Avaliação do impacto de uma intervenção pedagógica problematizadora no manejo do paciente com diabetes mellitus tipo 2 em uso de insulina

Abstract

Introduction: Diabetes mellitus is recognized for its increasing prevalence, as well as for its association with high mortality, reduced life quality and acute or chronic complications, hence the extreme relevance of treatment adherence of this health condition. Nevertheless, studies address the difficulty of metabolic control in these patients and point to the need for more effective educational approaches aimed at self-care. Among the educational modalities, the problematizing methodology stands out. Objective: To evaluate the effects of a problematizing educational intervention in the treatment of individuals with type 2 diabetes mellitus and to describe the study sample regarding sociodemographic, clinical, anthropometric, biochemical, lifestyle, drug adherence, attitudes towards self-care and knowledge about diabetes mellitus variables. Methodology: This randomized clinical trial evaluated patients with type 2 diabetes, on insulin therapy, with glycated hemoglobin above 7.0%, treated at a secondary health care service in the city of Juiz de Fora. Participants were followed up for six months and randomized into control or intervention groups. All patients received the routine care of patients with diabetes, and those in the intervention group also participated in monthly educational groups using the problematizing methodology. Results: 41 participants were included in the study, 21 in the control group and 20 in the intervention group. Most participants were female (61%); aged between 30 and 59 years (75.6%); married (58.5%); with schooling up to elementary school (63.5%); with family monthly income up to two minimum wages (82.9%); diagnosed with arterial hypertension (92.7%); diagnosed with dyslipidemia (68.3%); and with self-perceived health status as regular (61.6%). After six months of follow-up, patients in the intervention group presented significant increase in knowledge about diabetes (p = 0.0182), decrease in body weight (p = 0.0441), decrease in waist circumference (p = 0.0079) and increase in the practice of mild (p = 0.0123) and moderate physical activities (p = 0.0166). In both intervention and control groups, low medication adherence and difficulty in reaching the glycemic targets over the follow-up were observed. Conclusion: The use of the problematizing methodology had a positive impact on knowledge, practice of physical activities, reduction of body weight and reduction of waist circumference among individuals with type 2 diabetes mellitus.