VASCONCELOS, João Paulo Lima. Diabetes mellitus tipo 2 : um estudo prospectivo dos fatores que influenciam a hospitalização e a sonolência diurna. 2014. 92 f. Dissertação (Mestrado Ciências Médicas) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2014. / Submitted by denise santos (denise.santos@ufc.br) on 2014-11-19T16:36:23Z
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Previous issue date: 2014 / Type 2 diabetes mellitus (T2DM) is a common disease that affects a large number of individuals nowadays and is frequently associated with a sedentary life, reduced hours of sleep, obesity and metabolic alterations. Poor habits and associated comorbidities such as heart disease, peripheral neuropathy and depressive symptoms may influence functional outcome in these patients. Physical activity has been gradually recognized as an important tool in the therapeutic management of T2DM and metabolic syndrome. Usually, with increased disease duration, patients present worsening of symptoms and functional decline. Hospitalization has been recognized as a measure of disease severity and functional decline. Furthermore, daytime sleepiness is associated with greater morbidity and mortality in the population. This is a prospective study and the objective is to evaluate the relationship between physical activity, clinical and demographic characteristics and associated comorbidities. Also, an evaluation of risk factors associated with hospitalization and worsening of daytime sleepiness after two years is performed. Patients with T2DM (N=145) aged between 40 and 60 years (52.7±5.7 ) recruited from the Centro Integrado de Diabetes e Hipertensão (CIDH) in Fortaleza were studied from 2010 to 2013. At baseline and after two years, patients were evaluated about clinical and demographic characteristics, the development of stroke, arterial hypertension, hospitalization, use of hypnotics, level of physical activity and degree of daytime sleepiness. Behavioral questionnaires were used to evaluate comorbidity severity (Charlson Comorbidity Index), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventary), daytime sleepiness (Epworth Sleepiness Scale, ESS>10), physical activity level (International Physical Activity Questionnaire) and quality of life (Short-Form Health Survey, SF-36). In this study, 87 women and 58 men completed initial assessment and follow-up. Hypertension was initially found in 108 cases (74%) and 10 (6.9%) patients developed hypertension after two years. At baseline, nine individuals were smokers (6%) and 16 were alcohol users (16 %). After two years, the number of alcohol users was reduced (N=13; 9%). After two-years, the number of sedentary patients decreased from 70% (N=101) to 52 % (N=76) and an increased number of moderately active patients, initially (N=43) 30%, evolved to 35% (N= 51), and new active individuals were identified (13%, N= 18; p <0,005). After two-years, multiple regression analysis showed that a more active physical activity level (IPAQ) was independently associated with fewer hospitalizations. Excessive daytime sleepiness (EDS) (ESS>10) was frequently found (N=51, 35.1%). At baseline, men had more EDS than women (52.9% vs 33.0, p=0.02). Initially, multiple regression analysis showed that the level of physical activity was independently associated with excessive daytime sleepiness (OR=0.52, CI=0.29-0.92, p=0.02). After two years of follow-up, 75 patients (51.7%) remained at the same level of daytime sleepiness, 41 (28.3%) had higher levels of sleepiness levels and 29 (20.0%) showed reduced levels of daytime sleepiness. Patients with a sedentary lifestyle evolved with more daytime sleepiness and those more active evolved with less daytime sleepiness (ESE escores, p<0.05). DM2 female patients and cases with stroke evolved with more daytime sleepiness. Physical activity level was more beneficial to reduce daytime sleepiness in women. In conclusion, this study shows that better physical activity levels are associated with less hospitalization after two yesr. Our data confirm the beneficial effects of physical activity in patients with T2DM. / O Diabetes Mellitus Tipo 2 (DM2) é uma doença comum que afeta um grande número de indivíduos e frequentemente associa-se a hábitos sedentários, restrição das horas de sono, obesidade e alterações metabólicas. Hábitos e comorbidades associadas tais como, doenças cardiovasculares, disfunções neuropáticas e sintomas depressivos podem influenciar o desempenho funcional. Com o decorrer da doença, os pacientes apresentam piora dos sintomas e um declínio funcional. A atividade física tem sido reconhecida como uma ferramenta importante no manuseio terapêutico do DM2 e da síndrome metabólica. Este estudo consiste em uma avaliação prospectiva de pacientes com DM2, e tem por objetivo examinar a relação entre os níveis de atividade física, as características clinico/demográficas, as comorbidades associadas, as alterações do sono e a hospitalização inicialmente e dois anos de seguimento. Foram estudados 145 pacientes entre 40 e 60 anos (52,7±5,7) provenientes do Centro Integrado de Diabetes e Hipertensão (CIDH) na cidade de Fortaleza no período de 2010 a 2013. Foram utilizados questionários comportamentais para avaliar a gravidade das comorbidades (Charlson Comorbidity Index), a qualidade do sono (Pittsburgh Sleep Quality Index), os sintomas depressivos (Beck Depression Inventary), a sonolência diurna (SED) (Epworth Sleepiness Scale, ESSE>10), o nível de atividade física (International Physical Activity Questionnaire, IPAQ) e a qualidade de vida (Short-Form Health Survey, SF-36). Após dois anos, os indivíduos foram reavaliados quanto ao desenvolvimento de acidente vascular cerebral, hipertensão, internação hospitalar, uso de hipnóticos, grau de atividade física e piora da sonolência diurna. Oitenta e sete mulheres e 58 homens concluíram a avaliação inicial e o follow-up. A hipertensão arterial foi encontrada em 108 casos (74%) e novos casos (N=10, 6,9%) foram detectados. No início do estudo, nove indivíduos eram fumantes (6%) e 16 eram usuários de álcool (16%). Após dois anos, observou-se uma redução no número de usuários de álcool (9%). Em relação à atividade física, após dois anos, o número de pacientes sedentários diminuiu de 70% (N=101) para 52% (n=76) e observou-se um aumento do número de pacientes moderadamente ativos que progrediu de 30% para 35% (N= 51) e o surgimento de pacientes ativos (13%, N= 18; p <0,005). A análise prospectiva, após dois anos, mostrou que um estado físico mais ativo associou-se de forma independente com menor ocorrência de hospitalização (p=0.02). Sonolência foi comum entre os pacientes com DM2. Cinquenta e um (N= 51, 35%) apresentaram SED (ESE>10). Inicialmente, os homens apresentavam mais SED que as mulheres (52,9% vs 33,0, p=0,02). A análise de regressão logística múltipla na fase inicial mostrou que o nível de atividade física associou-se de forma independente com a SED (OR=0,52, CI=0,29-0.92, p=0,02). Após dois anos, 75 pacientes (51,7%) apresentaram o mesmo nível de sonolência, 41 (28,3%) pioraram e 29 (20.0%) melhoraram. Os pacientes sedentários evoluíram com piora da sonolência (ESS escores) e os mais ativos evoluíram com melhora (ESE escores, p<0,05). Pacientes com DM2 do sexo feminino e aqueles com acidente vascular cerebral evoluíram com piora da sonolência. A atividade física foi mais benéfica para reduzir o grau de sonolência nas mulheres. Em conclusão, esse estudo mostra que um melhor nível de atividade física associa-se com menor ocorrência de hospitalização após dois anos. Inicialmente os pacientes mais ativos apresentavam redução dos níveis de sonolência e os pacientes mais sedentários evoluíram com piora dos níveis de sonolência. Os dados atuais confirmam os benefícios da atividade física em pacientes com DM2. ABSTRACT Type 2 diabetes mellitus (T2DM) is a common disease that affects a large number of individuals nowadays and is frequently associated with a sedentary life, reduced hours of sleep, obesity and metabolic alterations. Poor habits and associated comorbidities such as heart disease, peripheral neuropathy and depressive symptoms may influence functional outcome in these patients. Physical activity has been gradually recognized as an important tool in the therapeutic management of T2DM and metabolic syndrome. Usually, with increased disease duration, patients present worsening of symptoms and functional decline. Hospitalization has been recognized as a measure of disease severity and functional decline. Furthermore, daytime sleepiness is associated with greater morbidity and mortality in the population. This is a prospective study and the objective is to evaluate the relationship between physical activity, clinical and demographic characteristics and associated comorbidities. Also, an evaluation of risk factors associated with hospitalization and worsening of daytime sleepiness after two years is performed. Patients with T2DM (N=145) aged between 40 and 60 years (52.7±5.7 ) recruited from the Centro Integrado de Diabetes e Hipertensão (CIDH) in Fortaleza were studied from 2010 to 2013. At baseline and after two years, patients were evaluated about clinical and demographic characteristics, the development of stroke, arterial hypertension, hospitalization, use of hypnotics, level of physical activity and degree of daytime sleepiness. Behavioral questionnaires were used to evaluate comorbidity severity (Charlson Comorbidity Index), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventary), daytime sleepiness (Epworth Sleepiness Scale, ESS>10), physical activity level (International Physical Activity Questionnaire) and quality of life (Short-Form Health Survey, SF-36). In this study, 87 women and 58 men completed initial assessment and follow-up. Hypertension was initially found in 108 cases (74%) and 10 (6.9%) patients developed hypertension after two years. At baseline, nine individuals were smokers (6%) and 16 were alcohol users (16 %). After two years, the number of alcohol users was reduced (N=13; 9%). After two-years, the number of sedentary patients decreased from 70% (N=101) to 52 % (N=76) and an increased number of moderately active patients, initially (N=43) 30%, evolved to 35% (N= 51), and new active individuals were identified (13%, N= 18; p <0,005). After two-years, multiple regression analysis showed that a more active physical activity level (IPAQ) was independently associated with fewer hospitalizations. Excessive daytime sleepiness (EDS) (ESS>10) was frequently found (N=51, 35.1%). At baseline, men had more EDS than women (52.9% vs 33.0, p=0.02). Initially, multiple regression analysis showed that the level of physical activity was independently associated with excessive daytime sleepiness (OR=0.52, CI=0.29-0.92, p=0.02). After two years of follow-up, 75 patients (51.7%) remained at the same level of daytime sleepiness, 41 (28.3%) had higher levels of sleepiness levels and 29 (20.0%) showed reduced levels of daytime sleepiness. Patients with a sedentary lifestyle evolved with more daytime sleepiness and those more active evolved with less daytime sleepiness (ESE escores, p<0.05). DM2 female patients and cases with stroke evolved with more daytime sleepiness. Physical activity level was more beneficial to reduce daytime sleepiness in women. In conclusion, this study shows that better physical activity levels are associated with less hospitalization after two yesr. Our data confirm the beneficial effects of physical activity in patients with T2DM. Keywords: Diabetes, Physical Activity, Hospitalization, Sleepiness, Epworth, Stroke LISTA DE ABREVIATURAS
| Identifer | oai:union.ndltd.org:IBICT/oai:www.repositorio.ufc.br:riufc/9844 |
| Date | January 2014 |
| Creators | Vasconcelos, João Paulo Lima |
| Contributors | Bruin, Veralice Meireles Sales de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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