Conhecimento dos pacientes diabéticos usuários do Sistema Único de Saúde acerca da retinopatia diabética / Knowledge of diabetic patients users of the Health Unic System about diabetic retinopathy

Resumo Objetivo: Avaliar o nível de conhecimento dos pacientes diabéticos, atendidos no Sistema Único de Saúde (SUS) na cidade de Boa Vista/Roraima, acerca da Retinopatia Diabética (RD). Métodos: Trata-se de um estudo transversal, descritivo, de caráter quantitativo, realizado através da aplicação de um questionário semi-estruturado para 150 indivíduos diabéticos, usuários do SUS, da cidade de Boa Vista - RR, durante o ano de 2017. As análises estatísticas foram realizadas utilizando os programas Microsoft Excel e EpiInfo 7®, fixando-se o nível de 5% para a rejeição da hipótese de nulidade. Resultados: Do total amostral pesquisado,76,7% dos indivíduos não possuía nenhum conhecimento sobre a RD, 19,3% tinha algum tipo de conhecimento, mas não possuía a patologia, 2,7% conhecia, possuía a RD e fazia tratamento e 1,3% conhecia, possuía a RD e não se tratava. Quanto a orientação, 40,6% dos participantes nunca recebeu nenhuma informação sobre o risco de perda da visão. Acerca do tipo de Diabetes, 44,7% dos participantes não sabia que tipo possuía, 42% relatou ter DM 2 e 13,3% DM1. Sobre o controle da glicose, 59,4% não conseguia mantê-lo. Foi evidenciada associação entre o controle da glicose e o conhecimento sobre RD, entre o tempo de instalação da DM e o conhecimento sobre RD e entre ter consultado um oftalmologista e conhecer sobre a RD. Conclusão: O nível de conhecimento sobre a RD é muito baixo, fator preocupante por tratar-se de uma das complicações mais importantes do Diabetes. Percebe-se que o sistema de saúde não está sendo eficiente como facilitador deste conhecimento.

Abstract Objective: To evaluate the level of knowledge of diabetic patients treated at the Unified Health System (SUS - Sistema Único de Saúde) in the city of Boa Vista / Roraima, about Diabetic Retinopathy (DR). Methods: This is a cross-sectional, descriptive, quantitative study conducted through the application of a semi-structured questionnaire for 150 diabetic individuals, SUS users, from the city of Boa Vista - RR, during the year 2017. Statistical analyzes were performed using the Microsoft Excel and EpiInfo 7® programs, setting the 5% level for the rejection of the null hypothesis. Results: Of the total sample, 76.7% of the individuals did not have any knowledge about DR, 19.3% had some type of knowledge, but did not have the pathology, 2.7% knew, had DR and was receiving treatment, 1,3% knew, had DR and was not receiving treatment. About orientation, 40.6% of the participants never received any information about the risk of vision loss. About the type of Diabetes, 44.7% of the participants did not know what type they had, 42% reported having DM 2 and 13.3% DM1. On glucose control, 59.4% could not maintain it. It was evidenced an association between glucose control and DR knowledge, between the time of DM installation and knowledge about DR, and between having consulted an ophthalmologist and knowing about DR. Conclusion: The level of knowledge about DR is very low, a worrying factor because it is one of the most important complications of diabetes. It is observed that the health system is not being efficient as facilitator of this knowledge.

Living under treatment for Systemic Hypertension and Diabetes Mellitus: Feelings and behaviors / Vidas en Tratamiento de la Hipertensión Arterial Sistémica y Diabetes Mellitus: sentimientos, comportamientos / Vidas em tratamento para Hipertensão Arterial Sistêmica e Diabetes Mellitus: sentimentos e comportamentos

ABSTRACT Objective: To understand the feelings and behaviors of people being treated for Systemic Hypertension (SH) and Diabetes Mellitus (DM). Method: A qualitative study based on Grounded Theory and Symbolic Interactionism, with 27 participants in treatment for SH and DM followed up by the Family Health Strategy team. Open, axial and selective coding was performed, giving rise to three theoretical categories and the central category. Results: The daily life is explicit in the (lack of)care of the self with the chronic disease and feelings of sadness and anxiety are expressed as reasons for the lack of control of the disease. It points out that people take care of themselves because of fear of complications, reinforced the need for guidance on the use of medication and the empowerment of the chronic patient for self-care and care for the other. Final considerations: Knowing behaviors and feelings of people with SH and/or DM allows a professional performance beyond the chronic condition.

