Programa de Pós-Graduação em Atenção e Estudo Clínico no Diabetes - PPGDIABETES/UFPA
URI Permanente desta comunidadehttps://repositorio.ufpa.br/handle/2011/17108
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Navegando Programa de Pós-Graduação em Atenção e Estudo Clínico no Diabetes - PPGDIABETES/UFPA por Orientadores "FELÍCIO, João Soares"
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Item Acesso aberto (Open Access) Protocolo de diagnóstico e tratamento da Doença Renal do Diabetes(Universidade Federal do Pará, 2024-02-09) FERREIRA, Neylane Kely Vasconcelos; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Diabetes mellitus (DM) affects millions of people worldwide and represents an important public health problem, being associated with several complications, among which diabetic kidney disease (DRD) stands out. DRD is part of the group of microvascular complications that represent the main cause of chronic kidney disease (CKD) in patients entering dialysis programs. In adults, DRD occurs in 20–40% of people with diabetes, and its presence significantly increases cardiovascular risk and healthcare costs. The objective of this study is to create a protocol on DRD, generating behavior algorithms to guide health professionals at all levels of care through a literature review on updates in pathophysiology, diagnosis and treatment. The study was carried out through an integrative literature review, based on searches in the PubMed and LILACS databases, with the terms “DIABETIC KIDNEY DISEASE” AND “DIAGNOSIS”; “DIABETIC KIDNEY DISEASE” AND “TREATMENT”; “DIABETIC KIDNEY DISEASE” AND “DIAGNOSIS” AND “TREATMENT” and their correlates in Portuguese. Repeated studies, case reports, letters to the editor, comments and studies not available in English or Portuguese were excluded. The present work also included observational and descriptive studies, literature reviews and systematic reviews. In addition, the study is based on data from work carried out by the endocrinology and diabetes research group at the Federal University of Pará. After reviewing the literature, the selected information served as the basis for the construction of a clinical protocol regarding screening, diagnosis, and treatment of diabetes kidney disease. The clinical applicability of our protocol consists of providing a tool, not only for the specialist, but for the general practitioner in primary, secondary and tertiary care, with the aim of enabling effective care for patients with diabetic kidney disease. Thus, the adoption by specialist or general medical professionals of a “PROTOCOL FOR DIAGNOSIS AND TREATMENT OF DIABETES KIDNEY DISEASE” appears as a promising resource in the approach to individuals affected by this comorbidity.Item Acesso aberto (Open Access) Protocolo de diagnóstico e tratamento da hipertensão arterial sistêmica no Diabetes Mellitus(Universidade Federal do Pará, 2024-02-23) OLIVEIRA, Cássio Antônio Bezerra de; QUEIROZ, Natércia Neves Marques de; http://lattes.cnpq.br/5359261920325026; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Hypertension is a chronic disease that often accompanies diabetes mellitus and the relationship between the two is complex. Like diabetes, it is an important cardiovascular risk factor and microvascular complications, such as nephropathy and retinopathy, and has higher health costs than diabetes itself. The treatment of hypertension in diabetes has been widely debated and there is still a need to reach a consensus on treatment goals and strategies. The objective of the present study was to develop a clinical protocol on the diagnosis and treatment of hypertension in diabetes mellitus whose main foundation was its applicability in the Brazilian public health system, focusing on medical adherence to recommendations, the impact of applying the evidence in primary and secondary care, and the evolution of health quality in these scenarios. To this end, an integrative literature review was carried out, selecting health articles based on the quality of evidence located in the PUBMED database and published in the last 20 years (2004-2024). Five researchers were responsible for selecting those with the best quality of evidence. National and international guidelines and works published by the UFPA diabetes clinical research group were also used. In the end, 106 articles were selected as theoretical references for preparing the protocol. The results were synthesized in the form of a clinical protocol containing concise texts and teaching resources (27 tables, 3 flowcharts and 1 figure) that will guarantee safety in clinical decision-making in primary and secondary health care settings, configuring a practical guide on the topic in question.Item Acesso aberto (Open Access) Protocolo de diagnóstico e tratamento da Neuropatia Diabética(Universidade Federal do Pará, 2024-02-09) VIEIRA, Jocyelle Nascimento; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Diabetic neuropathy (DN) is currently the most frequently observed chronic complication of