ABSTRACT
OBJETIVO: Analisar a correlação entre a consulta de enfermagem e o cumprimento de ações de autocuidado e práticas seguras em insulinoterapia por pessoas com diabetes. MÉTODO: Estudo observacional, retrospectivo e analítico. Analisaram-se características sociodemográficas e clínicas e acertos em questionário com 16 itens sobre práticas seguras em insulinoterapia, aplicado na primeira e segunda consulta de enfermagem. RESULTADOS: Constatou-se aumento significativo de acertos no questionário nos aspectos relacionados à insulinoterapia na segunda consulta (14,22±1,59), em comparação com a primeira (9,24±3,13) (p<0,001), sugerindo melhoria do autocuidado e da adesão às práticas seguras em insulinoterapia. CONCLUSÃO: Houve melhora do cumprimento de ações de autocuidado e práticas seguras em insulinoterapia, após as consultas de enfermagem, mostrando que essa intervenção é eficaz para promoção do tratamento insulínico adequado.
OBJECTIVE: To analyze the correlation between nursing consultation and the execution of self-care actions and safe practices in insulin therapy by people with diabetes. METHOD: Observational, retrospective, and analytical study. Sociodemographic and clinical characteristics and correct answers in a questionnaire with 16 items on safe practices in insulin therapy, applied in the first and second nursing consultations, were analyzed. RESULTS: There was a significant increase in the number of correct answers in the questionnaire regarding aspects related to insulin therapy in the second consultation (14.22±1.59) compared to the first (9.24±3.13) (p<0.001), suggesting improvement in self-care and adherence to safe practices in insulin therapy. CONCLUSION: There was an improvement in the execution of self-care actions and safe practices in insulin therapy after the nursing consultations, showing that this intervention effectively promotes adequate insulin treatment.
Subject(s)
Humans , Male , Female , Middle Aged , Office Nursing , Diabetes Mellitus , Patient Safety , Insulin/therapeutic use , Nursing Services , Self Care , Retrospective StudiesABSTRACT
ABSTRACT Insulin antibodies (IAs) induced by exogenous insulin rarely cause hypoglycemia. However, insulin autoantibodies (IAAs) in insulin autoimmune syndrome (IAS) can cause hypoglycemia. The typical manifestations of IAS are fasting or postprandial hypoglycemia, elevated insulin level, decreased C-peptide levels, and positive IAA. We report a 45-year-old male with type 1 diabetes mellitus (T1DM) treated with insulin analogues suffering from recurrent hypoglycemic coma and diabetic ketoacidosis (DKA). His symptoms were caused by exogenous insulin and were similar to IAS. A possible reason was that exogenous insulin induced IA. IA titers were 61.95% (normal: 300 mU/L and < 0.02 nmol/L when hypoglycemia occurred. Based on his clinical symptoms and other examinations, he was diagnosed with hyperinsulinemic hypoglycemia caused by IA. His symptoms improved after changing insulin regimens from insulin lispro plus insulin detemir to recombinant human insulin (Gensulin R) and starting prednisone.
Los anticuerpos contra la insulina (AI) inducidos por la insulina exógena raramente causan hipoglucemia. No obstante, los autoanticuerpos contra la insulina (AIA) en el síndrome autoinmune de insulina (SAI) pueden causar hipoglucemia. Las manifestaciones típicas del SAI son la hipoglucemia en ayunas o posprandial, niveles elevados de insulina, la disminución del nivel de péptido C y AIA positivos. Presentamos un paciente hombre de 45 años con diabetes mellitus de tipo 1 (DMT1) tratado con análogos de insulina, que sufría comas hipoglucémicos recurrentes y cetoacidosis diabética (CAD). Sus síntomas fueron causados por la insulina exógena y fueron similares al SAI. La posible razón fue que la insulina exógena indujo AI. El título de AI era del 61,95% (Normal: 300 mU/L y < 0,02 nmol/L cuando se producía la hipoglucemia. Basados en sus síntomas clínicos y otros exámenes, se le diagnosticó hipoglucemia hiperinsulinémica causada por la AI. Sus síntomas mejoraron después de cambiar el régimen de insulina de lispro más insulina detemir a insulina humana recombinante (Gensulin R) y de empezar a tomar prednisona.
Subject(s)
Humans , Male , Middle Aged , Autoimmune Diseases/diagnosis , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/drug therapy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Hypoglycemia/chemically induced , C-Peptide/therapeutic use , Coma , Hypoglycemic Agents/adverse effects , Insulin/therapeutic use , Insulin Antibodies/therapeutic useABSTRACT
ABSTRACT Objective To compare the major outcomes of use of metformin and glyburide in treatment of gestational diabetes mellitus. Methods Studies published in English, in the last 10 years, in the databases MEDLINE®, SciELO, LILACS and Cochrane Library were analyzed, and randomized controlled trials were selected. Health Sciences Descriptors were used to compose the search phrase, and the keywords "Gestational diabetes", "Glyburide", "Metformin" and their variations were searched in the Medical Subject Headings. PRISMA systematization was used to prepare this review, and a meta-analysis was conducted aiming to mathematically show the results of fasting blood glucose, postprandial blood glucose, birth weight and weight gain during pregnancy after using metformin and glyburide. Results The studies evaluated birth weight, neonatal hypoglycemia, mode of delivery, need for intensive care, Apgar score, macrosomia, fasting glucose, postprandial glucose and weight gain during pregnancy. In 60% of studies, there were no statistically significant differences regarding safety and efficacy of administration of metformin and glyburide. Meta-analysis demonstrated the absence of statistical differences between these drugs in fasting blood glucose (p=0.821), postprandial blood glucose (p=0.217) and birth weight (p=0.194). However, significant differences were shown in weight gain during pregnancy (p=0.036). Conclusion The methods are effective, but the adverse effects of glyburide are more common; therefore, the use of metformin should be recommended, if in monotherapy.
