Association between glycemic control in different emotional conditions and adherence to carbohydrate counting in people with type 1 diabetes during the COVID-19 pandemic in Brazil / Associação entre controle glicêmico em diferentes condições emocionais e adesão à contagem de carboidratos em pessoas com diabetes tipo 1 durante a pandemia de COVID-19 no Brasil

ABSTRACT Objective Evaluate the association between glycemic control in different emotional perceptions and the adherence to carbohydrate counting by adults with type 1 diabetes during the COVID-19 pandemic in Brazil. Methods This cross-sectional, descriptive, and analytical study was approved by the Research Ethics Committee (Opinion nº 4,147,663) and conducted in July 2020 using a Google Forms® form. Socioeconomic and demographic data were collected; glycemic monitoring according to the individuals' emotions at the time of measurement (happy, motivated, or hopeful; stressed or anxious; sad, distressed, or with depressive symptoms); data on adherence to carbohydrate counting and social distancing. Pearson's Chi-Square test was applied with adjusted residual analysis (p<0.05). Results Approximately 64.62% of the 472 participants, had hyperglycemia when stressed/anxious, and 52.97% when they felt sad/distressed/depressive (p<0.000). Associations were observed between having normoglycemia in any emotional situation and performing the carbohydrate counting (p<0.000); perceiving oneself as happy/motivated/hopeful and having hyperglycemia, and not measuring blood glucose was associated with not having the carbohydrate counting (p<0.000); being stressed or anxious was associated with not measuring blood glucose and not having the carbohydrate counting (p<0.000). Conclusion The need for multidisciplinary care to enhance mental health and adherence to treatment for people with type 1 diabetes is highlighted.

RESUMO Objetivo O estudo objetivou avaliar a associação entre o controle glicêmico em diferentes percepções emocionais e a adesão à contagem de carboidratos por adultos com diabetes tipo 1 durante a pandemia de COVID-19 no Brasil. Métodos Trata-se de um estudo transversal, descritivo e analítico aprovado pelo Comitê de Ética em Pesquisa (Parecer 4.147.663), realizado em julho de 2020 por meio de formulário Google Forms®. Foram coletados dados socioeconômicos e demográficos; monitoramento glicêmico de acordo com as emoções do indivíduo no momento da mensuração (feliz, motivado ou esperançoso; estressado ou ansioso; triste, angustiado ou com sintomas depressivos); dados sobre adesão à contagem de carboidratos e distanciamento social. Aplicou-se o teste qui-quadrado de Pearson com análise residual ajustada (p<0,05). Resultados Dos 472 participantes, 64,62% apresentavam hiperglicemia quando estressados/ansiosos, e 52,97%, quando se sentiam tristes/angustiados/depressivos (p<0,000). Foram observadas associações entre ter normoglicemia em qualquer situação emocional e realizar a contagem de carboidratos (p<0,000), perceber-se feliz/motivado/esperançoso e ter hiperglicemia, assim como não medir a glicemia foi associado a não ter a contagem de carboidratos (p<0,000). Estar estressado ou ansioso foi associado a não medir a glicemia e não ter a contagem de carboidratos (p<0,000). Conclusão Destaca-se a necessidade de atendimento multidisciplinar para potencializar a saúde mental e a adesão ao tratamento de pessoas com diabetes tipo 1.

Knowledge, Perceptions, Needs and Challenges of Dominican Adolescents with Type 1 Diabetes Mellitus / Conocimientos, percepciones, necesidades y desafíos de los adolescentes dominicanos con diabetes mellitus tipo 1

Introduction: The lack of metabolic control in patients with Type 1 Diabetes Mellitus (T1DM) can cause severe complications and reduce their life expectancy. Transition into adolescence among children with T1DM effects important changes that could negatively influence their metabolic control. Purpose: To determine knowledge, perceptions, needs and challenges of Dominican adolescents with T1DM. Methodology: Phone interviews to adolescents with T1DM between 14 and 18 years. Analysis included coding using the Health Belief Model, and using Nvivo, with a deductive and inductive approach. Results: Participants reported a high level of perceived susceptibility to complications, and severity associated to an incurable disease that causes severe complications. Within modifying factors, the family socioeconomic level was identified as relevant, and the role of support networks in managing their disease was mentioned as an external variable. Conclusions: Culturally, relevant interventions are needed to improve metabolic control and psychosocial aspects among Dominican adolescents with T1DM, including the use of a self-management mobile application; in addition, incorporating perspectives, context realities and knowledge of adolescents in developing therapeutical education strategies about T1DM could improve the impact of these strategies

Introducción: el descontrol metabólico en pacientes con diabetes tipo 1 (DMT1) puede provocar complicaciones severas y reducir la esperanza de vida. La transición a la adolescencia en jóvenes con DMT1 determina cambios importantes que pueden influenciar negativamente el control metabólico. Propósito: determinar el nivel de conocimiento, las percepciones, las necesidades y los desafíos de los adolescentes dominicanos con DMT1. Metodología: entrevistas telefónicas a adolescentes con DMT1, entre 14 y 18 años. El análisis incluyó la codificación con base al Modelo de Creencias de Salud, utilizando NVivo, a través de un abordaje deductivo e inductivo. Resultados: participantes reportaron un alto nivel de susceptibilidad percibida de sufrir complicaciones y una percepción de severidad asociada a una enfermedad incurable que causa complicaciones severas. En los factores modificadores se destacan determinantes sociales como el nivel socioeconómico de la familia y, en las variables externas, el rol de las redes de apoyo en el manejo de la enfermedad. Conclusiones: se requieren intervenciones culturalmente relevantes para mejorar el control metabólico y los aspectos psicosociales en los adolescentes dominicanos con DMT1, como sería una aplicación móvil para el automanejo; además, incorporar las perspectivas, las realidades contextuales y los conocimientos de los adolescentes en las estrategias de educación terapéutica sobre la DMT1 favorecería su impacto

Asociación entre síntomas depresivos de las madres y control metabólico en adolescentes con Diabetes Mellitus tipo 1 / Association between depressive symptoms in mothers and metabolic control in adolescents with type 1 diabetes

