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Abstract(s)
Introdução: A Diabetes Mellitus tipo 1 (DM1) é uma doença crónica imunomediada em
que as células beta do pâncreas são destruídas, resultando numa deficiente produção de
insulina. O tratamento da DM1 consiste, maioritariamente, no uso diário de insulina
exógena para manter a glicemia o mais aproximada possível dos valores de referência.
Este esforço terapêutico aumenta o risco de hipoglicemia, sendo esta a complicação
aguda mais comum do tratamento da DM1. Para além das consequências a curto prazo,
os eventos de hipoglicemia podem levar a repercussões de longo prazo, seja pelo efeito
fisiológico de repetição dos mesmos, seja pelo medo de hipoglicemias futuras, que leva
à adoção de comportamentos de compensação e evitamento de hipoglicemia. Assim, os
doentes podem desenvolver Fobia à Hipoglicemia (FaH), um estado de ansiedade,
desconforto e tensão. Por um lado, a FaH é um mecanismo adaptativo, que pode ajudar
pessoas com DM1 a evitar hipoglicemias e as suas consequências. Por outro lado,
quando a intensidade da FaH é excessiva, esta perturba o funcionamento normal dos
indivíduos, dificultando o controlo glicémico. Tanto a própria FaH como os
comportamentos resultantes desta podem afetar a Qualidade de Vida (QdV) das
pessoas com DM1. A QdV é um ideal multifacetado, que inclui fatores físicos,
psicológicos e sociais, sendo considerado um resultado de saúde importante, sendo a
sua otimização um objetivo fundamental do tratamento da diabetes. Esta dissertação
tem por intuito analisar um alargado conjunto de artigos científicos sobre a potencial
relação entre a FaH e a QdV em pessoas com DM1, com o objetivo de, caso se verifique
a sua existência, aprofundar o modo como estas variáveis se relacionam e influenciam.
Metodologia: Foi realizada uma pesquisa na plataforma PubMed usando as palavraschave “Fear of Hypoglycemia”, “Quality of Life”, “Diabetes Related Distress”, “WellBeing” e “Type 1 Diabetes”, em combinação. De todos os artigos, foram escolhidos os
que cumpriam os critérios de inclusão: que se focassem na DM1; que relacionassem a
FaH e a QdV; que se focassem em indivíduos adultos (18 anos ou mais).
Resultados: Foram analisados os 11 artigos resultantes da pesquisa que cumpriam os
critérios de inclusão. A FaH impacta a QdV, uma vez que está relacionada com
problemas de ansiedade, depressão, qualidade do sono, prática de atividade física e
controlo glicémico. A FaH tem consequências sociais frequentes, afetando
negativamente as relações e vida social, lazer, vida do dia a dia, vida sexual e saúde
mental. A FaH está associada à história de episódios de hipoglicemia
(independentemente da frequência) e a sintomas atuais de depressão, resultando num
pior bem-estar psicológico e num pior estado geral de saúde. A Qualidade de Vida Relacionada com a Diabetes (QdVRcD) pode ser um caminho pela qual a FaH afeta o
bem-estar psicológico dos doentes. O impacto mais negativo da hipoglicemia na QdV
está relacionado com a FaH em 1%, sendo mais explicado por como um indivíduo se
sente e perceciona a hipoglicemia do que pela sua frequência. A FaH é um fator
preditor de baixa QdV.
Discussão: A FaH pode ser espoletada tanto pela frequência dos episódios de
hipoglicemia, como pela sua severidade. Assim, os episódios sintomáticos de
hipoglicemia têm um impacto negativo na QdV, o que é particularmente importante
tendo em conta que estes são ocorrência comum para as pessoas com DM1. É
importante considerar a FaH como um aspeto vital da gestão do doente na prática
clínica, não só pelo seu impacto a nível de bem-estar psicológico, como também porque
a sua existência e severidade podem ajudar a determinar a terapêutica mais adequada.
Os programas com o objetivo primário ou secundário de reduzir a FaH, como os de
educação intensiva sobre hipoglicemias, a sua prevenção e tratamento fornecidos de
forma continuada por profissionais de saúde qualificados, a educação em diabetes,
Terapia Cognitivo Comportamental (TCC), psicoterapia, programas para pessoas com
reduzida consciência de hipoglicemia e intervenções de telemedicina podem ajudar a
mitigar a FaH, sendo necessário a utilização de abordagens individualizadas, centradas
no doente.
Conclusão: Os estudos publicados sugerem que a FaH prejudica a QdV em vários
domínios e que está associada a sintomas de ansiedade e depressão.
