ASSOCIATION BETWEEN NUTRITIONAL MANAGEMENT AND OBTAINING THERAPEUTIC TARGETS OF PATIENTS WITH TYPE 2 DIABETES MELLITUS ATTENDED IN PRIMARY HEALTH CARE
Keywords:
Primary Health Care, Diabetes Mellitus, Health Profile, Diet, Healthy, Health PromotionAbstract
Objectives: To analyze the characteristics of DM2 patients followed by extended family health teams (EqASF) including a nutritionist at a Basic Health Unit (UBS) in southern Brazil. Methods: Cross-sectional study conducted with all patients with DM2 treated by a nutritionist at a UBS between January 2018 and December 2019. Users who had individual follow-up for a period of at least three months with a professional nutritionist and at least two were included measurements of biochemical tests for diabetes control. Research data obtained from individual medical records. Results: Of the 142 patients seen, 64.1% were elderly. Regarding comorbidities, 83.8% of patients had Systemic Arterial Hypertension (HAS) and 67.9% had high risk for cardiovascular disease (CVD). The adjusted mean and standard error of fasting glucose and glycated hemoglobin (HbA1c) observed at baseline to nutritional follow-up were, respectively, 177.73 mg/dL (6.62) and 8.48% (0.18). After a follow-up period, the respondents had values of 151.89 mg/dL (11.19) for fasting glucose (p=0.017) and 7.76% (0.26) for HbA1c (p=0.001). As for the profile lipid levels, increased triglyceride values and risk indices for CVD were observed. A significant difference was observed in the improvement of glycemic control (fasting glucose and HbA1c) and in body mass index, although this cannot be considered as a clinical impact. Conclusion: Nutritional monitoring can help in glycemic control, as well as in reducing the risk of secondary complications for individuals with diabetes in Primary Health Care.
Downloads
References
Diretrizes da Sociedade Brasileira de Diabetes 2019-2020 [Internet]. São Paulo: Editora Clannad, 2019.
International Diabetes Federation. Diabetes Atlas. 9.ed. Brussels: IDF; 2019. Disponível em: http://www.diabetesatlas.org/
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019. Brasília (DF): Ministério da Saúde; 2020 [citado 14 mar 2021]. Disponível em:https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2019_vigilancia_fatores_risco.pdf
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2018: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2018. Brasília (DF): Ministério da Saúde; 2019 [citado 12 mai 2021]. Disponível em:https://portalarquivos2.saude.gov.br/images/pdf/2019/julho/25/vigitel-brasil-2018.pdf
Nilson EAF, Andrade RCS, Brito DA, Oliveira ML. Custos atribuíveis a obesidade, hipertensão e diabetes no Sistema Único de Saúde, Brasil, 2018. Rev Panam Salud Publica. 2020;44:e32. https://doi.org/10.26633/RPSP.2020.32
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Brasília (DF): Ministério da Saúde; 2011 [citado 10 abr 2021]. Disponível em:https://bvsms.saude.gov.br/bvs/publicacoes/plano_acoes_enfrent_dcnt_2011.pdf
Ministério da Saúde (BR). Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição. 1.ed. 1.reimpr. Brasília (DF): Ministério da Saúde; 2013 [citado 15 abr 2021]. Disponível em:https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_alimentacao_nutricao.pdf
Pi-Sunyer FX, Maggio CA, McCarron DA, Reusser ME, Stern JS, Haynes RB, Oparil S, et al. Multicenter randomized trial of a comprehensive prepared meal program in type 2 diabetes. Diabetes Care. 1999;22(2):191-7. https://doi.org/10.2337/diacare.22.2.191
Kulkarni K, Castle G, Gregory R, Holmes A, Leontos C, Powers M, et al. Nutrition Practice Guidelines for Type 1 Diabetes Mellitus positively affect dietitian practices and patient outcomes. The Diabetes Care and Education Dietetic Practice Group. J Am Diet Assoc. 1998;98(1):62-70. https://doi.org/10.1016/s0002-8223(98)00017-0
Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA. 1986;256(20):2835-2838. https://doi.org/10.1001/jama.1986.03380200073024
Martins MV, Souza JD, Martinho KO, Franco FS, Tinôco ALA. Association between triglycerides and HDL-cholesterol ratio and cardiovascular risk factors among elderly persons receiving care under the family health strategy of Viçosa, Minas Gerais. Revista Brasileira de Geriatria e Gerontologia. 2017;20(2):236-243. https://doi.org/10.1590/1981-22562017020.160059
Ukpabi OJ, Ewelike ID. The eighth joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure (joint national committee-8) report: Matters arising. Nigerian Journal of Cardiology. 2017;14(1):15. https://doi.org/10.4103/0189-7969.201909
World Health Organiztion. Physical Status: the use and interpretation of anthropometry. Geneva, Switzerland: WHO, 1995. (WHO Technical Report Series, n. 854).
