Dissertações em Atenção e Estudo Clínico no Diabetes (Mestrado) - PPGDIABETES/UFPA
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Dissertação 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/0014255351015569The 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.Dissertação 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/8482132737976863Diabetes 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.Dissertação 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/8482132737976863Clinical 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.Dissertação Acesso aberto (Open Access) Impactos do Diabetes Mellitus Tipo 2 na qualidade de vida da população amazônica: a importância da atuação da equipe multiprofissional(Universidade Federal do Pará, 2024-08-01) TORRES, Luana Cristina Fiel; PIANI, Pedro Paulo Freire; http://lattes.cnpq.br/6434100473666705In the diagnosis of Type 2 Diabetes Mellitus (T2DM), the individual produces insufficient insulin, and the group most affected by this disease are people over 30 years old, obese or overweight, caused by the result of the relationship between hereditary and environmental factors and/or associated with population aging and an unhealthy lifestyle, with low frequency of physical activity, obesity and inadequate diet. T2DM is a chronic disease associated with high morbidity and mortality and impaired Quality of Life (QoL) and represents a public health problem due to its increased incidence and prevalence. The objective of this research was to present the possible association between QoL and T2DM and the evidence regarding the impacts of factors such as the performance of the multidisciplinary team. For this purpose, a cross-sectional study was carried out with 30 patients, in which two scales were applied and analyzed: the “B-PAID” and the WHO Quality of Life (WHOQOL – Brief), from October 2023 to June 2024, at the Endocrinology outpatient clinic of the João de Barros Barreto University Hospital - Belém - PA, in addition to the sociodemographic survey such as gender, age group, race/ethnicity, municipality, team and complications of DM2. Through this study, a profile of participants was obtained, these being people of both genders, aged between 50-69 years, brown, who lived in Belém, had greater monitoring by the endocrinologist and the nurse and had as main complications hypertension and dyslipidemia. The results found after analyzing the climbs were that this participant profile had as risk factors their QoL, economic variables, physical pain as an impediment to performing their routine activities, the feeling of not having clear goals for their treatment; not knowing how to deal with complications resulting from DM2 and a future of possible worsening of these. Subsequently, the participants were divided into two groups: “participants accompanied by up to two professionals” and “participants accompanied by three or more professionals” and the result obtained was that the latter group had the possibility of greater success in their treatment and better quality of life.Dissertação Acesso aberto (Open Access) A dança jazz como estratégia de cuidado ao adolescente com Diabetes Mellitus Tipo 1: um relato de caso(Universidade Federal do Pará, 2024-02-26) DOURADO, Julyanna Nazareth da Silva; BENTO-TORRES, Natáli Valim Oliver; http://lattes.cnpq.br/1927198788019996; https://orcid.org/0000-0003-0978-211XDiabetes Mellitus (DM) is a metabolic disorder associated with persistent hyperglycemia due to inadequate insulin production or reduced effectiveness of its mechanism of action. Type 1 Diabetes Mellitus (DM1), previously called “insulin-dependent diabetes” or “juvenile-onset diabetes,” accounts for 5 to 10% of DM cases. The DM1 complications can affect the living conditions of adolescents over the years and influence their quality of life. Physical exercise is a therapeutic tool for the treatment of people with DM1 and can improve insulin sensitivity and glycemic control, improving quality of life, mental health, and physical fitness. Dance is a low-explored option of physical exercise in the context of DM. In the present study, we report a single case study to investigate the potential of Jazz Dance as an intervention to achieve glycemic management, promote mental health, improve the physical fitness and quality of life of a 12-year-old female teenager with DM1, improve physical fitness and quality of life in an adolescent with DM1. The intervention program encompasses 24 Jazz classes twice a week, lasting 60 minutes, at moderate intensity (65 to 75% of maximum heart rate, Polar@). Pre- and post-intervention assessments (1 day after the choreographic presentation) include usual physical activity practice (Physical Activity Questionnaire for Adolescents PAQ-A), quality of life (Diabetes Quality of Life for Youths - DQOLY), symptoms of anxiety and depression (Depression, Anxiety and Stress Scale - Short Form - DASS-21), physical fitness (muscle strength of lower and upper limbs and indirect measure of cardiorespiratory fitness), and glycemic control (glycemia and glycated hemoglobin). Discursive textual analysis was also applied to assess the adolescent and her caregiver experiences (CAAE: 66423922.2.0000.0017/Approval number: 5.913.924). The results demonstrated a reduction in Fasting Glycemia (-16.02%), HbA1c (-4.00%), pre-test (-24.21%) and post-test (-9.56%) heart rate, depressive and anxious symptoms (-7.14%), and improved quality of life (3.61%). There was an increase in muscular strength in the upper limbs (20.00%), flight time, strength, and power in the lower limbs (0.27%; 1.62%; 1.70%, respectively). Despite limited evidence on the effect of dancing on people with DM, the data presented indicate the beneficial potential of Jazz in the care of adolescents with DM1, just as the report of the experience lived by the adolescent points to the positive impact of the intervention on her self-care routine and perceived quality of life. Despite the limitations of extrapolating our results to the teenage population with DM1, it is necessary to expand the research to include a more significant number of participants, as well as expand research on dance modalities as part of the treatment of DM1, aiming to quantify and qualify more precisely the potential adaptations and modifications provided to these people through dance.Dissertação 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/5441579181314766Diabetes 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.Dissertação 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/8482132737976863Diabetic 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.Dissertação 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/5359261920325026Diabetes 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.Dissertação Acesso aberto (Open Access) A influência de polimorfismo de genes associados a remissão do Diabetes Tipo II, em pacientes operados de cirurgia bariátrica e metabólica pela técnica de by pass gástrico em Y-de-Roux(Universidade Federal do Pará, 2024-09-26) BITAR, Daniel Fadul; KHAYAT, André Salim; http://lattes.cnpq.br/6305099258051586; https://orcid.org/0000-0002-3451-6369Introduction: Obesity is the main risk factor for the development of type 2 diabetes mellitus (T2DM), characterized by a progressive loss of pancreatic function, resulting from genetic and environmental changes. Among the genetic changes are variants in key genes responsible for glycemic homeostasis, including GLP1R and TCF7L2. The genetic dysfunction of these genes decreases insulin secretion by β-pancreatic cells, influencing glycemic control. Objective: To evaluate the influence of genetic polymorphisms on the remission of type II diabetes in patients undergoing bariatric and metabolic surgery using the Roux-en-Y gastric bypass technique. Methodology: The research was approved by the ethics and research committee under number 6.158.558 and included a total of 70 patients who underwent bariatric surgery using the bypass technique. Two blood samples were collected, one for laboratory analyses (glucose, cholesterol, triglycerides, glycated hemoglobin, C-peptide) and another for genetic polymorphism analyses. Genomic DNA was extracted using the phenol-chloroform protocol and subsequently analyzed for quantification, purity, and integrity of the extracted samples. For polymorphism analysis, real-time PCR (RT-qPCR) was performed with specific Taqman probes on the ABI 7500 equipment. Statistical analyses were performed using the SPSS 29.0 program. Student's t-test and Spearman's correlation were used to evaluate clinical and biochemical factors. Fisher's exact test and Chi-square were used to analyze the correlation of the presence of variants. Significant values were considered with a p-value ≤ 0.05. Results: Regarding the rs10305420 polymorphism of the GLP1R gene, this variant decreases proportional weight loss over the years and increases glycated hemoglobin after bariatric surgery (p-value = 0.04). The rs7903146 polymorphism of the TCF7L2 gene influences glycated hemoglobin levels, increasing it after gastric bypass (p-value = 0.036). Conclusion: The rs10305420 variant of the GLP1R gene decreases proportional weight loss over the years and increases glycated hemoglobin A1C fraction; and the rs7903146 variant of the TCF7L2 gene in the presence of the T allele also influences the outcome of bariatric and metabolic surgery using the Roux-en-Y gastric bypass technique, increasing the glycated hemoglobin A1C fraction postoperatively and decreasing the remission of type 2 diabetes in patients undergoing this surgical procedure.Dissertação 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/8482132737976863Hypertension 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.Dissertação Acesso aberto (Open Access) Avaliação do crescimento linear em crianças com o