Estudo das características clínicas, socioeconômicas e comportamentais de pacientes com diabetes Mellitus tipo 1, usuários de diferentes terapias, e sua relação com o controle metabólico

Abstract

Introduction: The treatment of type 1 diabetes mellitus (T1DM) has achieved significant advances in recent decades, with exogenous insulin administration being the only form of treatment available. Changes in the different ways of administering insulin are becoming increasingly modern and refined. After all, the proper management of diabetes is crucial for preventing complications related to the disease and optimizing the quality of life. However, despite technological advances, in practice, such objectives are difficult to achieve in some cases. Objective: To evaluate the clinical, socioeconomic, and behavioral characteristics of patients with type 1 diabetes mellitus using different therapies, and their relationship with metabolic control. Methods: This cross-sectional study involved 181 patients with T1DM who were being followed up at a reference specialized outpatient clinic and private health units during the period 2019-2020. The sample was obtained for convenience, including patients who used different insulin administration modalities (multiple doses of insulin with injector pens, MDI, and CSII), and a comparison was made between the two groups. Good control was defined when glycated hemoglobin (HbA1c) was below 7%. Data were collected through interviews using a structured form, questionnaire, and review of clinical records. Univariate and multivariate logistic regressions were performed to assess the association with HbA1c levels. Results: There was no significant difference in HbA1c between patients using CSII and MDI (7.2%±1.1 vs. 7.5%±1.7; p=0.095). In the group of patients on MDI, there was a predominance of singles (p=0.021) and lower monthly family income (70.6%; < 5 minimum wages; p=0.000). On the other hand, in the group of CSII users, higher rates of disease duration (>10 years) (p=0.003), presence of obesity (p=0.018), arterial hypertension (p=0.030), and neurological symptoms such as depression (p=0.018), neuropathy (p=0.030), and episodes and symptoms of hypoglycemia (p=0.000). Three factors were identified that were independently associated with the level of HbA1c. HbA1c correlated with clinical variables (absence of diabetes complications) and variables related to diabetes education and professional support (glycemic self-monitoring <4 times/day and glucose sensor use with trend arrows for DM management). Absence of diabetes complications and glycemic self-monitoring <4 times/day were associated with inadequate glycemic control. Meanwhile, the use of the glucose sensor with trend arrows for DM management was associated with good glycemic control. Conclusion: Clinical, educational, and professional support factors were associated with the control and achievement of glycemic goals in both groups (CSII and MDI), with no difference between them regarding glycemic control. These results suggest that, regardless of the therapeutic modality, it is essential to address other aspects that influence glycemic results, such as multidisciplinary support, quality of care, and diabetes education, among others. In addition, the profile with higher family income, longer duration of illness, presence of comorbidities/complications of the disease, as well as episodes and symptoms of hypoglycemia, were common in the group that used CSII.