Introduction: Type 1 Diabetes (T1D) is a chronic immune-mediated disease in which the beta cells of the pancreas are destroyed, resulting in failure to produce insulin. The treatment of T1D mainly consists in the daily use of exogenous insulin to keep blood glucose levels as close as possible to reference values. This therapeutic effort increases the risk of hypoglycaemia, which is the most common acute complication of T1D treatment. In addition to the short-term consequences, hypoglycaemia events can lead to long-term repercussions, either due to the physiological effect of repeated hypoglycaemia events or the fear of future episodes, which leads to the adoption of coping and avoidance behaviours of hypoglycaemia. Thus, patients can develop Fear of Hypoglycemia (FoH), a state of anxiety, discomfort, and tension. FoH can be an adaptive mechanism, which can help people with T1D avoid hypoglycaemia, but when its intensity is excessive, it disrupts people’s normal functioning, making glycaemic control difficult. Both FoH itself and its resulting behaviours can affect the Quality of Life (QoL) of people with T1D. QoL is a multifaceted ideal, which includes physical, psychological, and social factors, and is considered an important health outcome, with its optimization being a fundamental objective of diabetes treatment. This dissertation aims to analyse a large set of scientific articles that address the potential relationship between FoH and QoL in people with T1D, with the aim of, if its existence is verified, explaining the way in which these variables are related and influence each other. Methodology: Research in the PubMed platform using as keywords “Fear of Hypo Hypoglycemia”, “Quality of Life”, “Diabetes Related Distress”, “Well-Being” and “Type 1 Diabetes” in various combinations. Of all the articles, the ones which met the inclusion criteria – focused on T1D; related FoH with QoL; focused on adult individuals (18 years or more) – where chosen. Results: Of the articles resulting from the research, 11 met the criteria and were analysed. FoH impacts QoL, as it is related to problems with anxiety, depression, sleep quality, physical activity and glycaemic control. FoH has social consequences, affecting qualities such as relationships and social life, leisure, daily life, sexual life and mental health. FoH is associated with a history of hypoglycaemic episodes (regardless of frequency) and current symptoms of depression, resulting in worse psychological wellbeing, worse general health, and Health Related Quality of Life (HRQoL) may be a pathway through which FoH affects the psychological well-being of patients. The most negative impact on hypoglycaemia on QoL is related to FoH in 1% being explained more by how an individual feels and perceives hypoglycaemia than by its frequency. FoH is a predictor of low QoL. Discussion: FoH can be triggered by both the frequency of hypoglycaemic episodes and their severity. Therefore, symptomatic episodes of hypoglycaemia also have a negative impact on QoL, which is particularly important considering that these are a common occurrence for people with T1D. It is important to consider FoH as a vital aspect of patient management in clinical practice, not only because of its impact on psychological well-being, but also because its existence and severity can help determine the most appropriate type of therapy. Programs with the primary or secondary objective of reducing FoH, such as intensive education about hypoglycaemia, its prevention and treatment provided on an ongoing basis by qualified health professionals, diabetes education, Cognitive Behavioural Therapy (CBT), psychotherapy, programs for people with impaired awareness of hypoglycaemia and telemedicine interventions can help mitigate FoH, requiring the use of individualized, patient-centred approaches. Conclusion: Published studies suggest that FoH impairs QoL in several domains and is associated with symptoms of anxiety and depression.
Introduction: Type 1 Diabetes (T1D) is a chronic immune-mediated disease in which the beta cells of the pancreas are destroyed, resulting in failure to produce insulin. The treatment of T1D mainly consists in the daily use of exogenous insulin to keep blood glucose levels as close as possible to reference values. This therapeutic effort increases the risk of hypoglycaemia, which is the most common acute complication of T1D treatment. In addition to the short-term consequences, hypoglycaemia events can lead to long-term repercussions, either due to the physiological effect of repeated hypoglycaemia events or the fear of future episodes, which leads to the adoption of coping and avoidance behaviours of hypoglycaemia. Thus, patients can develop Fear of Hypoglycemia (FoH), a state of anxiety, discomfort, and tension. FoH can be an adaptive mechanism, which can help people with T1D avoid hypoglycaemia, but when its intensity is excessive, it disrupts people’s normal functioning, making glycaemic control difficult. Both FoH itself and its resulting behaviours can affect the Quality of Life (QoL) of people with T1D. QoL is a multifaceted ideal, which includes physical, psychological, and social factors, and is considered an important health outcome, with its optimization being a fundamental objective of diabetes treatment. This dissertation aims to analyse a large set of scientific articles that address the potential relationship between FoH and QoL in people with T1D, with the aim of, if its existence is verified, explaining the way in which these variables are related and influence each other. Methodology: Research in the PubMed platform using as keywords “Fear of Hypo Hypoglycemia”, “Quality of Life”, “Diabetes Related Distress”, “Well-Being” and “Type 1 Diabetes” in various combinations. Of all the articles, the ones which met the inclusion criteria – focused on T1D; related FoH with QoL; focused on adult individuals (18 years or more) – where chosen. Results: Of the articles resulting from the research, 11 met the criteria and were analysed. FoH impacts QoL, as it is related to problems with anxiety, depression, sleep quality, physical activity and glycaemic control. FoH has social consequences, affecting qualities such as relationships and social life, leisure, daily life, sexual life and mental health. FoH is associated with a history of hypoglycaemic episodes (regardless of frequency) and current symptoms of depression, resulting in worse psychological wellbeing, worse general health, and Health Related Quality of Life (HRQoL) may be a pathway through which FoH affects the psychological well-being of patients. The most negative impact on hypoglycaemia on QoL is related to FoH in 1% being explained more by how an individual feels and perceives hypoglycaemia than by its frequency. FoH is a predictor of low QoL. Discussion: FoH can be triggered by both the frequency of hypoglycaemic episodes and their severity. Therefore, symptomatic episodes of hypoglycaemia also have a negative impact on QoL, which is particularly important considering that these are a common occurrence for people with T1D. It is important to consider FoH as a vital aspect of patient management in clinical practice, not only because of its impact on psychological well-being, but also because its existence and severity can help determine the most appropriate type of therapy. Programs with the primary or secondary objective of reducing FoH, such as intensive education about hypoglycaemia, its prevention and treatment provided on an ongoing basis by qualified health professionals, diabetes education, Cognitive Behavioural Therapy (CBT), psychotherapy, programs for people with impaired awareness of hypoglycaemia and telemedicine interventions can help mitigate FoH, requiring the use of individualized, patient-centred approaches. Conclusion: Published studies suggest that FoH impairs QoL in several domains and is associated with symptoms of anxiety and depression.
Description
Keywords
Endocrinologia Bem-Estar Diabetes Tipo 1 Fobia à Hipoglicemia Hipoglicemia Qualidade de Vida