Subject(s)
Humans , Female , Pregnancy , Diabetes, Gestational/drug therapy , Metformin/adverse effects , Metformin/therapeutic use , Blood Glucose , Glyburide/adverse effects , Glyburide/therapeutic use , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic useABSTRACT
OBJECTIVES@#Patients with classical type 1 diabetes mellitus (T1DM) require lifelong dependence on exogenous insulin therapy due to pancreatic beta-cell destruction and absolute insulin deficiency. T1DM accounts for about 90% of children with diabetes in China, with a rapid increase in incidence and a younger-age trend. Epidemiological studies have shown that the overall glycated haemoglobin (HbA1c) and compliance rate are low in Chinese children with T1DM. Optimal glucose control is the key for diabetes treatment, and maintaining blood glucose within the target range can prevent or delay chronic vascular complications in patients with T1DM. Therefore, this study aims to investigate the glycemic control of children with T1DM from Hunan and Henan Province with flash glucose monitoring system (FGMS), and to explore factors associated with glycemic variability.@*METHODS@#A total of 215 children with T1DM under 14 years old were enrolled continuously in 16 hospitals from August 2017 to August 2020. All subjects wore a FGMS device to collect glucose data. Correlation of HbA1c, duration of diabetes, or glucose scan rates with glycemic variability was analyzed. Glucose variability was compared according to the duration of diabetes, HbA1c, glucose scan rates and insulin schema.@*RESULTS@#HbA1c and duration of diabetes were positively correlated with mean blood glucose, standard deviation of glucose, mean amplitude of glucose excursions (MAGE), and coefficient of variation (CV) of glucose (all P<0.01). The glucose scan rates during FGMS wearing was significantly positively correlated with time in range (TIR) (P=0.001) and negatively correlated with MAGE and mean duration of hypoglycemia (all P<0.01). Children with duration ≤1 year had lower time below range (TBR) and MAGE when compared with those with duration >1 year (all P<0.05). TIR and TBR in patients with HbA1c ≤7.5% were higher (TIR: 65% vs 45%, TBR: 5% vs 4%, P<0.05), MAGE was lower (7.0 mmol/L vs 9.4 mmol/L, P<0.001) than those in HbA1c >7.5% group. Compared to the multiple daily insulin injections group, TIR was higher (60% vs 52%, P=0.006), MAGE was lower (P=0.006) in the continuous subcutaneous insulin infusion group. HbA1c was lower in the high scan rates (≥14 times/d) group (7.4% vs 8.0%, P=0.046), TIR was significantly higher (58% vs 47%, P<0.001), and MAGE was lower (P<0.001) than those in the low scan rate (<14 times/d) group.@*CONCLUSIONS@#The overall glycemic control of T1DM patients under 14 years old in Hunan and Henan Province is under a high risk of hypoglycemia and great glycemic variability. Shorter duration of diabetes, targeted HbA1c, higher glucose scan rates, and CSII are associated with less glycemic variability.
Subject(s)
Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Child , Diabetes Mellitus, Type 1/drug therapy , Glucose , Glycated Hemoglobin/analysis , Humans , Hypoglycemia/prevention & control , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic useABSTRACT
La intoxicación por bloqueantes de los canales de calcio es un cuadro poco frecuente en la población pediátrica. Los signos y síntomas pueden progresar de forma rápida y llevar al colapso cardiovascular y muerte. El sostén hemodinámico con inotrópicos y vasopresores no suele ser efectivo. La terapia con insulina y glucosa es un complemento eficaz del tratamiento inicial, que está ampliamente estudiado, y se utiliza en diferentes patologías con compromiso hemodinámico. Se presenta el caso de una paciente pediátrica con antecedente de ingestión de dosis altas de amlodipina con fines suicidas, con descompensación hemodinámica refractaria al tratamiento de soporte inotrópico habitual. A partir del tratamiento con insulina y glucosa, se logró la estabilidad hemodinámica, con evolución favorable de la paciente.
Calcium channel blocker poisoning is a rare condition in the pediatric population. Signs and symptoms can be rapidly progressive and lead to cardiovascular collapse and death. Hemodynamic support with inotropics and vasopressors is usually not effective. The insulin/glucose therapy is an effective complement to the initial treatment, which is widely studied and used in different pathologies with hemodynamic compromise. The case of a pediatric patient with a history of high-dose ingestion of amlodipine for suicidal purposes, with hemodynamic decompensation refractory to usual inotropic support treatment, is presented. From the insulin/glucose treatment, hemodynamic stability was achieved with a favorable evolution
Subject(s)
Humans , Female , Adolescent , Suicide, Attempted , Calcium Channel Blockers/poisoning , Amlodipine/poisoning , Drug Overdose/therapy , Glucose/therapeutic use , Insulin/therapeutic useABSTRACT
Objetivo: Avaliar a adesão ao tratamento e a qualidade de vida de pacientes diabéticos e identificar características epidemio- lógicas e da doença relacionadas. Métodos: Estudo transversal realizado com 98 pacientes diabéticos em acompanhamento. Foram aplicados: um questionário sociodemográfico; o Diabe- tes Quality of Life na versão brasileira, para avaliar qualidade de vida, e o teste Morisky-Green-Levine, para checar a adesão ao tratamento. O nível de significância adotado foi de 5%. Resul- tados: A maioria (87,8%) dos pacientes apresentou boa quali- dade de vida. O escore médio de qualidade de vida foi de 2,2. Existência de complicações, uso de insulina e má adesão ao tra- tamento foram fatores associados à pior qualidade de vida. A boa adesão ao tratamento (58,2%) foi associada à boa qualidade de vida (p<0,001). Conclusão: A boa adesão ao tratamento está relacionada à boa qualidade de vida. Deve-se enfatizar a impor- tância da adesão ao tratamento para prevenção de possíveis com- plicações e manutenção da qualidade de vida.
