Maria Cristina Foss de Freitas

Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in Brazil.

OBJECTIVE To determine the prevalence of patients with type 1 diabetes mellitus who meet the glycemic and cardiovascular (CV) risk factors goals and the frequency of screening for diabetic complications in Brazil according to the American Diabetes Association guidelines. RESEARCH DESIGN AND METHODS This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 1774 adult patients (56.8% females, 57.2% Caucasians) aged 30.3 ± 9.8 years with diabetes duration of 14.3 ± 8.8 years. RESULTS Systolic blood pressure was at goal in 40.3% and diastolic blood pressure was at goal in 26.6% of hypertensive patients. LDL cholesterol and HbA1c were at the goal in 45.2% and 13.2% of the patients, respectively. Overweight was presented in 25.6% and obesity in 6.9%. Among those with more than 5 years of disease, screening for retinopathy was performed in the preceding year in 70.1%. Nephropathy and feet complications were screened in 63.1% and 65.1%, respectively. CONCLUSIONS The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health.

Progress of the patients with diabetes mellitus who were managed with the staged diabetes management framework

Objective: To describe the progress of patients with diabetes mellitus seen by health care team members who followed the Staged Diabetes Management framework. Methods: This descriptive, prospective, and longitudinal study was conducted in a period of 12 months. The sample consisted of 54 patients with diabetes mellitus. Data were collected in three occasions through interviews: P0 Рat beginning of the study; P6 Рin six months; and, P12 Рat the end of the study. Results: There was an increase in adherence to diet from 61.1% in the P0 to 92.6% in the P12, in adherence to physical activities from 57.4% in the P0 to 66,7% in the P12, and in the use of medication. Conclusion: The use of the SDM framework among this sample of patients with diabetes promoted better adherence to diet, physical activities, and the use of medication.ABSTRACTObjective: To describe the progress of patients with diabetes mellitus seen by health care team members who followed the Staged DiabetesManagement framework. Methods: This descriptive, prospective, and longitudinal study was conducted in a period of 12 months. Thesample consisted of 54 patients with diabetes mellitus. Data were collected in three occasions through interviews: P0 Πat beginning of thestudy; P6 Πin six months; and, P12 Πat the end of the study. Results: There was an increase in adherence to diet from 61.1% in the P0 to92.6% in the P12, in adherence to physical activities from 57.4% in the P0 to 66,7% in the P12, and in the use of medication. Conclusion: The use of the SDM framework among this sample of patients with diabetes promoted better adherence to diet, physical activities, and theuse of medication. Keywords: Diabetes mellitus; Clinical protocols; Patient compliance; Nursing RESUMOObjetivo: Descrever a evolucao do tratamento de pacientes diabOticos por equipe multiprofissional utilizando o Protocolo Staged DiabetesManagement.

Relationship among social support, treatment adherence and metabolic control of diabetes mellitus patients

This cross-sectional and quantitative study aimed to analyze the relationship among social support, adherence to non-pharmacological (diet and physical exercise) and pharmacological treatments (insulin and/or oral anti-diabetic medication) and clinical and metabolic control of 162 type 2 diabetes mellitus patients. Data were collected through instruments validated for Brazil. Social support was directly correlated with treatment adherence. Adherence to non-pharmacological treatment was inversely correlated with body mass index, and medication adherence was inversely correlated with diastolic blood pressure. There were no associations between social support and clinical and metabolic control variables. Findings indicate that social support can be useful to achieve treatment adherence. Studies with other designs should be developed to broaden the analysis of relations between social support and other variables.El presente estudio objetivo analizar la relacion entre apoyo social, adhesion a los tratamientos no medicamentoso (dieta y ejercicio fisico) y medicamentoso(insulina y/o antidiabeticos orales) y control clinico-metabolico de 162 personas con diabetes mellitus tipo 2. Se trata de un estudio seccional, de abordaje cuantitativo. Los datos fueron recolectados por medio de instrumentos validados. El apoyo social tuvo correlacion directa con la adhesion al tratamiento. Se observo correlacion inversa entre adhesion al tratamiento no medicamentoso y indice de masa corporal, asi como entre adhesion medicamentosa y presion arterial diastolica. No hubo asociaciones entre apoyo social y variables de control clinico-metabolico. Se concluye que el apoyo social podra ser util para obtener la adhesion a los tratamientos. Estudios con otros delineamientos deben ser desarrollados, a fin de ampliar el analisis de las relaciones entre apoyo social y otras variables.