RESUMEN Objetivo: Comprender los sentimientos y comportamientos de personas en tratamiento de la hipertensión arterial sistémica (HAS) y la diabetes mellitus (DM). Método: Estudio cualitativo basado en la Teoría Fundamentada en los Datos y en el Interaccionismo Simbólico, con 27 participantes en tratamiento de la HAS y DM, y acompañados por el equipo Estrategia Salud de la Familia. Se procedió a la codificación abierta, axial y selectiva que originó las tres categorías teóricas y la categoría central. Resultados: El cotidiano de la vida está explícito en el (des) cuidado de sí con una enfermedad crónica. Los sentimientos de tristeza y ansiedad se expresan como motivos condicionantes para el descontrol de la enfermedad. Se señala que las personas se cuidan movidas por el miedo a las complicaciones. Se reforzó la necesidad de orientación sobre el uso de la medicación y del empoderamiento del paciente crónico para el autocuidado y cuidado del otro. Consideraciones finales: Conocer los comportamientos y sentimientos de las personas con HAS y/o DM permite una actuación profesional más allá de la condición crónica.

RESUMO Objetivo: Compreender os sentimentos e comportamentos de pessoas em tratamento para a Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM). Método: Estudo qualitativo embasado na Teoria Fundamentada nos Dados e no Interacionismo Simbólico, com 27 participantes em tratamento para HAS e DM acompanhados pela equipe Estratégia Saúde da Família. Procedeu-se a codificação aberta, axial e seletiva que originaram três categorias teóricas e a categoria central. Resultados: O cotidiano de vida está explícito no (des)cuidado de si com a doença crônica e sentimentos de tristeza e ansiedade são expressos como motivos condicionantes para o descontrole da doença. Aponta que as pessoas se cuidam movidas pelo medo das complicações, reforçou a necessidade de orientação sobre o uso da medicação e do empoderamento do doente crônico para o autocuidado e cuidado do outro. Considerações finais: Conhecer comportamentos e sentimentos das pessoas com HAS e/ou DM permite uma atuação profissional além da condição crônica.

Association between diabetes mellitus and depressive symptoms in the Brazilian population

ABSTRACT OBJECTIVE To determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease. METHODS Data were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire-9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals. RESULTS Of the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62). CONCLUSIONS Interventions to improve depressive symptoms should be prioritized in people with diabetes are female, older adults, indigenous, widowed, separated/divorced, obese and with incomplete elementary education.

Family Health Strategies: Profile/quality of life of people with diabetes / Estrategias Salud de la Familia: perfil/calidad de vida de personas con diabetes / Estratégias Saúde da Família: perfil/qualidade de vida de pessoas com diabetes

ABSTRACT Objective: To evaluate the quality of life and to analyze the epidemiological profile of people with diabetes treated in Family Health Strategies. Method: A cross-sectional study carried out with 350 people with diabetes. Results: Most people with diabetes are women, elderly, married, white, with low educational level, retired/pensioners, family income of up to two minimum wages. As the time of people with the disease increases, their quality of life decreases. People with complications from diabetes have a lower quality of life, with a statistically significant difference. Conclusion: Knowledge of the sociodemographic characteristics, clinical evaluation and quality of life of people with diabetes can improve the care process provided to this population.

RESUMEN Objetivo: Evaluar la calidad de vida y analizar el perfil epidemiológico de las personas con diabetes atendidas en Estrategias Salud de la Familia. Método: Estudio transversal, realizado con 350 personas con diabetes. Resultados: Las personas con diabetes, en su mayoría, son mujeres, ancianas, casadas, blancas, con bajo nivel instruccional, jubiladas/pensionistas, renta familiar de hasta dos salarios mínimos. A medida que aumenta el tiempo de las personas con la enfermedad, disminuye su calidad de vida. Las personas que tienen complicaciones derivadas de la diabetes tienen una calidad de vida menor, con diferencia estadística significativa. Conclusión: El conocimiento de las características sociodemográficas, de evaluación clínica y de la calidad de vida de las personas con diabetes puede mejorar el proceso de cuidado prestado a esta población.

