Avaliação, intervenção e acompanhamento de pacientes com diabetes mellitus tipo 2 na atenção básica de saúde, através de uma consultoria móvel especializada

Abstract

This thesis was writen in accordance with the rules of the Post Graduate Program in Health Sciences, Universidade Estadual de Maringá, and the results are shown in the form of two manuscripts. Manuscript 1: The objective of this study was to evaluate individuals with type 2 diabetes of the basic health of Maringa, Parana, Brazil, through clinical and laboratory parameters, and level of knowledge and quality of life related to the disease. A cross-sectional study was conducted in October 2014, with 61 participants selected randomly and obeying criteria of proportionality in relation to the population of patients with type 2 diabetes mellitus in each primary health care unit. Questionnaires were used to obtain the sociodemographic and lifestyle, clinical and laboratory data, as well as questionnaires DKN-A and DQOL-BR to assess, respectively, the knowledge level and quality of life related to diabetes. The most relevant results were an average HbA1c of 8.7% and a poor glycemic control (HbA1c> 7%) in 68.9% of patients. In disease risk for complications classification, 85.24% of the subjects had high or medium risk and 90% of individuals at high risk had poor glycemic control (HbA1c> 9%). More than half (56.14%) achieved a score indicating knowledge about diabetes. The median for the scores to evaluate quality of life related to the disease was higher than 2.0, indicating dissatisfaction with the disease. There was no significant association between HbA1c values and other variables studied, regardless of the degree of glycemic control. The findings suggest the need for more effective assistance and educational measures to reduce morbidity and mortality related to diabetes. Manuscript 2: The objective of this study was to evaluate the effects of specialized mobile consultancy in diabetes on clinical, laboratory, knowledge related to the disease and the impact on the lives of patients with type 2 diabetes mellitus in primary healthcare of Maringa, Parana Brazil. We conducted a randomized clinical trial from October 2014 to August 2015, with 52 patients assisted in primary health care. The intervention lasted six months and consisted of follow-up with an endocrinologist (five meetings ), with adjustment in treatment from clinical and laboratory tests and educational activity with application of Conversation Maps in diabetes. Statistical analysis involved comparison and association tests, considering statistical significance at p ≤ 0.05. The average age of patients was 63.8 years. Most were female (63.5%), had low education (59.6%), family history of type 2 diabetes (71.2%), used only oral antidiabetic medication (73.2%), had unfavorable anthropometric and laboratory parameters, high or medium rik for complications (84.6%), poor glycemic control (67.3%), and 71% of patients at high risk had poor glycemic control (HbA1c > 9%). The adjustment of the pharmacological treatment was necessary in 63.5% of patients. With the intervention, there was significant reduction of 0.46% in the average HbA1c (p = 0.0218), especially among individuals with poor glycemic control (0.71%, p = 0.0136). Additionally, there was an increase in knowledge score of the disease and significant decrease in mean body mass index and waist circumference and scores related to the impact of the disease. The intervention provided improved glycemic control and knowledge about the disease, reducing the values of body mass index, waist circumference and the impact of the disease on people's lives, which is indicative that specific assistance and educational measures favor living with the disease and its control.