Educação em diabetes mellitus: uma parceria entre o clínico e o especialista

Abstract

Introduction: Diabetes Mellitus (DM), a chronic disease with a possible outcome with several complications, is considered a public health problem. Brazil ranks fourth in the prevalence of diabetic patients in the world (14.3 million people), and 76% of these patients have been shown to have glycated hemoglobin greater than 7%, that is, they were not controlled. In 1988, with the creation of the Unified Health System (SUS) and 20 years later, with the creation of the Family Health Care Center (NASF), the specialized care for the population can be improved through population through reference teams and matrix support. However, little was achieved regarding care for the diabetic patient, maintaining a high rate of patients not adequately controlled and, consequently, the high mortality rate. The justification for this failure may be related to the inaccessibility of the diabetic patient to the information, either by limitation in the number of professionals, lack of training of the health professionals or by low educational level, once it has been demonstrated a prevalence of DM twice higher in patients with low schooling. Objectives: To implant and evaluate, in a Family Health Strategy unit, educational intervention applied to diabetic patients, together with the health team, as well as a protocol for the treatment of diabetic patients, supported by the guidelines of the Brazilian Diabetes Society and adapted to SUS, with the logic of in-service training and continuing education. Materials and methods: A quantitative, prospective and analytical study consisted in the implementation of a protocol of care by an endocrinologist in partnership with health professionals and in educational meetings with 28 patients and the health team using conversation maps. Laboratory data on glycemic control and questionnaire responses (Diabetes Self - Care Activity Questionnaire - QAD, Attitude - Diabetes Questionnaire - ATT - 19, Diabetes Knowledge Scale - DKN - A, Institutional Capacity Assessment Questionnaire for Attention Chronic diseases - ACIC and pre- and post-intervention retrospective questionnaire for professionals) were compared statistically (Wilcoxon, p <0.05) before and three months after protocol implantation. Results: There was a significant improvement in the knowledge scale (with 100% of the patients with a score better than 8 after the intervention, indicating a good knowledge of the disease), self-care (with significant improvement in foot and feeding care), attitude improvement in the attitude towards the disease in 53% of the patients) and in the glycemic control (HbA1c from 8.1% to 7.5%) of the participants, besides the improvement of the perception of the health team regarding the importance of the educational intervention. Conclusion: It has been concluded that diabetes education programs are important in educating, informing and motivating patients to adopt healthier lifestyles. For the health team, it stimulates reflection on the work process that has been conducted for these patients