RESUMO Objetivo: Avaliar a qualidade de vida e analisar o perfil epidemiológico de pessoas com diabetes atendidas em Estratégias Saúde da Família. Método: Estudo transversal, realizado com 350 pessoas com diabetes. Resultados: As pessoas com diabetes, em sua maioria, são mulheres, idosas, casadas, brancas, com baixo nível instrucional, aposentadas/pensionistas, renda familiar de até dois salários mínimos. À medida que aumenta o tempo das pessoas com a doença, diminui a sua qualidade de vida. As pessoas que possuem complicações decorrentes do diabetes possuem uma qualidade de vida menor, com diferença estatística significativa. Conclusão: O conhecimento das características sociodemográficas, de avaliação clínica e da qualidade de vida das pessoas com diabetes pode melhorar o processo de cuidado prestado a esta população.

Variables psicológicas asociadas a adherencia, cronicidad y complicaciones en pacientes con diabetes mellitus tipo 2 / Psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus

Background:: Lack of adherence to treatment may hamper the management of type 2 Diabetes Mellitus. Aim To identify if there is a profile of psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus. Material and Methods: The psychometric instruments Multidimensional Scale of Locus of Control in Health, Locus of Control of Rotter and Inventory of Temporary Orientation of Zimbardo & Boyd were applied to 192 patients aged 64 ± 10 years (78% women) with type 2 diabetes attending public primary health clinics. Adherence to treatment was assessed using glycosylated hemoglobin levels. Results: There was an inverse association between glycosylated hemoglobin and adherence to treatment (p < 0.01). Adherence in patients with renal damage and diabetic foot was associated with the psychological variables Negative Time Perspective Profile (p < 0.05) and External Locus of Control Powerful Other (p < 0.05). Conclusions: A psychological profile associated with adherence was observed in the presence of kidney damage and diabetic foot. A fatalistic present and a negative past are the outstanding features of a negative temporal profile.

Vivências de pessoas com diabetes e amputação de membros / Experiences of people with diabetes and amputation of members / Vivencias de personas con diabetes y amputación de miembros

Trata-se de um estudo exploratório, descritivo, com abordagem qualitativa, na perspectiva fenomenológica heideggeriana. Foi desenvolvido no Centro Integrado de Saúde Dr. Lineu Araújo e em Unidades Básicas de Saúde, de Teresina (PI), tendo como sujeitos doze pacientes diabéticos e amputados. Utilizou-se como técnica para produção dos dados a entrevista fenomenológica. Na tentativa de aproximação e apropriação dos significados por eles atribuídos, foram construídas quatro Unidades de Significação. Nesta perspectiva, Ser-pessoa-com-diabetes-e-amputações de membros significa vivenciar um cotidiano permeado por dificuldades, limitações e restrições impostas pela situação; sofrer pela dependência de outras pessoas, pela solidão imposta pelo isolamento social, seja por limitações pessoais, econômicas e/ou inadequação das políticas públicas.

This is an exploratory, descriptive, qualitative study, built up on Heidegger's phenomenological perspective. It was developed at the Integrated Health Center Dr. Lineu Araújo and at Basic Health Units of Teresina (PI), with the subjects being twelve diabetic patients that have suffered member's amputation. Phenomenological interview was used, as the technique for producing the data. In an attempt of approaching and appropriation of the meanings they attributed to the phenomena, four units of meaning were built. In this perspective, being-person-with diabetes-and-member amputations means experiencing a quotidian permeated by difficulties, restrictions and limitations imposed by the situation; suffering for dependence on others, loneliness imposed by social isolation, either by personal limitations, economic and / or inadequacy of public policies.