Objective: To evaluate adherence to treatment and quality of life of diabetic patients and to identify related epidemiological and disease characteristics. Methods: Cross-sectional study conducted with 98 diabetic patients undergoing treatment. A socio-demographic questionnaire, the Diabetes Quality of Life in the Brazilian version (to measure quality of life) and the Mo- risky-Green-Levine test (to check adherence to treatment) were applied. The level of significance was set at 5%. Results: Most patients (87.8%) showed good quality of life. The mean score of quality of life was 2.2. The existence of complications, insulin use, and poor treatment adherence were factors associated with worse quality of life. Good adherence to treatment, (58.2%) was associated with good quality of life (p<0.001). Conclusion: Satis- factory treatment adherence is associated with good quality of life. The importance of adherence to treatment to prevent possible complications and maintain quality of life shall be emphasized.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Quality of Life , Diabetes Mellitus/epidemiology , Medication Adherence/statistics & numerical data , Socioeconomic Factors , Brazil/epidemiology , Cross-Sectional Studies , Surveys and Questionnaires , Sex Distribution , Age Distribution , Diabetes Complications , Diabetes Mellitus/drug therapy , Sociodemographic Factors , Health Services , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic useABSTRACT
ABSTRACT Objective: The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Materials and methods: Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results: Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion: OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).
Subject(s)
Humans , Adult , Diabetes Mellitus, Type 1/drug therapy , Mobile Applications , Self Care , Blood Glucose/analysis , Glycated Hemoglobin/analysis , Insulin Infusion Systems , Glycemic Control , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic useABSTRACT
ABSTRACT Objectives: To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). Materials and methods: A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolled T2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34). The endpoints were evaluated using analysis of variance. Results: All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean ± SD patient age and body weight were 55.05 ± 7.58 years and 83.55 ± 9.65 kg, respectively. The mean ± SD duration of T2DM, glycated hemoglobin (HbA1c), and fasting plasma glucose (FPG) were 5.93 ± 2.98 years, 8.1 ± 0.53%, and 166.03 ± 26.80 mg/dL, respectively. The grand mean changes of HbA1c, FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA1c target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. Conclusion: The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA1c, but also body weight and blood pressure, with statistically significant results.
Subject(s)
Humans , Female , Adult , Benzhydryl Compounds/therapeutic use , Diabetes Mellitus, Type 2 , Diabetes Mellitus, Type 2/drug therapy , Glucosides/therapeutic use , Hypoglycemic Agents , Hypoglycemic Agents/therapeutic use , Blood Glucose , Glycated Hemoglobin , Cohort Studies , Treatment Outcome , Colombia , Drug Therapy, Combination , Insulin/therapeutic use , Metformin/therapeutic useABSTRACT
Esta síntese rápida de evidências foi comissionada e subsidiada pelo Ministério da Saúde, no âmbito do projeto GEREB-010-FIO-20 e faz parte da Coleção "Rapid response for health promotion". O problema: O cuidado integral e longitudinal da pessoa com hipertensão arterial sistêmica (HAS) e da diabetes mellitus tipo 2 (DM2) estão inseridas nas práticas do SUS, sobretudo na Atenção Primária à Saúde (APS), sendo a adesão ao tratamento um dos seus maiores desafios. Essa revisão rápida visa descrever as barreiras e os facilitadores da adesão ao tratamento terapêutico de HAS e DM2 na APS. Busca de evidência: Foram realizadas buscas em nove bases de dados que resultaram em 222 referências, e após o processo de seleção de acordo com os critérios de elegibilidade, 7 revisões sistemáticas (RS) foram incluídas nesta síntese narrativa. Na avaliação da qualidade metodológica (AMSTAR 2), uma RS foi classificada como de confiança baixa e seis de confiança criticamente baixa. As barreiras e facilitadores encontrados foram sintetizados, agrupando-se as estratégias conforme sua similaridade quanto aos usuários, profissionais de saúde e sistema de saúde. Barreiras: Sete RS apresentaram barreiras para a adesão ao tratamento de HAS ou DM. As intervenções encontradas foram: eHealth, acompanhamento clínico e tratamento farmacológico. Para os usuários, os aspectos emocionais (medo, angústia ou vergonha entre outros), aspectos sociais (acesso aos serviços, educação, custo) e aspectos individuais (estilo de vida, autocuidado, crenças, família) foram mencionados como barreiras à adesão ao tratamento. Os trabalhadores de saúde, por sua vez, referiram a falta de treinamento adequado, fluxo de trabalho, recursos humanos incipientes, além de suas emoções (medo e frustração com a baixa adesão do paciente ao tratamento) como aspectos impeditivos para a adesão dos pacientes de forma satisfatória. Recursos limitados, recursos humanos insuficiente, mão de obra desqualificada e sobrecarga de trabalho foram apontadas como barreiras ao nível do sistema de saúde. Facilitadores: Foram identificados facilitadores para a adesão ao tratamento de DM2 e de HAS em seis RS. Entre os usuários, organizar a atenção para que tenham experiências positivas no início do uso da insulina facilitou a adesão. Também, a oferta de cuidado integral, com a participação de farmacêuticos e agentes comunitários de saúde, foi benéfica inclusive por estimular ações de educação em saúde. Em relação aos trabalhadores, a adoção de abordagem centrada na pessoa e a participação de especialistas foi benéfica para adesão ao tratamento. Ações que tornam mais simples o uso de tecnologias de comunicação, melhorando sua utilização pelos usuários, aumentaram o uso dessas ferramentas para assegurar a adesão. Ademais, garantir o acesso aos medicamentos facilita enormemente que se cumpra o tratamento, bem como ter serviços com recursos físicos e equipes suficientes. Considerações finais: Esta síntese rápida de evidências encontrou barreiras e facilitadores relacionados aos usuários, aos profissionais de saúde e ao sistema de saúde. As intervenções identificadas foram eHealth, acompanhamento clínico, tratamentos farmacológicos com destaque para iniciação à insulina que podem ser aplicadas no contexto da APS. Embora algumas RS não trouxessem informações relativas ao contexto de saúde, decidiu-se incluí-las por haver um entendimento que essas estratégias poderiam ser realizadas em um ambiente de atenção primária. Além disso, houve algumas limitações metodológicas das revisões sistemáticas que devem ser consideradas. Essa síntese rápida não envolveu resultados sobre opções para enfrentamento do problema, uma vez que foram realizadas sínteses com esse foco anteriormente.