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502. PMID: 4337382.
American Diabetes Association. Standards of Medical Care in Diabetes - 2021. The Journal of Clinical and Applied Research and Education Diabetes Care. 2021;44(Suppl.1):S1-S232. Disponível em: https://care.diabetesjournals.org/content/diacare/suppl/2020/12/09/44.Supplement_1.DC1/DC_44_S1_final_copyright_stamped.pdf
Faludi AA, Izar MCO, Saraiva JFK, Chacra APM, Bianco HT, Afiune Neto A et al. Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017. Arq Bras Cardiol. 2017;109(2Supl.1):1-76. https://doi.org/10.5935/abc.20170121
World Health Organiztion. Obesity: preventing and managing the global epidemic: Report of a WHO consultation on obesity. (WHO Technical Report Series n. 894). Geneva, Switzerland: WHO, 2000.
Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;21(1):55-67. https://doi.org/10.1016/S0095-4543(21)00452-8
Ministério da Saúde (BR). Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Política Nacional de Atenção Básica. Brasília (DF): Ministério da Saúde; 2012 [citado 31 mai 2021]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_atencao_basica.pdf
Souza JD, Baptista MHB, Gomides DS, Pace AE. Adherence to diabetes mellitus care at three levels of health care. Escola Anna Nery. 2017;21(4):e20170045. https://doi.org/10.1590/2177-9465-EAN-2017-0045
Malta DC, Bernal BTI, Neto EV, Curci KA, Pasinato MTM, Lisboa RM, et al. Tendências de fatores de risco e proteção de doenças crônicas não transmissíveis na população com planos de saúde no Brasil de 2008 a 2015. Revista Brasileira de Epidemiologia. 2018;21(1): 1-14. https://doi.org/10.1590/1980-549720180020.supl.1.
Bottom A, Cúnico SD, Strey MN. Diferenças de gênero no acesso aos serviços de saúde: problematizações necessárias. Mudanças – Psicologia da Saúde. 2017;25(1):67-72. https://doi.org/10.15603/2176-1019/mud.v25n1p67-72
Moura PC, Pena GGP, Guimaraes JB, Reis JS. Educação nutricional no tratamento do diabetes na atenção primária à saúde: vencendo barreiras. Rev. APS. 2018;21(2): 226-234. https://doi.org/10.34019/1809-8363.2018.v21.15607
Parra DI, Romero Guevara SL, Rojas LZ. Influential Factors in Adherence to the Therapeutic Regime in Hypertension and Diabetes. Invest Educ Enferm. 2019;37(3):e02.https://doi.org/10.17533/udea.iee.v37n3e02
Zanetti ML, Arrelias CCA, Franco RC, Santos MA, Rodrigues FFL, Faria HTG. Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus. Revista da Escola de Enfermagem da USP. 2015;49(4):0619-0625. https://doi.org/10.1590/S0080-623420150000400012
Martinez EZ, Silva AS, Franco LJ, Santos SF, Terada NAY, Zucoloto ML. Association between diabetes, hypertension, activities of daily living and physical activity among elderly users of primary healthcare facilities. Revista Brasileira de Cineantropometria & Desempenho Humano. 2019;21:e55149. https://doi.org/10.1590/1980-0037.2019v21e55149
Aguayo-Verdugo N, Valenzuela-Suazo S, Luengo-Machuca L. AUTOCUIDADO, ALFABETIZACIÓN EN SALUD Y CONTROL GLICÉMICO EN PERSONAS CON DIABETES MELLITUS TIPO 2. Cienc. enferm. 2019;25(21):1-12. https://doi.org/10.4067/s0717-95532019000100217
Batista MCR, Priore SE, Rosado LEFPL, Tinôco ALA, Franceschini ACC. Avaliação dos resultados da atenção multiprofissional sobre o controle glicêmico, perfil lipídico e estado nutricional de diabéticos atendidos em nível primário. Revista de Nutrição. 2005;18(2):219-228. https://doi.org/10.1590/S1415-52732005000200006
Baldisserotto J, Kopittke L, Nedel FB, Takeda SP, Mendonça CS, Sirena SA, et al. Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil. BMC Public Health.2016;16:573. https://doi.org/10.1186/s12889-016-3230-7
Lima LA, Nedel FB, Olinto MTA, Baldisseroto J. Food habits of hypertensive and diabetics cared for in a Primary Health Care service in the South of Brazil. Revista de Nutrição. 2015; 28(2):197-206. https://doi.org/10.1590/1415-52732015000200008
