Efeitos de instrução e de automonitorização sobre seguimento de regras para aplicação de insulina em crianças com diabetes Tipo 1

Abstract

Diabetes mellitus type 1 (DM1) is a metabolic disease characterized by loss of the ability of the pancreas to produce insulin, which causes an increase in blood glucose (blood sugar), leading to acute and chronic complications. This research was conducted in two stages: in Stage 1, the objective was to characterize children with DM1 treated at an university federal hospital (UH) for the treatment of diabetes; and, in Stage 2, the objective was to analyze the effects of instruction and self-monitoring, according to their order of presentation, among the behavior of rule-following for the use of insulin in children with DM1, relating to family support reported by these children. Eleven children with DM1 participated in this study (n = 11) in Stage 1 and two (n = 2) in Stage 2 with their caregivers at this stage, all aged between 9 and 12 years. In Stage 1, the data collection was held in the waiting room of the Endocrinology clinic of the UH, and in Stage 2, it was held at the residence of the child. The instruments used for data collection were: Game of Treatment Adherence (GTA); Interview Guide on Insulin; Inventory of family support for treatment; Protocol for analysis of medical records; 24h recall; Manual with instructions on applying insulin; Game of application of insulin; and forms of selfmonitoring. The results obtained in Stage 1 showed that the sample size was too small and that the majority were female. However, in Stage 2, only two male participants agreed to continue the study. The GTA showed that the most participants learned the correct way to order the images of the game, indicating that these participants had access to the rules for the use of insulin at breakfast. It was also observed that children did not have a good glycemic control, according to data from medical records, since the majority presented results of the examination of glycated hemoglobin above 8%, regardless of the time of diagnosis. The most participants stated that Stage 1 was only using the pen to apply insulin. It was found that the majority (n = 8) of participants reported Stage 1 autonomy regarding the behavior of glycemia and insulin apply. In Stage 2, it was observed that, in both cases, the measurement of blood glucose was monitored by caregivers more than the actual application of insulin. Another result found was that the majority of children (n = 8) learned to measure blood glucose and to apply insulin with a family member - especially the mother. It was noted that family support did not appear to be a variable directly related to to the knowledge about insulin and its form of application by the patient. According to the results of Inventory of family support for treatment, the participants reported that perceived family suport treatment, especially emotional, followed by social support for diet and for taking blood glucose tests. In Stage 2, regarding the use of insulin, it was observed that the values of pre-prandial glycemia were not used by both participants as tips to select the rapid insulin unit to be used before meals. These results suggest that both the Manual with instructions on applying insulin as the forms of self-monitoring, as well as 24h recalls, produced no changes in the behavior of participants on this aspect. In this study, it was observed that the time of diagnosis of the participants of the Stage 2 showed a direct relation with the understanding of treatment rules. Therefore, it is expected that this research has contributed to the literature on treatment adherence in children with DM1 and the rule-following of the application of insulin, suggesting the use of instructions as justifications, followed by forms of self-monitoring as a behavioral technique in promoting behavioral treatment adherence in this population.