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Abstract(s)
Introdução: A diabetes mellitus é uma das doenças com maior impacto na saúde
global pela crescente prevalência e morbi-mortalidade que lhe está associada,
assumindo o pé diabético particular destaque entre as complicações da diabetes. A
presente monografia procurará enfatizar a importância da adaptação de estratégias
inovadoras para um controlo otimizado desta patologia, inclusivamente recorrendo a
novas tecnologias.
Materiais e Métodos: Foi realizada uma pesquisa nas bases de dados PubMed e
Cochrane Library. Na~o foram colocados limites temporais a` pesquisa. Foram
selecionados estudos observacionais e de intervenção aleatorizados, que usaram
aplicações de telemóvel, equipamentos de monitorização ou programas educacionais
para a educação e monitorização dos doentes diabéticos. Foram avaliados os resultados
quanto a parâmetros clínicos, analíticos e performance em escalas e questionários
sobre adesão, autocuidado, autoeficácia e conhecimento.
Resultados: Tendo em conta os parâmetros clínicos, num dos estudos a incidência de
úlceras foi significativamente inferior no grupo de terapia avançada, que usa um
termómetro digital de infravermelhos para medir e registar as temperaturas em cada
pé. A corroborar estes resultados, um estudo que usou um sistema de palmilhas para
deteção de pontos de pressão plantar observou a diminuição do número de pessoas
com presença de lesões pré-ulcerativas nos pés no grupo experimental. Outro estudo
apenas encontrou diferenças estatisticamente significativas no número absoluto de
úlceras e não no número de doentes que desenvolveram úlceras, nem no tempo até ao
desenvolvimento de úlceras. Em relação aos parâmetros analíticos, apenas um estudo
mostrou uma diferença estatisticamente significativa dos valores da HbA1c no grupo de
intervenção, em que era usada uma aplicação de telemóvel que permite a leitura da
glicemia em tempo real. Quanto aos scores de autoeficácia/autocuidado/conhecimento,
verificou-se uma tendência positiva nos grupos de controlo e intervenção,
individualmente e entre si.
Conclusões: Apesar de se ter mostrado uma tendência positiva na educação e
monitorização dos doentes diabéticos, existem ainda poucos estudos que avaliem
efetivamente o efeito destas estratégias na incidência e recidiva da ulceração. Para além
disso, verifica-se uma grande heterogeneidade, tanto nos objetivos, como nos desenhos
dos estudos, nos tipos de intervenção e nas medidas de outcome, não existindo ainda
condições que permitam concluir a eficácia da educação dos doentes com ou sem o uso
de tecnologia.
Background: Diabetes mellitus is one of the diseases with the greatest impact on global health due to its increasing prevalence and associated morbidity and mortality, with the diabetic foot assuming particular prominence among the complications of diabetes. This monograph will emphasize the importance of adapting innovative strategies for an optimized control of this pathology, including the use of new technologies. Methods: A search was conducted in PubMed and Cochrane Library databases. No temporal limits were placed on the search. Randomized observational and intervention studies that used cell phone applications, monitoring equipment or educational programs for the education and monitoring of diabetic patients were selected. Outcomes were assessed for clinical and analytical parameters and performance on scales and questionnaires on adherence, self-care, self-efficacy, and knowledge. Results: Considering clinical parameters, in one study the incidence of ulcers was significantly lower in the advanced therapy group, which uses a digital infrared thermometer to measure and record temperatures in each foot. Supporting these results, one study which used an insole system to detect plantar pressure points noted a decrease in people with pre-ulcerative foot lesions in the experimental group. Another study only found statistically significant differences in the absolute number of ulcers and not in the number of patients who developed ulcers, nor in the time to development of ulcers. Regarding analytical parameters, only one study showed a statistically significant difference in HbA1c values in the intervention group, where a cell phone application that allows real time blood glucose reading was used. As for the scores of self-efficacy/self-care/knowledge, there was a positive trend in the control and intervention groups, individually and between them. Conclusions: Although a positive trend has been shown in the education and monitoring of diabetic patients, there are still few studies that effectively assess the effect of these strategies on ulceration incidence and recurrence. Furthermore, there is great heterogeneity in the objectives, study designs, types of intervention and outcome measures, and there are still no conditions to conclude on the effectiveness of patient education with or without the use of technology.
Background: Diabetes mellitus is one of the diseases with the greatest impact on global health due to its increasing prevalence and associated morbidity and mortality, with the diabetic foot assuming particular prominence among the complications of diabetes. This monograph will emphasize the importance of adapting innovative strategies for an optimized control of this pathology, including the use of new technologies. Methods: A search was conducted in PubMed and Cochrane Library databases. No temporal limits were placed on the search. Randomized observational and intervention studies that used cell phone applications, monitoring equipment or educational programs for the education and monitoring of diabetic patients were selected. Outcomes were assessed for clinical and analytical parameters and performance on scales and questionnaires on adherence, self-care, self-efficacy, and knowledge. Results: Considering clinical parameters, in one study the incidence of ulcers was significantly lower in the advanced therapy group, which uses a digital infrared thermometer to measure and record temperatures in each foot. Supporting these results, one study which used an insole system to detect plantar pressure points noted a decrease in people with pre-ulcerative foot lesions in the experimental group. Another study only found statistically significant differences in the absolute number of ulcers and not in the number of patients who developed ulcers, nor in the time to development of ulcers. Regarding analytical parameters, only one study showed a statistically significant difference in HbA1c values in the intervention group, where a cell phone application that allows real time blood glucose reading was used. As for the scores of self-efficacy/self-care/knowledge, there was a positive trend in the control and intervention groups, individually and between them. Conclusions: Although a positive trend has been shown in the education and monitoring of diabetic patients, there are still few studies that effectively assess the effect of these strategies on ulceration incidence and recurrence. Furthermore, there is great heterogeneity in the objectives, study designs, types of intervention and outcome measures, and there are still no conditions to conclude on the effectiveness of patient education with or without the use of technology.
Description
Keywords
Autocuidado Cuidados com Os Pés Diabetes Mellitus Educação dos Pacientes Pé Diabético Telemedicina