Resumen: Introducción: Un mal control metabólico en pacientes con Diabetes Mellitus tipo 1 (DM1) se asocia a complica ciones a corto y largo plazo. Los adolescentes con Diabetes tipo 1 presentan peor control metabólico comparado con pacientes de otros grupos etarios. Escasos estudios han demostrado una asociación entre síntomas depresivos de las madres con el control metabólico de sus hijos adolescente. Objetivo: Evaluar la asociación entre síntomas depresivos maternos y control metabólico de adolescentes con DM1. Sujetos y Método: Estudio observacional transversal realizado en adolescentes, edades 10 a 18 años, con diagnóstico de DM1 de más de un año de evolución y sus madres. Se aplicó test de Beck II, cuestionario de depresión infantil, cuestionario SALUFAM y cuestionario de datos sociodemográficos. Se realizó hemoglobina glicosilada capilar, como marcador de control metabólico. Resultados: Se estudiaron 86 parejas (madre-hijo adolescente), adolescentes de edad media 14.04 años y 5.95 años de evolución de DM1. El 25.6% (n 22) de las madres presentó síntomas depresivos, asociándose a peor control metabólico en sus hijos (HbA1c: 7.66% y 8.91%, p < 0.001). El 17.9% de adolescentes presentó síntomas depresivos, no asociándose a síntomas depresivos maternos ni a peor control metabólico. Los síntomas depresivos maternos se asociaron a menor nivel educacional materno y pater no, mayor número de hijos en la familia, presencia de otros hermanos con enfermedades crónicas y a mayor vulnerabilidad en salud (SALUFAM). Conclusiones: La presencia de síntomas depresivos maternos se asocia a peor control metabólico en el adolescente con DM1, siendo fundamental un enfoque multidisciplinario familiar para obtener mejores resultados metabólicos en los adolescentes.

Abstract: Introduction: Poor metabolic control in patients with Type 1 Diabetes Mellitus (T1DM) is associated with short- and long-term complications. Adolescents with T1DM present poorer metabolic control than patients of other age groups. Few studies have shown an association between mothers with depressive symptoms and the metabolic control of their adolescent children. Objective: To evaluate the associa tion between maternal depressive symptoms and metabolic control of their adolescents with T1DM. Subjects and Method: Cross-sectional observational study carried out with adolescents aged between 10 and 18 years, with T1DM diagnosis of at least 1 year ago and their mothers. The Beck Depression Inventory-II and the SALUFAM questionnaire were applied, and sociodemographic data were co llected. Glycosylated hemoglobin from capillary blood was used as a marker of metabolic control. Results: 86 couples (mother-adolescent children) were studied. The average age of the adolescents was 14.04 years and the average evolution time of T1DM was 5.95 years. 27.325.6% of mothers had depressive symptoms, which was associated with worse metabolic control of their children (HbA1c of 7.66% and 8.91%, p-value <0.001). 17.9% of adolescents had depressive symptoms, which was not associated with maternal depressive symptoms or worse metabolic control. Maternal depressive symptoms were also associated with lower maternal and paternal educational levels, high number of children in the family, presence of other siblings with chronic illnesses, and high health vulnera bility (SALUFAM). Conclusions: The mother's depressive symptoms can be associated with worst metabolic control in T1MD adolescents. It is fundamental a multidisciplinary family approach to get better metabolic controls in T1DM adolescents.

Evaluation of the application of the Diabetes Quality of Life Questionnaire in patients with diabetes mellitus

ABSTRACT Objective Diabetes mellitus (DM) is a chronic disease with great impact on patients' quality of life (QoL). This variable can be measured using reliable, standardized, and validated instruments. The purpose of this study was to evaluate the application and reporting of the Diabetes Quality of Life Measure (DQOL) or the Diabetes Quality of Life for Youths Measure (DQOLY), an adapted version for young patients with DM. Materials and methods A systematic review of interventional and observational studies using the DQOL or DQOLY was performed. Searches were conducted in the electronic databases Medline, Scopus, Web of Science, Lilacs, and SciELO. Results After conducting the searches, 111 studies met the inclusion criteria and were included in the qualitative analysis. Of these, 32 studies were classified as interventional and 79 as observational, with 27,481 patients. The DQOL was applied in 82 studies, the DQOLY in another 27, and two studies used both instruments. DM was classified as type 1 DM in 69 studies and type 2 DM in 35 studies. Six studies included both patients. Improvement in patients' QoL after an intervention was observed in 13 interventional studies. Most of the studies (90%) provide a detailed description of the instrument and 52% the previous validation. The interpretation of the scores obtained varies among the studies, probably due to the differences inherent in cultural validations, translations, and adaptations. Conclusion The application of the instruments in clinical practice must be rigorously standardized and requires an accurate understanding of psychometric and statistical concepts. Arch Endocrinol Metab. 2020;64(1):59-65

Apego y estrés en niños con Diabetes tipo 1 y sus madres / Attachment and stress in children with type 1 Diabetes and their mothers

Resumen: Objetivo: Comprender la relación entre apego y diabetes y el rol mediador del estrés en niños con diabetes mellitus tipo 1 (DM1) y sus madres. Material y Método: Se aplicaron Instrumentos de evaluación correspondientes a Escalas de Apego (ECR-R), Estrés percibido (PSS), Seguridad (SS) y Estrés en niños (SiC), como medidas de autoreporte completadas por niños(as) y sus madres. Se analizaron variables demográficas, tiempo de inicio de diabetes, y el promedio de las ultimas 3 medi ciones de Hemoglobina glicosilada HbA1c como parámetro del control metabólico del último año. Resultados: Las estrategias de apego maternas e infantiles y el estrés materno mostraron una asocia ción significativa con los resultados de la diabetes del niño(a), aunque con importantes diferencias de género. Conclusiones: Las estrategias de apego, infantiles y maternas, son relevantes en el curso de la diabetes.

Abstract: Objective: To understand the relationship between attachment and diabetes and the role of stress mediators in children with type 1 diabetes (T1D) and their mothers. Material and Method: The following assessment instruments were applied as self-report measures: Attachment Scale (ECR- R), Perceived Stress Scale (PSS), Security Scale (SS), and the Stress in Children (SiC) questionnaire, which were completed by children and their mothers. We analyzed demographic variables, diabetes onset time, and the average of the last three glycosylated hemoglobin (HbA1c) measurements as a parameter of metabolic control in the last year. Results: Attachment strategies of both mother and child, as well as maternal stress, showed a significant association with the child's diabetes outcomes, although with important gender differences. Conclusions: Both mother and child attachment strate gies are relevant aspects of the T1D course.

Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review / Relação entre o bullying e diabetes mellitus tipo 1 em crianças e adolescentes: uma revisão sistemática

Abstract Objective: To carry out a systematic review on the relationship of bullying with type 1 diabetes in children and adolescents. Methods: Systematic review, according to the PRISMA methodology, in which the databases PubMed, Web of Science, Scopus, Thomson Reuters, Eighteenth Century Collections Online, Begell House Digital Library, LILACS, and SciELO were searched using the terms "bullied", "aggression", "peer victimization", "victimization", "school violence", "diabetes mellitus", "type 1 diabetes mellitus", "autoimmune diabetes", "children" and "adolescents." The authors included original studies, involving bullying associated with type 1 diabetes, with children and adolescents, without language restriction and publication period, with texts available in full. Results: Of the 32 articles found, four studies met the selection criteria. Of these studies 85.7% identified occurrence of victimization in diabetics or found a higher frequency in diabetic children and adolescents when compared with young people with other chronic conditions or with healthy peers. Association between bullying and worse glycemic control was observed in two studies, and all the studies mention the fact that type 1 diabetes is a limiting factor for socialization related to diabetes, with less social support and difficulties for the management of the disease in public environments, such as school. The type of bullying suffered varied, including physical, verbal, social, psychological, and sexual. Conclusion: Most of the studies showed an association between bullying and type 1 diabetes when compared to individuals with no such condition. Knowledge of this association has become essential for the follow-up of these patients and the implementation of preventive programs.

