Conhecimento sobre o diabetes e atitude para o autocuidado de idosos na atenção primária à saúde / Knowledge and attitude about diabetes self-care of older adults in primary health care

Resumo Objetivou-se avaliar o conhecimento sobre o diabetes, a atitude para o autocuidado e os fatores associados, por meio de estudo transversal, na linha de base de um ensaio clínico randomizado, com idosos diabéticos na atenção primária de saúde do Recife, Nordeste do Brasil. Utilizou-se o Diabetes Knowledge Scale (DKN-A) e o Diabetes Attitudes Questionnaire (ATT-19). Dos 202 idosos, 77,7% apresentaram conhecimento insuficiente sobre a doença, com destaque para a cetonúria, substituição de alimentos e desconhecimento das causas e dos cuidados com a hipoglicemia. Quanto à atitude, 85,6% tiveram ajustamento psicológico negativo em relação ao diabetes. O modelo de regressão logística mostrou que morar sozinho foi fator de proteção (OR = 0,24; IC95% 00,9-0,65; OR = 0,22; IC95% 0,07-0,71) e baixa escolaridade fator de risco (OR = 7,78; IC95% 3,36-18,01; OR = 13,05; IC95% 4,63-36,82) para conhecimento insuficiente e atitude negativa para o autocuidado, respectivamente. Os achados reforçam a necessidade de ações educativas interdisciplinares que incluam aspectos socioeconômicos, psicoemocionais e educacionais na gestão do diabetes com vistas à manutenção da autonomia e funcionalidade do idoso.

Abstract This study aimed to assess the knowledge about diabetes, the attitude for self-care and associated factors through a cross-sectional study, the baseline of a randomized clinical trial with elderly diabetic in primary health care in Recife, Northeastern Brazil. We used the Diabetes Knowledge Scale (DKN-A) and Diabetes Attitudes Questionnaire (ATT-19). Of the 202 elderly, 77.7% had insufficient knowledge of the disease, especially for ketonuria, food replacement and were unaware of the causes and care of hypoglycemia. As for attitude, 85.6% had a negative psychological adjustment for diabetes. The logistic regression model showed that living alone was a protective factor (OR = 0.24; 95% CI 0.09-0.65; OR = 0.22; 95% CI 0.07 to 0.71), and low education, a risk factor (OR = 7.78; 95% CI 3.36-18.01; OR = 13.05; 95% CI 4.63-36.82) for the insufficient knowledge and the negative attitude for self-care, respectively. The findings reinforce the need for interdisciplinary educational actions that include socioeconomic, psycho-emotional and educational aspects in diabetes management to maintain elderly autonomy and functionality.

Caracterización de eventos de hipoglicemia en pacientes diabéticos y no diabéticos atendidos en un servicio de urgencia / Hypoglycemia in an emergency room: review of 251 cases

Background Hypoglycemia is the main limitation for the achievement of glycemic goals in the treatment of diabetes. Aim To assess the incidence of hypoglycemia in an emergency department. To characterize and identify which patients are at higher risk of having it. Material and Methods We reviewed the electronic records of patients discharged from an adult emergency room with the diagnosis of hypoglycemia between May 2011 and December 2014. Age, sex, diagnosis of diabetes (DM), antidiabetic therapy, glycosylated hemoglobin, creatinine, destination at time of discharge, blood glucose, impairment of conscience, treatment of the event and predictions were recorded. Results Of 175,244 attentions analyzed, 251 in patients aged 69 ± 17 years (54% women) consulted for hypoglycemia (0.14%). Eighty one percent had a type 2 diabetes, 6% a type 1 diabetes and 12% were non-diabetic. Mean blood glucose was 44.1 mg/dl. In diabetic patients, mean glycosylated hemoglobin was 6.5%. Ninety seven percent had impairment of conscience and 77% were admitted to the hospital. Among patients without diabetes, the main comorbidity was the history of a gastric bypass surgery. In type 2 diabetes, glibenclamide used alone or with other medications was involved in 59% of the events, 87% of patients were older than 65 years with a mean glycosylated hemoglobin of 6.3% and 32% had renal failure. Conclusions The incidence of hypoglycemia was low. There were a significant number of events in older patients with type 2 diabetes mellitus and renal failure, who were treated with glibenclamide. Most of these patients had a glycosylated hemoglobin below accepted recommendations.

