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1.
Femina ; 49(4): 251-256, 20210430.
Article in Portuguese | LILACS | ID: biblio-1224096

ABSTRACT

O diabetes mellitus gestacional (DMG) é uma complicação que atinge o metabolismo da gestante, resultando em intolerância à glicose e consequente hiperglicemia, originada pela insuficiência de insulina materna. Este estudo tem como objetivo identificar os tratamentos disponíveis e mais utilizados para o DMG. Trata-se de um uma revisão de literatura, feita a partir de 22 referências, acerca dos tratamentos para o DMG. As bases de dados escolhidas foram Google Acadêmico, UpToDate, SciELO e o acervo da Universidade do Planalto Catarinense. Estudos apontam a insulina humana ­ NPH e regular ­ como a principal escolha, quando comparada aos seus análogos, apesar de ainda existirem muitas controvérsias quanto ao início do tratamento, o esquema terapêutico e os ajustes das doses. Pesquisas têm demonstrado bons resultados sobre a eficácia e a segurança dos hipoglicemiantes orais ­ gliburida e metformina ­ no tratamento de gestantes diabéticas, mas é evidente a necessidade de mais estudos para confirmar a efetividade deles e garantir um bom desenvolvimento do concepto. Concluiu-se que o controle dietético e o exercício físico são a primeira opção de tratamento para o DMG. Todavia, caso a euglicemia não seja atingida, opta-se pelo tratamento medicamentoso por meio da insulinoterapia ou hipoglicemiantes orais, o que possibilita a redução da incidência dos efeitos adversos ao binômio materno-fetal.(AU)


Gestational diabetes mellitus (DMG) is a complication that affects the pregnant woman's metabolism, resulting in glucose intolerance and consequent hyperglycemia, caused by insufficient maternal insulin. This study aims to identify the available and most used treatments for DMG. This is a literature review, based on 22 references, about treatments for Gestational Diabetes; the databases chosen were Google Scholar, UpToDate, SciELO and the collection of the Universidade do Planalto Catarinense. Studies point to human insulin ­ NPH and regular ­ as the main choice when compared to its analogues, although there are still many controversies about the beginning of treatment, therapeutic scheme and dose adjustments. Researches have shown good results on the efficacy and safety of oral hypoglycemic agents ­ glyburide and metformin ­ in the treatment of diabetic pregnant women, but it is evident the need for further studies to confirm their effectiveness and to guarantee a good development of the fetus. It was concluded that dietary control and physical exercise are the first treatment option for DGM. However, if euglycemia is not achieved, drug treatment is chosen through insulin therapy or oral hypoglycemic agents, which makes it possible to reduce the incidence of adverse effects to the maternal-fetal binomial.(AU)


Subject(s)
Humans , Female , Pregnancy , Diabetes, Gestational/diet therapy , Diabetes, Gestational/drug therapy , Diabetes, Gestational/therapy , Diabetes Mellitus/drug therapy , Exercise , Databases, Bibliographic , Glyburide/adverse effects , Glyburide/therapeutic use , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Metformin/adverse effects , Metformin/therapeutic use
2.
Esc. Anna Nery Rev. Enferm ; 25(1): e20190343, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1124793

ABSTRACT

RESUMO Objetivo descrever o processo de construção, avaliação e adequação de vídeos educativos sobre aplicação de insulina direcionados a pacientes adultos e cuidadores. Método estudo metodológico, de caráter descritivo, realizado em três fases: construção, avaliação e adequação. A construção dos vídeos foi realizada com base em revisão de literatura e no protocolo do município. A avaliação foi realizada com experts, por meio de um instrumento construído pelos pesquisadores. O nível de concordância entre os experts foi avaliado pelo índice de validade do conteúdo, que orientou o processo de adequação do material. Resultados os vídeos foram construídos contemplando os principais pontos críticos relacionados à aplicação de insulina. Os itens que obtiveram índice de validade de conteúdo < 0,8 foram reformulados. Conclusão e Implicações para a prática foram produzidos dois vídeos que abordam o transporte, armazenamento, preparo e aplicação da insulina, descarte de perfurocortantes e monitorização da glicemia. Os vídeos educativos construídos podem ser considerados ferramentas facilitadoras do processo de educação em diabetes mellitus e úteis na uniformização de orientações. A descrição do processo de construção, avaliação e adequação pode encorajar outros profissionais a desenvolver materiais que respondam às necessidades de seus contextos de trabalho e assim melhorar e qualificar o cuidado às pessoas.


RESUMEN Objetivo describir el proceso de construcción, evaluación y adecuación de vídeos educativos sobre la aplicación de insulina dirigidos a pacientes adultos y cuidadores. Método estudio de carácter descriptivo realizado en tres fases: construcción, evaluación y adecuación. La construcción de los vídeos se realizó en base a una revisión de la literatura y en el protocolo del municipio. La evaluación se realizó con expertos, utilizando un instrumento construido por los investigadores, el nivel de acuerdo entre los expertos se evaluó mediante el índice de validez de contenido, que guió el proceso de adaptación del material. Resultados los vídeos fueron construidos cubriendo los principales puntos críticos relacionados con la aplicación de insulina. Los ítems que obtuvieron un índice de validez de contenido <0.8 fueron reformulados. Conclusión e Implicaciones para la práctica se realizaron dos vídeos que abordan el transporte, el almacenamiento, la preparación y la aplicación de insulina, la eliminación de objetos punzantes y el control de la glucosa en sangre. Los vídeos educativos construidos pueden considerarse herramientas que facilitan el proceso de educación en diabetes mellitus y útiles para estandarizar las pautas. La descripción del proceso de construcción, evaluación y adaptación puede alentar a otros profesionales a desarrollar materiales que respondan a las necesidades de sus contextos de trabajo y así mejorar la atención a las personas.


ABSTRACT Objective to describe the process of development, evaluation, and adaptation of educational videos on insulin application whose target audience was adult patients and caregivers. Methods descriptive and methodological study, carried out in three phases: development, evaluation, and adaptation. The development of the videos was based on a literature review and the municipality's protocol. The evaluation was carried out by experts by applying an instrument designed by the researchers, and the level of agreement between the experts was assessed by the content validity index, which guided the material adaptation process. Results the videos were developed to address the main critical points related to insulin application. The items that obtained a content validity index < 0.8 were reformulated. Conclusion and implications for practice two videos were made addressing insulin transport, storage, preparation and application, sharps disposal, and blood glucose monitoring. The educational videos made in the present study can be considered tools that contribute to education in diabetes mellitus and are useful for standardizing guidelines. The description of the development, evaluation, and adaptation process can encourage other professionals to develop materials that meet the needs found in their work contexts and, consequently, improve and qualify the care provided to their patients.


