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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Abordagem nutricional em pessoas com Diabetes Mellitus Tipo 2: protocolo para nutricionistas da atenção primária à saúde
(Universidade Federal do Pará, 2023-12-13) QUEIROZ, Samara da Silva; CARVALHAL, Manuela Maria de Lima; http://lattes.cnpq.br/0708921042608519; HTTPS://ORCID.ORG/0000-0003-1397-0471; GOMES, Daniela Lopes; http://lattes.cnpq.br/0014255351015569
The nutritionist plays an important role in Primary Health Care (PHC) to promote Food and Nutritional Education (FNE) to users with DM2, aiming to achieve better glycemic management, mitigate complications arising from the disease and offer an improvement in the quality of life of these people. Therefore, this work aims to develop a protocol for nutritional management with a focus on DM2 to be used by nutritionists working in PHC. This is a methodological, developmenttype study, divided into three phases: bibliographical survey; preparation of illustrative material and validation of content, appearance and applicability of the material by expert judges and APS nutritionists. To prepare the protocol, an integrative review was carried out to define the content based on the needs found by PHC nutritionists. For validation, two instruments were used in electronic format: a form for content validation and another for apparent validation. The data obtained was compiled and stored in the Microsoft Office Excel version 2016 program. For data analysis, the Content Validity Index (CVI) was applied to the panel of experts. In the analysis of data judged by the target audience, items with a minimum level of agreement of 75% in positive responses were considered validated. This study is part of the project entitled “Creation and validation of protocols for associated interventions to control Diabetes Mellitus in primary health care” and all ethical aspects were respected, in accordance with Resolution 466/12, of the National Health Council. In validation content, the overall CVI average was 0.92, indicating an excellent degree of agreement among experts. Regarding validation with the target audience, a degree of agreement greater than 75% was obtained. At the end, the material was reviewed, adapting the protocol and creating illustrations. Given the above, it is concluded that the tool was validated, which attests to the effectiveness, relevance and applicability of the technology.
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Construção de tecnologia educativa do tipo álbum seriado acerca dos cuidados com os pés de pessoas com Diabetes
(Universidade Federal do Pará, 2022-08-31) SILVA, Marcelina Ribeiro da; QUEIROZ, Natércia Neves Marques; http://lattes.cnpq.br/5359261920325026
Diabetes Mellitus represents a heterogeneous etiological group of metabolic disorders that have in common hyperglycemia and disorders in the metabolism of carbohydrates, proteins and fats, resulting from defects in the action and/or secretion of insulin. This etiological group is associated with several comorbidities such as cardiovascular diseases, stroke, chronic renal failure, peripheral neuropathy and diabetic skin wounds or ulcerations. In addition, chronic ulcerations are more frequent in the lower limbs, such as the feet, and predominantly among the elderly, affecting 15% and all patients with diabetes, of this total, 14 to 24% undergo lower limb amputations and, after that, approximately 59% of patients die within five years. Therefore, the objective is to build an educational technology such as an educational flipchart as a tool to support guidelines on foot care for diabetic people. For this, it was decided to carry out a study on the construction of educational technology, through research of methodological development with a qualitative approach. The methodological trajectory was structured in two stages, namely: Narrative Literature Review (Step 1) and Construction of the flipchart (Step 2). The album started with the creation of a cover, pre-textual information such as a catalog sheet, authors' metadata, presentation and detailed summary. In the textual part, texts and images were included on the concepts of the disease, epidemiological aspects, risk factors, prevention, signs and symptoms, complications, diabetic foot and foot care, in order to address the main issues that generate doubts among patients. Therefore, the construction of this flipchart for diabetic patients was conceived with an easy-to-understand language, with clear and concise texts and colored figures, in order to bring the reader/user of health closer to a technical-scientific didactic knowledge, mainly, so that the target audience has the autonomy to perform self-care. In this scenario, this teachingassistance tool should be used to assist health professionals in guiding patients treated in health services, for this, it is intended to submit the album to formal validation. Regarding the making of the illustrations, we sought to present a colored material with illustrative figures that referred to the general and specific aspects of the disease in question, especially regarding the care of the feet of diabetic people. In addition, the main points on the subject were addressed, as well as the objectives achieved, as there were discussions and reflections on the subject, there was the construction of educational technology and the description of the construction process. Finally, with this study, we intend to provide for people with diabetes instrument of guidance with foot care.