Este es un estudio exploratorio, descriptivo, con enfoque cualitativo, desenvuelto en la perspectiva fenomenológica heideggeriana. Se desarrolló en el Centro Integrado de Salud Dr. Lineu Araújo y en una Unidad Básica de Salud de Teresina (PI), teniendo como sujetos doce pacientes diabéticos sometidos a amputaciones. Como técnica para producir los datos, se utilizó la entrevista fenomenológica. En un intento de acercamiento y apropiación de los significados que ellos atribuyen al fenómeno, se construyeron cuatro unidades de significado. En consecuencia, Ser persona-con diabetes-y- amputación de miembros significa experimentar un cotidiano impregnado por dificultades, restricciones y limitaciones impuestas por la situación; y sufrir por la dependencia de otros, y de la soledad impuesta por el aislamiento social, ya sea por limitaciones personales, económicas y / o por insuficiencia de políticas públicas.

Autoreporte de la calidad de vida relacionada con la salud en diabetes mellitus tipo 2 / Health related quality of life among patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus may affect profoundly the quality oflife of patients. Aim: To assess health related quality oflife among patients with Type 2 Diabetes Mellitus. Material ana Methods: The Diabetes Quality ofLife (DQOL) questionnaire was applied to 296patients with diabetes mellitus aged 63 ± lOyears (201 women) seen in primary health care centers. Results: The concern about the future effects of diabetes was the worst evaluated domain. Women perceived a lower health related quality oflife than men. There was an inverse correlation between age and satisfaction with treatment, concern about vocational, social and future effects of the disease. Conclusions: Type 2 diabetes affects health related quality of life, especially in some specific domains such as perception of the future.

Effects of stress management training on glycemic control in women with type 2 diabetes

Diabetes is the most complicated disease, which often leads to some psychological disorders especially stress, anxiety and depression. Complete treatment of this disease requires psychological assessment and cognitive behavioral therapy. The purpose of this research was to study the effects of stress management training on glycemic control, stress, depression and anxiety on women with type 2diabetes. The sample consisted of 46 type 2 diabetic women, aged between 32-65 years, who were matched for age and the some other criteria considered in this study. They were randomly divided into two groups, the experimental [n=23] and the control [n=23]. Using the DASS scale, depression, anxiety, and stress were assessed, and HbA1c levels for all patients were measured before the intervention. Then the experimental group underwent 12 sessions of stress management, based on the cognitive-behavior method 2 hours weekly, after which patients were again assessed for DASS and HbA1c and after 6 months as follow up period in both groups. There was a significant difference between experiental and control groups in HbA1C. The rate of HbA1C in experimental group significantly decreased compared to control [p<0.001]. Also There was a significant difference between two groups in DASS scale scores [depression, anxiety, stress] and HbA1c test after final session of intervention and after the 6 month follow up [P<0.001]. It is recommended to consider cognitive behavior therapy as an addition to treatment programs for type 2 diabetic patients

Perfil epidemiológico e nível de conhecimento de pacientes diabéticos sobre diabetes e retinopatia diabética / Epidemiologic profile and level of knowledge among diabetic patients about diabetes and diabetic retinopathy

OBJETIVO: Conhecer o perfil epidemiológico e nível de conhecimento de pacientes diabéticos sobre diabetes e retinopatia diabética (RD). MÉTODOS: Estudo transversal com pacientes atendidos no Ambulatório de Retina e Vítreo do Hospital do Servidor Público Estadual de São Paulo, os quais foram divididos em dois grupos: pacientes diabéticos encaminhados para primeira avaliação oftalmológica (G1) e pacientes já acompanhados no Ambulatório (G2). Os pacientes responderam questionário e submeteram-se a exame oftalmológico. Foram utilizados os testes x², exato de Fisher e não paramétricos de Mann-Whitney, presumindo nível de significância de 5 por cento. RESULTADOS: A amostra total foi composta por 357 pacientes (109 no G1 e 248 no G2). A maioria dos pacientes era do sexo feminino, casada, com ensino fundamental incompleto, com média de idade de 63,3 anos e afirmou saber o que é diabetes. Entretanto, 53,2 por cento não sabiam qual o seu tipo de diabetes. As complicações visuais do diabetes são as mais conhecidas. Menos de um terço dos pacientes já tinha ouvido falar em RD e 77,3 por cento não sabiam se eram acometidos. A maioria dos pacientes nunca havia recebido alguma explicação ou algum tipo de material escrito sobre diabetes ou RD. Somente 3,6 por cento dos pacientes participavam de algum programa de educação sobre diabetes. A AV média na amostra, em logMAR, foi de 0,57 no OD e 0,51 no OE. Metade dos pacientes não tinha RD. CONCLUSÃO: A maioria dos pacientes, apesar de receber acompanhamento multidisciplinar, apresentou pouco conhecimento sobre o diabetes e suas complicações.