Resumo: Objetivo: Realizar uma revisão sistemática sobre a relação do bullying com o diabetes tipo 1 em crianças e adolescentes. Métodos: Revisão sistemática, conforme a metodologia PRISMA, onde foram pesquisadas as bases de dados Pubmed, Web of Science, Scopus, Thomson Reuters, Eighteenth Century Collections Online, Begell House Digital Library, Lilacs e SciELO, usando os termos"bullying", "bullied", "aggression", "peer victimization", "victimization", "school violence", "diabetes mellitus", "type 1 diabetes", "type 1 diabetes mellitus", "autoimmune diabetes", "children" and "adolescents". Foram incluídos estudos originais, envolvendo bullying associado ao diabetes tipo 1, com população de crianças e adolescentes, sem restrição de idioma e período de publicação, com textos disponíveis na íntegra. Resultados: Dos 32 artigos encontrados, quatro atenderam aos critérios de seleção. Desses estudos, 85,7% identificaram ocorrência de vitimização em diabéticos ou constataram maior frequência em crianças e adolescentes diabéticos quando comparados com jovens com outras condições crônicas ou sadios. Associação entre bullying e pior controle glicêmico foi observada em dois estudos e todos os estudos mencionam o fato de ser portador do diabetes tipo 1, um fator limitante para socialização relacionado ao diabetes, com menor apoio social e dificuldades para o manejo da doença em ambientes públicos, como a escola. O tipo de bullying sofrido variou entre físico, verbal, social, psicológico e sexual. Conclusão: A maioria dos estudos evidenciou associação entre vitimização por bullying e diabetes tipo 1, quando comparada com indivíduos com ausência dessa condição. O conhecimento dessa associação torna-se fundamental para acompanhamento desses pacientes e implantação de programas preventivos.

Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus / Influência dos fatores socioeconômicos e psicológicos no controle glicêmico em crianças jovens com diabetes mellitus tipo 1

Abstract Objective: To evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. Methods: This was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. Results: A total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n = 50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. Conclusions: The socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.

Resumo Objetivo: Avaliar a influência dos fatores socioeconômicos e psicológicos no controle glicêmico de crianças pequenas portadoras de diabetes mellitus tipo 1. Métodos: Estudo de corte transversal, avaliou crianças pré-púberes, com diabetes mellitus tipo 1. Foram analisados os fatores socioeconômicos com o Critério de Classificação Econômica Brasil e as condições psicológicas através da versão brasileira do Problem Areas in Diabetes (B-Paid), associado ao controle glicêmico, mensurado pela hemoglobina glicada. Foi utilizada análise descritiva. As variáveis foram avaliadas bivariada e multivariantemente pelo modelo de regressão de Poisson robusto, os testes Exato de Fisher e Qui-Quadrado de Pearson para as razões de prevalência bruta e ajustada, sendo o intervalo de confiança estimado em 95%. Resultados: Foram incluídas no estudo 68 crianças com diabetes mellitus tipo 1. Foi observada uma associação negativa entre controle glicêmico (níveis de hemoglobina glicada), status socioeconômico (Critério de Classificação Econômica Brasil) e condição psicológica (versão brasileira do Problem Areas in Diabetes). Entre os participantes do estudo, 73,5% (n = 50) das crianças apresentaram status socioeconômico desfavorável, esses participantes apresentaram 1,4 vezes mais chances de apresentar valores alterados de hemoglobina glicada. Em relação a indivíduos com estado psicológico comprometido, houve uma prevalência de 26 (38,2%) apresentou uma pontuação acima de 70, sendo assim classificada com estresse psicológico, essas crianças foram 1,68 vezes mais prováveis (intervalo de confiança 95%: 1,101, 1,301) de apresentar níveis mais elevados de hemoglobina glicada. Conclusão: As condições socioeconômicas e as características psicológicas dos participantes do estudo foram negativamente associadas aos resultados da hemoglobina glicada. Esses dados reforçam a importância das variáveis estudadas como preditores de controle glicêmico.

Protocolo AGITO: Autocuidado em diabetes tipo 1 para um aplicativo de dispositivo móvel / AGITO Protocol: Self-care in type 1 diabetes for a mobile device application

Introdução: O estudo foi elaborado a partir da necessidade de se disponibilizar um protocolo que possa ser utilizado por meio de um aplicativo para dispositivos móveis como estratégia de autocuidado para adolescentes com diabetes tipo 1 utilizando a abordagem das emoções. Objetivo: Realizar a elaboração, validação e adequação cultural do protocolo AGITO em aplicativo de dispositivo móvel para autocuidado em diabetes tipo 1. Métodos: Estudo metodológico, abrangendo duas etapas: 1ª) Revisão Integrativa e 2ª) Elaboração, validação de conteúdo e adequação cultural. Foram contemplados os principais temas de práticas de autocuidado em diabetes tipo 1, concernente aos aspectos: educacionais, psicossociais e comportamentais. Na 2ª etapa, 32 profissionais da área da Saúde foram convidados a participar do Comitê de Juízes. A etapa final compreendeu dois ciclos de testes face a face do protocolo com 10 adolescentes com diabetes tipo 1. Resultados: Os resultados são apresentados de acordo com cada etapa. Primeira etapa: Na revisão integrativa 12 artigos atenderam os critérios de seleção. Os recursos dos aplicativos foram examinados a partir das funções de controle glicêmico, insulinoterapia, alimentação, atividade física, abordagem das emoções e relações sociais. Segunda etapa: O protocolo de autocuidado em diabetes tipo 1 nomeado AGITO foi consolidado em seis seções, denominadas:1º- Glicemia de jejum; 2º- Glicemia antes do almoço; 3º- Glicemia antes do lanche da tarde;4º- Glicemia antes do jantar; 5º- Glicemia antes do lanche de dormir; e 6º- Saúde emocional. A concordância entre os avaliadores e a população-alvo quanto à clareza e relevância dos itens foi confirmada pelo Índice de Validade de Conteúdo, que apresentou variação das médias entre 0,90 e 1,0. As principais alterações realizadas na adequação de conteúdo foram à inclusão de termos mais utilizados no cotidiano do autocuidado dos adolescentes com diabetes tipo 1. Conclusão: Este estudo fornece o protocolo do aplicativo AGITO com conteúdo validado, configurando-se um componente passível de ser utilizado como uma estratégia para o autocuidado em diabetes tipo 1 para adolescentes.(AU)