Duran RAB, Soler ZASG, Santos BMO, Morraye MA. Caracterização das Condições de Vida e Saúde dos Indivíduos Diabéticos Tipo II em uma Unidade de Saúde da Família – Votuporanga, SP. Investigação. 2010;10(2):123-130. https://doi.org/10.26843/investigacao.v10i0.342
Gaziano JM, Hennekens CH, O'Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997;96(8):2520-5. https://doi.org/10.1161/01.cir.96.8.2520
da Luz PL, Favarato D, Faria-Neto JR Jr, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics. 2008;63(4):427-32. https://doi.org/10.1590/s1807-59322008000400003
Trout KK, McCool WF, Homko CJ. Person-Centered Primary Care and Type 2 Diabetes: Beyond Blood Glucose Control. J Midwifery Womens Health. 2019;64(3):312-323. https://doi.org/10.1111/jmwh.12973
Bastiaens H, Sunaert P, Wens J, Sabbe B, Jenkins L, Nobels F, et al. Supporting diabetes self-management in primary care: pilot-study of a group-based programme focusing on diet and exercise. Prim Care Diabetes. 2009;3(2):103-9. https://doi.org/10.1016/j.pcd.2009.02.001
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, et al. PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-90. https://doi.org/10.1056/NEJMoa1200303
Teixeira-Lemos E, Nunes S, Teixeira F, Reis F. Regular physical exercise training assists in preventing type 2 diabetes development: focus on its antioxidant and anti-inflammatory properties. Cardiovasc Diabetol. 2011;10(12):1-15. https://doi.org/10.1186/1475-2840-10-12
Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, Gross JL, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305(17):1790-9. https://doi.org/10.1001/jama.2011.576
Boscariol R, Ouchi JD, Gonzaga MFN, Maragna RG. Diabetes mellitus tipo 2: educação, prática de exercícios e dieta no controle glicêmico. Revista Saúde em Foco. 2018;10:138-150.
Souza PLC, Silvestre MRS. Alimentação, estilo de vida e adesão ao tratamento nutricional no diabetes mellitus tipo 2. Revista EVS-Revista de Ciências Ambientais e Saúde. 2013;40(4):541-555.
Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials. J Acad Nutr Diet. 2017;117(12):1941-1962. https://doi.org/10.1016/j.jand.2017.06.364
Santos CRB, Gouveia LAV, Portella ES, Avila SSS, Soares EA, Lanzillotti HS. Índice de Alimentação Saudável: avaliação do consumo alimentar de diabéticos tipo 2. Nutrire Rev Soc Bras Aliment Nutr. 2009;34(1):115-129. Disponível em: http://sban.cloudpainel.com.br/files/revistas_publicacoes/219.pdf
Mattos PF, Neves AS. Importância da Atuação do Nutricionista na Atenção Básica à Saúde. Revista Praxis. 2017;1(2):11-15.
Gomes-Villas Boas LC, Foss MC, Freitas MCF, Torres HC, Monteiro LZ, Pace AE. Adesão à dieta e ao exercício físico das pessoas com diabetes mellitus. Texto & Contexto – Enfermagem. 2011;20(2):272-279. https://doi.org/10.1590/S0104-07072011000200008
Faria HT, Santos MA, Arrelias CC, Rodrigues FF, Gonela JT, Teixeira CR, et al. Adesão ao tratamento em diabetes mellitus em unidades da Estratégia Saúde da Família [Adherence to diabetes mellitus treatments in family health strategy units]. Rev Esc Enferm USP. 2014;48(2):257-63. https://doi.org/10.1590/s0080-623420140000200009
Downloads
Published
How to Cite
Issue
Section
License
Copyright
Submission of originals to Práticas e Cuidado: Revista de Saúde Coletiva (Practices and Care: Journal of Public Health - PC-RESC) implies the transfer of publication rights by the authors. The copyright for manuscripts published in this journal belongs to the authors, with PC-RESC retaining rights over the first publication. The authors may only use the same results in other publications if they explicitly indicate PC-RESC as the original publication medium.
Creative Commons License
Except where otherwise specified, the terms of a Creative Commons Attribution-ShareAlike 4.0 International License apply to the material published in this journal, which permits unrestricted use, distribution, and reproduction in any medium, provided the original publication is correctly cited.
This magazine is licensed under a License 