This rapid synthesis of evidence was commissioned and subsidized by the Ministry of Health, within the scope of the GEREB-010-FIO-20 project and is part of the "Rapid response for health promotion" Collection. The problem: Comprehensive and longitudinal care for people with systemic arterial hypertension (SAH) and type 2 diabetes mellitus (DM2) are part of SUS practices, especially in Primary Health Care (PHC), with adherence to treatment being one of the its biggest challenges. This quick review aims to describe the barriers and facilitators of adherence to the therapeutic treatment of SAH and T2DM in PHC. Search for evidence: Searches were carried out in nine databases that resulted in 222 references, and after the selection process according to the eligibility criteria, 7 systematic reviews (SR) were included in this narrative synthesis. In the methodological quality assessment (AMSTAR 2), one SR was classified as low confidence and six as critically low confidence. The barriers and facilitators found were synthesized, grouping the strategies according to their similarity in terms of users, health professionals and the health system. Barriers: Seven RS presented barriers to adherence to treatment for SAH or DM. The interventions found were: eHealth, clinical follow-up and pharmacological treatment. For users, emotional aspects (fear, anguish or shame, among others), social aspects (access to services, education, cost) and individual aspects (lifestyle, self-care, beliefs, family) were mentioned as barriers to treatment adherence. . Health workers, in turn, mentioned the lack of adequate training, workflow, incipient human resources, in addition to their emotions (fear and frustration with the patient's low adherence to treatment) as impediments to patient adherence to treatment. satisfactory way. Limited resources, insufficient human resources, unskilled labor and work overload were identified as barriers at the health system level. Facilitators: Facilitators were identified for adherence to DM2 and SAH treatment in six SRs. Among users, organizing attention so that they have positive experiences at the beginning of insulin use facilitated adherence. Also, the provision of comprehensive care, with the participation of pharmacists and community health agents, was beneficial, including encouraging health education actions. Regarding workers, the adoption of a person-centered approach and the participation of specialists was beneficial for treatment adherence. Actions that make the use of communication technologies simpler, improving their use by users, increased the use of these tools to ensure adherence. In addition, ensuring access to medicines greatly facilitates compliance with treatment, as well as having services with sufficient physical resources and staff. Final considerations: This rapid synthesis of evidence found barriers and facilitators related to users, health professionals and the health system. The interventions identified were eHealth, clinical follow-up, pharmacological treatments with emphasis on insulin initiation that can be applied in the context of PHC. Although some SRs did not bring information related to the health context, it was decided to include them because there was an understanding that these strategies could be carried out in a primary care environment. In addition, there were some methodological limitations of systematic reviews that should be considered. This quick synthesis did not involve results on options for coping with the problem, since syntheses with this focus were carried out previously.
Subject(s)
Humans , Adult , Primary Health Care/standards , Diabetes Mellitus, Type 2/prevention & control , Treatment Adherence and Compliance , Hypertension/prevention & control , Insulin/therapeutic useABSTRACT
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 useABSTRACT
Resumo Objetivo compreender a relação que as mulheres com diabulimia têm com o corpo. Método pesquisa qualitativa, desenvolvida com o Método da História Oral Temática, com quatro mulheres entre 18 e 30 anos que autorreferiram diabulimia. Resultados a relação das mulheres com o seu corpo foi pautada pela pressão social de magreza feminina que distorce a autoimagem, gera insatisfação com o corpo e a diminuição da autoestima. A perda de peso é proporcionalmente associada ao aumento da aceitação social e justifica a utilização de métodos deletérios à saúde como a diminuição da dose ou a suspensão do uso de insulina. As narradoras demonstraram conhecer os riscos, mas admitiram repeti-la em determinados contextos. Considerações finais e implicações para a prática o desejo que as mulheres com Diabetes Mellitus têm de perder peso precisa ser incorporado às estratégias de cuidado com a atenção dos profissionais da saúde à subjetividade, atuando para reconhecer e prevenir os transtornos alimentares em mulheres com diabetes e minimizar a adoção de ações prejudiciais à saúde.