diabetes mellitus (DM) and, at the same time, the most underdiagnosed, affecting up to half of these patients, depending on the diagnostic methodology used. It generally affects individuals with a long duration of the disease (>10 years), however, it may be present at diagnosis in patients with DM2 or manifest early, within the first five years of the disease, in patients with DM1. Additionally, once diagnosed, DN is usually irreversible, but its appropriate management in patients with early diagnosis increases the possibility of regression and stabilization of the disease, considerably delaying and preventing the onset of complications. The objective of this work was to create a protocol for diagnosing and treating diabetic neuropathy in an objective and didactic manner, with a focus on helping general practitioners and specialists, both in primary and tertiary care. The protocol was prepared using the integrative literature review method, which was divided into 6 phases. The first phase consisted of preparing the guiding question to define the studies to be included and then an integrative review was carried out in the PUBMED and SciElo databases with the terms “NEUROPATHY”, “TREATMENT”, “DIAGNOSIS”, “NEUROPATHY DIABETIC” and its counterparts in Portuguese. Guidelines from the main national and international diabetes scientific societies, one book and relevant information from relevant websites were also included. After data collection and analysis, 106 materials were used as theoretical references for the preparation of this protocol. This resulted in the construction of didactic and objective tables, charts and flowcharts. The clinical applicability of the study consists of providing a tool, not only for the specialist, but for the general practitioner at different levels of health care, with the aim of enabling effective care for individuals with DN. Thus, the main contributions of the protocol were the development of a total of 20 didactic and visual tools aimed at the prevention, tracking, diagnosis and treatment of DN. 5 flowcharts, 4 charts and 2 tables are authored by the author.Item Acesso aberto (Open Access) Protocolo de rastreio e tratamento da dislipidemia no paciente adulto com Diabetes Mellitus(Universidade Federal do Pará, 2023-05-15) PALÁCIOS, Amanda de Oliveira Góes; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Diabetes mellitus (DM) is a highly prevalent metabolic disease that keep rising, and its main cause of mortality is atherosclerotic cardiovascular diseases. Classically, besides the concomitance with other comorbidities that increase this risk, DM presents a dyslipidemic triad also favorable to this outcome: increased triglycerides, reduced HDL-c, and formation of small and dense LDL-c molecules. Aiming to guide the appropriate treatment of dyslipidemia in diabetic patients, it is necessary to prepare a scientific material that addresses the subject in a didactic manner, based on current scientific evidence and adapted to the reality of the Brazilian population. The protocol developed fulfills this purpose and, for this, it was carried out an integrative review of the literature in the PubMed database. As a result, flowcharts, tables, and figures were elaborated to guide the drug treatment of hypercholesterolemia and hypertriglyceridemia according to established goals after defining the cardiovascular risk. The stratification of this risk was intentionally made through criteria that would make this assessment feasible regardless of the use of calculators or other means, giving autonomy to the professional performing it. The material aims to serve from primary to tertiary care and is indicated for general practitioners and specialists.Item Acesso aberto (Open Access) Protocolo de tratamento medicamentoso no Diabetes Mellitus Tipo 2(Universidade Federal do Pará, 2022-04-30) JANAÚ, Luísa Corrêa; QUEIROZ, Natércia Neves Marques de; http://lattes.cnpq.br/5359261920325026; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Type 2 diabetes mellitus (DMT2) is a disease of high global prevalence, affecting millions of people worldwide. It is responsible for a range of complications, both microvascular (retinopathy and nephropathy) and macrovascular (peripheral arterial disease, atherosclerosis and cerebrovascular diseases) that have a great impact on the quality of life of affected patients and that demands high costs from the public health network. In order to avoid these complications in patients with T2DM, it is essential to maintain glycemic control through individualized treatment, considering both clinical and socioeconomic aspects, essential for good adherence and, consequently, adequate control of glycemic parameters. In view of this, the objective of this thesis was to elaborate a clinical protocol for the treatment and glycemic control of DMT2. For this, a rapid review was carried out in the Pubmed and LILACS databases, searching for references with a high level of scientific evidence. There were also used guidelines from the main