Diabetes mellitus tipo 2 : um estudo prospectivo dos fatores que influenciam a hospitalização e a sonolência diurna

Abstract

Type 2 diabetes mellitus (T2DM) is a common disease that affects a large number of individuals nowadays and is frequently associated with a sedentary life, reduced hours of sleep, obesity and metabolic alterations. Poor habits and associated comorbidities such as heart disease, peripheral neuropathy and depressive symptoms may influence functional outcome in these patients. Physical activity has been gradually recognized as an important tool in the therapeutic management of T2DM and metabolic syndrome. Usually, with increased disease duration, patients present worsening of symptoms and functional decline. Hospitalization has been recognized as a measure of disease severity and functional decline. Furthermore, daytime sleepiness is associated with greater morbidity and mortality in the population. This is a prospective study and the objective is to evaluate the relationship between physical activity, clinical and demographic characteristics and associated comorbidities. Also, an evaluation of risk factors associated with hospitalization and worsening of daytime sleepiness after two years is performed. Patients with T2DM (N=145) aged between 40 and 60 years (52.7±5.7 ) recruited from the Centro Integrado de Diabetes e Hipertensão (CIDH) in Fortaleza were studied from 2010 to 2013. At baseline and after two years, patients were evaluated about clinical and demographic characteristics, the development of stroke, arterial hypertension, hospitalization, use of hypnotics, level of physical activity and degree of daytime sleepiness. Behavioral questionnaires were used to evaluate comorbidity severity (Charlson Comorbidity Index), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventary), daytime sleepiness (Epworth Sleepiness Scale, ESS>10), physical activity level (International Physical Activity Questionnaire) and quality of life (Short-Form Health Survey, SF-36). In this study, 87 women and 58 men completed initial assessment and follow-up. Hypertension was initially found in 108 cases (74%) and 10 (6.9%) patients developed hypertension after two years. At baseline, nine individuals were smokers (6%) and 16 were alcohol users (16 %). After two years, the number of alcohol users was reduced (N=13; 9%). After two-years, the number of sedentary patients decreased from 70% (N=101) to 52 % (N=76) and an increased number of moderately active patients, initially (N=43) 30%, evolved to 35% (N= 51), and new active individuals were identified (13%, N= 18; p <0,005). After two-years, multiple regression analysis showed that a more active physical activity level (IPAQ) was independently associated with fewer hospitalizations. Excessive daytime sleepiness (EDS) (ESS>10) was frequently found (N=51, 35.1%). At baseline, men had more EDS than women (52.9% vs 33.0, p=0.02). Initially, multiple regression analysis showed that the level of physical activity was independently associated with excessive daytime sleepiness (OR=0.52, CI=0.29-0.92, p=0.02). After two years of follow-up, 75 patients (51.7%) remained at the same level of daytime sleepiness, 41 (28.3%) had higher levels of sleepiness levels and 29 (20.0%) showed reduced levels of daytime sleepiness. Patients with a sedentary lifestyle evolved with more daytime sleepiness and those more active evolved with less daytime sleepiness (ESE escores, p<0.05). DM2 female patients and cases with stroke evolved with more daytime sleepiness. Physical activity level was more beneficial to reduce daytime sleepiness in women. In conclusion, this study shows that better physical activity levels are associated with less hospitalization after two yesr. Our data confirm the beneficial effects of physical activity in patients with T2DM.