Self-care competence in the administration of insulin in older people aged 70 or over1

Psychosocial factors related to the behavioral intention of people with type 2 diabetes using insulin

OBJECTIVES

to analyze the psychosocial factors correlated with the behavioral intention of people with Type 2 Diabetes Mellitus (T2DM) towards insulin use.

METHODS

a cross-sectional study; a validated instrument based on the Theory of Planned Behavior was used to identify the direct measures (attitude, subjective norm and perceived control), indirect measures (behavioral, normative and control beliefs) and behavioral intention for the use of insulin. Descriptive analysis and Spearman's correlation were performed for data analysis.

RESULTS

a total of 211 individuals participated in the study, with a positive median of behavioral intention. Attitude, normative and behavioral beliefs were the psychosocial factors that presented a significant correlation (r=0.16, r=-0,15 and r=0.25, respectively; p<0.05) with the intention.

CONCLUSIONS

there is a positive behavioral intention in the use of insulin by people with T2DM. Attitude, normative beliefs and behavioral beliefs have a low magnitude correlation with the intention of people with T2DM to use insulin.

Esperança e Qualidade de Vida em Pessoas Idosas

Introdução: Estudo transversal, que objetivou avaliar a qualidade de vida (QV) e o sentimento de esperança e analisar a correlação entre esses construtos com dados demográficos. Métodos: Participaram 508 idosos, de ambos os sexos. Utilizaram-se os seguintes instrumentos: questionário demográfico, Escala de Esperança de Herth e WHOQOL-bref. Resultados: A idade variou de 60 a 92 anos (M=71,16; DP=5,95). As médias gerais de QV e esperança foram de 66,03 (DP=19,8) e 38,6 (DP=4,5), respectivamente. Não houve diferenças estatisticamente significativas entre as médias de QV e esperança, com relação à variável sexo. Foram encontradas correlações positivas e estatisticamente significativas entre todos os domínios da QV e a variável esperança. O modelo formado com as variáveis estudadas explicou 22,5% da variação da esperança, com destaque do fator psicológico da QV. Conclusão: A relação entre o sentimento de esperança e a qualidade de vida carece de uma maior atenção no campo da pesquisa e das intervenções com idosos.

Autoaplicação de insulina em adultos com diabetes mellitus no contexto domiciliar

Objetivo: sintetizar a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar. Método: revisão integrativa realizada entre dezembro de 2019 e janeiro de 2020, a partir da busca de publicações em periódicos indexados no PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS e BDENF utilizando-se os termos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal e self administration e seus correspondentes em português, combinados com o operador booleano AND. Foram incluídos artigos originais publicados entre 2009 e 2019, nos idiomas inglês, português e espanhol e que responderam à questão norteadora: qual a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar nos últimos 10 anos? Resultados: compuseram a amostra final oito artigos. Predominaram estudos realizados no Brasil, por enfermeiros no contexto da atenção primária à saúde. Em relação à técnica de autoaplicação de insulina, os resultados foram agrupados em quatro eixos: pré-aplicação, técnica de preparo da insulina, aplicação e pós-aplicação. Observaram-se ações inadequadas em todos os eixos tais como: transporte, armazenamento, autoaplicação, reutilização de agulhas e descarte incorreto. Tais inadequações podem resultar em procedimentos dolorosos, prejuízos no controle glicêmico e complicações para a saúde da pessoa com diabetes Mellitus. Conclusão: os resultados evidenciaram que a realidade da autoaplicação de insulina em adultos com DM no domicílio pode ser modificada a partir da educação em saúde pelo enfermeiro, bem como colaborar para o planejamento das ações estratégicas para diminuir tais problemas.

Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship

OBJECTIVE

To analyze the self-care activities of elderly people with diabetes mellitus and its correlation with the nurse-patient interpersonal relationship.

METHODS

Cross-sectional quantitative study, with 144 elderly people followed up in Family Health Units, with data collected by the Diabetes Self-Care Activities Questionnaire and Interpersonal Relationship Questionnaire in Nursing Care, being analyzed by descriptive and inferential statistics.