Introduction: The study was designed from the need to provide a protocol that can be used through a mobile application as a self-care strategy for adolescents with type 1 diabetes using the emotion approach. Objective: Carry out the elaboration, validation and cultural adequacy of the AGITO protocol in a mobile device application for selfcare in type 1 diabetes. Methods: Methodological study, covering two steps: 1st) Integrative Review and 2st) Preparation, content validation and cultural adequacy. The main themes of self-care practices in type 1 diabetes were considered, concerning the aspects: educational, psychosocial and behavioral. In the second stage, 32 health care professionals were invited to participate in the Judges Committee. The final stage comprised two cycles of face-to-face protocol testing with 10 adolescents with type 1 diabetes. Results: These are presented according to each stage. Stage One: In the integrative review 12 articles met the selection criteria. The app features were examined from the glycemic control, insulin therapy, diet, physical activity, emotional approach, and social relationships functions. Second stage: The type 1 diabetes self-care protocol named AGITO was consolidated into six sections, namely: 1- Fasting Blood Glucose; 2- Blood glucose before lunch; 3 - Blood glucose before the afternoon snack, 4 - Blood glucose before dinner; 5 - Blood glucose before bedtime snack; and 6- Emotional health. The agreement between the evaluators and the target population regarding the clarity and relevance of the items was confirmed by the Content Validity Index, which varied from 0.90 to 1.0. The main changes in content adequacy were the inclusion of terms most used in the self-care daily life of adolescents with type 1 diabetes. Conclusion: This study provides the AGITO application protocol with validated content, configuring a component that can be used as a strategy for self-care in type 1 diabetes for adolescents.(AU)

Autocuidado em pessoas com diabetes mellitus tipo 1: vivências de adolescentes / Self-care among type 1 diabetes mellitus bearing people: adolescents' experiences / Autocuidado de personas con diabetes mellitus tipo 1: vivencias de adolescentes

Objetivo: El objetivo fue identificar las vivencias de adolescentes en el manejo de diabetes mellitus, en relación al autocuidado. Métodos: Fue llevada a cabo investigación descriptiva, predominantemente cualitativa, en hospital de referencia en DM, en Fortaleza-Ce, Brasil. Resultados: Participaron del estudio a través de entrevistas semiestructuradas 14 adolescentes con DM, con edades entre 12-18 años. Las entrevistas fueron sometidas a análisis de contenido para desconexión de las categorías. Del análisis, emergieron tres temas: el primero relacionado con los pacientes que demostraron adherencia al autocuidado; el segundo acerca de los dilemas de ser adolescente con diabetes; y el tercero para actuación de los profesionales de la salud y familia para el adolescente manejar el autocuidado. Conclusiones: Esta investigación con adolescentes con diabetes señaló la importancia del autocuidado con apoyo como herramienta que puede llevarse a la práctica por profesionales y familia, fomentando la adherencia al tratamiento

Objetivo: Conhecer as vivências de adolescentes acerca do autocuidado. Métodos: Estudo qualitativo, entrevistas semiestruturadas foram conduzidas com 14 adolescentes, entre 12 a 18 anos, cadastrados em laboratório de endocrinologia pediátrica na cidade de Fortaleza, CE. Resultados: Com base nos dados desvelados observamos os seguintes enfrentamentos: adesão ao autocuidado; dilemas de ser adolescente com diabetes e ações do profissional de saúde e da família para o autocuidado do adolescente. Conclusão: Esta pesquisa com adolescentes portadores de diabetes demonstrou a importância do autocuidado apoiado como uma ferramenta que poderá ser operacionalizada por profissionais e família, favorecendo a adesão ao tratamento

Objective: This study aimed to identify the adolescents' experiences in the management of diabetes mellitus, regarding self-care. Methods: It is a descriptive research with a predominantly qualitative approach, which was carried out in a referral hospital in the assistance to patients with diabetes mellitus, located in Fortaleza city, Ceará State, Brazil. Fourteen adolescents bearing diabetes mellitus, within an age group from 12 to 18 years old, have participated in the study through semi-structured interviews. Results: The interviews were submitted to content analysis in order to identify the categories. After analysis, the following three thematic categories emerged: the first is related to patients who have demonstrated adherence to self-care; the second regarding the dilemmas of being an adolescent with diabetes; and the third concerning the actions of health professionals and the patients' relatives for the self-care management of adolescents. Conclusion: This research performed with adolescents bearing diabetes has revealed the importance of supported self-care as an instrument that can be worked out by both professionals and family, thus encouraging the treatment adherence

Hospitalization and mortality by diabetes mellitus in children: analysis of temporal series / Interna y mortalidad por diabetes mellitus en la infancia: análisis de series temporais / Internação e mortalidade por diabetes mellitus na infância: análise de séries temporais

ABSTRACT Objective: to analyze the trend of hospitalization rates and mortality due to Diabetes Mellitus in children and adolescents in Brazil. Method: temporal series study, hospitalization rates and diabetes mortality in children and adolescents. Data were obtained from the Hospital Information System and Mortality Information System, from 2005-2015, with analysis performed by polynomial regression modeling. Results: 87,100 hospitalizations and 1,120 deaths from diabetes were analyzed. Hospitalizations rates increased for both genders and all age groups, with an increase for adolescents aged 10-14 years. The mortality rate declined, except for the 15-19-year age group. In the overall mortality trend in Brazil, the South and Southeast showed a decrease, whereas for hospitalizations only the Center-West remained constant, while the others increased. Conclusion: however, there was a decrease in infant mortality and increase in hospitalizations.

RESUMEN Objetivo: analizar la tendencia de las tasas de internación y mortalidad por diabetes mellitus en niños y adolescentes en Brasil. Método: estudio de series temporales, de las tasas de internación y mortalidad por diabetes en niños y adolescentes. Los datos fueron obtenidos del Sistema de Informaciones Hospitalarias y del Sistema de Información sobre Mortalidad, de 2005-2015, con análisis realizado por el modelado de regresión polinomial. Resultados: se analizaron 87.100 internaciones y 1.120 muertes por diabetes. Las tasas de internaciones presentaron aumento para ambos sexos y todas las franjas etarias, con incremento para adolescentes entre 10-14 años. La tasa de mortalidad presentó caída, excepto para el grupo de edad de 15-19 años. A la tendencia de la mortalidad general en Brasil, las regiones Sur y Sudeste presentaron descenso, mientras que para las internaciones, sólo la región Centro-Oeste permaneció constante, mientras que las demás aumentaron. Conclusión: ocurrió decrecimiento de la mortalidad en la infancia, sin embargo, con aumento de las internaciones.

