Fatores de risco para ulceração e amputação de extremidades inferiores em portadores de diabetes mellitus

Abstract

Risk factors for lower-extremity ulceration and amputation in patients with diabetes mellitus Factores de riesgo de ulceración y amputación de extremidades inferiores en pacientes con diabetes mellitus RESUMO Objetivo: Analisar os fatores de risco para ulceração e amputação de extremidades inferiores em portadores de diabetes mellitus. Métodos: Estudo transversal, quantitativo, realizado em 2013, com 92 indivíduos diabéticos, cadastrados em uma Unidade de Saúde da Família em Maceió, Alagoas, Brasil, através de entrevistas e avaliação clínica dos pés. Investigaram-se as seguintes variáveis: características sociodemográficas (sexo, faixa etária, cor da pele, estado civil, escolaridade e renda) e fatores de risco complementares para o pé diabético (dados clínicos, estilo de vida e prática de autocuidado com os pés). Para identificar a associação entre as variáveis, utilizaram-se os testes Qui-quadrado com correção (Yates), Teste G e Exato de Fisher, sendo considerado o nível de significância de 5% (p < 0,05). Resultados: A amostra contemplou 92 portadores de diabetes mellitus, sendo 71,7% (66) do sexo feminino, com faixa etária predominante de 60-79 anos-48,0% (44). Observou-se prevalência de 95,6% (88) com risco para ulceração e 4,4% (4) com risco para amputação. Com relação ao risco de ulceração, 64,1% (59) foram classificados em risco 0 (menor risco). Conclusão: Encontrou-se maior prevalência de pacientes em menor risco para ulceração e amputação. Destaca-se o uso inadequado dos calçados como o fator de risco mais comum e o uso do tabaco como fator de risco com associação estatística significativa.

Risk Factors and Diagnosis of Diabetic Foot Ulceration in Users of the Brazilian Public Health System

“…In this study, adopting the classification proposed by IWGDF, only 28.2% of the participants were put on risk level 0, which is a frequency close to that in the study of Almeida et al (27.8%) [18]. A particular study [14], which did not abide by the present directives of the ABI [5, 8, 21], observed a prevalence of individuals in low risk (risk level 0), varying from 56.0% to 79.8%. The situation of possible failure in the detection of DM patients which, conversely, is associated with elevated risks, may delay the qualified professional in correctly addressing the problem.…”

“…In the current study, a higher frequency was observed among those who had an incomplete elementary schooling experience. As seen in other studies [14], the low schooling levels complicated the access to information and learning materials on diabetes, its prevention, and its complications. This fact reveals the importance and relevance of socially determined factors of diseases.…”

“…Conversely, these data cannot be possibly compared to those of other Brazilian studies, as most studies did not measure the ABI, although such objective procedure is recommended by the Brazilian Society of Diabetes [8], the Ministry of Health of Brazil [5], the American Diabetes Association [28], and the Society for Vascular Surgery [21]. A great number of Brazilian studies rely only on pulse palpation [14], an unreliable method of evaluation which may vary significantly depending on the observer [11]. PAD diagnosis is important for the DM patient, so as to implement the use of adequate footwear and proper medical monitoring with a vascular specialist surgeon, preventing the progression of complications of the DFU condition and its related high financial costs [29].…”

“…About 54.7% of the participants had an altered monofilament exam, according to current recommendations [5, 8, 21, 31]. However, it is not appropriate to compare the results to those of other papers that performed the same examination, since IWDGF [10] recommends the 10 g monofilament test to be undertaken on only 3 regions (1st, 3rd, and 5th metatarsal heads); however, other Brazilian studies performed the examination on 9 distinct locations of the feet [14].…”

Evolution of healing ulcers in the lower limbs of patients using Unna boot associated with shiatsu

“…promoting health and healthier lifestyles. 5 Complex ulcers are those that are difficult to heal, requiring more time and more material resources for their resolution, including, in addition to those mentioned above, others associated with different pathologies involving multiple organs and body segments. 6 Among the therapeutic possibilities for vasculogenic ulcers is the inelastic bandage of Unna paste, made of gauze fabric saturated with zinc oxide in a concentration that varies from 6% to 15%, plus calamine, glycerin, gelatin, and water or a bandage with glycerin, gelatin and zinc oxide.…”