Prevalência de alterações cinesiológicas funcionais e baropodométricas em diabéticos Tipo 1

Abstract

INTRODUCTION: The preventive approach to subjects with diabetes mellitus (DM) is not prevented the appearance of serious foot lesions or amputations. The changes in static and dynamic posture, the joint mobility, muscle strength and balance can modify the foot pressure distribution and increase the risk of ulceration, and for these reasons it is important to use methods to evaluate these parameters. AIMS: To evaluate the prevalence of changes in functional kinesiological and baropodometric evaluation in patients with type 1 diabetes (T1DM). METHODS: 107 patients with T1DM and 32 controls (matched for sex, age and BMI) were investigated for the presence of peripheral arterial disease, peripheral neuropathy (PN), cardiovascular autonomic neuropathy. They performed functional kinesiological evaluation (ankle mobility (AM), muscle strength (MS) of the lower limbs and postural assessment; baropodometry test (for evaluation of foot pressure distribution and postural balance), and determination of A1c glycohemoglobin(A1c). Epi-Info 7 and STATA 11.2 were used for statistical tests: chisquare test, Fisher exact test, Kruskal-Wallis and Pearson correlation coefficient (r) (p ≤ 0.05). RESULTS: In DM group, 58.8% were female, 28.7 ± 1.1 years old and BMI 23.7 ± 0.4 kg / m². A significant limitation, comparing with control group, of AM (p = 0.001), the leg MS (p = 0.023) and foot MS (p = 0.005).There was an association between: limitation of AM with age (p = 0.002), time of diagnosis (p = 0.018) and peripheral neuropathy (p = 0.023); reduction of MS with age (p = 0.009), BMI (p <0.05) and A1c levels (p <0.05); and change in stabilometry with age (p = 0.0212), time of diagnosis (p = 0.000) and A1c (p = 0.035). The postural changes and the foot pressure distribution were frequent, 100% and 75.7% respectively, but with no difference when compared to the control group. In group DM1 without PN there was also observed a limitation of AM (p = 0.003) and MS, but only in the feet (p = 0.014). There was no significant difference in the findings of baropodometry, stabilometry and postural assessment. CONCLUSION: The functional kinesiological changes in T1DM showed a high prevalence, even in a youth population, and these changes seem to precede the diagnosis of clinically detectable peripheral neuropathy. In addition, both, feet MS and limitation of AM, suggest that this process begins in the distal body segment and may subsequently rise to other joints, and muscle groups. The recognition and the approach of such changes, now neglected, may contribute to the prevention of foot lesions.