Hypoglycaemia in Children: Review of the Literature

Hypoglycaemia is a common metabolic condition in children. It often presents urgent and therapeutic challenges and it has been documented to affect many childhood conditions. Its clinical presentation is not classical and requires a high index of suspicion for an early diagnosis and prompt management. Undiagnosed or undertreated hypoglycaemia has been found to increase mortality in children when it is present. This review sought to review the subject of hypoglycaemia in children and calls for testing for it in all sick and admitted children

Fatores predisponentes para hipoglicemia: aumentando a segurança do paciente crítico que utiliza insulina intravenosa / Predisposing factors for hypoglycemia: security measures for critical patients on intravenous insulin / Factores predisponentes para hipoglucemia: aumentando la seguridad del paciente crítico que utiliza la insulina intravenosa

Pesquisa com o objetivo de identificar os fatores predisponentes para hipoglicemia nos pacientes críticos que receberam infusão contínua de insulina. Estudo documental, retrospectivo, se rastrearam 550 prontuários dos anos de 2012 e 2013 de pacientes do pós-operatório de cirurgia cardíaca, dos quais 168 receberam insulina intravenosa e 74 apresentaram hipoglicemia grave. Os resultados principais apontam que entre os pacientes que apresentaram hipoglicemia grave, a maioria erado sexo masculino (60,11%), idosos (md=61,78), com sobrepeso (26,75Kg/m2,), hipertensos (78,57%) e isquêmicos (52,38%). Os fatores predisponentes encontrados para hipoglicemia, com significado estatístico foram ser diabético (OR=3,6), ter insuficiência renal (OR=5,4), em uso de aminas vasoativas (OR=3,1). Conclui-se que uma medida de segurança, para pacientes com estes fatores, é a coleta de amostras de sangue venoso e o uso de hemogasometros para a aferição da medida glicêmica.

Documentary, retrospective cross research aiming at describing the predisposing factors studied in critically ill patients receiving continuous insulin infusion. Tracking was made of five hundred and fifty (550) medical records for the years 2012 and 2013 of post-operative cardiac surgery patients who received intravenous insulin. Main results show that nearly half of the patients had at least one record of hypoglycemia, the majority were male (60.11%), elderly (md = 61.78), overweight (26,75Kg / m2), hypertense (78.57%), and ischemic (52.38%). Predisposing factors for hypoglycemia, with statistical significance identified among patients were as follows: diabetes (OR = 3.6); renal failure (OR = 5.4); and use of vasoactive amines (OR = 3.1). Conclusions identified security actions for patients in those conditions such as venous blood collection as well as the use of blood meters to assess glycemic levels.

Investigación con el objetivo de identificar los factores predisponentes para hipoglucemia en los pacientes críticos que recibieron infusión continua de insulina. Estudio documental, retrospectivo, se rastrearon 550 historiales de los años 2012 a 2013 de pacientes del posoperatorio de cirugía cardíaca, de los cuales 168 recibieron insulina intravenosa y 74 presentaron hipoglucemia grave. Los resultados principales apuntan que entre los pacientes que presentaron hipoglucemia grave, la mayoría era del sexo masculino (60,11%), ancianos (MD=61,78), con sobrepeso (26,75Kg/m2), hipertensos (78,57%) e isquémicos (52,38%). Los factores predisponentes encontrados para hipoglucemia, con significado estadístico fueron ser diabético (OR=3,6), tener insuficiencia renal (OR=5,4), en empleo de aminas vasoactivas (OR=3,1). Se llega a la conclusión de que una medida deseguridad, para pacientes con estos factores, es la recolecta de muestras de sangre venosa y el empleo de hemogasometría para la verificación de la medida glucémica.

Hipoglicemia em adultos / Hypoglycemia in adults

A hipoglicemia é um evento potencialmente grave, com significativa morbidade. É rara em indivíduos sem diabetes, e pode ocorrer com frequência variável em pacientes com diabetes mellitus, especialmente naqueles que utilizam insulina. Para minimizar esse risco é imprescindível que se individualize o tratamento, estabelecendo metas glicêmicas de acordo com a idade, expectativa de vida, comorbidades e estilo de vida

Hypoglycemia is a potentially serious event with significant morbidity. It is rare in individuals without diabetes and can occur in a quite variable frequency in diabetic patients, especially in those that use insulin. In order to minimize its risk in these groups, it is essential to individualize treatment, establishing glycemic targets according to age, life expectancy, comorbidities and lifestyle