Subject(s)
Humans , Audiovisual Aids , Patient Education as Topic , Diabetes Mellitus, Type 1/drug therapy , Insulin/administration & dosage , Self Care , Insulin/therapeutic use
3.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 664-672, May-June, 2020. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1128613

ABSTRACT

Objetivou-se avaliar a condição metabólica e estrutural das células espermáticas bovinas após congelação, com adição prévia de IGF-I e insulina no meio diluidor seminal. Os ejaculados de seis touros Nelore foram submetidos a quatro tratamentos: controle; insulina (100µUI/mL); IGF-I (150ng/mL) e insulina + IGF-I (50µUI/mL e 75ng/mL, respectivamente). Após a congelação, realizaram-se os testes de termorresistência rápida, coloração pelo corante azul de tripan e Giemsa, além da análise computadorizada da motilidade espermática, da integridade das membranas plasmática e acrossomal, e da peça intermediária por meio de sondas fluorescentes. O teste de termorresistência rápida apresentou efeito dentro do tempo de cada tratamento, mas não entre os tratamentos. Na análise computadorizada da motilidade espermática, foram observados movimento, motilidade e velocidade espermáticos; não houve efeitos dos tratamentos sobre qualquer uma dessas variáveis. Respostas iguais foram obtidas com as sondas fluorescentes e o corante azul de tripan/Giemsa. A adição de insulina e IGF-I, de forma isolada ou combinada, ao meio diluidor para congelação de sêmen não produziu efeitos sobre as condições metabólica e estrutural das células espermáticas.(AU)


This study aimed to evaluate the metabolic and structural condition of the spermatic bovine cells after the freezing, with addition, previously, of IGF-I and Insulin in the seminal thinner medium. The semen of 6 Nellore bulls were submitted to four treatments: Control, Insulin (100µUI/mL); IGF-I (150ng/mL) and Insulin + IGF-I (50µUI/mL and 75ng/mL, respectively). After freezing, rapid resistance tests, Tripan and Giemsa Blue staining, and computerized analysis of sperm motility and integrity of the plasma and acrosomal membranes and the intermediate part were performed by fluorescent probes. The term rapid resistance test had effect within the time of each treatment, but not between treatments. In the computer analysis of sperm motility, sperm movement, motility and velocity no effects of treatments were observed on any of these variables. The same results were obtained with the fluorescent probes and the Blue dye Trypan / Giemsa. The addition of Insulin and IGF-I, alone or in combination, to the semen freezing dilution medium had no effect on the metabolic and structural condition of sperm cells.(AU)


Subject(s)
Semen/metabolism , Insulin-Like Growth Factor I/administration & dosage , Cryopreservation/veterinary , Insulin/administration & dosage , Cattle , Indicators and Reagents
4.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 334-337, Mar. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136205

ABSTRACT

SUMMARY OBJECTIVE To present the results of metabolic control in patients with type 2 Diabetes Mellitus from a private clinic in Northern Mexico, METHODS This cross-sectional study used retrospective data obtained from electronic records from a private outpatient clinic at the end of 2018. Inclusion criteria were a diagnosis of T2DM and age ≥ 18 years. Baseline characteristics (age, gender, drug use) were reported. The achievement of glycated hemoglobin goals was established as <7%. RESULTS A total of 3820 patients were evaluated. Their mean age was 59.86 years (+/-15.01). Of the population, 46.72% were men, and 53.28% were women. Glycated hemoglobin goals were adequate in 1872 (54%) patients. There were 3247 patients (85%) treated with oral medications, of which 1948 (60%) reported glycated hemoglobin less than 7%. Insulin use was reported in 573 (15%) patients, with 115 (20%) reporting glycated hemoglobin less than 7%. The most frequently used basal insulin was glargine in 401 (70%) patients. CONCLUSIONS Our findings are clearly higher than the control rate reported by our national health surveys of 25% with glycated hemoglobin < 7%, but similar to that reported in other countries. The most commonly used therapeutic scheme was the combination of oral hypoglycemic agents. The percentage of cases that include insulin in their treatment was lower. Clinical inertia to insulin initiation and intensification has been defined as an important cause of this problem.


RESUMO OBJETIVO Apresentar os resultados do controle metabólico de pacientes com Diabetes Mellitus tipo 2 em uma clínica privada no norte do México, MÉTODOS Este estudo transversal utilizou dados retrospectivos obtidos em prontuários eletrônicos de um ambulatório privado no final de 2018. Os critérios de inclusão foram o diagnóstico de DM2 e idade ≥ 18 anos. Características basais (idade, sexo, uso de drogas) foram relatadas. A realização de metas de hemoglobina glicada foi estabelecida como <7%. RESULTADOS Um total de 3820 pacientes foram avaliados. A média de idade foi de 59,86 anos (+/- 15,01). Da população, 46,72% eram homens e 53,28% eram mulheres. Objetivos de hemoglobina glicada foram adequados em 1872 (54%) pacientes. Havia 3247 pacientes (85%) tratados com medicamentos orais relatando em 1948 (60%) menos de 7%. O uso de insulina foi relatado em 573 (15%) pacientes, com 115 (20%) relatando menos de 7%. A insulina basal mais utilizada foi a glargina, em 401 (70%) pacientes. CONCLUSÕES Nossos resultados são claramente mais altos do que a taxa de controle relatada por nossos levantamentos nacionais de saúde de 25% com hemoglobina glicada <7%, mas semelhante à relatada em outros países. O esquema terapêutico mais utilizado foi a combinação de hipoglicemiantes orais. A porcentagem de casos que incluem insulina no tratamento foi menor. A inércia clínica à iniciação e intensificação da insulina tem sido definida como uma importante causa desse problema.