RESUMO Objetivo: analisar a tendência das taxas de internação e mortalidade por Diabetes Mellitus em crianças e adolescentes no Brasil. Método: estudo de séries temporais, das taxas de internação e mortalidade por diabetes em crianças e adolescentes. Os dados foram obtidos do Sistema de Informações Hospitalares e do Sistema de Informações sobre Mortalidade, de 2005-2015, com análise realizada pela modelagem de regressão polinomial. Resultados: foram analisadas 87.100 internações e 1.120 óbitos por diabetes. As taxas de internações apresentaram aumento para ambos os sexos e todas as faixas etárias, com incremento para adolescentes entre 10-14 anos. A taxa de mortalidade apresentou queda, exceto para o grupo etário de 15-19 anos. À tendência da mortalidade geral no Brasil, as regiões Sul e Sudeste apresentaram decréscimo, enquanto que para as internações, apenas a região Centro-Oeste permaneceu constante, enquanto as demais aumentaram. Conclusão: ocorreu decréscimo da mortalidade na infância, porém, com aumento das internações.

Translation and validation of Pediatric Quality of Life InventoryTM 3 0 Diabetes Module (PedsQLTM 3 0 Diabetes Module) in Brazil-Portuguese language / Tradução e validação do Pediatric Quality of Life InventoryTM 3 0 Diabetes Module (PedsQLTM 3 0 Diabetes Module) para a língua portuguesa do Brasil

Abstract Objective: The aim of the present study was to create a translated version of the Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 Diabetes Module) in Brazilian Portuguese that was conceptually equivalent to the original American English version and to linguistically validate it in a Brazilian pediatric population with type 1 diabetes mellitus and their parents or caregivers. Methods: The instrument was translated, back-translated, and then administered to 83 children/adolescents (5-18 years) with type 1 diabetes mellitus and their family members and to 25 parents/caregivers of patients aged between 2 and 4 years. The final translated version was tested for reliability by analyzing internal consistency, intraobserver (test-retest) reliability, and concurrent validity. Results: Cronbach's alpha coefficient for the total score of the questionnaires of children/adolescents (α = 0.85) and their parents (α = 0.82) was above the recommended minimum of 0.70 for group comparisons. Intraobserver reliability and concurrent validity exhibited a significant positive correlation (p < 0.001), indicating the reliability of the translated instrument. A moderate but significant positive correlation (r = 0.40; p < 0.001) was demonstrated between the total scores of patient self-report and parent proxy-report scales. There was no significant correlation between glycated hemoglobin (HbA1c) levels and the respective scores in the questionnaires answered by patients and their parents/caregivers. Conclusion: The analysis of the translated version of the PedsQLTM 3.0 Diabetes Module revealed adequate psychometric characteristics with respect to reliability and validity following administration to a sample of Brazilian children/adolescents with type 1 diabetes mellitus and their caregivers.

Resumo Objetivo: Produzir uma versão do questionário Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 Diabetes Module) para a língua portuguesa do Brasil, que fosse conceitualmente equivalente à versão original em inglês, e proceder à sua validação linguística numa população pediátrica brasileira portadora de diabetes mellitus tipo 1 (DM1) e seus pais ou cuidadores. Métodos: A tradução do instrumento foi feita pela metodologia de tradução-tradução reversa, foi aplicado a 83 crianças/adolescentes (5-18 anos) portadores de diabetes mellitus tipo 1 com seus parentes e a 25 pais/cuidadores de pacientes entre 2 e 4 anos de idade. A confiabilidade da versão traduzida foi avaliada pelas seguintes análises: consistência interna, confiabilidade teste-reteste e validade concorrente. Resultados: O coeficiente alfa de Cronbach para a pontuação total do questionário das crianças/adolescentes (α = 0,85) e seus pais (α = 0,82) excedeu o mínimo recomendado 0,70 para comparação entre grupos. Na confiabilidade intraobservador e validade concorrente observou-se correlação positiva e estatisticamente significativa (p < 0,001), indicou a fidedignidade do instrumento traduzido. Na comparação entre os escores totais obtidos por pais/cuidadores e crianças/adolescentes, houve uma correlação positiva, pequena, mas significativa (r = 0,40; p < 0,001). Não houve correlações estatisticamente significativas entre os níveis de hemoglobina glicada e os escores obtidos nos questionários respondidos pelos pacientes e seus pais/cuidadores. Conclusão: As análises do instrumento PedsQLTM 3.0 Módulo Diabetes demonstraram propriedades psicométricas adequadas em termos de confiabilidade e validade quando aplicado nessa amostra de crianças/adolescentes brasileiros portadores de DM tipo 1 e seus cuidadores.

Health-related quality of life in a cohort of youths with type 1 diabetes

SUMMARY Health-related quality of life (HRQOL) in type 1 diabetes mellitus (T1DM) has been widely studied. The objectives of this study were to evaluate and identify the factors influencing the HRQOL of children and adolescents with T1DM. MATERIAL AND METHODS: In total, 59 patients (9-16 years, T1DM for ≥1 year) responded to a version of the Diabetes Quality of Life Instrument for Youth (DQOLY) adapted to adapted to Brazilian patients, the Instrumento de Qualidade de Vida para Jovens com Diabetes (IQVJD). This instrument comprises 50 items (domains satisfaction, impact, and concerns, with the lowest scores corresponding to better HRQOL) and a questionnaire gathering social, demographic, and clinical parameters. RESULTS: The mean age of the patients was 13.6 years, and 57.6% were girls. The median age at diagnosis was 7.16 years, 63% presented diabetic ketoacidosis (DKA) at diagnosis and 29% during follow-up. Mean glycated hemoglobin (HbA1c) in the previous year was 10%. All patients administered multiple insulin doses (mean 4.2 applications/day), 74.5% used rapid-acting and intermediate-acting insulin analogs, and 67.8% used pens for insulin application. The results of the DQOLY were within the cutoff limit for better HRQOL. An isolated analysis of each domain and the questionnaire results showed that the following factors were associated with better HRQOL: height Z-score, lower HbA1c, practice of physical activity, use of pen, fewer hospitalizations, and residence in a rural area. There was a high DKA rate at diagnosis, and the metabolic control was inappropriate in most patients. Despite coming from low-income households, most patients had access to the recommended treatment. CONCLUSION: Among T1DM patients, 71% had IQVJD scores compatible with better HRQOL.

