Dissertações em Atenção e Estudo Clínico no Diabetes (Mestrado) - PPGDIABETES/UFPA

URI Permanente para esta coleçãohttps://repositorio.ufpa.br/handle/2011/17109

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Cartilha educativa para pessoas idosas que vivem com Diabetes Mellitus Tipo 2
(Universidade Federal do Pará, 2024-02-26) LOBATO, Alyne Maciel; SOUZA, Ana Carolina Contente Braga de; http://lattes.cnpq.br/0609863332556837
Diabetes Mellitus is a complex chronic condition characterized by hyperglycemia and metabolic dysregulations. Type 2 Diabetes Mellitus (DM2), the most common type of diabetes, is marked by the progressive and irreversible loss of insulin secretion by pancreatic β cells, associated with resistance to insulin action in peripheral tissues, resulting in a higher incidence and late diagnosis. Treatment requires a multifaceted approach, especially in older people, who face additional challenges due to aging. This includes lifestyle changes such as diet, exercise and medication administration, as well as the need for health education to promote treatment adherence and self-care. The DM2 approach demands a holistic view of the patient, considering the particularities of aging. Given the above, the study aims to develop an educational booklet for elderly people living with DM2, aiming to provide easyto-understand information, self-care guidelines and information records. The study is characterized as qualitative and descriptive, divided into two stages: the review of publications from the last five years (2018-2023) on the subject in the VHL, Scielo, Periódicos Capes and Pubmed databases and the development of an assistive technology in the format of primer. 725 results related to the theme proposed during the search were identified. Of these, 111 studies were selected to support the study in question. Among these, 17 studies were highlighted as main results and guided the discussion of the topics. Subsequently, the booklet was created, covering everything from the presentation of what type 2 diabetes is, to the self-care process and recommendations for elderly people. It is concluded, based on the conduct of this study, that the process of health education for the elderly population is essential. Consequently, it aims to strengthen self-care practices, increase adherence to medication therapy, promote lifestyle changes and raise awareness about the importance of preventing complications in elderly people living with DM2. Such measures aim to improve the overall quality of life of these individuals.
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Cartilha educativa sobre saúde óssea para pessoas que vivem com Diabetes Mellitus
(Universidade Federal do Pará, 2024-06-21) KHALED, Isabel Jane Campos Lobato; QUEIROZ, Natércia Neves Marques; http://lattes.cnpq.br/5359261920325026
Diabetes Mellitus has been linked to poorer bone health, leading to a higher risk of fractures in people living with diabetes. DM affects bone health in various ways. To prevent and manage bone problems in patients, some strategies need to be adopted, such as strict glycemic control, a diet with adequate intake of calcium and vitamin D, and physical exercises with an emphasis on strengthening activities. The educational approach values popular experiences and promotes the individual's autonomy in self-care. The aim of this study was to develop an educational booklet with the purpose of generating knowledge for the individual, using a descriptive-exploratory methodology to develop a lightweight health technology. The material was produced using easily understandable language and objective images.
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Efeitos da suplementação de altas doses de colecalciferol sobre a excreção urinária de albumina em pacientes com Diabetes Mellitus Tipo 1
(Universidade Federal do Pará, 2022-08-26) SILVA, Lorena Regina Velasco Guimarães; SOUZA, Ana Carolina Contente Braga de; http://lattes.cnpq.br/0609863332556837
Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease. The first clinical sign of this condition is microalbuminuria, currently called elevated urinary albumin excretion (UAE). Experimental and observational studies and clinical trials conducted in recent years suggest the effective role of vitamin D (VD) and its synergistic action with inhibitors of the renin-angiotensin-aldosterone system to counteract the worsening of DKD. The present study aimed to evaluate the effects of administration of high doses of cholecalciferol in the UAE of patients with type 1 diabetes (T1DM). For this, a clinical trial was carried out, in which patients with T1DM treated at the Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará (Belém, Brazil), were divided into two groups, according to baseline levels of 25-hydroxy-vitamin D - 25(OH)D - to receive cholecalciferol at doses of 10000 IU per day if 25(OH)D < 30 ng/ml and 4000 IU per day of cholecalciferol if 25(OH)D ≥ 30 ng/ml, for a period of 3 months. Before and after the intervention, patients underwent 24-hour microalbuminuria and isolated microalbuminuria collections. A total of 64 patients were included in this study, with a mean age of 27.9 ± 10.6 years and a mean duration of diabetes of 11.8 ± 7.9 years. There was a significant increase in 25(OH)D levels (26.7 ± 9 versus 55.1 ± 24.1 ng/mL, p <0.001) and a reduction in albuminuria in both methods evaluated, microalbuminuria in an isolated sample (urinary albumin:creatinine ratio) - UACR (62.5 ± 129.4 versus 55.6 ± 143.4 mg/g, p = 0.0027) and 24-hour urinary albumin excretion - 24-h UAE (76.4 ± 179.1 versus 58 ± 133.4 mg/ 24 h, p=0.002). The prevalence of DKD decreased from 37.5% at baseline to 25% after cholecalciferol supplementation. In patients classified as microalbuminuric (n=20) at the beginning of the study, in addition to a significant reduction in UAE assessed by 24-h UAE, reversion of microalbuminuria was observed in 40% of the patients in the sample (n=8). The results of the present study suggest that VD high-dose supplementation can promote a reduction in UAE in individuals with T1DM, especially in those in the early stages of DKD (microalbuminuric).
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Exercício físico e controle glicêmico em pacientes com diabetes mellitus tipo 1: uma revisão rápida e proposta de material informativo e didático
