Maria Lúcia Zanetti

O cuidado sob a ótica do paciente diabético e de seu principal cuidador

Este estudo de caso tem por objetivo descrever como o paciente diabetico e seu principal cuidador percebem as dificuldades para o controle do diabetes. Os dados foram coletados por meio de registro audiogravado e submetidos a analise tematica de conteudo, no Centro Educativo de Enfermagem para Adultos e Idosos, em abril de 2003. Os temas que emergiram da analise foram: transgressao alimentar, problemas com a medicacao e influencias interpessoais. Esses temas reportam-se as influencias interpessoais familiares e do grupo de iguais, que estao alicercadas em um conjunto de crencas e valores que interferem na motivacao e na capacidade de os pacientes enfrentarem a sua doenca. Com base nos resultados, recomenda-se conhecer os padroes de resposta do paciente e de seu principal cuidador, em relacao aos seus sentimentos, conflitos e necessidades, estabelecendo um vinculo efetivo que proporcione condicoes para, em conjunto, tracarem-se estrategias direcionadas a alcancar o controle metabolico.

O cuidado à pessoa diabética e as repercussões na família

This study aimed to understand the repercussions in the family of the care offered after the implementation of a diabetes education program. We interviewed six relatives of diabetes patients from a university center in Ribeirão Preto-SP, Brazil, in 2007. Thematic data analysis made it possible to identify three themes: relatives recognize that the Center constitutes a differential for adherence to the food plan, physical activity and medication; the Center is acknowledged as an educative space to get together and control diabetes; the patient as an element that multiplies and expands the knowledge about diabetes in the family. The results indicate that the education program favorably affected the family, expanding its knowledge repertoire about treatment, and that the family cores support is fundamental in treatment adherence.La finalidad de este estudio fue comprender las repercusiones en la familia de la atencion ofrecida tras la implementacion de un programa educativo en diabetes. Entrevistamos a seis familiares de pacientes diabeticos de un centro universitario de Ribeirao Preto-SP, Brasil, en 2007. El analisis tematico de los datos posibilito identificar tres temas: familiares reconocen que el Centro constituye un diferencial para adhesion al plano alimentario, actividad fisica y medicamentos; el Centro es reconocido como espacio educativo para convivencia y control del diabetes; el paciente como elemento que multiplica y expande el conocimiento acerca del diabetes en la familia. Los resultados apuntan que el programa educativo repercutio favorablemente en la familia, ampliando su repertorio de conocimientos sobre el tratamiento, y que el apoyo del nucleo familiar es fundamental en la adhesion al tratamiento.

Factors related to patient adherence to antidiabetic drug therapy

The objective of the present study was to assess patient adherence to antidiabetic drug therapy and its association with factors related to the patient, patient-provider relationship, therapeutic regimen and the disease itself. The study comprised 46 diabetic patients enrolled in a research and extension education center in the State of Sao Paulo, southeastern Brazil, in 2007. Data was collected through interviews using a questionnaire and the Treatment Adherence Measure (TAM). The patient adherence level to antidiabetic drug therapy was 78.3%. In conclusion, since prevalence of adherence is below that recommended in the literature, and in the light of poor blood glucose control and alleged failure of therapeutic regimen, health providers are urged to measure diabetic patient treatment adherence, because it is key to adequate diabetes management with drugs.The objective of the present study was to assess patient adherence to antidiabetic drug therapy and its association with factors related to the patient, patient-provider relationship, therapeutic regimen and the disease itself. The study comprised 46 diabetic patients enrolled in a research and extension education center in the State of Sao Paulo, southeastern Brazil, in 2007. Data was collected through interviews using a questionnaire and the Treatment Adherence Measure (TAM). The patient adherence level to antidiabetic drug therapy was 78.3%. In conclusion, since prevalence of adherence is below that recommended in the literature, and in the light of poor blood glucose control and alleged failure of therapeutic regimen, health providers are urged to measure diabetic patient treatment adherence, because it is key to adequate diabetes management with drugs.

