Efeitos de instruções e de feedback sobre adesão ao tratamento em adolescentes com diabetes tipo 1

Abstract

Type 1 Diabetes Mellitus (DM1) is a metabolic disease, mainly diagnosed in childhood and adolescence, characterized by the loss in the ability of the pancreas to produce insulin, which causes an increase in blood glucose leading to acute and chronic complications. The treatment requires the daily emission of a set of behaviors by the patient (such as measuring blood glucose, the application of insulin, following a dietary protocol and the regular practice of physical exercise), which require a higher value of response cost from the patient, demanding family support and procedures that promote adherence. This research was composed by two studies. Study 1: Descriptive with cross-sectional design, investigated the relation among family support, knowledge of diabetes and treatment adherence behaviors. Thirteen adolescents with DM1 answered an interview guide on treatment routine, the Family support to treatment inventory, and the Diabetes Knowledge Assessment scales (DKN-A). Statistical tests showed that there was a positive correlation among family support (p-value 0.004), knowledge on diabetes (p-value 0.013), and reports on the emission of treatment adherence behaviors, regardless of period since diagnosis or age of participants. Study 2: The purpose of this study was to analyze the effects of the exclusive use of instruction (presented through a web-based tutorial on diabetes education) and the effects of the combined use of instructions with feedback (utilizing the Glic app for smartphones) on treatment adherence behavior of adolescents with DM1, having as control condition (baseline) the routine of an endocrinology outpatient clinic. Five adolescents with DM1, who were attended at a university hospital (UH), participated of the study. Data were collected at the UH and at the participant's residence. The instruments used were: Interview Guide on treatment routine, Diabetes Knowledge Assessment scales (DKN-A), Protocol for analysis of medical records; 24-hour dietary recall; Tutorial on DM1 Education; Glic App and Protocol for evaluation of the Glic app. Participants were individually exposed to the design: A (baseline), followed by B (instructions with the tutorial), then C (instruction and feedback with Glic), returning to B and repeating C plus Follow-up. Data collection consisted of 33 audio recorded meetings with an average interval of three days. The results showed that regardless of the treatment applied, whether instruction through the Tutorial or instruction with feedback using the Glic app, no participant presented a significant increase in adherence to treatment indicators in all classes of target behavior analyzed in this study. It was observed that, depending on the treatment, the results showed benefits or even occasional harms in some of the target behaviors. Despite the participants were exposed to smartphones for a long period, a low adherence to this technology as auxiliary in the treatment of diabetes was noticed. The capacity-building of health care professionals is recommended for the use of multimedia resources and the investigation of the relation between social coping skills and adherence to treatment in adolescents with DM1 is also suggested.