(Universidade Federal do Pará, 2022-08-28) OLIVEIRA, Adriana Alves; TORRES, Natáli Valim Oliver Bento; http://lattes.cnpq.br/1927198788019996; https://orcid.org/0000-0003-0978-211X
Diabetes Mellitus (DM), which is characterized by a metabolic disorder that causes hyperglycemia in affected patients, is currently one of the major public health problems, as it affects more and more people around the world and generates increasingly high costs. . Among its classifications, there is Type 1 Diabetes Mellitus (DM1), which is the focus pathology of our study. DM1 may have an unknown or autoimmune origin, attacking the beta cells of the pancreas, which produce insulin, the hormone responsible for capturing glucose into the cells. As a result, glucose is not captured to generate energy, causing hyperglycemia in the body, in addition to not controlling hepatic gluconeogenesis. People who have DM1 can present different types of complications, whether micro (nephropathies, neuropathies, retinopathies) or macrovascular (coronary diseases and/or stroke), hence the importance of promoting adequate glycemic control in these patients, in order to prevent such complications. For this, several studies have shown that in addition to a balanced diet and drug treatment, it is important to include regular physical exercise in the routine of patients with this metabolic syndrome. Therefore, the objective of this work was to analyze the effects of physical exercises on the glycemic control of patients with DM1, through a quick review of the literature (PROSPERO nº CRD42021277762), to develop an informative booklet for professionals who work with such patients, in addition to the creation of didactic material for discussion on the introduction of physical exercises in the routine of people with type 1 Diabetes Mellitus (CAAE 39536920.5.0000.0017). Our review of the literature points out that, regardless of the modality practiced, performing physical exercises has several health benefits, such as reduced medication dosage, improved physical well-being, cardiovascular conditioning, improved insulin resistance, lipid profile, among others. others. From the theoretical basis through a quick review and reading of guiding positions and documents from societies, in addition to reading recent and relevant articles for the care of the person with diabetes, an informative booklet was built aimed at health professionals and didactic material for discussion about the introduction of physical exercises in the routine of people with type 1 Diabetes Mellitus. The booklet has two main parts: a first theoretical part, constructed in an objective and synthetic way, composed of information about diabetes, its pathophysiology, main complications and the effects of physical exercise on people with DM1, in addition to a flowchart to guide the decision on the indication and safety for the practice of physical exercises according to blood glucose and risk factors. The second part of the booklet was constructed in an illustrative way to configure itself as a didactic instrument for the discussion with health professionals about the necessary information and care, prior to the beginning of an exercise program, in order to guarantee patient safety. This second part was composed of dialogues between the character Bete (person with DM1) and the professional (Dr. Cinesia).
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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/8482132737976863
Diabetes 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.
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Protocolo de rastreio e diagnóstico do Diabetes Mellitus Gestacional
(Universidade Federal do Pará, 2022-08-31) SOUZA, Larissa Mayane Reis Barros de; SOUZA, Ana Carolina Contente Braga de; http://lattes.cnpq.br/0609863332556837
Gestational diabetes mellitus (GDM) is associated with severe adverse perinatal outcomes and unfavorable short- and long-term health consequences for both mother and child. Due to the increasing prevalence of GDM worldwide, the impact and importance of this medical condition in prenatal care is growing. There is no consensus on the best forms of diagnosis for GDM, different criteria are adopted worldwide which currently often leads to a late diagnosis. The aim of this study is to develop an objective and didactic clinical protocol to help general practitioners and specialists on the diagnosis of GDM, in both primary and tertiary care. The study was carried out using the method of rapid literature review, which occurred through searches in the PUBMED and Scielo databases, with the terms "GESTATIONAL DIABETES MELLITUS CLASSIFICATION", "GESTATIONAL DIABETES DIAGNOSIS", "GESTATIONAL DIABETES RISK ALGORITHM", “ALGORITHM OF COMPLICATIONS OF GESTATIONAL DIABETES MELLITUS” and its correlates in english. Repeated studies, case reports, letters to the editor, comments and studies not available in English or Portuguese were excluded. Observational, descriptive studies, literature reviews, meta-analyses and systematic reviews were included. 107 publications were carried out for this protocol, which resulted in 11 flowcharts, 9 figures and 4 tables, in addition to explanatory texts, presented in 8 topics: categorization of hyperglycemia in pregnancy (pre-gestational diabetes, overt diabetes and GDM), maternal physiology, risk factors in GDM, maternal and fetal complications, screening and diagnosis of GDM, investigation of diabetes mellitus in the puerperium and practical examples for diagnosis of GDM. This project resulted in the creation of a practical instrument, which allows medical professionals carry out the diagnosis between the different forms of hyperglycemia in pregnancy, better understanding of the pathophysiology, risk factors and maternal-fetal complications of GDM, and therefore, assist professionals in the screening and and diagnosis, in situations of total/ partial financial viability and/or technical availability, regarding both GDM and diabetes mellitus in the puerperium, in order to promote early therapeutic intervention when applicable.
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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/8482132737976863
Type 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.
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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/8482132737976863
Clinical 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.

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