Subject(s)
Humans , Male , Female , Adult , Aged , Diabetes Mellitus, Type 2/metabolism , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Glycated Hemoglobin A , Cross-Sectional Studies , Retrospective Studies , Drug Therapy, Combination , Insulin Glargine/administration & dosage , Mexico , Middle Aged
5.
Arch. endocrinol. metab. (Online) ; 64(1): 82-88, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088767

ABSTRACT

ABSTRACT Objective The insulin tolerance test (ITT) has been accepted as the gold standard test for assessing the integrity of the growth hormone (GH) - insulin-like growth factor (IGF-1) axis and the hypothalamic-pituitary-adrenal (HPA) axis. The goal of the test is to achieve clinical and biochemical hypoglycemia at a blood glucose level ≤ 40 mg/dL to effectively and correctly assess the HPA and GH-IGF-1 axes. In this study, the GH and cortisol responses of patients who achieved and failed to achieve biochemical hypoglycemia during an ITT were compared. Subjects and methods One hundred thirty-five patients with pituitary disorders were included in the study. Samples for blood glucose levels were obtained after clear symptoms of clinical hypoglycemia developed. The patients were enrolled in the hypoglycemic and nonhypoglycemic groups according to whether their plasma glucose level ≤ 40 mg/dL or > 40 mg/dL during an ITT, and the groups were compared in terms of their GH and cortisol responses. Results The mean age, body mass index and waist circumference of the two patient groups were found to be similar. The mean blood glucose level was significantly lower in the hypoglycemic group than in the nonhypoglycemic group (19.3 and 52.0 mg/dL, respectively). When the two groups were compared in terms of peak cortisol and GH responses, no statistically significant differences were found. Conclusion The data presented suggest that clinically symptomatic hypoglycemia is as effective as biochemically confirmed hypoglycemia during an ITT. Arch Endocrinol Metab. 2020;64(1):82-8


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Insulin-Like Growth Factor I/analysis , Hydrocortisone/blood , Human Growth Hormone/blood , Glucose Tolerance Test/methods , Hypoglycemia/blood , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pituitary-Adrenal System/metabolism , Blood Glucose Self-Monitoring , Retrospective Studies , Glucose Tolerance Test/adverse effects , Hypoglycemia/diagnosis , Hypoglycemia/metabolism , Hypothalamo-Hypophyseal System/metabolism
6.
Braz. j. med. biol. res ; 53(1): e8652, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055481

ABSTRACT

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4-10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (-0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [-2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Insulin Infusion Systems , Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 2/drug therapy , Liraglutide/administration & dosage , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pilot Projects , Diabetes Mellitus, Type 2/blood
7.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1103960

ABSTRACT

Objetivo: Identificar as tecnologias existentes para minimização de hipoglicemia em pacientes adultos durante a infusão contínua de insulina (ICI) venosa. Método: Revisão integrativa das produções científicas disponíveis em português, inglês e espanhol, indexadas nas bases de dados da Biblioteca Virtual de Saúde (BVS), tendo como recorte temporal os anos de 2005 a 2015. Resultados: Após a busca, seleção e análise dos artigos, foram selecionados 06 estudos para compor a amostra, os quais se encontravam disponíveis na integra, e que evidenciavam tecnologias existentes para a minimização da ocorrência de hipoglicemia durante a ICI venosa. A amostra caracterizou protocolos informatizados e protocolos de papel utilizados durante o tratamento. Conclusão: O estudo conseguiu identificar tecnologias que foram criadas para minimização da ocorrência de hipoglicemia durante a infusão contínua de insulina. Os protocolos informatizados foram considerados mais eficazes na minimização de eventos hipoglicêmicos


Objective: The study's purpose has been to identify existing technologies for minimizing hypoglycemia in adult patients undergoing continuous intravenous insulin infusion. Methods: It is an integrative review of scientific literature available in Portuguese, English and Spanish, indexed in the Virtual Health Library (VHL), over the period from 2005 to 2015. Results: After accomplishing the search, selection and analysis of the articles, 06 complete studies were found addressing the technologies to minimize hypoglycemia during continuous intravenous insulin infusion. This sample also featured computer protocols and paper protocols used during treatment. Conclusion: This research was able to identify technologies that were created to minimize the occurrence of hypoglycemia during continuous infusion of insulin. The computer protocols were considered to be more effective in minimizing hypoglycemic events


Objetivo: Identificar las tecnologías ya existentes para la minimización de la hipoglucemia en pacientes adultos durante la infusión continua de la insulina por las venas. Metodología: Revisión integrativa de las producciones científicas disponibles en portugués, inglés y español, indexadas en las bases de los datos de la Biblioteca virtual de salud (BVS) utilizando como marco de tiempo los años de 2005 a 2015. Resultados: Después de la búsqueda, selección y analice de los artículos, 06 fueron seleccionados para componer la amostra de estudio que se encuentra disponible, en su totalidad, donde evidenciaban tecnologías para la minimización de la hipoglucemia durante la ICI en las venas. La amostra caracterizó protocolos informatizados y protocolos de papel utilizados durante el tratamiento. Conclusión: El estudio consiguió identificar tecnologías que fueron creadas para minimizar las ocurrencias de hipoglucemias durante la infusión continua de la insulina. Los protocolos informatizados fueron considerados más eficaces en la minimización de las eventualidades hipoglucémicas


Subject(s)
Humans , Male , Female , Adult , Adult , Biomedical Technology , Hypoglycemia/prevention & control , Insulin/administration & dosage , Critical Care/methods , Guidelines as Topic , Hypoglycemic Agents , Insulin/adverse effects , Nursing Assessment
8.
Rev. Esc. Enferm. USP ; 54: e03562, 2020. tab, graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1101392

ABSTRACT

Abstract Objective: To identify the scientific evidence on the frequency of handling errors of conventional and smart pump infusions in intravenous insulin therapy in intensive care units. Method: A systematic review with meta-analysis conducted in the Virtual Health Library, MEDLINE via PubMed, Scopus and Web of Science databases. Articles were assessed regarding the level of evidence by applying the Oxford Center for Evidence-Based Medicine Evidence Scale. Results: Twelve (12) publications were selected which met the eligibility criteria. The programming error rate using the conventional infusion pump ranged from 10% to 40.1%, and the smart pump technology error rate ranged from 0.3 to 14%. The meta-analysis of two studies favored the smart pump in reducing the relative risk of programming errors by 51%. Conclusion: Based on selected articles, the smart pump reduces the risk of programming errors.