Estados hiper e hipoglicêmicos agudos: conduta atual / Acute hyper and hypoglycaemic states: current conduct

Os estados hiperglicêmicos e hipoglicêmicos agudos são exemplos das mais comuns emergências médicas com que nos deparamos no campo das alterações do metabolismo. Os estados hiperglicêmicos agudos compreendem a cetoacidose diabética e o coma hiperosmolar hiperglicêmico não cetótico. Neste artigo, analisamos essas condições hiperglicêmicas, que representam um desafio para o clínico e o médico generalista que trabalham no terreno nas emergências médicas

The acute hypoglycemic and hyperglycemic situations are examples of the most common medical emergencies that we face in the field of metabolic disorders. The acute hyperglycemic situations include diabetic ketoacidosis and hyperosmolar hyperglycemic coma hyperosmolar nonketotic. In this article, we analyze these two hyperglycemic conditions that represent a challenge to the clinician and general practitioner working in the field in medical emergencies

Hypoglycaemia in anesthesiology practice: diagnostic, preventive, and management strategies

Diabetes mellitus has emerged as one of the fastest growing non communicable diseases worldwide. Management of diabetic patients during surgical and critically illness is of paramount challenge to anesthesiologist and intensivist. Among its major acute complications, hypoglycemia has been given lesser attention as compared to other major acute complications; diabetic ketoacidosis and hyperosmolar non ketotic coma. However, newer studies and literary evidence have established the serious concerns of morbidity and mortality, both long- and short-term, related to hypoglycemia. basis. Invariably, diabetic patients are encountered in our daily routine practice of anesthesia. During fasting status as well as the perioperative period, it is hypoglycemia that is of high concern to anesthesiologist. Management has to be based on clinical, pharmacological, social, and psychological basis, so as to completely prevent the complications arising from an acute episode of hypoglycemia. This review aims to highlight various aspects of hypoglycemia and its management both from endocrine and anesthesia perspective

Infusão contínua de insulina e controle glicêmico em pacientes sépticos: implicações para a enfermagem em terapia intensiva / Continuous infusion of insulin and glycemic control in septic patients: implications for nursing in intensive care

O objeto de estudo é o resultado do controle glicêmico proveniente da infusão contínua de insulina (ICI) em pacientes sépticos da terapia intensiva. Os objetivos foram determinar a incidência de hipoglicemia encontrada entre pacientes de duas Unidades de Terapia Intensiva (UTI), que receberam ICI e sua relação com os valores da faixa-alvo de cada protocolo e discutir as implicações para a prática de enfermagem relacionadas à incidência de hipoglicemia. Trata-se de estudo transversal, bicêntrico, retrospectivo, com técnica de coleta de dados por análise do prontuário e avaliação quantitativa dos mesmos. Desenvolvida em duas UTIs, uma de um hospital de oncologia da rede federal e outra de um hospital geral da rede estadual do estado do Rio de Janeiro. As medidas glicêmicas de pacientes sépticos que utilizaram ICI no ano de 2010 nas duas UTIs foram transcritas para o instrumento de coleta de dados, gerando 2213 medidas em 29 pacientes (11,88%) na UTI 1 e 923 medidas em 20 pacientes (9,85%) na UTI 2. Os registros de hipoglicemia foram divididos em duas categorias: as medidas com valores definidos pelo protocolo adotado e aquelas com valores inferiores a 50mg/dL, caracterizados como hipoglicemia grave pelo Institute for Healthcare Improvement; nas duas categorias houve a necessidade de intervenção com a administração de glicose hipertônica a 50%. Dezesseis pacientes da UTI 1 apresentaram hipoglicemia, sendo quatro (25,00%) com medidas entre 50 e 60mg/dL e doze (75,00%) com medidas inferiores a 50mg/dL; treze pacientes da UTI 2 apresentaram hipoglicemia, sendo dez (76,92%) com medidas entre 50 e 80mg/dL e três (23,08%) com medidas inferiores a 50mg/dL. O cálculo da incidência considerou o total dos episódios de hipoglicemia independente da categoria. Comparando as duas UTIs, foi encontrada na UTI 1 uma incidência global de hipoglicemia quase cinco vezes maior (22,60:4,54)...