Redução da pressão arterial, da IMC e da glicose após treinamento aeróbico em idosas com diabete tipo 2

BACKGROUND The aging process is associated with the development of several diseases, which can be attenuated by the practice of physical activities. Aerobic training is an effective method to maintain and improve cardiovascular function. Additionally, it has a crucial role in the prevention and treatment of several chronic-degenerative diseases, especially diabetes mellitus. } OBJECTIVE To verify the effect of a 13-week aerobic training program on blood pressure (BP), body mass index (BMI) and glycemia levels in elderly women with type-2 diabetes mellitus (DM2). METHODS Eleven sedentary elderly women with DM2, aged 61.0 ± 9.1 years, were submitted a 13-week aerobic training program, constituting group G2. Eleven controlled elderly women (aged 60.2 ± 6.8 years) were not submitted to the aerobic training, constituting the control group (G1). G1 attended educational lectures once a week, whereas G2 walked three times a week. RESULTS Both groups presented a significant decrease in glycemia and diastolic blood pressure levels. No significant decreases in BMI were observed after the aerobic training in either group. CONCLUSION The 13-week aerobic training program was enough to promote significant decrease in the diastolic blood pressure and glycemia levels; therefore, this type of exercise training decreases the risk factors for cardiovascular and metabolic diseases.

Causas referidas para o desenvolvimento de úlceras em pés de pessoas com diabetes mellitus

ABSTRACT Objective: To analyze the root causes referred to in the etiology of foot ulcers in people with diabetes mellitus (DM). Methods: A sectional study, quantitative, conducted at the Diabetes Clinic of a University Hospital in Ribeirao Preto – SP (Brazil). Data were collected using a structured instrument and physical examination of the feet of a sample of 30 diabetic patients. Results: The sample had a mean age of 57.5 years, was predominantly male with a low educational level; 90% had type 2 DM, long-term and poorly controlled; obesity / overweight in 77%; and, 93.3% had plantar insensitivity. The metatarsal region was the site of ulcer most frequently mentioned, and the cause was the callus. Conclusion: The root causes involved in the etiology of these ulcers correspond, directly or indirectly, to extrinsic factors that can be prevented with basic care and at low cost. The plantar insensitivity, a key factor triggering the ulcers, was not recognized by these people. Keywords: Diabetes mellitus; Diabetic foot; Foot ulcer; Risk factorsOBJETIVO: Analizar las causas referidas en la etiologia de las ulceras en pies de personas con Diabetes mellitus (DM). METODOS: Estudio seccional, cuantitativo, realizado en el consultorio externo de Diabetes de un Hospital Universitario en Ribeirao Preto - SP. Los datos fueron recolectados con un instrumento estructurado y examen fisico de los pies de una muestra de 30 pacientes diabeticos. RESULTADOS: muestra conformada por personas con una edad promedio de 57,5 anos, predominio del sexo masculino y baja escolaridad;el 90% poseian DM tipo 2, de larga duracion y mal controlado; obesidad/sobre peso en el 77% e insensibilidad plantar en el 93,3%. La region metatarsiana fue referida, con mayor frecuencia, como el lugar de la ulcera y la causa fue la callosidad. CONCLUSION: Las causas que estan involucradas en la etiologia de las ulceras corresponden, de forma directa o indirecta, a factores extrinsecos que pueden ser prevenidos con cuidados basicos y de bajo costo. Entre tanto la insensibilidad plantar, factor fundamental desencadenante de las ulceras, no fue reconocida por las personas.

