Fatores associados a adesão à contagem de carboidratos e controle glicêmico em adultos com diabetes mellitus tipo 1 no Brasil

Abstract

Introduction: Carbohydrate Counting (CC) is a strategy to assist in the treatment of patients with Type 1 Diabetes Mellitus (DM1), being recognized as a method that provides flexibility to food choices and helps in glycemic control, however, failure in adherence This strategy is still the main factor responsible for the reduction of therapeutic performance with CC. Objective: To analyze factors associated with adherence to CC and glycemic control in adults with DM1 in Brazil. Methods: These are two cross-sectional, descriptive, and analytical studies, carried out using online forms, one during the period of social isolation and the other after this period. The form of the first study collected data regarding sociodemographic and socioeconomic data, supplies’ acquisition, eating habits, CC, and social distancing. The second evaluated the knowledge of CC, clinical and anthropometric, sociodemographic, and socioeconomic data, follow-up with health professionals and understanding of the concepts of CC. The forms were built on the Google Forms® platform and disseminated through social networks, after approval of the project by the Ethics and Research Committee. For statistical analysis, the Statistical Package for Social Science software, version 24.0, was used. Results: The first study had 472 participants, of which 37.71% reported performing CC at the same frequency as before social distancing. Performing CC was associated with the type of city (p = 0.027), family income (p = 0.000), use of emergency financial aid (p = 0.045), type of insulin administration and glycemic monitoring (p < 0.000) and cook more (p = 0.012). Participants who maintained or reduced their consumption of ultra-processed foods were 0.62 times more likely to adhere to the CC (OR 0.626, 95% CI: 0.419–0.935) and participants who cooked more were 1.67 times more likely to adhere to the CC (OR 1.67, 95% CI: 1.146–2.447). In the second study, 173 adults participated, of which 57.2% had increased HbA1c. There was an association between having adequate HbA1c and having the diagnosis time <10 years (p=0.006), performing CC at lunch (p=0.040) and dinner (p=0.018), using specific applications (p=0.001) and kitchen scale to perform the CC (p=0.001), having learned to perform the CC from the nutritionist (p=0.037) and knowing how to correctly define the concepts of food bolus (p=0.001), correction bolus (p=0.000) and insulin ratio /carbohydrate (p<0.000). Participants who were undergoing CC were 3.273 times more likely to have adequate HbA1c and participants with diagnosis time <10 years were 2.686 times more likely to have adequate HbA1c. Conclusion: The studies showed that having better financial and sociodemographic conditions and using more advanced technologies for insulin administration and glycemic monitoring was associated with greater adherence to the practice of CC, as well as the performance of CC by adults with DM1 helped in the adherence to a lifestyle healthy life during social distancing period. In addition, strategy characteristics favored adequate HbA1c values in this public.