RESUMO A qualidade de vida relacionada à saúde (HRQOL) no diabetes mellitus tipo 1 (T1DM) tem sido amplamente estudada. Os objetivos deste estudo foram avaliar e identificar os fatores que influenciam a HRQOL de crianças e adolescentes com T1DM. MATERIAL E MÉTODOS: No total, 59 pacientes (9-16 anos, T1DM por ≥1 ano) responderam a uma versão do Instrumento de Qualidade de Vida para Jovens com Diabetes (DQOLY) adaptada aos pacientes brasileiros (IQVJD). Esse instrumento compreende satisfação, impacto e preocupações de domínios, com os menores índices correspondentes a uma melhor HRQOL, e um questionário que reúne parâmetros sociais, demográficos e clínicos. RESULTADOS: A idade média foi de 13,6 anos e 57,6% eram meninas. A idade mediana no diagnóstico foi de 7,16 anos, 63% apresentaram cetoacidose diabética (DKA) no diagnóstico e 29% durante o seguimento. A hemoglobina glicada média (HbA1c) no ano anterior foi de 10%. Todos os pacientes receberam doses múltiplas de insulina (média de 4,2 aplicações/ dia), 74,5% utilizavam análogos de insulina de ação rápida e de ação intermediária e 67,8% usavam canetas para aplicação de insulina. Os resultados do DQOLY estavam dentro do limite de corte para melhor HRQOL. Uma análise isolada de cada domínio e os resultados do questionário mostraram que os seguintes fatores estavam associados a uma maior HRQOL: score z de altura, HbA1c menor, prática de atividade física, uso de caneta, menos hospitalizações e residência em uma área rural. Houve uma alta taxa de cetoacidose diabética no diagnóstico, e o controle metabólico foi inadequado na maioria dos pacientes. Apesar de serem provenientes de famílias de baixa renda, a maioria dos pacientes teve acesso ao tratamento recomendado. CONCLUSÃO: Entre pacientes com T1DM, 71% tinham escores IQVJD compatíveis com melhor HRQOL.

Psychiatric disorders in adolescents with type 1 diabetes: a case-control study

Objectives: To study the prevalence of psychiatric disorders in adolescents with and without type 1 diabetes, the factors associated with its presence, and to test the reliability of a screening tool for use in clinical settings. Methods: Eighty-one adolescents were enrolled in this case-control study, including 36 diabetic participants and 45 controls. Clinical and sociodemographic data were collected and psychiatric symptoms and diagnoses were obtained from adolescents and their parents using a screening tool (Strengths & Difficulties Questionnaire) and a semi-structured interview (Development and Well-Being Assessment). Results: Psychiatric disorders were identified in 22.2% of the sample (30.56% among diabetic adolescents vs. 15.56% of controls: OR = 2.39, 95%CI 0.82-6.99; p = 0.11). Overweight (body mass index percentile ≥ 85) was the only factor associated with psychiatric disorder (OR = 3.07; 95%CI 1.03-9.14; p = 0.04). Compared to the semi-structured interview, the screening instrument showed 80% sensitivity, 96% specificity, 88.9% positive predictive value and 92.3% negative predictive value for the presence of psychiatric diagnoses in adolescents. Conclusion: Psychiatric morbidity was high in this sample of adolescents, especially among those with diabetes. Routine use of the Strengths and Difficulties Questionnaire can help with early detection of psychiatric disorders in this at-risk group.

Type 1 diabetes mellitus: can coaching improve health outcomes?

ABSTRACT Objective: To evaluate the introduction of coaching in the interdisciplinary care of individuals with type 1 diabetes mellitus in the public health care system. Subjects and methods: Ten patients routinely attending a public health care service and with a glycated hemoglobin (HbA1c) level above 75% participated in eight coaching sessions. This study evaluated the patients' self-management of the disease and personal behavior. The participants were assessed at the beginning of the program and on two occasions after the intervention, with evaluation of biochemical and anthropometric data, and frequency of self-monitoring of blood glucose (SMBG). Questionnaires were applied during these evaluations to analyze emotional burden (B-PAID), medication adherence (Morisky Adherence Scale), and self-efficacy (IMDSES). Results HbA1c had a median level of 8.0% (range 76-10.3%) at the beginning of the study and reduced significantly 3 months after initiation of the intervention (7.78% [6.5-10%], p = 0.028), with no significant increase at 6 months (8.3% [713-9.27%], p = 0.386). SMBG improved significantly from the beginning to the end of the study, with the median number of glucose tests per week varying from 16.5 (range 0-42) at baseline to 29.0 (7-42) at 3 months and 27.5 (10-48) at 6 months (p = 0.047). No significant differences were observed in anthropometric parameters or in the scores of the instruments between the three measurements. Conclusion: A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs and could be an auxiliary method to help individuals with type 1 diabetes achieve their treatment goals.

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias: revisión de la literatura / Psychosocial impact of type 1 diabetes mellitus in children, adolescents and their families: literature review

La diabetes mellitus tipo 1 es la patología endocrina crónica más común en niños. El tratamiento incluye dieta, actividad física, medicación con insulina y un autocontrol adecuado. Este autocontrol puede ser dificultoso, provocando que niños, adolescentes y sus familias sufran diversas complica ciones psicosociales. Existe una relación inversa entre autocontrol y presencia de complicaciones psicosociales, siendo los principales problemas ansiedad y depresión, donde los adolescentes llegan a ser 2,3 veces más propensos a presentar problemas de salud mental. Las familias se ven afectadas inicialmente en el período de debut por un estado de shock, con sentimientos de angustia e ira. Los necesarios cambios de hábitos y estilos de vida pueden generar problemas psicosociales entre los que destacan trastornos ansiosos, depresivos y alimenticios. Posteriormente, el niño o adolescente y su grupo familiar pueden transitar a un nuevo equilibrio caracterizado por un buen autocontrol y adherencia al tratamiento o profundizar los trastornos individuales y grupales, trastornos que pue den reaparecer, especialmente en la adolescencia. El tratamiento integral de la diabetes mellitus tipo 1 requiere atender estos aspectos mediante equipos multidisciplinarios que incluyen profesionales médicos y del ámbito psicosocial. En esta revisión se analizan los principales aspectos relacionados al impacto psicosocial en niños y adolescentes con diabetes mellitus tipo 1 y sus familias.

Type 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental health problems. Families are initially affected, in the debut period by a state of shock, with feelings of distress and anger. The necesary changes in habits and lifestyles can lead to psychosocial problems, including anxiety, depression and eating disorders. Subsequently, the child or adolescent and his or her family group may move into new balance characterized by good self-control and adherence to tratment, or deepen individual and group disorders which may reappear, especially in adolescence. The comprehensive treatment of type 1 diabetes mellitus requires addressing these aspects through multidisciplinary teams which include medical and phychosocial professionals. This review analyses the main aspects related to the psychosocial impact of diabetes mellitus type 1 among children, adolescents and their families.