This study aims to get the glycemic control result from the insulin continuous infusion (ICI) in septic patients in intensive care. The objectives were to determine the hypoglycemia incidence in patients from two Intensive Care Units (ICU) who received ICI and its relation to the target range values for each protocol, and discuss the implications for nursing practice related to hypoglycemia incidence. It is a bi-centric and retrospective cross-sectional study with data collection technique, by analyzing the records and their quantitative assessment. It was developed in two ICUs, one oncology hospital belonging to Union and another to state of Rio de Janeiro. Glycemic measures from septic patients who used ICI in 2010 in both ICUs were collected to data, yielding two thousand, two hundred and thirteen measured in twenty-nine patients (11.88%) from ICU 1, and nine hundred and twenty-three measures in twenty (9.85%) patients from ICU 2. Hypoglycemia records were divided into two categories, measures with values defined by the adopted protocol and measures with values less than 50mg/dL, characterized as severe hypoglycemia by the Institute for Healthcare Improvement. In both categories, it was necessary to intervene, administering hypertonic glucose of 50%. Sixteen patients from ICU 1 had hypoglycemia, four (25%) measuring between 50 and 60mg/dL and twelve (75%) with measures less than 50mg/dL. Thirteen patients from ICU 2 had hypoglycemia, ten (76.92%) measuring between 50 and 80mg/dL and three (23.08%) with measures less than 50mg/dL. For the incidence calculation, the total hypoglycemia episodes were considered independently of category. Comparing the two ICUs, global incidence of hypoglycemia was found in ICU 1 almost five times higher (22.60:4.54)...

Diagnóstico y manejo de la hipoglicemia en adultos diabéticos hospitalizados: evaluación de competencias en un equipo profesional multidisciplinario de salud / Competences on hypoglycemia management among healthcare professionals in a clinical hospital

Background: A tight glycemic control of hospitalized patients increases the risk of hypoglycemia, whose management is not always optimal. Aim: To assess the hypoglycemia management competences of a multidisciplinary team in a clinical hospital. Material and Methods: An anonymous questionnaire about hypoglycemia management was answered by 11 staff physicians, 42 residents and 28 nurses of the department of medicine and critical care unit ofa university hospital. Results: Respondents had a mean of 60 percent of correct answers, without significant differences between groups. The capillary blood glucose level that defines hypoglycemia was known by most of the respondents, but the value that defines severe episodes was known only by 60 percent. The initial management and follow up was well known only for severe episodes. Less than 50 percento knew the blood glucose value that required continuing with treatment. Conclusions: Although most professionals are able to recognize hypoglycemia, the knowledge about is management if insufficient.

Hipoglicemia infantil / Hypoglycemia of infancy

Hypoglycemia of infancy is a common metabolic disorder that can have serious neurological consequences. Therefore, its early diagnosis and treatment are crucial prognostic factors. Hypoglycemia has a variety of causes and a good clinical history, physical examination and laboratory determination will orient the correct diagnosis. Occasionally a molecular study will be required.

Hypoglycemia in diabetic - The role of new technologies

One common obstacle in the treatment of diabetics is hypoglycemia. Hypoglycemia in diabetic is unpredictable and life threatening. It is a consequence of either treatment or part of the natural history of diabetes. Therefore, many dietary and therapeutic maneuvers have been initiated to tackle such obstacle. Twenty-eight years old Bahraini male known diabetic since birth was suffering from frequent attacks of hypoglycemia mandating visits to the Accident and Emergency Department. His blood biochemistry parameters were normal except for the high HbA1c. His general examination was normal. Several treatment regimens were initiated to combat his hypoglycemia with little success. New insulin analogue was prescribed for the patient to reduce the magnitude and frequency of hypoglycemic attacks and improve the blood sugar control. This method of treatment combined with dietary interventions proved effective in reducing the hypoglycemic attacks in clinical trials

Insulinoma, presentación y evolución de dos casos clínicos / Insulinoma, evolution and presentation of 2 clinical cases

Insulinoma is a very uncommon tumor in children, with an incidence in adults of 2 per million inhabitants. Clinical manifestations include neuroglycopenic or autonomic manifestations due to hypoglycemia. We describe 2 pediatric patients with insulinoma, characterized by repeated episodes of hypoglycemia associated to high insulin serum levels and presence of a small mass in the pancreas by imaging studies. The diagnosis was very prompt in one case and delayed in the other, emphasizing the need for an appropriate diagnosis of hypoglycemia during childhood.