Resumen Objetivo: Identificar las evidencias acerca de la frecuencia de errores en el manejo de las bombas de infusión convencional y smart pump en la terapia insulínica intravenosa en unidades de cuidados intensivos. Método: Revisión sistemática con metaanálisis llevada a cabo en las bases de datos Biblioteca Virtual de Saúde, MEDLINE por vía PubMed, Scopus y Web of Science. Los artículos fueron evaluados en cuanto al nivel de evidencia por la aplicación de la Escala de Evidencia del Oxford Centre for Evidence-Based Medicine. Resultados: Se seleccionaron 12 publicaciones que atendieron los criterios de elegibilidad. El índice de errores de programación utilizando la bomba de infusión convencional varió del 10% al 40,1% y en la tecnología smart pump varió del 0,3% al 14%. El metaanálisis de dos estudios fue favorable a la smart pump en la reducción del riesgo relativo de errores de programación en el 51%. Conclusión: Considerando como base los artículos seleccionados, la smart pump reduce el riesgo de errores de programación.


Resumo Objetivo: Identificar as evidências científicas acerca da frequência de erros no manuseio das bombas de infusão convencional e smart pump na terapia insulínica intravenosa em unidades de cuidados intensivos. Método: Revisão sistemática com metanálise realizada nas bases de dados Biblioteca Virtual de Saúde, MEDLINE via PubMed, Scopus e Web of Science. Os artigos foram avaliados quanto ao nível de evidência pela aplicação da Escala de Evidência do Oxford Centre for Evidence-Based Medicine. Resultados: Foram selecionadas 12 publicações que atenderam aos critérios de elegibilidade. A taxa de erros de programação usando a bomba de infusão convencional variou de 10% a 40,1% e na tecnologia smart pump variou de 0,3 a 14%. A metanálise de dois estudos foi favorável a smart pump na redução do risco relativo de erros de programação em 51%. Conclusão: Considerando como base os artigos selecionados, a smart pump reduz o risco de erros de programação.


Subject(s)
Infusion Pumps , Insulin/administration & dosage , Intensive Care Units , Medication Errors , Review , Critical Care Nursing
9.
Gac. méd. Méx ; 155(2): 156-161, mar.-abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1286477

ABSTRACT

Resumen Introducción: Poco se ha evaluado el rechazo de los médicos a prescribir insulina a sus pacientes; el retraso en intensificar el tratamiento impide una atención adecuada y de calidad. Objetivo: Identificar la percepción de los médicos acerca de las barreras para iniciar la insulina en los pacientes con diabetes. Método: Por Índice Smith y análisis multivariado, en 81 médicos familiares se evaluó la relevancia y agrupación de los conceptos relacionados con las barreras para la prescripción de insulina. Resultados: 35.8 % de los médicos mostró confianza en prescribir insulina; casi la mitad calificó la intensificación del tratamiento entre moderadamente y poco importante (39.5 y 6.2 %). Las barreras se relacionaron con el médico (39.5 %), el paciente (37 %), el tratamiento con insulina (11.1 %) y la institución (6.2 %); 6.2 % de los médicos no percibió ninguna barrera. Las barreras se agruparon en cinco factores, que explicaron 62.48 % de la varianza: cultura de los pacientes, falta de habilidades, miedo a los eventos adversos, inseguridad y falta de capacitación. Conclusión: La inercia clínica no resultó de una condición clínica compleja o comorbilidades del paciente, sino de la percepción del médico y de su confianza en sus habilidades clínicas y comunicativas.


Abstract Introduction: Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care. Objective: To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes. Method: Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors. Results: Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training. Conclusion: Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor’s perception and confidence in his/her clinical and communication skills.


Subject(s)
Humans , Male , Female , Middle Aged , Practice Patterns, Physicians'/statistics & numerical data , Physicians, Primary Care/statistics & numerical data , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Quality of Health Care , Attitude of Health Personnel , Clinical Competence , Communication , Diabetes Mellitus, Type 2/drug therapy
10.
Ciênc. Saúde Colet ; 24(3): 997-1005, mar. 2019. tab
Article in Portuguese | LILACS | ID: biblio-989579

ABSTRACT

Resumo Investigar os fatores associados ao controle glicêmico de pessoas com diabetes mellitus (DM). Estudo transversal realizado com 746 pessoas com DM tipo 2 e 40 anos ou mais de idade. Elegeu-se as seguintes variáveis: socioeconômicas, dados clínicos, estilo de vida e o risco para o desenvolvimento de úlceras nos pés. A coleta dos dados ocorreu por meio de entrevista, análise do prontuário e exame clínico dos membros inferiores. Utilizou-se o modelo de regressão múltipla de Poisson para determinação das razões de prevalência (RP) brutas e ajustadas da alteração do exame de hemoglobina glicada (HbA1c), considerada como variável dependente desta pesquisa, sendo esta classificada como elevada quando o valor apresentava resultado superior a 7%. Identificou-se a elevação da HbA1c em 68,9% dos participantes e foi mais prevalente em indivíduos com idade entre 50 e 69 anos (RP = 1,38/IC95% = 1,09-1,75), os que faziam uso de insulina (RP = 1,35/IC95% = 1,24-1,47), obesos (RP = 1,14/IC95% = 1,03-1,25) e naqueles que possuíam risco de ulceração nos pés (RP = 1,14/IC95% = 1,09-1,28). Os indivíduos na faixa etária entre 50 e 69 anos, os que faziam uso de insulina, os obesos e os que possuíam risco de ulceração nos pés apresentaram maiores taxas de prevalência de alteração na hemoglobina glicada.


Abstract Investigate the factors associated with the glycemic control in people with diabetes mellitus (DM). Cross-sectional study with 746 people with type-2 DM of age 40 or older. The following variables were selected: socioeconomic, clinical data, lifestyle and the risk of developing foot ulcers. Data collection occurred through interviews, medical record analysis and clinical examination of the lower limbs. We used the Poisson multiple regression model to determine the crude and adjusted prevalence ratios (PR) of the glycemic alteration. The alteration in the glycated hemoglobin (HbA1c) test was considered as a dependent variable in this study, which has been classified as high when the result was higher than 7%. The alteration in HbA1c was present in 68.9% of the participants and was more prevalent in individuals aged between 50 and 69 (PR = 1.38/IC95% = 1.09-1.75), who were taking insulin (PR = 1.35/IC95% = 1.24-1.47), obese (PR = 1.14/IC95% = 1.03-1.25) and who had foot ulceration risk (PR = 1.14/IC95% = 1.09-1.28). Individuals aged between 50 and 69; the ones who used insulin; the obese ones; and those who had a risk of foot ulceration, presented higher prevalence rates of alteration in the glycated hemoglobin.


