ABSTRACT
The purpose of this study was to look at the determinants of the unsteady walking (UW) symptom in patients with type 2 diabetes mellitus (T2DM) by defining if UW and/or the Diabetic Neuropathy Symptoms Score (DNSS) are associated with positive scores in Beck's Depression Inventory (BDI) and with a positive Michigan Neuropathy Screening Instrument score (MNSI). We evaluated 203 T2DM patients without visible gait disturbances. They were divided into UW (+) and UW (−) or DNSS (+) and DNSS (−) according to symptoms. We found a prevalence of 48.3% for UW (+) and of 63% for DNSS (+) in our sample. In univariate analysis, the presence of UW was significantly associated with waist circumference (P=0.024), number of comorbidities (P=0.012), not practicing physical exercise (P=0.011), positive BDI score (P=0.003), presence of neuropathic symptoms by the MNSI questionnaire (P<0.001), and positive diabetic neuropathy screening by MNSI (P=0.021). In multivariate analysis, UW (used as a dependent variable) was independently associated with a positive BDI score (P<0.001; 95%CI=1.01-1.03), T2DM duration (P=0.023; 95%CI=1.00-1.03), number of co-morbidities (P=0.032; 95%CI=1.01-1.37), and a sedentary lifestyle (P=0.025; 95%CI=1.06-2.5). The UW symptom and a positive DNSS are more closely related to a positive score for depression than to presence of neuropathy in T2DM.
Subject(s)
Humans , Male , Female , Middle Aged , Depression/psychology , Diabetes Mellitus, Type 2/complications , Diabetic Neuropathies/complications , Sedentary Behavior , Sensation Disorders/etiology , Walking/physiology , Cross-Sectional Studies , Diabetic Neuropathies/physiopathology , Diabetic Neuropathies/psychology , Mass Screening , Prevalence , Severity of Illness IndexABSTRACT
OBJETIVO: Avaliar o impacto dos sintomas depressivos e da dor neuropática na qualidade de vida (QV) de pacientes diabéticos com polineuropatia distal diabética (PNDD). MÉTODOS: Foram avaliados 204 pacientes com diabetes melito tipo 2. O diagnóstico de PNDD foi realizado por meio do Escore de Sintomas Neuropáticos e Escore de Comprometimento Neuropático. A gravidade da dor neuropática foi avaliada por meio da Escala Visual Analógica (EVA); os sintomas depressivos, por meio do Inventário Beck de Depressão (IBD); a QV, com o World Health Organization Quality of Life abreviado (WHOQOL-bref). RESULTADOS: Pacientes com PNDD apresentaram escores mais altos no IBD (12,6 ± 7,2 versus 9,9 ± 7,3; p = 0,018) e no EVA (5,0 ± 2,4 versus 2,6 ± 2,9, p < 0,001). Em relação à QV, apresentaram escores mais baixos no domínio físico (52,8 ± 15,5 versus 59,2 ± 17,0; p = 0,027) e ambiental (56,6 ± 12,3 versus 59,6 ± 13,6; p = 0,045). CONCLUSÕES: Pacientes diabéticos com PNDD apresentam pior QV nos domínios físico e ambiental do WHOQOL-bref, provavelmente devido à maior sintomatologia depressiva e gravidade de dor.