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A influência de polimorfismo de genes associados a remissão do Diabetes Tipo II, em pacientes operados de cirurgia bariátrica e metabólica pela técnica de by pass gástrico em Y-de-Roux
(Universidade Federal do Pará, 2024-09-26) BITAR, Daniel Fadul; KHAYAT, André Salim; http://lattes.cnpq.br/6305099258051586; https://orcid.org/0000-0002-3451-6369
Introduction: Obesity is the main risk factor for the development of type 2 diabetes mellitus (T2DM), characterized by a progressive loss of pancreatic function, resulting from genetic and environmental changes. Among the genetic changes are variants in key genes responsible for glycemic homeostasis, including GLP1R and TCF7L2. The genetic dysfunction of these genes decreases insulin secretion by β-pancreatic cells, influencing glycemic control. Objective: To evaluate the influence of genetic polymorphisms on the remission of type II diabetes in patients undergoing bariatric and metabolic surgery using the Roux-en-Y gastric bypass technique. Methodology: The research was approved by the ethics and research committee under number 6.158.558 and included a total of 70 patients who underwent bariatric surgery using the bypass technique. Two blood samples were collected, one for laboratory analyses (glucose, cholesterol, triglycerides, glycated hemoglobin, C-peptide) and another for genetic polymorphism analyses. Genomic DNA was extracted using the phenol-chloroform protocol and subsequently analyzed for quantification, purity, and integrity of the extracted samples. For polymorphism analysis, real-time PCR (RT-qPCR) was performed with specific Taqman probes on the ABI 7500 equipment. Statistical analyses were performed using the SPSS 29.0 program. Student's t-test and Spearman's correlation were used to evaluate clinical and biochemical factors. Fisher's exact test and Chi-square were used to analyze the correlation of the presence of variants. Significant values were considered with a p-value ≤ 0.05. Results: Regarding the rs10305420 polymorphism of the GLP1R gene, this variant decreases proportional weight loss over the years and increases glycated hemoglobin after bariatric surgery (p-value = 0.04). The rs7903146 polymorphism of the TCF7L2 gene influences glycated hemoglobin levels, increasing it after gastric bypass (p-value = 0.036). Conclusion: The rs10305420 variant of the GLP1R gene decreases proportional weight loss over the years and increases glycated hemoglobin A1C fraction; and the rs7903146 variant of the TCF7L2 gene in the presence of the T allele also influences the outcome of bariatric and metabolic surgery using the Roux-en-Y gastric bypass technique, increasing the glycated hemoglobin A1C fraction postoperatively and decreasing the remission of type 2 diabetes in patients undergoing this surgical procedure.
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Protocolo clínico para o atendimento de análogos de insulina às pessoas com Diabetes Mellitus na rede pública de saúde do município de Belém-Pará
(Universidade Federal do Pará, 2024-02-29) NORONHA, Hirley Gabriel Reimão; SANTOS, Ândrea Kely Campos Ribeiro dos; http://lattes.cnpq.br/3899534338451625; https://orcid.org/0000-0001-7001-1483
Diabetes mellitus (DM) is a metabolic disorder that causes a persistent hyperglycemic state, related to inadequate insulin production and/or the ineffective mechanism of action of this hormone. DM1 is caused by the partial or total destruction of pancreatic beta cells, responsible for insulin secretion. DM2 arises from the combination of progressive resistance to the action of insulin, associated with the gradual loss of this hormone secretion. GDM occurs due to intolerance to carbohydrates in the diet that began during pregnancy, however, it does not meet the diagnostic criteria for Pre-Gestational DM. Approximately 6.9% of adults living in Belém-PA reported having some form of DM. DM treatment involves non-drug and drug measures. The multidisciplinary approach allows for better control of glycemic levels, ensuring a better quality of life. Drug treatment is carried out through a combination of oral antidiabetics with or without the addition of insulin therapy in DM2 and depends on hormonal insulin replacement in DM1. Exogenous insulin is currently available in the following formulations: long-acting, intermediate-acting, rapid-acting and ultrafast-acting. Insulin analogues are molecules where the amino acid structure is altered through genetic engineering and recombinant DNA technology, modifying the pharmacokinetic and pharmacodynamic properties compared to regular human insulins, while preserving the biological and stability properties of the insulin molecule. The present Clinical Protocol aims to standardize the care of long-acting and ultra-rapid insulin analogues in the public network of the city of Belém-PA, optimizing the treatment of patients with stable, unstable, or difficult-tocontrol DM, enabling the reduction of acute complications. and chronic diseases, improving patients’ quality of life.