Subject(s)
Humans , Male , Female , Adult , Aged , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Socioeconomic Factors , Glycated Hemoglobin A/metabolism , Poisson Distribution , Prevalence , Cross-Sectional Studies , Interviews as Topic , Diabetic Foot/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Life Style , Middle Aged , Obesity/epidemiology
11.
Rev. Assoc. Med. Bras. (1992) ; 65(1): 24-32, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-985013

ABSTRACT

SUMMARY INTRODUCTION In acute myocardial infarction (AMI), each 18 mg/dl (1 mmol/L) increment is associated with a 3% increase in mortality rates. All strategies applied for reducing blood glucose to this date, however, have not presented encouraging results. METHODOLOGY We searched the Medline (PubMed) and Cochrane Library databases for randomized clinical trials (RCTs) from 1995 to 2017 that used the intensive strategy or GIK therapy for blood glucose control during the acute stage of the AMI. We included eight studies. In order to identify the effects of GIK or insulin therapy, we calculated a overall risk ratio (RR) with meta-analysis of fixed and random effects models. A two-tail p-value of < 0.05 was considered statistically significant. RESULTS A total of 28,151 patients were included: 1,379 intensively treated with insulin, 13,031 in GIK group, and 13,741 in the control group. The total mortality was 10.5% (n=2,961) and the RR of 1.03 [95%CI 0.96-1.10]; I2 = 31%; p = 0.41 for the combined intensive insulin plus GIK groups in comparison with the control group. In meta-regression analyses, intense reductions in blood glucose (> 36 mg/dL) in relation to the estimated average blood glucose (estimated by HbA1c) were associated with higher mortality, whereas lower reductions in blood glucose (< 36 mg/dL) were not associated with mortality. The lowering of blood glucose in the acute phase of MI compared with the average blood glucose was more effective around 18 mg/dL. CONCLUSION This meta-analysis suggests that there may be a tenuous line between the effectiveness and safety of reducing blood glucose in the acute phase of MI. The targets must not exceed a reduction greater than 36 mg/dL in relation to estimated average blood glucose.


RESUMO INTRODUÇÃO No infarto agudo do miocárdio (IAM), cada incremento de 18 mg/dl (1 mmol/L) se associa a um aumento de 3% na mortalidade. As estratégias de redução da glicemia tentadas até o momento, entretanto, não trouxeram resultados animadores. METODOLOGIA Foram pesquisadas nas bases de dados Medline (PubMed) e Cochrane Library os ensaios clínicos randomizados (ECRs) de 1995 a 2017 que utilizaram estratégia intensiva ou a terapia GIK no controle glicêmico durante a fase aguda do IAM. Foram incluídos oito estudos. Para identificar os efeitos da insulinoterapia ou da terapia GIK, calculamos um risco relativo geral (RR) com meta-análises de modelos de efeitos fixos e aleatórios. Um valor de p-bicaudal < 0,05 foi considerado estatisticamente significativo. RESULTADOS Foram incluídos 28.151 pacientes, sendo 1.379 no grupo de tratamento intensivo da glicemia, 13.031 no GIK e 13.741 no controle. A mortalidade total foi de 2.961 (10,5%), computando um risco relativo de 1,03 [95%CI 0,96-1,10]; I 2 = 31%; p = 0,41 para o grupo intensivo ou GIK contra o grupo conservador. Reduções intensas (> 36 mg/dL) em relação à glicemia estimada média se associaram à maior mortalidade, enquanto reduções menores não se associaram com seu incremento ou redução. A redução glicêmica na fase aguda em relação à glicemia estimada média foi mais efetiva e segura na faixa em torno de 18 mg/dL. CONCLUSÃO Esta meta-análise levanta a hipótese de haver um limite tênue entre efetividade e segurança para a redução glicêmica na fase aguda, sendo que os alvos não devem exceder uma redução maior do que 36 mg/dL de glicemia.


Subject(s)
Humans , Hyperglycemia/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Myocardial Infarction/mortality , Myocardial Infarction/drug therapy , Randomized Controlled Trials as Topic , Treatment Outcome , Diabetes Mellitus, Type 2/drug therapy , Insulin/administration & dosage , Myocardial Infarction/physiopathology , Myocardial Infarction/metabolism
13.
Arch. endocrinol. metab. (Online) ; 62(6): 585-590, Dec. 2018. tab
Article in English | LILACS | ID: biblio-983810

ABSTRACT

ABSTRACT Objective: The aim was to characterize blood glucose fluctuations in patients with fulminant type 1 diabetes (FT1DM) at the stable stage using continuous blood glucose monitoring systems (CGMSs). Subjects and methods: Ten patients with FT1DM and 20 patients with classic type 1 diabetes mellitus (T1DM) (the control group) were monitored using CGMSs for 72 hours. Results: The CGMS data showed that the mean blood glucose (MBG), the standard deviation of the blood glucose (SDBG), the mean amplitude glycemic excursions (MAGE), the blood glucose areas and the percentages of blood glucose levels below 13.9 mmol/L were similar between the two groups. However, the percentage of blood glucose levels below 3.9 mmol/L was significantly higher in the FT1DM group compared to the T1DM group (p < 0.05). The minimum (Min) blood glucose level in the FT1DM group was significantly lower than that of the T1DM group (p < 0.05). Patients with FT1DM had severe dysfunction of the islet beta cells and alpha cells compared to patients with T1DM, as indicated by lower C-peptide values and higher glucagon/C-peptide values. Conclusion: In conclusion, patients with FT1DM at the stable stage were more prone to hypoglycemic episodes as recorded by CGMSs, and they had a greater association with severe dysfunction of both the beta and alpha islet cells compared to patients with T1DM.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Blood Glucose/analysis , Diabetes Mellitus, Type 1/blood , Reference Values , Blood Glucose/metabolism , C-Peptide/blood , Glucagon/blood , Blood Glucose Self-Monitoring/methods , Case-Control Studies , Retrospective Studies , Statistics, Nonparametric , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Insulin/blood
14.
Medicina (B.Aires) ; 78(4): 286-289, ago. 2018. tab
Article in Spanish | LILACS | ID: biblio-954996