diagnóstico de Diabetes Mellitus Tipo 1(Universidade Federal do Pará, 2024-02-21) BARBOSA, Bruna Lopes; FELÍCIO, Karem Miléo; http://lattes.cnpq.br/5289063715182942The Type 1 Diabetes Mellitus (T1DM) is characterized by the destruction of the ß-cells resulting in loss of endogenous insulin production. It is one of the most common presentations of youth-onset diabetes. The treatment needs multi-disciplinary approach and is based on intensive insulin therapy. The chronic hyperglycemia and severe insulin deficiency are known to be associated with impaired linear growth. The dysregulation of the GH-IGF-1 axis in T1DM is characterized by decreases in circulating IGF-1, GHR and GHBP, along with increases in GH and IGFBP-1. This study evaluated the influence of glycemic control in the linear growth of T1DM patients treated at Universitary Hospital João de Barros Barreto and compared the growth of these patients with the WHO`s reference. For that, a retrospective cohort study was made using data from medical records at the period between 5 and 19years old from 78 patients (40 females/ 38 males) following the criteria of age at the diagnosis £ 15 years old (females) and £ 17 years old (males). They were at diagnosis 8,6 years old, the duration of the disease was de15,4 years, glycated hemoglobin (HbA1C) 10,5 %. Among them, 58 patients (28 females/ 28 males) were achieved the final height (FH). The female’s FH was 156,2cm (Z score -1,11SDS) and the male’s FH was 166cm (Z score -1,45SDS). Only 19% were above the OMS`s media. But 26% had short stature. 9% were at Z≤ -3SDS. HbA1C ≥ 9,5% was related with worse FH. Each 1% of elevation in HbA1C was associated with a reduction of 2,23cm on FH, and 26% of FH variability were influenced by HbA1C level. The ones with HbA1C ³ 9% had significant stature loss compared to TH. In conclusion, the T1DM patients evaluated were shorter than the media of WHO`s charts, however the majority did not have short stature. HbA1C levels were negatively associated with stature loss compared to TH and final heigh. There was no correlation between FH and weight, insulin total dose, gender and diabetes duration.Dissertação Acesso aberto (Open Access) Caracterização da adesão ao acompanhamento nutricional por adultos com Diabetes Mellitus Tipo 1 durante a pandemia de COVID-19 no Brasil(Universidade Federal do Pará, 2024-02-23) TOMPSON, Amanda Cristina Cunha; GOMES, Daniela Lopes; http://lattes.cnpq.br/0014255351015569Diabetes Mellitus (DM) is a chronic disease with complex treatment, therefore, it is believed that adherence to nutritional treatment has been impaired during the Covid-19 pandemic. Maintaining nutritional care online is a strategy to improve adherence to healthy eating, which improves glycemic control and prevents clinical complications of DM. The objective of this study was to characterize adherence to nutritional monitoring of adults living with DM1 during the COVID- 19 pandemic in Brazil. This is a descriptive and analytical cross-sectional study, carried out in July 2020. An online form was used to collect sociodemographic and economic data, characteristics of nutritional monitoring and eating habits, as well as social distancing of adults diagnosed with DM1 residents in Brazil. Pearson's Chi-Square test was applied, with adjusted residual analysis, considering a statistical significance level of p<0.05. Of the 472 participants, 86.02% were female, 62.50% lived in the capital or metropolitan region and 32.42% had a family income between 3 and 5 minimum wages. When evaluating nutritional monitoring, 62.08% did not undertake and maintained non-adherence to nutritional monitoring during the pandemic, 4.66% of participants maintained nutritional monitoring online and 2.12% maintained these consultations in person. Having better education (p=0.048) and income (p=0.009) was associated with maintaining online nutritional monitoring. A positive association was found between adequate consumption of fruits (p=0.001) and vegetables (p=0.049) and maintaining online or in-person and online nutritional monitoring. There was a positive association between starting face-to-face nutritional monitoring and consuming less food via delivery (p=0.024). Maintaining or starting to follow-up in person or online was associated with adhering to carbohydrate counting (p=0.047). Adhering to telenutrition consultations is an innovative and complementary alternative to DM healthcare.Dissertação Acesso aberto (Open Access) Cartilha educativa para pessoas idosas que vivem com Diabetes Mellitus Tipo 2(Universidade Federal do Pará, 2024-02-26) LOBATO, Alyne Maciel; SOUZA, Ana Carolina Contente Braga de; http://lattes.cnpq.br/0609863332556837Diabetes Mellitus is a complex chronic condition characterized by hyperglycemia and metabolic dysregulations. Type 2 Diabetes Mellitus (DM2), the most common type of diabetes, is marked by the progressive and irreversible loss of insulin