PURPOSE: To assess the epidemiologic profile and level of knowledge of diabetic patients about diabetes and diabetic retinopathy (DR). METHODS: Cross-sectional study with patients seen at Retina and Vitreous sector of Hospital do Servidor Público Estadual de São Paulo. The subjetcs were assigned into two groups: diabetic patients sent for first ophthalmologic evaluation (G1) and patient already followed in the sector (G2). The patients answered a questionnaire and were submitted to ophthalmologic examination. It had been used chi-square (x²), exact of Fisher and non-parametric of Mann-Whitney tests, with level of significance of 5 percent. RESULTS: The total sample was composed for 357 patients (109 in G1 and 248 in G2). The majority of the patients were female, married, with incomplete basic education, age average of 63.3 years and affirmed to know what it is diabetes. However, 53.2 percent did not know their type of diabetes. The visual complications of diabetes are most known. Less of one third of the patients had heard of DR and 77.3 percent did not know if they had it. The majority of the patients had never received any explanation or lecture about diabetes or DR. Only 3.6 percent of the patients had participated of programs of education on diabetes. The visual acuity, in logMAR scale, was of 0.57 in OD and 0.51 in the OS. Half of the patients did not have DR. CONCLUSION: The majority of the patients have low knowledge about diabetes and its complications.

Déficit cognitivo: mais uma complicação do diabetes melito? / Cognitive deficit: another complication of diabetes mellitus?

Com o envelhecimento da população, as doenças crônicas serão mais prevalentes, como o diabetes melito (DM) e aquelas caracterizadas por disfunções cognitivas, como as demências. Alguns estudos mostraram associação do DM e outros fatores de risco cardiovascular associados a distúrbios cognitivos. Além das complicações vasculares, estudos sugerem ação da hiperglicemia e dos produtos avançados finais de glicação (PAFG) em estresse oxidativo e acúmulo de substância β-amilóide intracerebral. Outros fatores também vêm sendo investigados, como o papel da insulinemia, da genética e do IGF-1 (insulin-like growth factor-1). Estudos mostraram que o bom controle glicêmico e a ingestão de dieta rica em gordura poliinsaturada, ômega-3 ou alimentos antioxidantes podem ter papel protetor contra os déficits cognitivos. Esclarecimentos sobre a associação entre DM e cognição e sua fisiopatologia podem ser essenciais para a prevenção e o tratamento de déficits cognitivos, levando a impacto positivo sobre a qualidade de vida dos pacientes idosos com DM.

As the population getting older, the chronic diseases will be more prevalent as diabetes mellitus (DM) and diseases characterized by cognitive deficits, as dementia. Studies have already shown an association between DM and cardiovascular risk factors associated with cognitive impairment. Besides the vascular complications of DM, studies have proposed the role of hyperglycemia and advanced glycosilation end products (AGEP) causing oxidative stress and β-amiloid protein brain deposition. Other factors have also been investigated, such as the role of insulinemia, genetic and IGF-1 (insulin-like growth factor-1). Some studies showed that good glucose control and intake of poli-unsaturated fat, Ômega-3 or anti-oxidative food can play a protector role against cognitive deficits. Improving knowledge about the association between DM and cognition and its physiopathology, can be essential for the prevention and treatment of cognitive impairment, leading to a beneficial impact on the quality of life of elderly patients with DM.