national and international diabetes scientific societies, as well as the expertise and publications by the research group in endocrinology and diabetes of the Federal University of Pará in the area. This resulted in a total of 195 publications (7 of which were authored by the group) included as a theoretical reference for the elaboration of the protocol. Based on this, explanatory texts, 10 concept tables and 6 didactic and objective flowcharts focused on individual characteristics of diabetics were generated in order to aid general and specialist physicians in the management of patients treated at the 3 levels of care of the Brazilian Unified Health System, aimed at preventing complications and reducing public spending. The strengths of the protocol were: the creation of a flowchart linking the diagnostic criteria to the glycemic targets for each test; initial treatment flowchart based on blood glucose levels at the time of diagnosis; flowchart with low-cost medication options for socially vulnerable patients; and creation of an insulin therapy flowchart incorporating the findings of the PARADIGM study, authored by the group.Item Acesso aberto (Open Access) Protocolo nutricional no Diabetes Mellitus Tipo 2(Universidade Federal do Pará, 2022-08-29) PALHETA, Rayelly Cíntia Ataíde; GOMES, Daniela Lopes; http://lattes.cnpq.br/0014255351015569; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Type 2 diabetes mellitus (T2DM) is a disease with high prevalence worldwide, representing about 90 to 95% of all diabetes mellitus (DM) cases, resulting from increased peripheral insulin resistance associated with a deficient insulin secretion, which may remain undiagnosed for years. Nutritional care in T2DM is essential in the treatment of the disease, being able to improve glycemic control and to reduce glycated hemoglobin in a range of 1% to 2%. Therefore, it is essential to know nutritional strategies to patients with diabetes, in order to reach an adequate glycemic control through individualized treatment. Thus, this work objectives to develop a nutritional protocol based on a rapid review in Pubmed and LILACS databases, searching for up-to-date references with a high level of scientific evidence, in addition to the guidelines of the main scientific national and international diabetes societies. We also rely on the authors' clinical experience and publications on nutritional therapy in T2DM, in order to create didactic and objective flowcharts for glycemic, lipid and blood pressure control, as well as for weight loss in T2DM, which aim to help health professionals in the approaching of these patients, as for the primary health care scenarios, as well as for the secondary and tertiary levels.Item Acesso aberto (Open Access) Vitamina D, qualidade de vida e alto risco de depressão em indivíduos com Diabetes Mellitus Tipo 2 e Doença Renal Diabética: um estudo transversal(Universidade Federal do Pará, 2024-02-23) REIS, Melissa de Sá Oliveira dos; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863Clinical Depression is highly prevalent in patients living with Diabetic Kidney Disease (DKD) and Diabetes Mellitus 2 (DM2) and is related to high morbidity and mortality, in addition, Health-Related Quality of Life (HRQoL) is also potentially impacted in these patients. Vitamin D (VD) deficiency has been associated with depression and worse HRQoL in patients with DRD. This study aims to investigate the association between vitamin D levels, HRQOL and depression in patients with DRD who are not receiving dialysis treatment. To this end, this was a cross-sectional study, which included 51 patients with DM2 and DRD, not on dialysis and with severely elevated albuminuria, treated at the João de Barros Barreto University Hospital. To measure depressive symptoms (SD), the Beck Depression Inventory (BDI) was used and HRQoL was analyzed using the EQ-5D-5L instrument. Additionally, the Glomerular Filtration Rate estimate was calculated by CKD-EPI Refit. Result: The prevalence of depression was 46.9% and was strongly associated with quality of life levels assessed by the EQ-5D. Impacting both domains and utility indices (Domain “Pain and discomfort” 0.7±0.8 vs 1.1±0.8, p<0.05; Utility index “United States” 0.89 [0.78-1] vs 0.71[0.60-0.84], p<0.05). Worse quality of life was even associated with the severity of depression. With regard to DV, it directly impacted HRQoL, but no direct association was found between DV and depression. Models with simple logistic regression showed that patients with peripheral neuropathy (PN) had a six times greater risk of experiencing depression (OR 6.56, R²=0.12, p<0.05). Additionally, the duration of DM2 was also important, with each year of illness increasing the risk of depression by 12% (OR 1.135, R²=0.18, p<0.05). The data suggested that depression has a high prevalence in patients with T2DM and DRD and is strongly associated with low levels of HRQoL. HV impacted quality of life, but was not directly associated with the prevalence and severity of depression.