secretion by pancreatic β cells, associated with resistance to insulin action in peripheral tissues, resulting in a higher incidence and late diagnosis. Treatment requires a multifaceted approach, especially in older people, who face additional challenges due to aging. This includes lifestyle changes such as diet, exercise and medication administration, as well as the need for health education to promote treatment adherence and self-care. The DM2 approach demands a holistic view of the patient, considering the particularities of aging. Given the above, the study aims to develop an educational booklet for elderly people living with DM2, aiming to provide easyto-understand information, self-care guidelines and information records. The study is characterized as qualitative and descriptive, divided into two stages: the review of publications from the last five years (2018-2023) on the subject in the VHL, Scielo, Periódicos Capes and Pubmed databases and the development of an assistive technology in the format of primer. 725 results related to the theme proposed during the search were identified. Of these, 111 studies were selected to support the study in question. Among these, 17 studies were highlighted as main results and guided the discussion of the topics. Subsequently, the booklet was created, covering everything from the presentation of what type 2 diabetes is, to the self-care process and recommendations for elderly people. It is concluded, based on the conduct of this study, that the process of health education for the elderly population is essential. Consequently, it aims to strengthen self-care practices, increase adherence to medication therapy, promote lifestyle changes and raise awareness about the importance of preventing complications in elderly people living with DM2. Such measures aim to improve the overall quality of life of these individuals.Dissertação 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/0014255351015569Introduction: 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.Dissertação 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/0000-0001-7001-1483Diabetes 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.Dissertação 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/0609863332556837Diabetic 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).Dissertação 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/0014255351015569Social 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.Dissertação Acesso aberto (Open Access) Controle glicêmico e automonitorização da glicemia capilar: uma cartilha regionalizada para o paciente diabético(Universidade Federal do Pará, 2022-02-04) CAVALCANTE, Regina do Socorro Oliveira Pinheiro; http://lattes.cnpq.br/0014255351015569; FELÍCIO, Karem Miléo; http://lattes.cnpq.br/5289063715182942Diabetes mellitus is today a health problem worldwide, bringing serious micro and macrovascular complications when not properly treated; it is considered a difficult disease to control because its treatment requires changes in several aspects of the individual's life. Treatment consists of trying to maintain glycemic control, that is, maintaining blood glucose levels in the body in acceptable proportions; it requires discipline so that the medications are used correctly; changes in eating habits, maintaining a healthy diet, following an individual eating plan prescribed by a competent professional, and abandoning physical inactivity with the performance of regular physical activities. Glycemic control can be performed through periodic blood tests such as fasting blood glucose, glycated hemoglobin, and also through selfmonitoring, where the patient himself works by assessing his blood glucose levels daily and adjusting insulin amounts as instructed by his doctor. The self-monitoring techniques and parameters are passed on to the patient through Health Education, by the team responsible for their monitoring. Observing the importance of the diabetic patient maintaining glycemic control, aiming to prevent complications of the disease, we sought to carry out this study, which has as main objective, the production of a regionalized booklet for the patient containing the main guidelines on glycemic control and self-monitoring of capillary blood glucose, with easy-tounderstand language and illustrations that help them understand; the information was obtained through a literature review. It is intended to implement the booklet in primary health care, in Belém-PA, first with instructions on the subject to the health team that is working, so that the booklet is passed on to the user with appropriate information and clarifications.Dissertação 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/8482132737976863Type 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.Dissertação 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/5359261920325026Diabetes 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.