ABSTRACT

La polineuropatía desmielinizante inflamatoria crónica (PDIC) se presenta generalmente con síntomas motores, debilidad tanto en los músculos proximales como en los distales con reflejos globalmente disminuidos o ausentes. La neuritis insulínica es un trastorno caracterizado por dolor agudo de las extremidades, y daño de los nervios periféricos con afectación predominante de las fibras pequeñas, en los pacientes diabéticos sometidos a un rápido control glucémico. El dolor es raro en la PDIC clásica. Describimos el caso de una mujer de 54 años con diabetes mellitus (DB) tipo II, en tratamiento reciente con insulina, que consultó por un cuadro de debilidad e hiperalgesia de los cuatro miembros de dos meses de evolución. Al examen físico presentaba dolor de intensidad 10/10 y alodinia en los cuatro miembros, a niveles proximal y distal, con fuerza muscular reducida de los músculos proximales y arreflexia patelar y aquilea bilateral. Se realizó un estudio electrofisiológico, el cual mostró una polineuropatía sensitiva y motora desmielinizante. Se indicó tratamiento con inmunoglobina humana recombinante, con total remisión del cuadro. Estudios realizados posteriormente demostraron positividad débil de los anticuerpos GM1, GD1a, GD1b y anti-asialo GM1. Previo al alta hospitalaria se recibieron los resultados de VDRL sérica positiva, y FTA-Abs. VDRL en líquido cefalorraquídeo fue negativa por lo que se descartó neurosífilis, indicándose tratamiento con penicilina benzatínica.


Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder characterized by motor symptoms such as weakness in both proximal and distal muscles with globally diminished or absent reflexes. Insulin neuritis is referred as an acute pain in the extremities, due to the damage of peripheral nerves affecting mainly small fibers, in diabetic patients treated with insulin who achieved rapid glycemic control. Pain is unusual in classic CIDP. We report the case of a 54-year-old female patient with type II diabetes mellitus, and a recent onset of insulin therapy, who presented at the emergency room with a 2-month history of weakness and hyperalgesia of extremities. Physical examination showed marked pain and proximal and distal allodynia in the 4 limbs, with reduced muscle strength of the proximal muscles and patellar and achillear areflexia. Electrophysiological study showed sensory and motor polyneuropathy with a demyelinating predominance. Treatment with recombinant human immunoglobin was started, and the patient presented a total remission of the condition. Complementary studies confirmed weak serum positivity of GM1, GD1a, GD1b and anti-asialo GM1. Prior to hospital discharge, results of positive serum VDRL and FTA-Abs were received. VDRL in cerebrospinal fluid was negative, so neurosyphilis was ruled out, and treatment with benzathine penicillin was indicated.


Subject(s)
Humans , Female , Middle Aged , Syphilis/complications , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/chemically induced , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/adverse effects , Insulin/adverse effects , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/diagnosis , Diabetes Mellitus, Type 2/complications , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage
15.
Arch. endocrinol. metab. (Online) ; 62(2): 212-220, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887651

ABSTRACT

ABSTRACT Objective To observe the effect of short-term insulin intensive treatment on the monocyte chemoattractant protein-1 (MCP-1) as well as on the nuclear factor-kappa B (NF-κB) expression of peripheral blood monocyte. This is also in addition to observing the serum MCP-1 level in newlydiagnosed type 2 diabetic patients and probing its anti-inflammation effects. Subjects and methods Twenty newly-diagnosed type 2 diabetic patients were treated with an insulin intensive treatment for 2 weeks. MCP-1 and NF-κB expression on the monocyte surface were measured with flow cytometry, the serum MCP-1 level was measured by enzyme linked immunosorbent assay (ELISA) during pretreatment and post-treatment. Results After 2 weeks of the treatment, MCP-1 and NF-κB protein expression of peripheral blood monocyte and serum MCP-1 levels decreased significantly compared with those of pre-treatment, which were (0.50 ± 0.18)% vs (0.89 ± 0.26)% (12.22 ± 2.80)% vs (15.53 ± 2.49)% and (44.53 ± 3.97) pg/mL vs (49.53 ± 3.47) pg/mL, respectively (P < 0.01). The MCP-1 expression on monocyte surface had a significant positive relationship with serum MCP-1 levels (r = 0.47, P < 0.01). Conclusions Short-term insulin intensive therapy plays a role in alleviating the increased inflammation reaction in type 2 diabetics.


Subject(s)
Humans , Male , Female , Middle Aged , Monocytes/chemistry , NF-kappa B/adverse effects , Chemokine CCL2/drug effects , Diabetes Mellitus, Type 2/drug therapy , Inflammation/prevention & control , Insulin/administration & dosage , Enzyme-Linked Immunosorbent Assay , Case-Control Studies , NF-kappa B/blood , Chemokine CCL2/blood , Diabetes Mellitus, Type 2/blood , Flow Cytometry
16.
SãoPaulo; s.n; s.n; 2018. 127 p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1361485

ABSTRACT

Pacientes diabéticos apresentam alterações no sistema imunológico que promovem, em parte, maior suscetibilidade de infecções bacterianas. O tratamento com insulina melhora a sobrevida e reduz o número de infecções recidivas no paciente com diabetes mellitus do tipo 1 (DM1). Pouco se sabe sobre os efeitos do diabetes e a ação da insulina nos macrófagos. Neste trabalho, investigamos a proteína fosfatidilinositol-3-quinase (PI3K), proteína quinase B (Akt) e as quinases ativadas por mitógenos (MAPK) em macrófagos derivados de medula óssea (BMDM) e sua participação no estímulo por lipopolissacarídeo (LPS) na presença ou não do tratamento com insulina através da secreção dos mediadores inflamatórios fator de necrose tumoral (TNF)-α, interleucina (IL)-6 e IL-10. Observamos que os BMDM de animais com DM1 apresentam aumento da expressão da subunidade catalítica PI3K p110alpha com redução na subunidade reguladora PI3K p55 e maior expressão da fosforilação das proteínas Akt (Serina-473 e Treonina-308), quinase regulada por sinal extracelular (ERK) 1/2 e quinase ativada por estresse/quinase Jun-amino-terminal (SAPK/JNK) MAPK. Observou-se alteração na concentração das citocinas TNF-α, IL-6 e IL-10 no sobrenadante da cultura de BMDM dos animais diabéticos após estímulo com LPS, menor taxa de metabolismo mitocondrial, no entanto, sem resultar em morte celular, tampouco na expressão do receptor do tipo Toll 4 na membrana celular. Já o reestímulo destas células com LPS promoveu aumento na concentração de TNF-α sem alteração das demais citocinas. Além disto, o tratamento com insulina, simultaneamente ao estímulo com LPS, dos BMDM oriundos de animais diabéticos aumentou a concentração de TNF-α, IL-6, da fosforilação de p38, ERK 1/2 e SAPK/JNK MAPK, PI3K p55 e da Akt (Serina-473), o que não ocorreu nos BMDM dos animais não diabéticos sob a mesma condição. Este efeito foi abolido pela inibição farmacológica da PI3K e da ERK 1/2, resultando em novo aumento da concentração de TNF-α e IL-6. A análise conjunta destes resultados indica que a insulina, através da modulação das vias PI3K, Akt, ERK 1/2 e SAPK/JNK, amplifica o aumento da concentração de TNF-α e IL-6 sob estímulo com LPS


