Melhorando a triagem da neuropatia diabética na atenção primária à saúde: uma proposta

Abstract

Early detection of diabetes mellitus and its complications are real challenges for Public Health. In a public system hierarchically organized as SUS (primary, secondary and tertiary levels), primary care is the entry into the health system. It is essential the effective screening of DM and its complications to avoid functional loss and early retirements. One of the most feared complications of diabetes mellitus is the diabetic neuropathy, a highly prevalent condition that accounts for about 70% of the cases of non-traumatic amputation. Therefore, the screening of diabetes mellitus can reduce personal, social and familial impacts of this chronic condition. Objective: to develop a screening test of simple application for early detection of diabetes mellitus by the nurse in primary care. Method: a cross-sectional study was made with data of 269 subjects based on medical records of diabetic patients attended at Hiperdia Center/Juiz de Fora-MG. Demographic, clinical and neurological data of the population evaluated between January of 2010 to December of 2014 were statistically analyzed. Results: sixty-two percent were female; the average age was 58.7 years and body mass index average was of 30.6 kg/cm2; the average time of diagnosis of diabetes mellitus was 11.5 years and glycated hemoglobin (HbA1c) was 9.1%. Burning sensation in the feet (64.9%), paresthesia (83.8%), numbness (73%) and neuropathic pain (54.1%) were the most prevalent symptoms, but the symptoms were bad predictors for the diagnostic of probable diabetic neuropathy. On the other hand, abnormalities of thermal sensitivity and pain as well as the absence of ankle jerk reflex were most often related to the presence of diabetic neuropathy.