Resumen Objetivo comprender la relación que tienen las mujeres con diabulimia con el cuerpo. Método investigación cualitativa, desarrollada con el Método de Historia Oral Temática, con cuatro mujeres entre 18 y 30 años que autoinformado diabulimia. Resultados la relación de la mujer con su cuerpo estuvo guiada por la presión social de la delgadez femenina que distorsiona la imagen de sí misma, genera insatisfacción con el cuerpo y la disminución de la autoestima. La pérdida de peso se asocia proporcionalmente con una mayor aceptación social y justifica el uso de métodos nocivos para la salud, como reducir la dosis o suspender el uso de insulina. Los narradores demostraron conocer los riesgos, pero admitieron repetirlo en determinados contextos. Consideraciones finales e implicaciones para la práctica el deseo que tienen las mujeres con Diabetes Mellitus de adelgazar debe incorporarse a las estrategias de atención con la atención de los profesionales de la salud a la subjetividad, actuando para reconocer y prevenir los trastornos alimentarios en mujeres con diabetes y minimizar la adopción de acciones nocivas para la salud.
Abstract Objective to understand the relationship that women with diabulimia have with the body. Method a qualitative research, developed with the Thematic Oral History Method, with four women between 18 and 30 years of age who reported diabulimia. Results women's relationship with their bodies has been guided by the social pressure of female thinness that distorts self-image, generates dissatisfaction with the body and diminishes self-esteem. Weight loss is proportionally associated with increased social acceptance and justifies the use of harmful methods to health such as reducing the dose or suspending the use of insulin. The narrators showed to know the risks, but admitted to repeat it in certain contexts. Final considerations and implications for practice the desire that women with Diabetes Mellitus have to lose weight needs to be incorporated into the strategies of care with the attention of health professionals to subjectivity, acting to recognize and prevent eating disorders in women with diabetes and minimize the adoption of actions harmful to health.
Subject(s)
Humans , Female , Adult , Young Adult , Body Image , Diabetes Mellitus, Type 1/therapy , Diabulimia/psychology , Qualitative Research , Insulin/therapeutic useABSTRACT
Um dos avanços tecnológicos no tratamento do diabetes mellitus tipo 1 (DM1) é o uso do sistema de Infusão Contínua de Insulina (SICI). Essa revisão sistemática de mapeamento teve como objetivo agrupar e descrever as evidências dos estudos relacionados ao uso do SICI em crianças e adolescentes com DM1. A estratégia de busca foi estruturada a partir da ferramenta PCO, utilizando-se uma combinação de descritores e palavras-chaves. Buscas bibliográficas foram conduzidas nas seguintes bases de dados: PubMed, Embase, CINAHL, Lilacs e PsycINFO, aplicando-se um único filtro, que foi o temporal, delimitando-se a publicação dos estudos até dezembro de 2020. Os critérios de inclusão foram: estudos primários e secundários, quantitativos e qualitativos, que tivessem como objetivo abordar o uso do SICI em crianças e adolescentes (0-18 anos) com DM1; e estudos que abordassem as perspectivas das próprias crianças e adolescentes, dos profissionais de saúde e dos familiares. Constituíram critérios de exclusão: estudos que comparassem a terapia de múltiplas injeções de insulina com a terapia por meio do SICI ou que incluíssem adultos jovens e adultos conjuntamente às crianças e adolescentes, participantes com diabetes mellitus tipo 2 (DM2) ou usuários do SICI com foco no sistema de monitorização contínua de glicose (CGM) ou pâncreas artificial. Utilizou-se o software Rayyan para exclusão das referências duplicadas e para a triagem dos títulos e resumos das referências capturadas, a qual foi conduzida por dois revisores independentes. Os dados dos estudos incluídos foram analisados com auxílio de uma ferramenta de extração adaptada e validada por pesquisadores especialistas em diabetes e com experiência no desenvolvimento de métodos de síntese de conhecimento. Os resultados foram analisados segundo a técnica de análise de conteúdo. Incluiu-se um total de 113 estudos na revisão, dentre eles, estudos originais, revisões de literatura e publicações de literatura cinzenta. Mapas de geocodificação dos estudos foram produzidos com auxílio do software ArcGis 10.5 para ilustrar o local de desenvolvimento dos estudos. A análise geográfica dos estudos possibilitou identificar maior concentração de publicações conduzidas em países desenvolvidos. Esta revisão reuniu as evidências para o uso do SICI em crianças e adolescentes com DM1, as quais foram apresentadas por meio das seguintes categorias: indicações e contraindicações para o uso do SICI; controle metabólico; redes de apoio; e benefícios e desafios do uso do SICI. As indicações para o uso do SICI superam as contraindicações. Apesar de grande parte dos estudos evidenciar melhora do controle metabólico de crianças e adolescentes em uso do SICI, a piora desse controle foi descrita em algumas pesquisas, o que sugere que esse parâmetro não deve ser analisado de forma isolada. As redes de apoio foram citadas como um dos fatores que influenciam os parâmetros de controle metabólico, conformando as subcategorias: apoio familiar e apoio da equipe de saúde e escola. Foram elencados desafios para o uso do SICI na população pediátrica, porém, vale ressaltar que parte destes desafios tem sido superada com o avanço da ciência e da tecnologia moderna. Múltiplos benefícios também foram descritos na literatura, os quais podem auxiliar profissionais de saúde na tomada de decisão para a melhor escolha e acompanhamento do tratamento do DM1 em crianças e adolescentes. Esta revisão reúne evidências sobre o uso do SICI em crianças e adolescentes com DM1 e contribui com o corpo de conhecimento relacionado à temática