OBJECTIVE: To investigate the impact of depressive symptoms and neuropathic pain in the quality of life (QL) of diabetic patients with diabetic distal polyneuropathy (DDP). METHODS: Two hundred and four patients with type 2 diabetes mellitus were evaluated. The diagnosis of DDP was achieved using the Neuropathy Disability Score and Neuropathy Symptom Score questionnaires. The severity of neuropathic pain was assessed by means of a Visual Analogue Scale (VAS); the severity of depression, by means of the Beck Depression Inventory (BDI); and QL was assessed by means of the World Health Organization Quality of Life Instrument-bref (WHOQOLbref). RESULTS: Patients with DDP presented significant higher scores in BDI (12.6 ± 7.2 versus 9.9 ± 7.3; p = 0.018) and in VAS (5.0 ± 2.4 versus 2.6 ± 2.9; p < 0.001). They also presented significant lower scores in the physical (52.8 ± 15.5 versus 59.2 ± 17.0; p = 0.027) and environmental domains (56.6 ± 12.3 versus 59.6 ± 13.6; p = 0,045). CONCLUSIONS: Diabetic patients with DDP presented a worse QL in the physical and environmental domains of the WHOQOL-bref, probably due to more depressive symptoms and the severity of pain.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Depression/psychology , /psychology , Diabetic Neuropathies/psychology , Neuralgia/psychology , Quality of Life , Depression/diagnosis , Diabetic Neuropathies/diagnosis , Epidemiologic Methods , Neuralgia/diagnosisABSTRACT
A neuropatia diabética periférica é uma das complicações do diabetes mellitus, definida como uma disfunção dos nervos periféricos, que aliada à má perfusão sanguínea, ocasiona o surgimento de feridas, especialmente nos membros inferiores. Estudo descritivo, realizado no hospital Universitário Alcides Carneiro, entre maio e junho de 2005. Avaliou a percepção de portadores de pé diabético frente à prática de autocuidado, mediante a utilização de entrevista e uma ficha de observação. Os resultados evidenciaram ausência da prática do autocuidado, inferindo a necessidade de ações educativas voltadas à realidade sócio-cultural dos portadores.
Subject(s)
Humans , Self Care , Diabetic Neuropathies/psychology , Diabetic FootABSTRACT
The objective of the present study was to establish the frequency of psychiatric comorbidity in a sample of diabetic patients with symmetric distal polyneuropathy (SDPN). Sixty-five patients with type 2 diabetes mellitus were selected consecutively to participate in the study at Instituto Estadual de Diabetes e Endocrinologia. All patients were submitted to a complete clinical and psychiatric evaluation, including the Portuguese version of the structured clinical interview for DSM-IV, the Beck Depression Inventory, the Neuropathy Symptom Score, and Neuropathy Disability Score. SDPN was identified in 22 subjects (33.8 percent). Patients with and without SDPN did not differ significantly regarding sociodemographic characteristics. However, a trend toward a worse glycemic control was found in patients with SDPN in comparison to patients without SDPN (HbA1c = 8.43 ± 1.97 vs 7.48 ± 1.95; P = 0.08). Patients with SDPN exhibited axis I psychiatric disorders significantly more often than those without SDPN (especially anxiety disorders, in general (81.8 vs 60.0 percent; P = 0.01), and major depression - current episode, in particular (18.2 vs 7.7 percent; P = 0.04)). The severity of the depressive symptoms correlated positively with the severity of SDPN symptoms (r = 0.38; P = 0.006), but not with the severity of SDPN signs (r = 0.07; P = 0.56). In conclusion, the presence of SDPN seems to be associated with a trend toward glycemic control. The diagnosis of SDPN in diabetic subjects seems also to be associated with relevant psychiatric comorbidity, including anxiety and current mood disorders.
Subject(s)
Humans , Male , Female , Middle Aged , /psychology , Diabetic Neuropathies/psychology , Mental Disorders/epidemiology , Polyneuropathies/psychology , Ambulatory Care/statistics & numerical data , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Mental Disorders/diagnosis , Mental Disorders/etiology , Psychiatric Status Rating Scales/statistics & numerical data , Severity of Illness Index , Socioeconomic FactorsABSTRACT
Com base em conceitos axiais da psicologia médica, o autor estuda dois tipos de pacientes largamente encontrados nos serviços médicos em todo o mundo: aqueles acometidos por doenças somáticas crônicas e os doentes psicologicamente crônicos. Neste estudo, ele enfatiza as peculiaridades de ambos os tipos de pacientes entre os diabéticos particularmente os que sofrem de polineuropatia diabética