Avaliação dos cuidados em pacientes com diabetes mellitus, dois anos após intervenção pelo método de gerenciamento de caso

Abstract

Type 2 diabetes mellitus (DM2) is one of the most common chronic diseases worldwide, whose incidence and prevalence have shown significant increases. The performance of the health team, especially the nurse, is of great importance for glycemic control of these people and aims to assist in maintaining health and preventing chronic complications. The literature, through clinical trial studies, has demonstrated effective methods for glycemic control. This is a cross-sectional study that aimed to evaluate the treatment in patients with diabetes mellitus, two years after intervention by the case management method. Participants in a clinical trial were invited for current assessment of clinical and sociodemographic variables and use of health services. The variables were compared with data obtained at the end of the trial. The data collection consisted of three stages: collection of personal/individual data; data collection in medical records in Basic Health Units; and data collection in medical records of the previous study. Data were processed in Microsoft Excel® 2010 and presented in absolute numbers and frequency. Spreadsheet was exported to the software SPSS 20.0, and data were analyzed using descriptive and inferential statistics at 5% significance level. Analyses were run according to the group of the individual, intervention or control. For the variables of interest, we applied the chi-square test and McNemar tested, and linear models were analyzed to know the difference of mean values between the end of the trial and the present research. There was predominance of women (69.6%), married (73.9%) with a mean of 6.87 years for the diagnosis of diabetes mellitus. Of the participants, 66.7% did not use insulin treatment, 71.0% did not undergo ophthalmologic evaluation and 89.9% did not undergo nephrology assessment during the 24 months after the intervention. Only 2.9% of the patients underwent assessments of feet. Tests have shown that after the trial, there was a reduction in the number of participants who performed regular physical activity. Participants in the intervention group showed a significant increase in glycated hemoglobin, total and LDL cholesterol, and reduced HDL. The risk for diabetic foot increased in the comparison group. After the end of the trial, there was no adequate control of glycemic variables and chronic complications for patients with type 2 diabetes mellitus. The nurse is an essential professional in the continuity of care and the development of health surveillance of people with this disease, who have the right to receive comprehensive and systematic care, according to health policy