pharmacological treatment and glycemic control in patients with type 2 diabetes and investigate factors associated with these conditions. Method: This is a cross-sectional study with patients ≥ 18 years old with type 2 diabetes mellitus, treated at a private endocrinology service, using oral antidiabetics for at least 6 months and with a glycated hemoglobin (HbA1c) measurement for a maximum of 12 months. The MMAS-8 (Morisky Medication Adherence Scale) and a questionnaire with sociodemographic and clinical data were used. Results presented as prevalence ratio (PR) and 95% confidence interval (CI), adjusted by logistic regression using the enter method. The level of statistical significance adopted was 5%. Results: A total of 134 patients participated in the study, with a mean age of 56.7 ± 12.9 years, 58.2% of whom were women. Therapeutic adherence was demonstrated by 78.4% of patients, with a positive association with education and a negative association with age and time since diagnosis. Glycemic control was verified by 68.7%, with no statistically significant difference in relation to sex, age, race, education and time since diagnosis. Among patients considered adherent, 77.1% had adequate glycemic control, while among patients considered non-adherent, 37.9% were considered controlled (p<0.001). Conclusion: Pharmacological treatment adherence was associated with glycemic control in patients with type 2 diabetes followed up in a private endocrinology office.

Maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years: a case control study

ABSTRACT Objective To determine the maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years. Methods A case-control study conducted with children aged 6 to 7 years. Applications with questions about asthma symptoms in the last 12 months, maternal and childhood data in the first 2 years of life, and anthropometric data were collected. Children who presented asthma symptoms were considered as cases and those without asthma symptoms were considered as controls, later divided into two subgroups that were eutrophic or overweight/obesity. Logistic regression was performed to estimate the association between asthma symptoms (adequate weight and overweight/obesity) and gestational and personal factors, calculating odds ratio and 95% confidence interval (95%CI). Values of p<0.05 were considered significant. Results Two hundred and one children were evaluated, 25.4% had asthma symptoms, 37.2% of them were overweight/obesity. Waist circumference, triceps skinfold, and body mass index were higher in the group with overweight/obesity asthma symptoms compared to no asthma symptoms (p<0.05). Factors significantly associated with asthma and overweight/obesity symptoms included: the maternal history of asthma (odds ratio of 3.73; 95%CI: 1.10-12.6) and hypertension during pregnancy (odds ratio of 3.29; 95%CI: 1.08-9.94). Conclusion Maternal history of asthma and hypertension during pregnancy increased the chances of children, at 6 and 7 years of age, having symptoms of asthma and obesity.

Qualidade de vida de crianças e adolescentes com diabetes mellitus tipo 1 / Quality of life of children and adolescents with type 1 diabetes mellitus

Introdução: O diabetes mellitus tipo 1 (DM1) é uma doença autoimune, poligênica, decorrente de destruição das células ß pancreáticas, ocasionando deficiência completa na produção de insulina. Objetivo: avaliar a qualidade de vida (QV) de crianças e adolescentes com diabetes mellitus tipo 1 (DM1), seu perfil clínico e epidemiológico. Métodos: Estudo transversal, que incluiu crianças e adolescentes com idade entre 2 e 18 anos, que frequentavam uma Associação de Diabéticos Infanto Juvenis de Santa Catarina. Para avaliação utilizou-se dados sociodemográficos, de caracterização da doença e seu controle e o Questionário de QV Pediátrico PedsQL 3.0 - Módulo Diabetes Mellitus. Resultados: Participaram do estudo 30 crianças e adolescentes, sendo a média de idade de 12,6 anos (DP±3,7 anos); 56,7% eram do sexo feminino, 70% com diagnóstico entre 5 e 7 anos de idade, e 96,6% frequentavam a ADIJT há menos de 5 anos. A minoria dos pacientes apresentou um bom controle de hemoglobina glicada (23,3%). Verificou-se uma correlação forte e significativa entre os pacientes e seus responsáveis nos escores de QV segundo sintomas (R2=0,701), barreiras no tratamento (R2=0,759) e preocupações (R2=0,811), e uma diferença significativa para o domínio comunicação na comparação das crianças de 5 a 7 anos com as de 8 a 12 anos (p=0,042). Conclusão: Um grande percentual de pacientes com DM1 apresentou controle inadequado da doença, apesar da adequada autoavaliação de QV.