Knowledge of diabetic patients about their disease before and after implementing a diabetes education program

E um estudo quase-experimental, prospectivo, comparativo. O objetivo foi avaliar o conhecimento dos pacientes diabeticos acerca da doenca, antes e depois da implementacao de um Programa de Educacao em diabetes. Participaram 54 pacientes diabeticos, de abril de 2004 a abril de 2005. Na coleta de dados, utilizou-se um questionario. A populacao caracterizou-se por pacientes adultos e idosos, com idade entre 29 e 78 anos, com mediana de 60 anos, com predominio do sexo feminino (40/54-74,1%), brancos (32/54-59,3%), casados (37/54-68,5%), aposentados (23/54-42,6%), ensino fundamental incompleto (32/54-59,3%) e renda entre um e dois salarios minimos (16/54-29,6%). Quanto ao conhecimento dos pacientes acerca de sua doenca, houve aumento significativo (p<0,05), com destaque para os topicos gerais do diabetes mellitus: conceito, fisiopatologia e tratamento; outros topicos destacados foram a atividade fisica e alimentacao.

Levantamento dos fatores de risco para diabetes mellitus tipo 2 em uma instituição de ensino superior

The increase in the populations life expectancy, the decrease in peoples physical activity and the increase in calorie intake play an important role in the onset of diabetes. Therefore, this study aims at identifying risks factors for type-2 diabetes mellitus in 99 subjects from a teaching institution in a city in the interior of Sao Paulo State, Brazil. The results enabled the conclusion that 51.5% of the subjects were overweight; 51.5% had hereditary antecedents, 70% did not do physical exercises regularly, 68% felt stressed at work and 6% had altered pressure levels. The results showed the need for an education program within the institution aiming at awaking in the subjects the need to look for healthy life styles in order to prevent risks factors for type-2 diabetes.El aumento de expectativa de vida de la poblacion, la reduccion de la actividad fisica y EL aumento de la ingestion de calorias ejercen un importante papel en el aumento del numero de personas con diabetes. De esta manera, el objetivo del estudio es identificar los factores de riesgo para la diabetes mellitus de tipo 2, en 99 sujetos de una institucion de ensenanza, en una ciudad del interior del estado de Sao Paulo. Los resultados nos permitieron concluir que: 51,5% de los sujetos estan con sus pesos arriba del normal u obesos; 51,5% tienen antecedentes hereditarios, 70% no practican ejercicio fisico con regularidad, 68% se sienten muy cansados en el trabajo y 6% presentan niveles de tension alternados. Los resultados destacan la necesidad de un programa educativo junto a las instituciones, con el fin de despertar en los sujetos la necesidad de buscar un estilo de vida saludable para prevenir los factores de riesgo de la diabetes del tipo 2.

Sleep quality in type 2 diabetics.

Sleeping disorders in type 2 diabetic patients constitute risk factors for aggravating diabetes since they can affect the metabolic control through insulin resistance syndrome. This was an observational, cross-sectional study. The majority (52%) of subjects had scores indicating poor sleep quality. The Pittsburgh Sleep Quality Index (PSQI) scores showed patients with a time after diagnosis over 10 years and hypertension had the poorest sleep quality. For those with hemoglobin A1c > 7% taking sleeping medicines and those who had normal body mass index (BMI), the sleep quality was even poorer. The findings of the present study reinforce the relevance of this topic since there are no specific tools for sleep evaluation of type 2 diabetics making it difficult to make any assertions on the sleep quality of these patients.Sleeping disorders in type 2 diabetic patients constitute risk factors for aggravating diabetes since they can affect the metabolic control through insulin resistance syndrome. This was an observational, cross-sectional study. The majority (52%) of subjects had scores indicating poor sleep quality. The Pittsburgh Sleep Quality Index (PSQI) scores showed patients with a time after diagnosis over 10 years and hypertension had the poorest sleep quality. For those with hemoglobin A1c >7% taking sleeping medicines and those who had normal body mass index (BMI), the sleep quality was even poorer. The findings of the present study reinforce the relevance of this topic since there are no specific tools for sleep evaluation of type 2 diabetics making it difficult to make any assertions on the sleep quality of these patients. DESCRIPTORS: sleep disorders; diabetes mellitus, type 2; quality of life

Dificuldades dos pacientes diabéticos para o controle da doença: sentimentos e comportamentos

