Programa de Pós-Graduação em Atenção e Estudo Clínico no Diabetes - PPGDIABETES/UFPA

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Associação entre saúde mental e hábitos alimentares em indivíduos com Diabetes Tipo 1 durante o distanciamento social pela pandemia de COVID-19 no Brasil
(Universidade Federal do Pará, 2021-07-02) AINETT, Waléria do Socorro de Oliveira; GOMES, Daniela Lopes; http://lattes.cnpq.br/0014255351015569
Social distancing was considered by the World Health Organization (WHO) as the strategy to combat the COVID-19 pandemic, in order to prevent the spread of the disease, but this strategy caused a series of changes in people's social lives, including disabled persons. Type 1 Diabetes Mellitus (T1DM). Changes in mental health are often associated with diabetes, which can result in lower adherence to treatment and worse outcomes related to the management of the disease. Considering that the context experienced during social distancing can affect the mental health and eating habits of individuals with T1DM, the present study aimed to evaluate the association between mental health and eating habits of individuals with T1DM during social distancing by COVID-19 in Brazil. This was a cross-sectional study carried out in July 2020 using an online form. Sociodemographic and economic data, mental health perception through the adapted DSM-5 Level 1 Symptoms Scale - adult - were used, in addition to data on eating habits, through the consumption pattern of fruits, vegetables, sweets, ultra-processed foods, cooking habits, number of daily meals, change in food and water use. The results showed that participants who perceived moderate and severe symptoms of depression and anxiety had a positive association with increased food consumption in general, especially sweets and ultra-processed foods, such as snacks (snacks and cookies), as well as having a positive association with reduced fruit consumption and reduced cooking habits. Individuals with lower perceptions of symptoms of depression and anxiety showed a negative association with bad eating habits. It was evidenced that situations of social distancing, such as the one caused by the COVID-19 pandemic, can affect the mental health of individuals with T1DM, in this way, greater perceptions of symptoms of depression and anxiety can cause changes in consumption and food choices, affecting self-care and adherence to nutritional therapy recommended for this population.
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/5289063715182942
Diabetes 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.
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/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.
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/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.
Acesso aberto (Open Access)
Protocolo de classificação e diagnóstico do Diabetes Mellitus
(Universidade Federal do Pará, 2022-05-02) SILVA, Ariel Regina Silva da; SOUZA, Ana Carolina Contente Braga de; http://lattes.cnpq.br/0609863332556837
Diabetes mellitus (DM) is characterized as a metabolic disorder of multiple etiology that results in persistent hyperglycemia due to failure in insulin action and/or secretion. According to the World Health Organization (WHO), the American Diabetes Association (ADA) and the Brazilian Society of Diabetes (SBD), DM is classified according to etiology into four clinical classes: type 1 DM (T1DM), type 2 DM (T2DM), other specific types of DM (caused by different etiologies) and gestational DM. To diagnose DM and its types, it is necessary to associate clinical data (clinical history, personal and family history, signs, symptoms, physical examination) with the results of laboratory tests: fasting glucose, glycated hemoglobin A1C, oral test glucose tolerance test (OGTT) and/or specific antibody dosage (anti insulin, anti-GAD, antiislet, etc.), among others. The present work aimed to produce a protocol for clinicians and specialists on the classification and diagnosis of DM. Using a rapid review methodology, recent and relevant publications on the topic were selected in two databases: National Center for Biotechnology Information (NCBI/PUBMED) and Scientific Electronic Library Online (SCIELO). The selection was performed based on the evaluation of pre-determined inclusion and exclusion criteria, by a panel of two researchers with expertise in the area. The clinical protocol was elaborated focusing on the classification and diagnosis of DM, presented through didactic texts, easy to be understanding and in a language suitable for health professionals. Visual elements such as figures, charts and flowcharts were added to the material to highlight the most important information about the main types of DM, including the most specific and/or rare (LADA, MODY, neonatal diabetes mellitus, etc.), to assist the health professional to perform the early diagnosis of DM and identify the probable etiology of the disease. The reduction in the delay in recognizing the disease and causes may imply changes in the therapy and prognosis of the condition, in addition to directing family counseling for affected patients.