RESULTS

There was a greater accomplishment of the activities Take insulin injections as recommended (6.74), Take diabetes medications as recommended (6.55) and Take the indicated number of diabetes pills (6.52). The interpersonal relationship showed moderate effectiveness (80.6%). The correlation between self-care with diabetes and interpersonal relationships showed a positive and significant value in the dimension Specific feeding.

CONCLUSION

The effectiveness of the interpersonal relationship in nursing care resulted in greater compliance with activities related to specific food.

Evaluation of Antidiabetic Injectable Technique: Is There an Association between Accuracy and Health Literacy or Duration of Diabetes?

Introduction:

Effective diabetes pharmacotherapy often involves injectable medications, which if used inappropriately represents a type of unintentional medication nonadherence that leads to poor outcomes.

Objectives:

The primary objective of this study was to assess the percent of patients who accurately prepared, administered, stored, and disposed of their injectable diabetes medication. Secondary objectives included comparing the accuracy of injectable use among those with diabetes <5 years vs. ≥ 5 years duration and those with limited vs. proficient health literacy.

Methods:

This was a prospective analysis conducted on a convenience sample of patients who received a pilot pharmacist-led, quality improvement service at an urban, ambulatory care clinic. The service components included health literacy screening, using the Rapid Assessment of Adult Literacy in Medicine – Short Form (REALM-SF) tool, evaluation of injectable technique by use of a standardized questionnaire, and provision of medication education. Duration of diabetes was determined by patient self-report. Chi-square and Fisher’s exact tests were utilized to assess accuracy of injectable technique in two group comparisons: (1) patients with limited vs. proficient health literacy and (2) patients with diabetes <5 years vs. ≥5 years.

Results:

Thirty-five patients were included in the analysis. Despite the majority (71.4%) of patients reporting prior education on injectable use, 54.3% reported at least one error in product use. Significant findings noted were that those with limited health literacy had higher rates of accurately using the skin-fold technique and appropriate angle for injection vs. those with proficient health literacy (p<0.05 for both comparisons). Likewise, more patients in the cohort of diabetes duration ≥5 years accurately rotated the injection site vs. those with a duration <5 years (p=0.001).

Conclusion:

Errors in injectable technique were common in this study and spanned across health literacy levels and duration of diabetes. Patients prescribed injectable diabetes medications should be routinely educated on proper technique for use.

Insulin Injection Technique Questionnaire: results of an international study comparing Brazil, Latin America and World data

BACKGROUND

In 2014-2015, the largest international survey of insulin injection technique in patients with diabetes taking insulin was conducted in 42 countries, totaling 13,289 participants. In Brazil, patients from five public health centers were included. This study aims to evaluate insulin injection technique in Brazilian patients and compare results with Latin America (LatAm) and World data.

METHODS

The insulin Injection Technique Questionnaire (ITQ) survey consisted of an initial patient section (questions applied by an experienced nurse), followed by observation of injection technique and examination of the injection sites by the health care professional.

RESULTS

In Brazil, 255 patients were evaluated: 25% had type 1 diabetes mellitus (T1DM) and 75% had T2DM. In this study, 79% of patients injected less than 4 times a day, and 17.3% used insulin pens, compared to 28% in LatAm and 86% worldwide. Syringes were used by 78% of patients in Brazil, compared to 65% in LatAm and 10% globally. Differences in needle length were substantial-nearly 64% in Brazil inject with 8 mm length needle compared to 48% in LatAm and 27% worldwide. Additionally, 48% of patients in Brazil skip doses, 80% reuse pen needles and 57% reuse syringes with 27% having lipohypertrophy by exam.

CONCLUSION

Brazilian patients use syringes more and pens less, inject with larger needles and have more lipohypertrophy when compared to Latin America and World data. Their re-use of needles and syringes is also high. This study showed that in Brazil, teaching of proper injection technique has to be more widespread, and more intensive during diabetes educational sessions, and the type of delivered supplies must be updated to smaller, shorter needles preferred by patients, in order to facilitate adherence to treatment. From the ITQ, we conclude that there are many aspects of insulin injection technique that may be improved in Brazil.