Validación de una escala de creencias de salud sobre diabetes tipo 1 para el contexto mexicano: HBM-T1DM / Validation of a scale of health beliefs about type 1 diabetes for the Mexican context: HBM-T1DM

Resumen: Objetivo: Generar una escala para medir las creencias de salud en adolescentes y jóvenes mexicanos con diabetes tipo 1 (T1DM) para determinar el grado en que éstas afectan la adherencia al tratamiento y ser capaces de desarrollar campañas de mercadotecnia social más efectivas. Material y métodos: Con base en el Modelo de Creencias de la Salud (HBM, por sus siglas en inglés), se generó una escala que se sometió a tres pruebas de campo y se administró en dos regiones de México a jóvenes con diabetes tipo1. Se realizaron pruebas de fiabilidad, estabilidad, validez por convergencias-discriminación y validez predictiva. Resultados: El principal predictor son las barreras percibidas para apegarse al tratamiento, seguida de la autoeficacia para controlar la enfermedad, susceptibilidad/vulnerabilidad a complicaciones de la enfermedad y beneficios percibidos del tratamiento. Conclusión: Esta escala puede resultar especialmente útil para dar un mejor seguimiento a pacientes jóvenes mexicanos con T1DM y evitar secuelas de la enfermedad.

Abstract: Objective: To generate a scale to measure health beliefs among Mexican adolescents and young people with type 1 diabetes (T1DM) to determine the extent to which they affect adherence to treatment and to be able to develop more effective social marketing campaigns. Materials and methods: Based on the Health Belief Model (HBM), a scale was generated; three field tests were applied, and it was administered in two regions of Mexico to young people with type 1 diabetes. Tests of reliability, stability, convergence-discrimination and predictive validity were developed. Results: The main predictor is perceived barriers to treatment adherence, followed by self-efficacy to disease control, susceptibility/vulnerability to disease complications and perceived benefits of treatment. Conclusion: This scale may be especially useful for better monitoring young Mexican patients with T1DM and prevent sequelae of disease.

Qualidade de vida relacionada à saúde de adolescentes com dm1- revisão integrativa / Quality of life related to health of adolescents with dm1: an integrative review

Resumo Objetivou-se analisar a produção científica sobre a qualidade de vida relacionada à saúde (QVRS) de adolescentes com diabetes mellitus tipo1. Trata-se de uma revisão integrativa, cujos critérios de inclusão foram artigos disponíveis na íntegra on line nos idiomas português, inglês e espanhol, publicados e indexados nas bases de dados Lilacs, Medline, Adolec e BDENF, no período de 2003 a 2013, e que retratassem a temática QVRS, diabetes tipo1 em adolescentes. Foram analisados 22 artigos, dos quais se extraíram os seguintes temas: construção e validação de instrumentos para mensurar a QVRS dos adolescentes diabéticos; QVRS de adolescentes com diabetes; fatores que interferem na qualidade de vida de adolescentes com diabetes e recursos utilizados para auxiliar o adolescente na gestão com o diabetes. A QVRS de adolescentes diabéticos é um tema que tem sido estudado e divulgado com frequência na literatura internacional, porém com pouca repercussão nacional. Predominaram estudos publicados em periódicos internacionais em língua inglesa. Por essa razão, entende-se que é necessário desenvolver mais pesquisas dessa natureza no Brasil, visto que a mensuração da QVRS de adolescentes diabéticos poderá auxiliar a equipe multiprofissional a planejar a assistência.

Abstract This study aimed to analyze the scientific literature on health-related quality of life (HRQOL) of adolescents with type 1 diabetes mellitus. This is an integrative review whose inclusion criteria were full-text papers available online in Portuguese, English and Spanish; published and indexed in databases Lilacs, Medline, Adolec, BDENF, in the period 2003-2013 that reflected the theme HRQOL, Type 1 diabetes and adolescents. Twenty-two papers were analyzed, from which the following themes were retrieved: development and validation of tools to measure the HRQOL of diabetic adolescents; HRQOL of adolescents with diabetes; factors affecting the quality of life of adolescents with diabetes and resources used to assist adolescents in diabetes management. The HRQOL of adolescents with diabetes has been a widely studied and disseminated topic in international literature, but has poorly echoed in Brazil. Studies published in international journals in English predominated. Thus, we emphasize the importance of conducting research of this nature in Brazil, since the measurement of HRQOL of diabetic adolescents may help the multidisciplinary team in care planning.

Questionnaire on adaptation to type 1 diabetes among children and its relationship to psychological disorders / Questionário de adaptação ao diabetes mellitus tipo I em pediatria: relação com a psicopatologia / Cuestionario de adaptación a la diabetes-mellitus tipo I en pediatría: relación con la psicopatología

ABSTRACT Objective: to study the psychometric properties of an adaptive disease response questionnaire for use with Spanish children with type 1 diabetes; to analyse this response in this sample and to observe the relationship between adaptive response and levels of anxiety-depression. Method: a total of 100 patients with type 1 diabetes aged between nine and 16 years (M=12.28, SD=1.78) participated in the study, of which 59% were children. Data was collected in public hospitals via interviews using the Adaptive Disease Response Questionnaire and Anxiety and Depression Scale. The data was analysed using Pearson correlations, multiple hierarchical linear regressions, Student's t Test for independent samples, and Cohen's d effect size to determine reliability and validity. Result: the instrument was shown to have adequate psychometric properties. Adaptive response was generally high. Adaptive response is negatively related to emotional distress, being a better predictor of depression than of anxiety. There was no association betwee adaptation and sex and age. Conclusion: promoting a better adaptive response appears to reduce emotional distress, especially in the case of depression, regardless of the age or gender of the patients.

RESUMO Objetivo: estudar as propriedades psicométricas do Questionário de Resposta Adaptativa à Doença em pacientes pediátricos com diabetes mellitus tipo I no contexto espanhol, analisar essa resposta na amostra em questão e observar a relação entre a resposta adaptativa e os níveis de ansiedade-depressão. Método: participaram do estudo um total de 100 pacientes com diabetes mellitus tipo I, com idades entre 9 e 16 anos (M = 12,28, DP = 1,78), dos quais 59% eram crianças. Os dados foram coletados em hospitais públicos por meio de entrevista, utilizando-se o Questionário de Resposta Adaptativa à Doença e a Anxiety and Depression Scale (Escala de Ansiedade e Depressão). Para análise dos dados, calculou-se confiabilidade, correlações de Pearson, regressões lineares e testes t em função do sexo e da idade. Resultado: o instrumento possui propriedades psicométricas adequadas. A resposta adaptativa é geralmente elevada. Essa resposta está negativamente relacionada ao sofrimento emocional, sendo um melhor preditor de depressão do que de ansiedade. Não há diferenças na adaptação à doença em função de sexo e idade. Conclusão: a promoção de uma melhor resposta adaptativa parece reduzir o sofrimento emocional, especialmente no caso de depressão, independentemente da idade ou sexo dos pacientes.