One of the technological advances in type 1 diabetes mellitus (T1DM) treatment is the use of Continuous Subcutaneous Insulin Infusion (CSII). The aim of this systematic mapping review was to group and describe the evidence from research on the use of CSII in children and adolescents with T1DM. The search strategy was structured based on the PCO tool, using a combination of descriptors and keywords. Bibliographic searches were undertaken in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, applying a single time-based filter to delimit the publication of studies until December 2020. The inclusion criteria were: primary and secondary studies, quantitative and qualitative, aimed at discussing the use of CSII in children and adolescents (0-18 years) with T1DM; and studies addressing the perspectives of the actual children and adolescents, the health professionals and Family members. Exclusion criteria were: studies that compared multiple insulin injection therapy with therapy using CSII or that included young adults and adults together with the children and adolescents, participants with type 2 diabetes mellitus (T2DM), or with CSII users focusing on the continuous glucose monitoring (CGM) system or artificial pancreas. The software Rayyan was used to exclude duplicated references and to screen the titles and abstracts of the collected references, which was conducted by two independent reviewers. The data from the included studies were analyzed with the help of an extraction tool, adapted and validated by researchers with diabetes expertise and knowledgeable on the development of knowledge synthesis methods. The content analysis technique was used to analyze the results. In total, 113 studies were included in the review, covering original studies, literature reviews and grey literature publications. Geocoding maps of the studies were produced in ArcGis 10.5 to illustrate where the studies had been developed. Through the geographic analysis of the studies a greater concentration of publications in developed countries was identified. This review gathered evidence on the use of CSII in children and adolescents with T1DM, presented in the following categories: indications and contraindications for the use of CSII; metabolic control; support networks; and benefits and challenges of CSII use. The indications in favor of using CSII outweigh the contraindications. Although most of the studies evidence improved metabolic control in children and adolescents who use CSII, some studies described worse control, suggesting that this parameter should not be analyzed in isolation. The support networks were mentioned as one of the factors that influence the metabolic control parameters. This category includes the following subcategories: family support and support from the health team and school. Challenges were listed for the use of CSII in the pediatric population, although it should be highlighted that advanced science and modern technology have overcome some of these. Multiple benefits have also been described in the literature, which can help health professionals to make decisions in order to better choose and monitor T1DM treatment in children and adolescents. This review gathers evidence on the use of CSII in children and adolescents with T1DM and contributes to the body of knowledge on the theme
Subject(s)
Humans , Child , Adolescent , Insulin Infusion Systems , Diabetes Mellitus/drug therapy , Insulin/administration & dosage , Insulin/therapeutic useABSTRACT
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 useABSTRACT
Abstract Objective: To describe insulin use and postoperative glucose control in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: We examined 2,390 patients with and without diabetes enrolled in the Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) Study who underwent CABG surgery (01/2004 - 06/2005) to describe postoperative insulin use, variation in insulin use across different hospitals, and associated in-hospital complications and clinical outcomes. Logistic regression was used to assess the adjusted relationship between insulin use and clinical outcomes. Results: Overall, insulin was used in 82% (n=1,959) of patients, including 95% (n=1,203) with diabetes (n=1,258) and 67% (n=756) without diabetes (n=1,132). Continuous insulin was used in 35.5% of patients in the operating room and in 56% in the intensive care unit. Continuous insulin use varied significantly among centers from 8-100% in patients with diabetes. When compared with all patients not receiving insulin, insulin use in patients without diabetes was associated with a higher rate of death or major complication (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI] 1.15-2.04; P=0.003). In patients with diabetes, insulin use was not associated with a higher risk of adverse outcomes (adjusted OR=1.01; 95% CI 0.52-1.98; P=0.98). Conclusion: The postoperative use of insulin is high among CABG patients in the United States of America. Insulin use in patients without diabetes was associated with worse clinical outcomes compared to patients (both with and without diabetes) who did not receive insulin. Further investigation is needed to determine the optimal use of postoperative insulin after CABG.
Subject(s)
Humans , Male , Coronary Artery Bypass , Insulin/therapeutic use , United States , Logistic Models , Risk Factors , Treatment Outcome , Diabetes Mellitus/drug therapyABSTRACT
