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, Karem Miléo"
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Item Acesso aberto (Open Access) Avaliação do crescimento linear em crianças com o diagnóstico de Diabetes Mellitus Tipo 1(Universidade Federal do Pará, 2024-02-21) BARBOSA, Bruna Lopes; FELÍCIO, Karem Miléo; http://lattes.cnpq.br/5289063715182942The Type 1 Diabetes Mellitus (T1DM) is characterized by the destruction of the ß-cells resulting in loss of endogenous insulin production. It is one of the most common presentations of youth-onset diabetes. The treatment needs multi-disciplinary approach and is based on intensive insulin therapy. The chronic hyperglycemia and severe insulin deficiency are known to be associated with impaired linear growth. The dysregulation of the GH-IGF-1 axis in T1DM is characterized by decreases in circulating IGF-1, GHR and GHBP, along with increases in GH and IGFBP-1. This study evaluated the influence of glycemic control in the linear growth of T1DM patients treated at Universitary Hospital João de Barros Barreto and compared the growth of these patients with the WHO`s reference. For that, a retrospective cohort study was made using data from medical records at the period between 5 and 19years old from 78 patients (40 females/ 38 males) following the criteria of age at the diagnosis £ 15 years old (females) and £ 17 years old (males). They were at diagnosis 8,6 years old, the duration of the disease was de15,4 years, glycated hemoglobin (HbA1C) 10,5 %. Among them, 58 patients (28 females/ 28 males) were achieved the final height (FH). The female’s FH was 156,2cm (Z score -1,11SDS) and the male’s FH was 166cm (Z score -1,45SDS). Only 19% were above the OMS`s media. But 26% had short stature. 9% were at Z≤ -3SDS. HbA1C ≥ 9,5% was related with worse FH. Each 1% of elevation in HbA1C was associated with a reduction of 2,23cm on FH, and 26% of FH variability were influenced by HbA1C level. The ones with HbA1C ³ 9% had significant stature loss compared to TH. In conclusion, the T1DM patients evaluated were shorter than the media of WHO`s charts, however the majority did not have short stature. HbA1C levels were negatively associated with stature loss compared to TH and final heigh. There was no correlation between FH and weight, insulin total dose, gender and diabetes duration.Item Acesso aberto (Open Access) Controle glicêmico e automonitorização da glicemia capilar: uma cartilha regionalizada para o paciente diabético(Universidade Federal do Pará, 2022-02-04) CAVALCANTE, Regina do Socorro Oliveira Pinheiro; http://lattes.cnpq.br/0014255351015569; FELÍCIO, Karem Miléo; http://lattes.cnpq.br/5289063715182942Diabetes mellitus is today a health problem worldwide, bringing serious micro and macrovascular complications when not properly treated; it is considered a difficult disease to control because its treatment requires changes in several aspects of the individual's life. Treatment consists of trying to maintain glycemic control, that is, maintaining blood glucose levels in the body in acceptable proportions; it requires discipline so that the medications are used correctly; changes in eating habits, maintaining a healthy diet, following an individual eating plan prescribed by a competent professional, and abandoning physical inactivity with the performance of regular physical activities. Glycemic control can be performed through periodic blood tests such as fasting blood glucose, glycated hemoglobin, and also through selfmonitoring, where the patient himself works by assessing his blood glucose levels daily and adjusting insulin amounts as instructed by his doctor. The self-monitoring techniques and parameters are passed on to the patient through Health Education, by the team responsible for their monitoring. Observing the importance of the diabetic patient maintaining glycemic control, aiming to prevent complications of the disease, we sought to carry out this study, which has as main objective, the production of a regionalized booklet for the patient containing the main guidelines on glycemic control and self-monitoring of capillary blood glucose, with easy-tounderstand language and illustrations that help them understand; the information was obtained through a literature review. It is intended to implement the booklet in primary health care, in Belém-PA, first with instructions on the subject to the health team that is working, so that the booklet is passed on to the user with appropriate information and clarifications.Item Acesso aberto (Open Access) Protocolo de Controle Glicêmico do Diabetes Mellitus Tipo 1 e Tipo 2(Universidade Federal do Pará, 2022-02-07) LEAL, Valéria Suênya Galvão; FELÍCIO, Karem Miléo; http://lattes.cnpq.br/5289063715182942Diabetes Mellitus (DM) is a chronic and complex disease characterized by chronic hyperglycemia with great impact on morbidity and mortality, affecting different age ranges and the predominant types are type 1 DM (DM1) and type 2 DM (DM2). Additionally, there is a high prevalence and incidence worldwide and the trend is growing in adults as well as in children and adolescents, economically impacting the public health costs. In all forms of DM, there is a risk of developing microvascular complications (retinopathy, diabetes kidney disease, neuropathy) and macrovascular complications (peripheral arterial disease, cardiovascular and cerebrovascular diseases) that develop over the years due to off-target glucose levels. Therefore, the assessment and monitoring of blood glucose through glycated hemoglobin (HbA1c), fasting blood glucose (FG) and postprandial blood glucose (PPG), time on target, and glycemic variability are essential to prevent these complications, since they help in choosing the appropriate treatment to achieve the glycemic target stipulated by the current scientific societies. Despite these resources, there are still occurrences of uncontrolled glycemia among patients for various reasons, and insufficient achievement of glycemic goals. The objective of this study was to create a clinical protocol of glycemic control in a clear and didactic way in order to help health professionals in the management of patients with DM1 and DM2 through the elaboration of algorithms and explanatory texts, corroborating the achievement of glycemic goals. The protocol was produced in 3 stages. First, for an updated theoretical basis, a literature review was performed about the tools and ways to evaluate the glycemic control, the current glycemic goals, and the "power" of action of antidiabetic agents on HbA1c, FG, and PPG. This review was done by a rapid review of the literature in the PUBMED and LILACS databases with the terms "GLYCEMIC CONTROL", "GLUCOSE MONITORING", "GLYCEMIC VARIABILITY", "GLYCEMIC GOAL" and their correlates in Portuguese. Also, the guidelines of the major national and international diabetes scientific societies, four books, and relevant information from pertinent websites were included. This resulted in a total of 44 materials that were used as theoretical references for the development of this protocol. Based on these references, tables, charts, and didactic and objective flowcharts were elaborated. The main contributions of the protocol were the creation of the glycemic control goal tables for HbA1c, FG, and PPG; a table with the main antidiabetic drugs and their potential reduction; glycemic profile diaries of 4, 7, and 8 points; original flowcharts exemplifying the treatment and potential decrease of glycated hemoglobin for DM2 and DM1; and a flowchart for the management of glycemic control in special situations of physical exercise, disease situations, driving vehicles, and surgeries.