Acesso aberto (Open Access)
Cartilha educativa sobre cuidados com o uso de insulina injetável no tratamento do Diabetes Mellitus
(Universidade Federal do Pará, 2022-08-25) GOMES, Adriana dos Santos Mendes; SANTOS, Márcia Costa dos; http://lattes.cnpq.br/5450061620179886
Introduction: Diabetes Mellitus (DM) is a hormonal disorder characterized by persistent hyperglycemia resulting from a deficiency in the production and/or action of insulin. Currently, for the drug treatment of DM, we have two classes of injectable drugs: insulin and Glucagon-like peptide 1 (GLP-1) analogues, with insulin being the most used injectable drug today. Objectives: To create educational material on care with the injectable drug insulin aimed at patients with DM. Methodology: A bibliographic research was carried out in the MEDLINE, Pubmed and Scielo portals, which resulted in 2.920 publications and 29 scientific articles were registered. After analyzing the texts, the Educational Booklet on care with the use of the injectable drug insulin in the treatment of diabetes mellitus was prepared as a final product. It is a methodological development study, which refers to the elaboration, validation and evaluation of an instrument and research technique that can later be used by other people (POLIT; BECK, 2011). The booklet was edited using Office Word software free version 2021 and CorelDraw Graphics Suite X8 2021 and configured for printing on A4 sheet (210mm x 297 mm) in ―portrait‖ format. After delimiting the content of the booklet, the Flesch Reading Ease Index (IFLF) was applied in order to assess the ease with which a text can be read. After that, it was necessary to validate it, through the evaluation of a committee composed of content professor judges (JDC) and professional health care judges (JPSA). Results: The booklet addressed the following points about care with the use of insulin: types of insulin currently available, how to obtain it from SUS, what supplies are needed, how to carry out its application and care in the disposal of materials used. In the analysis of the booklet, the IFLF test revealed an index of 79.94 (%), being within the range of 70-80, which classifies the material as reasonably Easy. The judges carried out the validation of the educational material based on the evaluation of 3 aspects of the content: clarity of language, practical relevance and theoretical relevance. The global CVI (average of all grades) was calculated for the educational booklet, with values of 0.9 for clarity of language, 0.97 for practical relevance and 0.96 for theoretical relevance, indicating an excellent level of agreement between the judges. Conclusion: The educational material is presented with reasonably easy reading and presented good content validation, indicating that it is material of good understanding and content. It is hoped that this material will be well accepted, encourage education in DM, and serve as a practical guide for patients with diabetes in their daily lives and that it will develop skills and favor the autonomy and self-care of these individuals.
Acesso aberto (Open Access)
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.
Acesso aberto (Open Access)
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).
Acesso aberto (Open Access)
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).
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/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.
Acesso aberto (Open Access)
Cartilha nutricional para pessoas com Diabetes Mellitus Tipo 1
(Universidade Federal do Pará, 2022-08-29) SOUZA, Laysa Lira de; QUEIROZ, Natércia Neves Marques; http://lattes.cnpq.br/5359261920325026
Diabetes is a chronic condition that is related to an insufficient production of insulin or an occasional deficient insulin production is diabetes in glycemic metabolism. Type 1 Diabetes Mellitus (T1D) predominantly consists of an injury to the body's own insulin-producing cells; in this case, most of them are those planned during childhood and childhood insulin to survive. The treatment of T1D involves insulin therapy, food education and physical activity, and progress has been made. Diabetes education programs are essential tools for improving metabolic control and patient inclusion in their treatment. Therefore, the objective of this study is the elaboration of a nutritional education booklet for people living with type 1 diabetes mellitus, in order to assist in the treatment. For this, educational material such as a booklet on nutrition education for people with type 1 diabetes mellitus was prepared. Through a methodological development research with a qualitative approach. The approach was structured in two stages: the first stage was the bibliographic survey that took place between the months of September 2021 to July 2022, in the databases and virtual libraries LILACS, SciELO, MEDLINE, and PUBMED, 7 relevant references were added to the topic addressed in the booklet and 5 most recent guidelines and positions from the Brazilian Society of Diabetes seeking references with a high level of scientific evidence. The second stage consisted in the elaboration of the booklet, based on the scientific content obtained through the previous stage. The material was produced using an easy-tounderstand language and objective images. Comprising information about diet in T1D, carbohydrate counting strategies, elaboration of tables in the identification of food groups in the search to offer autonomy and information about food in T1D. And after the preparation of the material, the objective is to validate it, through considerations of selected judges with expertise in the subject.
Acesso aberto (Open Access)
Abordagem multiprofissional na assistência ao paciente com Diabetes Mellitus: uma revisão integrativa
(Universidade Federal do Pará, 2022-08-30) SANTOS, Grace Kelly Cabral dos; PIANI, Pedro Paulo Freire; http://lattes.cnpq.br/6434100473666705
Diabetes Mellitus (DM) as a chronic disease without visible symptoms at its beginning may have particular effects on the behavior of patients, as well as raising ways of how to approach the population in terms of regards its prevention. The symptomatological silence in the initial phase of the disease has repercussions on preventive behaviors and the chronicity of the disease, is an aspect that can favor the establishment of habits that become a patient's lifestyle or it can reduce care due to fatigue in following diets or guidelines, which implies another lifestyle in which guidelines about the disease are not the patient's priority. The component of subjectivity must be considered in any approach to disease in a health system that involves promotion, prevention, treatment and rehabilitation. Here, subjectivity is understood as individual processes that directly imply adherence to health treatment (GUIMARÃES; MENEGHEL, 2003). DM is a metabolic disorder characterized by hyperglycemia persistent, due to deficiency in insulin production or action, or in both mechanisms (SOCIEDADE BRASILEIRA DE DIABETES, 2019). DM is a rapidly growing public health problem throughout the world. world. By 2021, the International Diabetes Federation projected that 16% of world population between 20 and 79 years of age, living with diabetes. And the estimate for the year 2045, it will be approximately 783 million people with Diabetes (INTERNATIONAL DIABETES FEDERATION, 2021). In the Americas, estimates are that 62 million individuals live with DM, and these numbers tend to increase each year. To contain the advance of DM, there is a global agreement to reduce the number of DM and Obesity by the year of 2025 (PAHO, 2021a).