Introduction: Type 1 diabetes mellitus (T1DM) is an autoimmune polygenic disease resulting from the destruction of pancreatic ß cells, causing a complete deficiency in insulin production. Objective: To evaluate the quality of life (QoL) of children and adolescents with type 1 diabetes mellitus (T1DM), their clinical and epidemiological profile. Methods: A cross-sectional study, which included children and adolescents aged between 2 and 18 years, who attended an Association of Diabetic Children and Youth (ADIJT) in Santa Catarina. For evaluation, we used sociodemographic data, characterization of the disease and its control, and the Pediatric QoL Inventory PedsQL 3.0 ­ Diabetes Mellitus Module. Results: Thirty children and adolescents participated in the study, with a mean age of 12.6 years (SD±3.7 years); 56.7% were female, 70% were diagnosed between 5 and 7 years of age, and 96.6% had attended ADIJT for less than 5 years. A minority of patients had a good control of glycated hemoglobin (23.3%). There was a strong and significant correlation between patients and their caregivers in QOL scores according to symptoms (R2=0.701), barriers to treatment (R2=0.759) and concerns (R2=0.811), and a significant difference for the communication domain in the comparison of 5-7-year-olds with 8-12-year-olds (p=0.042). Conclusion: A large percentage of patients with T1DM had inadequate disease control, despite adequate QOL self-assessment.

Relação entre índice de massa corporal e asma em adolescentes escolares de São José, Santa Catarina, Brasil / Association between body mass index and asthma symptoms among teenage students in São José, Santa Catarina, Brazil

Objetivo: Identificar a relação entre o IMC e os sintomas e gravidade de asma em adolescentes escolares. Metodologia: Trata-se de um estudo transversal de base populacional em escolas públicas e particulares do município de São José ­ SC, incluindo adolescentes entre 12 a 14 anos de idade. As características de asma foram avaliadas pelo questionário International Study of Asthma and Allergies in Childhood (ISAAC). O indicador antropométrico para classificar o grau nutricional nos adolescentes foi Índice de Massa Corpórea. O nível de significância foi de p > 0,05, e os dados foram analisados usando Statistical Package for the Social Sciencies (SPSS) versão 20.0. Resultados: Foram avaliados estudantes adolescentes (n=2042; 1116 [54,6%] feminino). Um total de 26,4% adolescentes apresentou IMC com percentil >85º, sem diferença estatisticamente significativa entre os que apresentaram critérios para asma e os que não tinham sintomas de asma (28,1% versus 26,3%; p = 0,633). Apenas 263 adolescentes apresentaram critérios de provável asma, mostrando uma prevalência de 13% da doença, em relação a gravidade a maioria apresentou uma menor gravidade não tendo uma associação significativa com sobrepeso e/ou obesidade. Não se encontrou nenhuma relação entre prevalência de sintomas, gravidade e o estado nutricional entre os adolescentes asmáticos eutróficos, com sobrepeso ou obesidade. Conclusão: Este estudo mostrou elevada prevalência de sobrepeso e/ou obesidade entre os adolescentes escolares, independente da presença de sintomas de asma. Entre aqueles com sintomas de asma, houve predomínio de sobrepeso no gênero feminino, entretanto a gravidade dos sintomas de asma não foi associada ao IMC.

Introduction: The association between asthma and obesity in adolescents has been investigated; however, findings from the literature are still controversial. Objective: To identify the association between body mass index (BMI) and asthma symptoms and severity among students aged 12-14 years. Methodology: Cross-sectional population-based study conducted in public and private schools in São José, Santa Catarina, Southern of Brazil. Asthma symptoms were assessed using the International Study of Asthma and Allergies in Childhood (ISAAC). BMI (greater than or equal to the 85percentile) was used to assess the nutritional status. Data were analyzed using descriptive statistics. The association between overweight/obesity (BMI ≥ 85 percentile) and asthma severity was analyzed by calculating odds ratios and confidence intervals. The level of significance was set at p <0.05.Results: A total of 2,042 adolescents (54.6% female) were surveyed. The prevalence of asthma symptoms was 13%, with predominance in female. Of the total, 26.4% had a BMI ≥ 85 percentile. No statistically significant difference was found between the groups with and without asthma symptoms (28.1% versus 26.3%; p = 0.633). No significant associations were found between prevalence and severity of asthma symptoms and overweight and/or obese subjects. Conclusion: There was a high prevalence of overweight and/or obesity among adolescents, regardless of the presence of asthma symptoms. Among those with asthma symptoms, there was a prevalence of overweight among girls, though severity of asthma symptoms was not associated with BMI.