Protocolo de Controle Glicêmico do Diabetes Mellitus Tipo 1 e Tipo 2

Abstract

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.