El insulinoma es un tumor muy infrecuente en la edad pediátrica y la incidencia reportada en adultos es de 2 casos por millón de habitantes. La presentación de la enfermedad consiste en la presencia de síntomas neuroglicopénicos y autonómicos desencadenados por los episodios de hipoglicemia. Se describen dos pacientes con insulinoma esporádico. El cuadro clínico consistió en episodios repetidos de hipoglicemia asociados a niveles aumentados de insulina sérica y a imágenes sugerentes de un tumor pancreático. El diagnóstico fue muy oportuno en uno de los casos y muy tardío en el otro, lo que resalta la necesidad de estar muy alerta ante casos de hipoglicemia durante la niñez.

Diagnosis and management of hypoglycaemia due to pancreatic insulin-secreting neoplasia in a German shepherd dog

A 7-year-old castrated male German shepherd dog was presented with a 10-day history of intermittent lethargy, weakness and episodic seizures. Laboratory findings after admission revealed hypoglycaemia and hyperinsulinaemia. Provisional diagnosis of insulinoma was made based on the presence of concurrent hypoglycaemia and elevated insulin level. In exploratory laparotomy a small nodular mass was detected on the pancreas. Other abdominal organs were normal in gross inspection. The mass was removed surgically. Histopathology of the excised pancreatic nodule confirmed the diagnosis of insulinoma. The dog became seizure free following the surgical operation

Hipoglicemia hiperinsulinêmica persistente endógena no adulto: relato de caso / Endogenous persistent hypoglicemia of adult: case report

A hipoglicemia hiperinsulinêmica persistente endógena em adultos é, na maioria dos casos, causada por insulinoma. A Nesidioblastose, uma hiperinsulinemia funcional rara por hiperplasia das células beta do pâncreas, tem sido descrita principalmente em neonatos. Apresentamos o caso de uma paciente de 34 anos com quadro clínico-laboratorial compatível com hipoglicemia hiperinsulinêmica endógena (Glicemia jejum: 54 mg/dl / Valor de referência (VR): 60­99 mg/dl; Insulina sérica: 70,9 mcU/ml / VR: < 29,1 mcU/ml; e Peptídeo C: 7,1 ng/ml / VR: 1,1­5,0 ng/ml - simultâneos à glicemia). Foi aventada a hipótese de insulinoma. Em função da ausência de imagem característica aos exames radiológicos (ultra-som e tomografia de abdome), optou-se pela laparotomia exploradora, onde também não foi evidenciado tumor pancreático macroscopicamente. Os exames histopatológico e imuno-histoquímico evidenciaram hiperplasia de células beta, de segmento distal do pâncreas, compatível com nesidioblastose. A paciente evoluiu com estabilidade clínica por cerca de dois meses, quando se verificou recidiva das crises hipoglicêmicas, refratárias ao uso de Octreotide. Optou-se pela realização de "octreosan", que indicou nesidioblastose difusa, sendo procedida pancreatectomia parcial extensa. Seguiu-se o uso contínuo de Octreotide, com controle eficaz das crises hipoglicêmicas. Uma vez que esse é um diagnóstico raro no adulto, objetiva-se, nesse artigo, divulgar o manejo diagnóstico-terapêutico em casos de hipoglicemia hiperinsulinêmica endógena.

Persistent Hyperinsulinemic Endogenous hypoglycemia in adults is, in most cases, due to Insulinoma. Nesidioblastosis, a peculiar functional hyperinsulinemia from hypertrophic beta cells, has been described mainly in newborns. This article describes a 34-year-old patient who presented hyperinsulinemic endogenous hypoglycemia clinical and laboratorial situation (Fasting glycemia: 54 mg/dl / Reference Interval (RI): 60­99 mg/dl; Serum insulin: 70.9 mcU/ml / RI: < 29.1 mcU/ml; e C peptide: 7.1 ng/ml / RI: 1.1­5.0 ng/ml). It was suspected Insulinoma. Because of the lack of typical images in radiologic exams (ultrasonography and computerized tomography) it had been decided to do laparotomy, but it was not found any macroscopic pancreatic tumor. Histological and histochemistry examination of a distal pancreatic segment showed alteration suitable to nesidioblastosis. The patient presented clinical stability during the next two months, however, after that, there was a recurrence of a hypoglycemia crisis, refractory to Octreotide administration. It was done "octreoscan", which showed expanded nesidioblastosis, being done extensive partial pancreatectomy. Octreotide was used again, with a good control of the hypoglycemia crisis. As it is an uncommon diagnosis in an adult, the objective of this article is to describe the diagnostic and therapeutic aspects in cases of hyperinsulinemic endogenous hypoglicemia.