Aspectos psicológicos e controle glicêmico de um grupo de pacientes com Diabetes Mellitus tipo 1 em Minas Gerais

Abstract

Psychological aspects and patients' acceptance of type 1 diabetes (DM1) may exercise some influence in their glycemic control. In this project the influence of psychological aspects were evaluated on glycemic control of DM1 patients. A retrospective study of participants from Diabetes Weekend (DW), an educational project in DM1 was carried out in Minas Gerais. In a sample of 150 subjects (66M/84F, 21.6+/-13.5 years and duration of DM of 8.5+/-7.9 years) we analyzed: type of insulin, insulin delivery, insulin dose per day and insulin dose per day in DW, psychological profile, capillary glycemia and previous history of convulsion crisis, severe hypoglycemia or diabetic ketoacidosis (CAD). Glucose was monitored 4 times a day by a digital glucose monitor. 20.9% of the patients with DM1 felt very well (G1); 39.5% well (G2), 25.6% with difficult glycemic control (G3), 9.3% trying to accept (G4) and 4.7% reported to be very bad about their DM1. The average capillary glycemia (ACG, in mg/dl) was significantly lower in G1 than in the others (169.8; G2: 182.3; G3: 199.3; G4: 200.7). There were no significant association of this psychological aspects and previous history of CAD, hypoglycemia or convulsion crisis. DM1 duration over 5 years was associated to lower acceptance of the disease (p= 0.017) and age of patients (p= 0.000). 13.9% of patients reported to be ashamed of their disease; the ACG was significantly higher in this group as compared to others (246.2 vs. 178.1; p= 0.007). In 91 patients (60.4%) who mention to have apprehension of feeling sick in public the ACG was significantly higher (200.4 vs. 184.5; p= 0.014). The systematic glucose monitoring showed positive association between psychological aspects and worse glycemic control. The psychological and multidisciplinary approach of DM1 patients is very important to try to improve the metabolic control, to prevent future complications, which results in better quality of life for these patients.

Correlation between parameters of self-monitoring of blood glucose and the perception of health-related quality of life in patients with type 1 diabetes mellitus

“…Another Brazilian study yielded similar results, showing evidence of a direct relationship between higher glycemic levels in patients who were more dissatisfied with T1D (20). One possible explanation would be that the patients felt uncomfortable when visualizing high glucose levels since hyperglycemia is well known to be associated with complications of the disease.…”

Fatores emocionais, qualidade de vida e adesão ao tratamento em adultos com diabetes tipo 2

“…Tais estudos sugerem que esses indivíduos, ao serem expostos a situações aversivas, apresentariam dificuldades no manejo da doença comprometendo a adesão ao tratamento e consequentemente a sua qualidade de vida. No caso específico do diabetes, estudos sugerem haver correlação positiva entre esses fatores e o curso da doença [8][9][10][11] .…”

Feelings of women after the diagnosis of type 2 diabetes

“…Some studies show that the psychological profile and acceptance of the disease affect glycemic levels (8)(9) and can often compromise the life condition of people with diabetes, due to functional limitations, financial hardship, stress and depression (10) . In turn, the depressive state can cause decreased motivation to comply with the treatment, thus impairing glycemic control.…”