La relación entre inmunidad y cáncer es compleja. Las células tumorales desarrollan mecanismos de evasión a las respuestas del sistema inmunitario. Esta capacidad permite su supervivencia y crecimiento. La inmunoterapia ha transformado el tratamiento oncológico mejorando la respuesta inmunitaria contra la célula tumoral. Esta se basa en el bloqueo de los puntos de control inmunitario mediante anticuerpos monoclonales contra la molécula inhibidora CTLA-4 (antígeno 4 del linfocito T citotóxico [CTLA-4]) y la proteína 1 de muerte celular programada y su ligando (PD-1/PD-L1). Aunque los inhibidores de los puntos de control inmunitario (ICIs) son fármacos bien tolerados, tienen un perfil de efectos adversos conocido como eventos adversos inmunorrelacionados (EAI). Estos afectan varios sistemas, incluyendo las glándulas endocrinas. Los eventos adversos endocrinos más frecuentes son la disfunción tiroidea, la insuficiencia hipofisaria, la diabetes mellitus autoinmune y la insuficiencia suprarrenal primaria. El creciente conocimiento de estos efectos adversos endocrinos ha llevado a estrategias de tratamiento efectivo con el reemplazo hormonal correspondiente. El objetivo de esta revisión es reconocer la incidencia de estas nuevas endocrinopatías, la fisiopatología, su valoración clínica y el manejo terapéutico. (AU)
The relationship between immunity and cancer is complex. Tumor cells develop evasion mechanisms to the immune system responses. This ability allows their survival and progression. Immunotherapy has transformed cancer treatment by improving the immune response against tumor cells. This is achieved by blocking immune checkpoints with monoclonal antibodies against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 and its ligand (PD-1 / PD-L1). Although the immune checkpoint inhibitors (ICIs) are well tolerated drugs, they have a profile of adverse effects known as immune-related adverse events (irAES). These involve diverse systems, including the endocrine glands. The most frequent endocrine immune-related adverse events are thyroid and pituitary dysfunction, autoimmune diabetes mellitus and primary adrenal insufficiency. The increasing knowledge of these irAES has led to effective treatment strategies with the corresponding hormonal replacement. The objective of this review is to recognize the incidence of these new endocrinopathies, the physiopathology, their clinical evaluation, and therapeutic management. (AU)
Subject(s)
Humans , Endocrine System Diseases/chemically induced , Immunotherapy/adverse effects , Thyroid Diseases/diagnosis , Thyroid Diseases/chemically induced , Thyroid Diseases/pathology , Thyroid Diseases/therapy , Thyroxine/administration & dosage , Triiodothyronine/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/chemically induced , Adrenal Insufficiency/pathology , Adrenal Insufficiency/therapy , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/chemically induced , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Endocrine System Diseases/diagnosis , Endocrine System Diseases/physiopathology , Endocrine System Diseases/therapy , Hypophysitis/diagnosis , Hypophysitis/chemically induced , Hypophysitis/pathology , Hypophysitis/therapy , Glucocorticoids/administration & dosage , Insulin/therapeutic use , Methimazole/therapeutic use , Mineralocorticoids/therapeutic use , Antibodies, Monoclonal/therapeutic use , Neoplasms/immunologyABSTRACT
Introducción: El comportamiento clínico de la diabetes mellitus tipo 1 y el enfoque terapéutico de los trastornos de la conducta alimentaria se complejizan cuando estos coinciden en una misma persona. Objetivo: Describir algunos aspectos del comportamiento clínico y enfoque terapéutico de los trastornos de la conducta alimentaria en personas con diabetes mellitus tipo 1. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer semestre de 2019. Se utilizaron como buscadores de información científica a Pubmed y a Google Académico. Como criterios iniciales de elegibilidad, se evaluaron artículos de revisión, de investigación y páginas Web que, en general, tenían menos de 10 años de publicados, en idioma español, portugués e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 65 artículos, de los cuales 33 fueron referenciados. Conclusiones: El comportamiento clínico de los trastornos de la conducta alimentaria en pacientes con diabetes mellitus tipo 1 combina síntomas y signos propios de ambas dolencias. Ambas entidades nosológicas se deben prevenir, pesquisar, diagnosticar e intervenir desde los servicios de atención primaria de salud, a través de una perspectiva interdisciplinaria. El tratamiento endocrinológico, unido a la terapia individual, la psicoeducación relacionada con los trastornos de la conducta alimentaria, la terapia familiar y un plan de tratamiento integral para la salud mental son imprescindibles desde el primer nivel de atención(AU)
Introduction: The clinical behavior of type 1 diabetes mellitus and the therapeutic approach to eating disorders become more complex when they coincide in the same person. Objective: To describe some aspects of the clinical behavior and therapeutic approach of eating disorders in people with type 1 diabetes mellitus. Methods: A search of relevant literature on the subject was carried out in the first semester of 2019. We used, as search engines for scientific information, Pubmed and Google Scholar. As initial eligibility criteria, we evaluated review articles, research articles, and web pages which, in general, were published less than 10 years ago, in Spanish, Portuguese and English, and which made, in their titles, specific reference to the topic of the study. Articles that did not meet these conditions were excluded. This allowed the study of 65 articles, of which 33 were referenced. Conclusions: The clinical behavior of eating disorders in patients with type 1 diabetes mellitus combines symptoms and signs typical of both conditions. Both nosological entities must be prevented, screened, diagnosed and intervened, starting in primary health care services, through an interdisciplinary perspective. Endocrinological treatment, together with individual therapy, eating disorders-related psychoeducation, family therapy, and a comprehensive treatment plan for mental health are essential, starting in the first level of care(AU)
Subject(s)
Humans , Male , Female , Bulimia/diagnosis , Bulimia/epidemiology , Feeding and Eating Disorders/epidemiology , Diabulimia/complications , Insulin/therapeutic useABSTRACT
O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 21 artigos e 13 protocolos.
