CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / 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 (52.7Â5.7 ) 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: / O Diabetes Mellitus Tipo 2 (DM2) à uma doenÃa comum que afeta um grande nÃmero de indivÃduos e frequentemente associa-se a hÃbitos sedentÃrios, restriÃÃo das horas de sono, obesidade e alteraÃÃes metabÃlicas. HÃbitos e comorbidades associadas tais como, doenÃas cardiovasculares, disfunÃÃes neuropÃticas e sintomas depressivos podem influenciar o desempenho funcional. Com o decorrer da doenÃa, os pacientes apresentam piora dos sintomas e um declÃnio funcional. A atividade fÃsica tem sido reconhecida como uma ferramenta importante no manuseio terapÃutico do DM2 e da sÃndrome metabÃlica. Este estudo consiste em uma avaliaÃÃo prospectiva de pacientes com DM2, e tem por objetivo examinar a relaÃÃo entre os nÃveis de atividade fÃsica, as caracterÃsticas clinico/demogrÃficas, as comorbidades associadas, as alteraÃÃes do sono e a hospitalizaÃÃo inicialmente e dois anos de seguimento. Foram estudados 145 pacientes entre 40 e 60 anos (52,7Â5,7) provenientes do Centro Integrado de Diabetes e HipertensÃo (CIDH) na cidade de Fortaleza no perÃodo de 2010 a 2013. Foram utilizados questionÃrios 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 sonolÃncia diurna (SED) (Epworth Sleepiness Scale, ESSE>10), o nÃvel de atividade fÃsica (International Physical Activity Questionnaire, IPAQ) e a qualidade de vida (Short-Form Health Survey, SF-36). ApÃs dois anos, os indivÃduos foram reavaliados quanto ao desenvolvimento de acidente vascular cerebral, hipertensÃo, internaÃÃo hospitalar, uso de hipnÃticos, grau de atividade fÃsica e piora da sonolÃncia diurna. Oitenta e sete mulheres e 58 homens concluÃram a avaliaÃÃo inicial e o follow-up. A hipertensÃo arterial foi encontrada em 108 casos (74%) e novos casos (N=10, 6,9%) foram detectados. No inÃcio do estudo, nove indivÃduos eram fumantes (6%) e 16 eram usuÃrios de Ãlcool (16%). ApÃs dois anos, observou-se uma reduÃÃo no nÃmero de usuÃrios de Ãlcool (9%). Em relaÃÃo à atividade fÃsica, apÃs dois anos, o nÃmero de pacientes sedentÃrios diminuiu de 70% (N=101) para 52% (n=76) e observou-se um aumento do nÃmero 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 anÃlise prospectiva, apÃs dois anos, mostrou que um estado fÃsico mais ativo associou-se de forma independente com menor ocorrÃncia de hospitalizaÃÃo (p=0.02). SonolÃncia 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 anÃlise de regressÃo logÃstica mÃltipla na fase inicial mostrou que o nÃvel de atividade fÃsica associou-se de forma independente com a SED (OR=0,52, CI=0,29-0.92, p=0,02). ApÃs dois anos, 75 pacientes (51,7%) apresentaram o mesmo nÃvel de sonolÃncia, 41 (28,3%) pioraram e 29 (20.0%) melhoraram. Os pacientes sedentÃrios evoluÃram com piora da sonolÃncia (ESS escores) e os mais ativos evoluÃram com melhora (ESE escores, p<0,05). Pacientes com DM2 do sexo feminino e aqueles com acidente vascular cerebral evoluÃram com piora da sonolÃncia. A atividade fÃsica foi mais benÃfica para reduzir o grau de sonolÃncia nas mulheres. Em conclusÃo, esse estudo mostra que um melhor nÃvel de atividade fÃsica associa-se com menor ocorrÃncia de hospitalizaÃÃo apÃs dois anos. Inicialmente os pacientes mais ativos apresentavam reduÃÃo dos nÃveis de sonolÃncia e os pacientes mais sedentÃrios evoluÃram com piora dos nÃveis de sonolÃncia. Os dados atuais confirmam os benefÃcios da atividade fÃsica 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 (52.7Â5.7 ) 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.teses.ufc.br:8762 |
| Date | 05 August 2014 |
| Creators | JoÃo Paulo Lima Vasconcelos |
| Contributors | Veralice Meireles Sales de Bruin, Miguel Nasser Hissa |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em CiÃncias MÃdicas, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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