Diabetic patients present alterations in the immune system that promote in part a greater susceptibility of bacterial infections. Insulin treatment improves survival and reduces the number of recurrent infections in patients with type 1 diabetes mellitus (DM1). Little is known about the effects of diabetes and the action of insulin on macrophages. In this work we investigated the phosphatidylinositol-3-kinase (PI3K) / protein kinase B (Akt) and mitogen-activated kinase (MAPK) proteins in bone marrow-derived macrophages (BMDM) and their participation in lipopolysaccharide (LPS) or treatment with insulin through the secretion of inflammatory mediators tumor necrosis factor (TNF) -α, interleukin (IL) -6 and IL-10. We observed that BMDM of animals with DM1 increased PI3K p110alpha catalytic subunit expression with a reduction in the PI3K p55 regulatory subunit and increased expression of the phosphorylation of the Akt (Serine-473 and Threonine-308), extracellular signal regulated kinase (ERK) 1/2 and Jun-amino-terminal stress-kinase / kinase (SAPK / JNK) MAPK. Changes in the concentration of TNF-α, IL-6 and IL-10 cytokines in the supernatant of the BMDM culture of diabetic animals after stimulation with LPS were observed, possibly due to a lower rate of mitochondrial metabolism, however, without resulting in cell death , so little in the expression of the Toll 4 receptor on the cell membrane. The re-stimulation of these cells with LPS promoted an increase in TNF-α concentration without alteration of the other cytokines. In addition, insulin and simultaneously LPS stimulation of BMDM from diabetic animals increased the concentration of TNF-α, IL-6, phosphorylation of p38, ERK 1/2 and SAPK / JNK MAPK, PI3K p55 and Akt (Serine-473), which did not occur in the BMDM of non-diabetic animals under the same condition. This effect was abolished by pharmacological inhibition of PI3K and ERK 1/2, resulting in a further increase in the concentration of TNF-α and IL-6. The analysis of these results indicate that insulin by modulating the PI3K, Akt, ERK 1/2 and SAPK / JNK pathways amplifies the concentration levels of TNF-α and IL-6 under stimulation with LPS


Subject(s)
Animals , Male , Mice , Diabetes Mellitus, Type 1/classification , Macrophages , Bacterial Infections/drug therapy , Lipopolysaccharides/agonists , Cytokines/pharmacokinetics , MAP Kinase Signaling System , Alloxan/pharmacology , Infections/drug therapy , Insulin/administration & dosage
17.
Braz. J. Pharm. Sci. (Online) ; 54(2): e17617, 2018. tab, graf
Article in English | LILACS | ID: biblio-951924

ABSTRACT

ABSTRACT We investigated whether oral lactate could prevent seizures and deaths in mice with severe hypoglycemia induced by a high dose of insulin. For this purpose, mice were fasted for 15 h and then given an intraperitoneal injection of regular insulin (5.0 U/kg or 10.0 U/kg). Immediately after insulin injection, the mice received an oral dose of saline (control), glucose (5.5 mmol/kg), or lactate (18.0 mmol/kg). Glucose and lactate levels were measured in the blood and brain before and after the seizures began. Glucose and lactate delayed (p < 0.05) the onset of seizures associated with severe insulin-induced hypoglycemia. Elevated (p < 0.05) brain levels of lactate were associated with an absence of seizures in mice that received glucose or lactate, suggesting that lactate could prevent convulsions associated with severe insulin-induced hypoglycemia. However, the same oral dose of lactate that delayed the onset of convulsions also increased the mortality rate. In contrast, diazepam (3.0 mg/kg) prevented seizures and markedly decreased the frequency of death during severe insulin-induced hypoglycemia. The results demonstrated that in contrast to oral glucose, oral lactate intensifies insulin toxicity.


Subject(s)
Animals , Male , Female , Rats , Hypoglycemia/chemically induced , Insulin/administration & dosage , Anticonvulsants/adverse effects , Lactic Acid/adverse effects , Diazepam
18.
Rev. gaúch. enferm ; 39: e20170066, 2018. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-960847

ABSTRACT

Resumo OBJETIVO Identificar os fatores associados à autoaplicação de insulina em adultos com Diabetes Mellitus. MÉTODO Estudo transversal desenvolvido no município de Viçosa-MG, que avaliou 142 pacientes. A coleta de dados foi realizada entre abril e julho de 2013 mediante entrevista no domicílio do participante. Regressão logística múltipla foi utilizada. RESULTADO A prevalência de autoaplicação de insulina foi de 67,6%, apresentando associação com idade entre 57 e 68 anos (OR = 0,3; IC95%: 0,1 - 0,9), conviver com companheiro e filhos (OR = 2,5; IC95%: 1,1 - 5,0), ter 9 anos ou mais de estudo (OR = 8,4; IC95%: 1,9 - 37,9), morar em área não coberta pela Estratégia Saúde da Família (ESF) (OR = 2,8; IC95%: 1,1 - 7,0). CONCLUSÃO Autoaplicação de insulina mostrou-se associada à idade, escolaridade, situação conjugal e cobertura da ESF. O reconhecimento desses fatores pode contribuir para o desenvolvimento de estratégias para adesão à autoaplicação de insulina.