Relação entre apoio social, adesão aos tratamentos e controle metabólico de pessoas com diabetes mellitus

This cross-sectional and quantitative study aimed to analyze the relationship among social support, adherence to non-pharmacological (diet and physical exercise) and pharmacological treatments (insulin and/or oral anti-diabetic medication) and clinical and metabolic control of 162 type 2 diabetes mellitus patients. Data were collected through instruments validated for Brazil. Social support was directly correlated with treatment adherence. Adherence to non-pharmacological treatment was inversely correlated with body mass index, and medication adherence was inversely correlated with diastolic blood pressure. There were no associations between social support and clinical and metabolic control variables. Findings indicate that social support can be useful to achieve treatment adherence. Studies with other designs should be developed to broaden the analysis of relations between social support and other variables.El presente estudio objetivo analizar la relacion entre apoyo social, adhesion a los tratamientos no medicamentoso (dieta y ejercicio fisico) y medicamentoso(insulina y/o antidiabeticos orales) y control clinico-metabolico de 162 personas con diabetes mellitus tipo 2. Se trata de un estudio seccional, de abordaje cuantitativo. Los datos fueron recolectados por medio de instrumentos validados. El apoyo social tuvo correlacion directa con la adhesion al tratamiento. Se observo correlacion inversa entre adhesion al tratamiento no medicamentoso y indice de masa corporal, asi como entre adhesion medicamentosa y presion arterial diastolica. No hubo asociaciones entre apoyo social y variables de control clinico-metabolico. Se concluye que el apoyo social podra ser util para obtener la adhesion a los tratamientos. Estudios con otros delineamientos deben ser desarrollados, a fin de ampliar el analisis de las relaciones entre apoyo social y otras variables.

Root causes for the development of foot ulcers of people with diabetes mellitus

ABSTRACT Objective: To analyze the root causes referred to in the etiology of foot ulcers in people with diabetes mellitus (DM). Methods: A sectional study, quantitative, conducted at the Diabetes Clinic of a University Hospital in Ribeirao Preto – SP (Brazil). Data were collected using a structured instrument and physical examination of the feet of a sample of 30 diabetic patients. Results: The sample had a mean age of 57.5 years, was predominantly male with a low educational level; 90% had type 2 DM, long-term and poorly controlled; obesity / overweight in 77%; and, 93.3% had plantar insensitivity. The metatarsal region was the site of ulcer most frequently mentioned, and the cause was the callus. Conclusion: The root causes involved in the etiology of these ulcers correspond, directly or indirectly, to extrinsic factors that can be prevented with basic care and at low cost. The plantar insensitivity, a key factor triggering the ulcers, was not recognized by these people. Keywords: Diabetes mellitus; Diabetic foot; Foot ulcer; Risk factorsOBJETIVO: Analizar las causas referidas en la etiologia de las ulceras en pies de personas con Diabetes mellitus (DM). METODOS: Estudio seccional, cuantitativo, realizado en el consultorio externo de Diabetes de un Hospital Universitario en Ribeirao Preto - SP. Los datos fueron recolectados con un instrumento estructurado y examen fisico de los pies de una muestra de 30 pacientes diabeticos. RESULTADOS: muestra conformada por personas con una edad promedio de 57,5 anos, predominio del sexo masculino y baja escolaridad;el 90% poseian DM tipo 2, de larga duracion y mal controlado; obesidad/sobre peso en el 77% e insensibilidad plantar en el 93,3%. La region metatarsiana fue referida, con mayor frecuencia, como el lugar de la ulcera y la causa fue la callosidad. CONCLUSION: Las causas que estan involucradas en la etiologia de las ulceras corresponden, de forma directa o indirecta, a factores extrinsecos que pueden ser prevenidos con cuidados basicos y de bajo costo. Entre tanto la insensibilidad plantar, factor fundamental desencadenante de las ulceras, no fue reconocida por las personas.

Evolução do tratamento de pacientes diabéticos utilizando o protocolo staged diabetes management

