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

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Acesso aberto (Open Access)
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)
Avaliação do crescimento linear em crianças com o diagnóstico de Diabetes Mellitus Tipo 1
(Universidade Federal do Pará, 2024-02-21) BARBOSA, Bruna Lopes; FELÍCIO, Karem Miléo; http://lattes.cnpq.br/5289063715182942
The Type 1 Diabetes Mellitus (T1DM) is characterized by the destruction of the ß-cells resulting in loss of endogenous insulin production. It is one of the most common presentations of youth-onset diabetes. The treatment needs multi-disciplinary approach and is based on intensive insulin therapy. The chronic hyperglycemia and severe insulin deficiency are known to be associated with impaired linear growth. The dysregulation of the GH-IGF-1 axis in T1DM is characterized by decreases in circulating IGF-1, GHR and GHBP, along with increases in GH and IGFBP-1. This study evaluated the influence of glycemic control in the linear growth of T1DM patients treated at Universitary Hospital João de Barros Barreto and compared the growth of these patients with the WHO`s reference. For that, a retrospective cohort study was made using data from medical records at the period between 5 and 19years old from 78 patients (40 females/ 38 males) following the criteria of age at the diagnosis £ 15 years old (females) and £ 17 years old (males). They were at diagnosis 8,6 years old, the duration of the disease was de15,4 years, glycated hemoglobin (HbA1C) 10,5 %. Among them, 58 patients (28 females/ 28 males) were achieved the final height (FH). The female’s FH was 156,2cm (Z score -1,11SDS) and the male’s FH was 166cm (Z score -1,45SDS). Only 19% were above the OMS`s media. But 26% had short stature. 9% were at Z≤ -3SDS. HbA1C ≥ 9,5% was related with worse FH. Each 1% of elevation in HbA1C was associated with a reduction of 2,23cm on FH, and 26% of FH variability were influenced by HbA1C level. The ones with HbA1C ³ 9% had significant stature loss compared to TH. In conclusion, the T1DM patients evaluated were shorter than the media of WHO`s charts, however the majority did not have short stature. HbA1C levels were negatively associated with stature loss compared to TH and final heigh. There was no correlation between FH and weight, insulin total dose, gender and diabetes duration.
Acesso aberto (Open Access)
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.
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)
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)
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.
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)
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)
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 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 hipertensão arterial sistêmica no Diabetes Mellitus
(Universidade Federal do Pará, 2024-02-23) OLIVEIRA, Cássio Antônio Bezerra de; QUEIROZ, Natércia Neves Marques de; http://lattes.cnpq.br/5359261920325026; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Hypertension is a chronic disease that often accompanies diabetes mellitus and the relationship between the two is complex. Like diabetes, it is an important cardiovascular risk factor and microvascular complications, such as nephropathy and retinopathy, and has higher health costs than diabetes itself. The treatment of hypertension in diabetes has been widely debated and there is still a need to reach a consensus on treatment goals and strategies. The objective of the present study was to develop a clinical protocol on the diagnosis and treatment of hypertension in diabetes mellitus whose main foundation was its applicability in the Brazilian public health system, focusing on medical adherence to recommendations, the impact of applying the evidence in primary and secondary care, and the evolution of health quality in these scenarios. To this end, an integrative literature review was carried out, selecting health articles based on the quality of evidence located in the PUBMED database and published in the last 20 years (2004-2024). Five researchers were responsible for selecting those with the best quality of evidence. National and international guidelines and works published by the UFPA diabetes clinical research group were also used. In the end, 106 articles were selected as theoretical references for preparing the protocol. The results were synthesized in the form of a clinical protocol containing concise texts and teaching resources (27 tables, 3 flowcharts and 1 figure) that will guarantee safety in clinical decision-making in primary and secondary health care settings, configuring a practical guide on the topic in question.
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.
Acesso aberto (Open Access)
Protocolo de manejo da úlcera do pé em portadores de Diabetes: diagnóstico, classificação e tratamento
(Universidade Federal do Pará, 2024-06-25) SILVA, Josyelle Liliam Ferreira; SILVA, Lilian de Souza D Albuquerque; http://lattes.cnpq.br/5441579181314766
Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia due to changes in insulin production and/or action. Foot ulcers in patients with diabetes represent one of the main chronic complications and are associated with high rates of morbidity and mortality. The aim of the present study is to formulate a protocol on the management of these ulcers. For this, an integrative literature review was carried out in the period from 2014 to 2024 in the databases of Google Scholar, Pubmed, Lilacs and Scielo. The main global guidelines on the subject were used, and the clinical characteristics, social profile and level of complexity of health care were taken into account in order to propose the best approaches. Didactic material was formulated with explanatory texts, tables and flowcharts to simplify the diagnosis, classification of ulcers and treatment of this condition. This clinical protocol serves as a tool for quick and upto-date consultation for any health professional who works with the care of these patients, to facilitate the management of this condition and simplify communication between the team involved in the care.
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 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 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)
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 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)
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.
Acesso aberto (Open Access)
Vitamina D, qualidade de vida e alto risco de depressão em indivíduos com Diabetes Mellitus Tipo 2 e Doença Renal Diabética: um estudo transversal
(Universidade Federal do Pará, 2024-02-23) REIS, Melissa de Sá Oliveira dos; FELÍCIO, João Soares; http://lattes.cnpq.br/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.