Acesso aberto (Open Access)
Construção de um protocolo de exercícios físicos para o atendimento a pessoas com diabetes mellitus tipo 2: revisão rápida
(Universidade Federal do Pará, 2022-08-30) RIBEIRO, Andressa Karoline Pinto de Lima; TORRES, Natáli Valim Oliver Bento; http://lattes.cnpq.br/1927198788019996; https://orcid.org/0000-0003-0978-211X
Type 2 Diabetes Mellitus (DM2) accounts for 90-95% of all diabetes cases. This form covers individuals with relative insulin deficiency and peripheral insulin resistance. Physical exercise is an efficient therapeutic strategy for the treatment of people with DM2 as it contributes to glycemic control, as well as reducing cardiovascular risk factors, increasing physical fitness, contributing to body weight control and improving people's quality of life. Objective: Formulate a physical exercise protocol aimed at health professionals for the treatment and maintenance of glycemic control of adults with type 2 Diabetes Mellitus. Methodology: The study consists in the elaboration of the protocol from a rapid review in search of studies who investigated the effects of physical exercise on the glycemic control of adults with type 2 Diabetes Mellitus (DM2) to analyze which exercise parameters (modality, frequency, volume, intensity, interval and progression) are recommended to achieve better glycemic control in the population of interest. The PICOT strategy was adopted for the elaboration of the inclusion criteria of the studies and the PRISMA protocol for the writing of the manuscript. PubMed and LILACS databases were used. The study selection process took place through 4 steps: identification, selection by title and abstract, eligibility assessment and inclusion. Two authors independently extracted data on population, intervention and outcome from each study, and the extracted information was organized into tables. The methodological quality of each study was analyzed based on the PEDro scale (PROSPERO - CRD 42021262614). Results: From a total of 1152 articles, 17 studies met the inclusion criteria and were analyzed. A total of 1,141 (745 in exercise groups and 396 in sedentary control groups) people with T2DM were included. Regarding the type of study, 15 (88.2%) were randomized clinical trials and 2 (11.8%) were non-randomized clinical trials. The age of patients ranged from 45.6 to 61.7 years. The mean intervention time was 17 weeks, ranging from 9 to 48 weeks. Six studies 35.3% reported that no adverse events occurred during the intervention, two (11.8%) reported some event and nine (52.9%) did not present any information. The theoretical basis obtained from the rapid review and other studies supported the construction of a guidance protocol for professionals about physical exercise as a treatment for DM2 and management of glycemic control. The following elements were elaborated: frameworks of concepts, flowcharts and explanatory texts constructed with objective and easy-to-understand language as didactic tools in order to assist in the outpatient routine of professionals responsible for prescribing exercises in the management of patients treated at all levels of care of the Unified Health System (SUS). Discussion: Aerobic, resistance and combined training are associated with decreases in HbA1c, fasting glucose or postprandial glucose. however, combined training should be prioritized as they appear to have greater effects on glycemic control than either method alone. Conclusion: The protocol created from this review aims to offer professionals working at the various levels of health care in the SUS, updated, objective information, presented in a didactic way about physical exercise as a form of treatment for DM2. It is recommended that physical exercise protocols include both resistance and aerobic exercise, as their effects are greater on glycemic control than either method alone.
Acesso aberto (Open Access)
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.
Acesso aberto (Open Access)
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.
Acesso aberto (Open Access)
Protocolo de rastreio da Retinopatia Diabética
(Universidade Federal do Pará, 2023-04-14) SOUSA, Juliana Ferreira de; SANTOS, Márcia Costa dos; http://lattes.cnpq.br/5450061620179886
Diabetic Retinopathy (DR) is one of the main microvascular complications of Diabetes Mellitus (DM) that is mainly present in patients with a long time of the disease and with inadequate glycemic control. This study aims to create a clinical protocol for screening diabetic retinopathy. For this, a literature review was carried out with research in the PubMed, SciELO (Scientific Library Online) and LILACS (Latin American and Caribbean Literature in Health Sciences) databases. The terms “diabetic retinopathy”, “diabetes mellitus”, “screening” and “treatment” were used, with the following inclusion criteria: literature reviews, rapid reviews and systematic reviews, and exclusion criteria: repeated studies, case reports , letter to the editor, comments and studies not available in English and Portuguese. After reviewing the literature, a protocol was developed with guidelines for tracking diabetic retinopathy, with emphasis on flowcharts, charts and texts aimed at health professionals. Based on this study, a clinical protocol for tracking DR was developed, which is objective and clear and can help health professionals who assist patients with DM.
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/8482132737976863
Diabetes 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.
Acesso aberto (Open Access)
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.
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/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.
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/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.