RESUMEN Objetivo: estudiar las propiedades psicométricas del Cuestionario de Respuesta Adaptativa de la Enfermedad en pacientes pediátricos con diabetes-mellitus tipo I en el contexto español, analizar en esta muestra esta respuesta y observar la relación entre la respuesta adaptativa y los niveles de ansiedad-depresión. Método: un total de 100 pacientes con diabetes-mellitus tipo I participaron, con edades entre los 9 y los 16 (M=12,28, DT=1,78), de los cuales el 59% eran niños. Los datos fueron obtenidos en hospitales públicos mediante una entrevista aplicando el Cuestionario de Respuesta Adaptativa de la Enfermedad y el Anxiety and Depression Scale. Para el análisis de datos, se calculó la fiabilidad, correlaciones de Pearson, regresiones lineales y pruebas t en función de sexo y edad. Resultado: el instrumento presenta adecuadas propiedades psicométricas. La respuesta adaptativa es elevada en general. Esta respuesta se relaciona manera negativa con el malestar emocional, siendo mejor predictor de la depresión que de la ansiedad. No se observan diferencias en la adaptación a la enfermedad en función del sexo y edad. Conclusión: promover una mejor respuesta adaptativa parece reducir el malestar emocional, especialmente en el caso de la depresión, con independencia de la edad o sexo de los pacientes.

Correlation between parameters of self-monitoring of blood glucose and the perception of health-related quality of life in patients with type 1 diabetes mellitus

ABSTRACT Objective The aim of this study was to evaluate how different parameters of short-term glycemic control would correlate with the perception of health-related quality of life (HRQoL) in patients with type 1 diabetes mellitus (T1D). Subjects and methods A total of 50 T1D patients aged 18 to 50 years were evaluated with the questionnaires Problem Areas in Diabetes (PAID) scale and Diabetes Quality of Life (DQOL) measure after 30 days of self-monitoring of blood glucose (SMBG). Glycemic control was evaluated using glycated hemoglobin (HbA1c), mean glucose levels (MGL) in the prior month's data from SMBG (Accu-Check 360o), number of hypoglycemic episodes (< 70 mg/dL and < 50 mg/dL), and glycemic variability (GV). Results PAID correlated positively with MGL (r = 0.52; p < 0.001) and HbA1c (r = 0.36; p < 0.0097), but not with GV (r = 0.17; p = 0.23) or number of hypoglycemic episodes (r = 0.15; p = 0.17 for glucose < 70 mg/dL and r = 0.02; p = 0.85 for glucose < 50 mg/dL). After multiple linear regression, only MGL remained independently related to PAID scores. DQOL scores had a positive correlation with MGL (r = 0.45; p = 0.001), but not with HbA1c (r = 0.23; p = 0.09), GV (r = 0.20; p = 0.16), or number of hypoglycemic episodes (r = 0.06 p = 0.68). Conclusion In T1D patients, MGL, but not HbA1c or number hypoglycemic episodes, was the glycemic control parameter that best correlated with short-term perception of HRQoL.

Control metabólico y rendimiento escolar en niños con diabetes tipo 1 / Metabolic control and school performance in children with type 1 diabetes

El impacto de la diabetes tipo 1 (DM1) en el rendimiento escolar es controversial. Objetivo: Evaluar la relación entre rendimiento escolar y control metabólico en niños con DM1 (N-DM1) y comparar sus resultados con niños de la población general (N-PG). Pacientes y Método: Se revisaron datos clínicos de 66 N-DM1. Se compararon las calificaciones de N-DM1 según Hemoglobina Glicosilada (HbA1c) < 7,5% y ≥ 7,5% con N-PG del mismo nivel, comuna, tipo de colegio (municipal, particular subvencionado y particular pagado) y localidad. Para la comparación de los grupos se utilizó la regresión lineal simple y el test de suma de los rangos de Wilcoxon (Mann y Whitney) previa comprobación de incumplimiento de normalidad con el test de Shapiro-Wilk según el caso. Se consideró un valor de p < 0,05 como estadísticamente significativo con una confiabilidad del 95%. Resultados: La edad fue 13,4 ± 2,9 años, tiempo de evolución DM1 5,3 ± 3,2 años, HbA1c 8,6 ± 1,9% y controles de glicemia capilar 3,2 ± 1,2 veces por día. Las calificaciones no mostraron correlación con HbA1c, duración de DM1, hipotiroidismo, problemas de salud mental, antecedentes de hipoglicemia ni de cetoacidosis. N-DM1 de educación básica mostraron calificaciones inferiores a N-PG del mismo nivel 5,6 ± 0,7 vs 6,0 ± 0,2 (p = 0,0002). Las calificaciones se correlacionaron con el número de controles diarios de glicemia capilar, coeficiente de correlación de Pearson (r) de 0,25, 0,41, 0,52 y 0,58 con el promedio general, matemática, lenguaje e historia respectivamente (p < 0,05). Un 6,1% de N-DM1 y 4,8% de N-PG no fue promovido de curso (p = 0,65). La deserción escolar fue 10,5% en N-DM1 y 7,7% en N-PG (p = 0,47). Conclusión: N-DM1que cursaban educación básica tuvieron calificaciones inferiores a N-PG y los pacientes que controlaban su glicemia capilar con mayor frecuencia mostraron mejores calificaciones. La DM1 puede tener un impacto deletéreo en el rendimiento escolar.

The impact of type 1 diabetes (T1D) on school performance is controversial. Objective: To study the relationship between school performance and metabolic control in children with T1D (Ch-T1D), comparing their school grades to general population children (Ch-GP). Patients and Method: Clinical data for 66 Ch-T1D was reviewed, school grades were compared in Ch-T1D with Glycated Haemoglobin (HbA1c) HbA1c < 7.5% and ≥ 7.5%. School marks were also compared between Ch-T1D and Ch-GP from the same level, community and school type (public, private o chartered). Simple linear regression analysis and Mann Whitney test were used to compare groups. A p < 0.05 was considered significant. Results: Ch-T1D were: 13.4 ± 2.9 years old, T1D duration: 5.3 ± 3.2 years, HbA1c was 8.6 ± 1.9% and capillary blood glucose was measured 3.2 ± 1.2 times per day. Grade averages showed no correlation with HbA1c, diabetes duration, hypothyroidism, mental health issues, neither with hypoglycemia or ketoacidosis records. However, primary education Ch-T1D showed lower grades than Ch-GP 5.6 ± 0.7 and 6.0 ± 0.2 (p = 0,0002). School grades correlated with the number of capillary blood glucose readings per day, Pearson correlation coefficient (r) 0.25, 0.41, 0.52 and 0.58 with general grade point average, math, language, and history average respectively (p < 0.05). School non-pass rate was 6.1% in Ch-T1D and 4.8% in Ch-GP (p = 0.65) and school dropout rate was 10.5% in Ch-T1D and 7.7% in Ch-GP (p = 0.47). Conclusion: Ch-T1D attending primary school showed lower school grades than Ch-GP, and patients who more frequently checked capillary blood glucose showed better school grades. T1D may have a deleterious impact on school performance.