Subject(s)
Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Disease Progression , Betacoronavirus/drug effects , Piperacillin/therapeutic use , Technology Assessment, Biomedical , Vaccines/supply & distribution , Chloroquine/therapeutic use , Tissue Plasminogen Activator/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Ritonavir/therapeutic use , Drug Combinations , Lopinavir/therapeutic use , Fingolimod Hydrochloride/therapeutic use , Tazobactam/therapeutic use , Hydroxychloroquine/therapeutic use , Insulin/therapeutic use , Anticoagulants/therapeutic useABSTRACT
Objetivo: Analisar a percepção dos diabéticos tipo 1 sobre a insulinoterapia. Métodos: Trata-se de estudo epidemiológico analítico de percepção, tendo sido realizado com pacientes de um Serviço de Apoio e Assistência aos Diabéticos e seus Familiares, no período de abril a agosto de 2018. Resultados: Os 33 diabéticos tipo 1 avaliados eram predominantemente do sexo feminino (60,6%) e a média de idade foi de 21±9 anos. A maioria afirmou portar o Cartão de Identificação do Diabético (78,8%). Mais de dois terços dos pacientes afirmaram saber quando aplicar a insulina de correção. A aferição da glicemia capilar foi relatada por 78,8%. Das insulinas utilizadas no esquema basal, a glargina e a NPH foram citadas como as mais utilizadas. Do total de pacientes, 97% referiram fazer autoaplicação, e 90,9% disseram posicionar a agulha corretamente sobre a pele. Quanto aos locais de aplicação, 84,8% realizavam rodízio. A maioria dos pacientes (78,8%) que aplicavam a insulina não referiu desconforto durante ou após a aplicação, e 69,7% mostraram conhecimento sobre o significado de distrofia. Conclusão: O serviço de educação continuada desenvolvido pelo Serviço de Apoio e Assistência aos Diabéticos e seus Familiares é efetivo na aquisição de bons hábitos e dos devidos cuidados para esses pacientes. A educação do indivíduo com diabetes tipo 1 e de sua família, bem como o acompanhamento por uma equipe multidisciplinar, é essencial para o bom controle da doença,
Objective: To analyze the perception of type 1 diabetes (DM 1) patients of insulin therapy. Methods: This is an epidemiological study of analysis of perception and was performed at the service for care and support of diabetes patients and their families from April to August 2018. Results: The 33 type 1 diabetes mellitus patients evaluated were predominantly female (60.6%) and the mean age was 21 years ± 9 years. Most reported having the diabetes medical ID card (78.8%). More than two thirds of the patients reported knowing when to apply the correction insulin. The capillary glycemia measurement was reported by 78.8%. Of the insulins used in the baseline regimen, Glargine and NPH were cited as the most used. Of the total patients, 97% reported self-application and 90.9% reported positioning the needle correctly on the skin. As for the application sites, 84.8% reported rotating sites. Most patients (78.8%) who applied insulin did not report discomfort during or after application, and 69.7% showed knowledge about the meaning of dystrophy. Conclusion: The continuing education service developed by the Service for Care and Support of Diabetics and their Families is effective in promoting good habits and the proper care of these patients for their disease.The education of the individual with type 1 diabetes and of his/her family, as well as follow-up by a multidisciplinary team, is essential for good disease control.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Patient Participation , Social Work Department, Hospital , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Blood Glucose/analysis , Attitude to Health , Surveys and Questionnaires , Sex Distribution , Age Distribution , Insulin/administration & dosage , Lipodystrophy/prevention & controlABSTRACT
RESUMO Objetivo: Analisar a taxa de reuso de seringas e agulhas e identificar as práticas de descarte de perfurocortantes por usuários de insulina. Método: Estudo transversal, realizado com pessoas diagnosticadas com diabetes mellitus tipo II de um Centro de Referência em Diagnóstico e Terapêutica da região Centro-Oeste do Brasil. Foram utilizados dados secundários provenientes de prontuários e fichas de consulta. As diferenças de proporção foram estimadas pelo teste qui-quadrado, considerando-se p<0,05. Resultados: A taxa de reuso de seringas e agulhas foi de 94,9%. Houve alta prevalência do reuso de seringas e agulhas por mulheres, com mais de 60 anos, com tempo de estudo menor do que cinco anos, que possuíam mais de 11 anos de diagnóstico. A maioria dos usuários descartou as agulhas e seringas no lixo domiciliar. Tais dados evidenciam que as práticas de autocuidado realizadas pelas pessoas com DM quanto ao reuso e descarte de perfurocortantes não são seguras e podem favorecer complicações. Conclusão: Apesar das características demográficas e clínicas não terem apresentado associação com o reuso, esforços devem ser direcionados para as práticas de educação em saúde, levando em consideração o contexto da pessoa, a condição socioeconômica, nível de escolaridade e seu papel ativo no seguimento do tratamento.
RESUMEN Objetivo: analizar la taza de reutilización de jeringas y agujas e identificar las prácticas de desecho de punzocortantes por usuarios de insulina. Método: estudio transversal, realizado con personas diagnosticadas con diabetes mellitus tipo II de un Centro de Referencia en Diagnóstico y Terapéutica de la región Centro-Oeste de Brasil. Fueron utilizados datos secundarios provenientes de registros médicos y fichas de consulta. Las diferencias de proporción fueron analizadas por la prueba de chi-cuadrado, considerándose p<0,05. Resultados: la taza de reutilización de jeringas y agujas fue de 94,9%. Hubo alta prevalencia de la reutilización de jeringas y agujas por mujeres, con más de 60 años, con tiempo de estudio menor que cinco años, que poseían más de 11 años de diagnóstico. La mayoría de los usuarios descartólas agujas y jeringas en la basura domiciliaria. Tales datos evidencian que las prácticas de autocuidado realizadas por las personas con DM respecto a la reutilización y desecho de punzocortantes no son seguras y pueden favorecer complicaciones. Conclusión: Aunque las características demográficas y clínicas no hayan presentado asociación con la reutilización, esfuerzos deben ser dirigidos para las prácticas de educación en salud, teniendo en cuenta el contexto de la persona, la condición socioeconómica, el nivel de escolaridad y su rol activo en el sector del tratamiento.
ABSTRACT Objective: To analyze the rate of reuse of syringes and needles and identify the practices of disposal of sharps by insulin users. Method: Cross-sectional study conducted with people diagnosed with type II diabetes mellitus at a Reference Center for Diagnosis and Therapy in the Midwest region of Brazil. Secondary data from medical records and consultation forms were used. Differences in proportions were estimated by the chi-square test, considering p < 0.05. Results: The rate of reuse of syringes and needles was 94.9%. There was a high prevalence of reuse of syringes and needles by women, people aged over 60 years, with less than five years of schooling, and more than 11 years of diagnosis. Most users discarded needles and syringes in domestic waste. Thus, self-care practices of people with DM regarding the reuse and disposal of sharps are not safe and may favor complications. Conclusion: Althoughdemographic and clinical characteristics had no association with reuse, efforts should be directed towards health education practices, taking into account the person's context, socioeconomic condition, educational level, and active role in the follow-up treatment.