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Protocolo de abordagem nutricional no Diabetes Mellitus Tipo 1 no estado do Pará para profissionais de saúde
(Universidade Federal do Pará, 2022-08-26) TEIXEIRA, Marcela Rassy; GOMES, Daniela Lopes; http://lattes.cnpq.br/0014255351015569
The main objective of this dissertation is to develop a nutritional therapy protocol in Type 1 Diabetes Mellitus for professionals. This is a methodological study, which is a product of the Postgraduate Program in Attention and Clinical Study in Diabetes - PPGDIABETES of the Federal University of Pará - UFPA. With the title of "Creation and validation of protocols for associated interventions for the control of Diabetes Mellitus in Primary Health Care", from the João de Barros Barreto University Hospital (HUJBB) - UFPA, approved by the Research Ethics Committee of the HUJBB (opinion number 4. 481,093) and carried out in 2021, which aims to build and evaluate intervention tools by pilot test. A literature review was carried out, with a search for current and relevant topics for clinical practice, using this information to build the protocol that was later submitted to the pilot test and evaluated by two nutritionists specializing in the area of diabetes mellitus, to adjust appearance and content. . As a result, algorithms, tables and charts were developed to guide the nutritional approach protocol that includes the following variables: summary of diagnostic criteria and glycemic goals, stages of readiness for behavior change, anthropometric assessment, proposal of food diaries, recommendations nutritional supplements, proposal of therapeutic steps for the use of technology in diabetes, dietary strategies and updating of a Carbohydrate Count Table adapted to the North region. It is concluded that the present protocol can be considered for outpatient follow-up and in food and nutrition education activities for patients with type 1 diabetes mellitus, in order to support professionals during clinical practice.
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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/5289063715182942
Diabetes 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.
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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/8482132737976863
Diabetic 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.
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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/8482132737976863
Type 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.
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Relação entre os determinantes das escolhas alimentares e os fatores socioeconômicos, demográficos, clínicos e antropométricos em pessoas com Diabetes Mellitus do Tipo 2 acompanhados em um hospital público de referência
(Universidade Federal do Pará, 2024-02-28) SOUZA, Adriane Fonseca de; GOMES, Daniela Lopes; http://lattes.cnpq.br/0014255351015569
Introduction: Investigating the determinants of food choices in type 2 Diabetes Mellitus (DM2) is essential for a better understanding of why people eat what they eat, helping to guide the nutritionist's conduct to achieve greater patient adherence to their treatment. Objective: To identify the determinants of food choices and their correlation with the socioeconomic, demographic, clinical and anthropometric aspects of adults with DM2 followed at a reference Public Hospital in Belém do Pará. Methodology: Cross-sectional, descriptive and analytical study, with adults with DM2, SUS users, receiving care at the Endocrinology outpatient clinic of the João de Barros Barreto University Hospital, from August to December 2023. A research form was applied to survey socioeconomic, demographic and clinical variables. Next, the anthropometric assessment was carried out, with subsequent application of The Eating Motivation Survey (TEMS) form to describe the determinants of food choices using the Spearman correlation test. The project was approved by the Research Ethics Committee.Results: 62 participants were evaluated, of both sexes (75.8% female), with a mean age of 55.6±6.5 years, with the majority presenting an overweight nutritional status (80.7%). The TEMS domains with the highest scores were habits (11.1±2.9) and preferences (11.0±2.4). The following correlations were found: 1) dimension of natural issues with family configuration (p2:-0.223; p: 0.040); 2) dimension of visual attraction with time since diagnosis (p2:-0.261; p: 0.020); 3) dimension of traditional diet with percentage of arm circumference (p2:0.261; p: 0.020); 4) weight control dimension with neck circumference (p2:-0.219; p: 0.044); 5) dimension of social image with the failure to carry out nutritional monitoring (p2: 0.297; p: 0.009); 6) the variable of not undergoing nutritional treatment also correlated with the dimensions of preference (p2: 0.453; p: 0.000), convenience (p2: 0.271; p: 0.016), pleasure (p2: 0.337; p: 0.004), traditional food (p2: 0.326; p: 0.005), price (p2: 0.295; p: 0.010), visual attraction (p2: 0.289; p: 0.011), and emotion control (p2: 0.263; p: 0.019). Conclusion: Therefore, it is concluded that correlations were found between different determinants of food choices with socioeconomic and clinical-anthropometric characteristics, which suggests the importance of a detailed anamnesis and of considering these aspects in dietary prescription for better patient adherence.

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