This study aimed to identify difficulties diabetic patients face during treatment in controlling the disease. A total of 24 diabetic patients, attended in the Nurse Educational Center for Adults and Elders in 2003, participated in the study. The data was collected individually, through a written report guided by a question previously elaborated, on a pre-scheduled date. The Content Analysis technique was used in the data analysis. The results showed several difficulties related to the treatment follow up: rejection and denial of the patients condition, suffering and revolt due to restrictions imposed by the diet, physical activity and medication. It is possible to infer that the focus of the education approach should not be restricted to the transmission of knowledge; it should also include emotional, social and cultural aspects that also influence in the treatment follow up.Este estudio tuvo como objetivo identificar las dificultades de los pacientes diabeticos en relacion altratamiento para el control de la enfermedad. Participaron 24 diabeticos acompanados en el Centro Educativo deEnfermeria para Adultos y Ancianos en 2003. Para obtener los datos, se utilizo un relato escrito, de forma individual,en dia predeterminado, a partir de una pregunta orientadora previamente elaborada. En el analisis de los datos seutilizo la tecnica de Analisis de Contenido. Los resultados mostraron que son innumeras las dificultades relacionadasal seguimiento del tratamiento: rechazo y negacion de la condicion de enfermo, sufrimiento y revuelta debido a lasrestricciones impuestas por la alimentacion, actividad fisica y medicamentos. Es posible inferir que el enfoque de laaproximacion educativa no debe restringirse apenas a la transmision de conocimientos; tambien es importante queenglobe aspectos emocionales, sociales y culturales que influencian en el seguimiento del tratamiento.DESCRIPTORES: diabetes mellitus; educacion en salud; enfermedad cronica

Difficulties of diabetic patients in the illness control: feelings and behaviors

This study aimed to identify difficulties diabetic patients face during treatment in controlling the disease. A total of 24 diabetic patients, attended in the Nurse Educational Center for Adults and Elders in 2003, participated in the study. The data was collected individually, through a written report guided by a question previously elaborated, on a pre-scheduled date. The Content Analysis technique was used in the data analysis. The results showed several difficulties related to the treatment follow up: rejection and denial of the patients condition, suffering and revolt due to restrictions imposed by the diet, physical activity and medication. It is possible to infer that the focus of the education approach should not be restricted to the transmission of knowledge; it should also include emotional, social and cultural aspects that also influence in the treatment follow up.Este estudio tuvo como objetivo identificar las dificultades de los pacientes diabeticos en relacion altratamiento para el control de la enfermedad. Participaron 24 diabeticos acompanados en el Centro Educativo deEnfermeria para Adultos y Ancianos en 2003. Para obtener los datos, se utilizo un relato escrito, de forma individual,en dia predeterminado, a partir de una pregunta orientadora previamente elaborada. En el analisis de los datos seutilizo la tecnica de Analisis de Contenido. Los resultados mostraron que son innumeras las dificultades relacionadasal seguimiento del tratamiento: rechazo y negacion de la condicion de enfermo, sufrimiento y revuelta debido a lasrestricciones impuestas por la alimentacion, actividad fisica y medicamentos. Es posible inferir que el enfoque de laaproximacion educativa no debe restringirse apenas a la transmision de conocimientos; tambien es importante queenglobe aspectos emocionales, sociales y culturales que influencian en el seguimiento del tratamiento.DESCRIPTORES: diabetes mellitus; educacion en salud; enfermedad cronica

Knowledge and attitude: important components in diabetes education

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05% of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.Estudio transversal, realizado en un centro de investigacion y extension universitaria brasileno, en el periodo de marzo a noviembre de 2007. El objetivo fue verificar conocimientos y actitudes de personas con diabetes mellitus que participaban de un programa de educacion en el auto cuidado en diabetes. Como metodo se uso una muestra constituida por 82 adultos con diabetes mellitus. Para recoleccion de los datos fueron utilizadas versiones portuguesas de los cuestionarios Diabetes Knowledge Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Los resultados mostraron que 78,05% tuvieron puntajes superiores a 8 en relacion al conocimiento en diabetes, indicando conocimiento y comprension acerca de la enfermedad. En cuanto a la actitud, los puntajes variaron entre 25 y 71 puntos, sugiriendo dificultad en el enfrentamiento de la enfermedad. Se concluye que, a pesar que los participantes obtuvieron un buen puntaje en el conocimiento, todavia asi no modificaron la actitud para el enfrentamiento mas adecuado de la enfermedad.

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.