Resumen OBJETIVO Identificar los factores asociados con la autoadministración de insulina en adultos con diabetes mellitus. MÉTODOS Se trata de un estudio transversal desarrollado en el municipio de Viçosa-MG, en el que se evaluaron 142 pacientes. La recolección de datos se llevó a cabo entre abril y julio de 2013 mediante entrevistas en el hogar del participante. Se aplicó la regresión logística múltiple. RESULTADOS La prevalencia de la auto-administración de insulina fue de 67,6% y se asoció con edad entre 57 y 68 años (OR = 0,3; IC del 95%: 0,1 - 0,9), que viven con una pareja e hijos ( OR = 2,5; IC del 95%: 1.1 5,0), con 9 o más años de educación (OR = 8,4; IC del 95%: no 1,9-37,9), que viven en un área cubierta por la Estrategia de Salud de la familia (ESF) (OR = 2,8; IC del 95%: 1.1 7.0). CONCLUSIÓN La autoadministración de insulina se asoció con la edad, la educación, el estado civil y la cobertura del ESF. El reconocimiento de estos factores puede contribuir para la adhesión a la autoadministración de insulina.


ABSTRACT Objective: To identify the factors associated with the self-application of insulin in adult individuals with Diabetes Mellitus. Method: A cross-sectional study developed in the city of Viçosa-MG, which assessed 142 patients. The data collection was performed between April and July 2013 through an interview at the participant's home. Multiple logistic regression was used. Results: The prevalence of the self-administration of insulin was of 67.6%, and it was associated with ages between 57 and 68 years old (OR = 0.3, 95% CI: 0.1-0.9), living with a partner and children (OR = 2.5, 95% CI: 1.1-5.0), 9 years or more of study (OR = 8.4, 95% CI: 1.9-37.9), living in an area not covered by the Family Health Strategy (FHS) (OR = 2.8, 95% CI: 1.1 - 7.0). Conclusion: The self-application of insulin was associated with age, schooling, marital status, and the FHS coverage. The recognition of these factors may contribute to the adherence to the self-application of insulin.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Diabetes Mellitus/drug therapy , Medication Adherence , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Brazil/epidemiology , Self Administration , Marriage , Catchment Area, Health , Comorbidity , Patient Education as Topic , Cross-Sectional Studies , Surveys and Questionnaires , Age Factors , Insurance Coverage , Continental Population Groups , Diabetes Mellitus/psychology , Diabetes Mellitus/epidemiology , Educational Status , Hospitalization/statistics & numerical data , Hypertension/epidemiology , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Middle Aged , National Health Programs
19.
Rev. saúde pública (Online) ; 52: 60, 2018. tab, graf
Article in English | LILACS | ID: biblio-903473

ABSTRACT

ABSTRACT OBJECTIVE: To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy. METHODS: This is a prospective, non-randomized, quasi-experimental study. We have included 45 patients over 60 years old, from both sexes, with glycated hemoglobin (HbA1c) > 8.5% using oral hypoglycemic agents and insulin. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement. All patients received insulin pen, refills of Neutral Protamine Hagedorn and regular insulin, needles for the pen, blood glucose meter, and capillary blood glucose tests (three tests/day). Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention. RESULTS: Glycated hemoglobin at baseline was 10.34% (SE = 0.22%) and 8.54% (SE = 0.24%, p < 0.001) and 8.09% (SE = 0.21%, p < 0.001) at 12 and 24 weeks after intervention, respectively, with a significant reduction from baseline. CONCLUSIONS: More frequent medical visits, with treatment inputs including the use of insulin pens and self-monitoring, have improved glycemic control (reduction of 2.25% in HbA1C, on average, at 24 weeks of follow-up). Our data support a change in the management and medical behavior of older patients with chronically decompensated diabetes.


Subject(s)
Humans , Male , Female , Aged , Glycemic Index/drug effects , Diabetes Mellitus, Type 2/prevention & control , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Socioeconomic Factors , Blood Glucose/drug effects , Brazil , Glycated Hemoglobin A , Prospective Studies , Risk Factors , Controlled Clinical Trial , Middle Aged
20.
Esc. Anna Nery Rev. Enferm ; 22(3): e20170387, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-953456

ABSTRACT

Objective: The objective of this study was to construct and validate a low-cost simulator to train diabetes mellitus patients and their caregivers on the administration of insulin. Method: Action research study with a qualitative approach, through a validation methodological study. Results: A low-fidelity simulator was constructed with the areas recommended for insulin administration adapted to allow skill training. Validation was done by nine experts on the subject. Conclusions: The prototype has low cost and greater anatomical functional fidelity than the models currently available in the market. Implications for practice: The simulator developed can be used by health professionals, caregivers or by the patients themselves as a tool in the training for insulin administration. Its use may favor the identification of critical points related to the application technique, allowing the planning of more directive and effective educational interventions.


Objetivo: Este estudio tuvo como objetivo la construcción y validación de un simulador de bajo costo para uso en la capacitación de pacientes con diabetes mellitus y de sus cuidadores para la aplicación de insulina. Método: Investigación-acción de abordaje cualitativo y estudio metodológico de validación. Resultados: Se ha construido un simulador de baja fidelidad con las áreas recomendadas para la aplicación de insulina adaptadas para permitir el entrenamiento de la habilidad. La validación fue hecha por nueve expertos en el tema. Conclusiones: El prototipo presenta bajo costo y mayor fidelidad anatómica funcional que los modelos actualmente disponibles en el mercado. Implicaciones para la práctica: El simulador desarrollado puede ser utilizado por profesionales de la salud, cuidadores o por los propios pacientes como herramienta en la capacitación para aplicación de insulina. Su uso puede favorecer la identificación de puntos críticos relacionados con la técnica de aplicación, permitiendo la planificación de intervenciones educativas más directivas y eficaces.


Objetivo: Este estudo teve como objetivo a construção e validação de um simulador de baixo custo para uso na capacitação de pacientes com diabetes mellitus e de seus cuidadores para a aplicação de insulina. Método: Pesquisa-ação de abordagem qualitativa e estudo metodológico de validação. Resultados: Foi construído um simulador de baixa fidelidade com as áreas recomendadas para aplicação de insulina adaptadas para permitir o treinamento da habilidade. A validação foi feita por nove experts no assunto. Conclusões: O protótipo apresenta baixo custo e maior fidelidade anatômico funcional do que os modelos atualmente disponíveis no mercado. Implicações para prática: O simulador desenvolvido pode ser utilizado por profissionais da saúde, cuidadores ou pelos próprios pacientes como ferramenta na capacitação para aplicação de insulina. Seu uso pode favorecer a identificação de pontos críticos relacionados a técnica de aplicação, permitindo o planejamento de intervenções educacionais mais diretivas e eficazes.


Subject(s)
Humans , Health Education/statistics & numerical data , Low Cost Technology/statistics & numerical data , Diabetes Mellitus/nursing , Insulin/administration & dosage
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