Objective: To describe the progress of patients with diabetes mellitus seen by health care team members who followed the Staged Diabetes Management framework. Methods: This descriptive, prospective, and longitudinal study was conducted in a period of 12 months. The sample consisted of 54 patients with diabetes mellitus. Data were collected in three occasions through interviews: P0 Рat beginning of the study; P6 Рin six months; and, P12 Рat the end of the study. Results: There was an increase in adherence to diet from 61.1% in the P0 to 92.6% in the P12, in adherence to physical activities from 57.4% in the P0 to 66,7% in the P12, and in the use of medication. Conclusion: The use of the SDM framework among this sample of patients with diabetes promoted better adherence to diet, physical activities, and the use of medication.ABSTRACTObjective: To describe the progress of patients with diabetes mellitus seen by health care team members who followed the Staged DiabetesManagement framework. Methods: This descriptive, prospective, and longitudinal study was conducted in a period of 12 months. Thesample consisted of 54 patients with diabetes mellitus. Data were collected in three occasions through interviews: P0 Πat beginning of thestudy; P6 Πin six months; and, P12 Πat the end of the study. Results: There was an increase in adherence to diet from 61.1% in the P0 to92.6% in the P12, in adherence to physical activities from 57.4% in the P0 to 66,7% in the P12, and in the use of medication. Conclusion: The use of the SDM framework among this sample of patients with diabetes promoted better adherence to diet, physical activities, and theuse of medication. Keywords: Diabetes mellitus; Clinical protocols; Patient compliance; Nursing RESUMOObjetivo: Descrever a evolucao do tratamento de pacientes diabOticos por equipe multiprofissional utilizando o Protocolo Staged DiabetesManagement.

Relación entre apoyo social, adhesión al tratamiento y control metabólico de personas con Diabetes Mellitus

This cross-sectional and quantitative study aimed to analyze the relationship among social support, adherence to non-pharmacological (diet and physical exercise) and pharmacological treatments (insulin and/or oral anti-diabetic medication) and clinical and metabolic control of 162 type 2 diabetes mellitus patients. Data were collected through instruments validated for Brazil. Social support was directly correlated with treatment adherence. Adherence to non-pharmacological treatment was inversely correlated with body mass index, and medication adherence was inversely correlated with diastolic blood pressure. There were no associations between social support and clinical and metabolic control variables. Findings indicate that social support can be useful to achieve treatment adherence. Studies with other designs should be developed to broaden the analysis of relations between social support and other variables.El presente estudio objetivo analizar la relacion entre apoyo social, adhesion a los tratamientos no medicamentoso (dieta y ejercicio fisico) y medicamentoso(insulina y/o antidiabeticos orales) y control clinico-metabolico de 162 personas con diabetes mellitus tipo 2. Se trata de un estudio seccional, de abordaje cuantitativo. Los datos fueron recolectados por medio de instrumentos validados. El apoyo social tuvo correlacion directa con la adhesion al tratamiento. Se observo correlacion inversa entre adhesion al tratamiento no medicamentoso y indice de masa corporal, asi como entre adhesion medicamentosa y presion arterial diastolica. No hubo asociaciones entre apoyo social y variables de control clinico-metabolico. Se concluye que el apoyo social podra ser util para obtener la adhesion a los tratamientos. Estudios con otros delineamientos deben ser desarrollados, a fin de ampliar el analisis de las relaciones entre apoyo social y otras variables.

Perception of social support by individuals with diabetes mellitus and foot ulcers

Objective: To evaluate the perception of social support and the relationship of sociodemographic, clinical and metabolic control variables in individuals with diabetes mellitus and foot ulcers in an outpatient unit. Methods: A quantitative cross-sectional approach was carried out using a social support network inventory. Results: Participants had a high perception of social support; family and health professionals were identified as the main support sources. Fasting plasma glucose values were directly related with social support. Conclusion: Family members were identified as the main support source, which emphasizes their importance in the health care process.OBJETIVO: Evaluar el apoyo social percibido y su relacion con las variables sociodemograficas, clinicas y de control metabolico de personas con Diabetes mellitus y ulceras en los pies, con seguimiento ambulatorio. METODOS: Estudio de abordaje cuantitativo, seccional, realizado por medio del Inventario de la Red de Soporte Social. RESULTADOS: Hubo una elevada percepcion de apoyo social en la muestra estudiada, siendo las principales fuentes de apoyo los familiares y los profesionales de la salud. En el estudio de la relacion entre el AS y las variables sociodemograficas, clinicas y de tratamiento, no hubo correlaciones estadisticamente significativas. En cuanto a las variables de control metabolico, el valor de la glicemia plasmatica en ayuno presento relacion directa con el apoyo social. CONCLUSION: La familia fue la fuente de apoyo mas senalada, reiterando su importancia en el proceso del cuidado a la salud.