Evaluation, intervention, and follow-up of patients with diabetes in a primary health care setting in Brazil: the importance of a specialized mobile consultancy

Wilson Eik Filho; Letícia Pastorelli Bonjorno; Ana Julia Mendes Franco; Márcia Lorena Alves Dos Santos; Eniuce Menezes de Souza; Sonia Silva Marcon

doi:10.1186/s13098-016-0173-1

Evaluation, intervention, and follow-up of patients with diabetes in a primary health care setting in Brazil: the importance of a specialized mobile consultancy

Diabetol Metab Syndr. 2016 Aug 8:8:56. doi: 10.1186/s13098-016-0173-1. eCollection 2016.

Authors

Wilson Eik Filho¹, Letícia Pastorelli Bonjorno², Ana Julia Mendes Franco², Márcia Lorena Alves Dos Santos³, Eniuce Menezes de Souza³, Sonia Silva Marcon⁴

Affiliations

¹ Endocrinology Unit, Department of Medicine, Universidade Estadual de Maringá, and Postgraduate Program in Health Sciences, Health Sciences Center, Universidade Estadual de Maringá, Maringá, Parana Brazil ; Avenida Mandacarú, 1590-Zona 07, Maringá, PR CEP: 87083-240 Brazil.
² Medical School, Universidade Estadual de Maringá, Maringá, Parana Brazil.
³ Department of Statistics, Universidade Estadual de Maringá and Postgraduate Program in Biostatistics, Universidade Estadual de Maringá, Maringá, Parana Brazil.
⁴ Postgraduate Program in Health Sciences, Health Sciences Center, Universidade Estadual de Maringá, Maringá, Parana Brazil.

Abstract

Background: Studies show that educational interventions improve glycemic control in patients with diabetes mellitus (DM), reducing the occurrence of complications associated with the disease.

Objectives: To evaluate the effects of a mobile DM consultancy on clinical and laboratory parameters, disease knowledge, and quality of life in patients with type 2 DM (T2DM) at a primary health care network in Brazil.

Methods: Randomized clinical trial conducted in a city in southern Brazil with 52 patients with T2DM receiving care at a primary health care setting. The intervention lasted for 6 months and consisted of a follow-up with an endocrinologist (five meetings), treatment adjustment based on clinical evaluation and laboratory tests, and educational activities with conversation maps in DM. The statistical analysis included comparison and association tests, considering p values ≤0.05 as statistically significant.

Results: The mean age of the patients was 63.8 years. Most participants were female (63.5 %), had low educational level (59.6 %) and family history of T2DM (71.2 %), used only oral hypoglycemic agents to manage their DM (73.2 %), presented unfavorable anthropometric and laboratory parameters, a high or medium risk of complications (84.6 %), and inadequate glycemic control (67.3 %; with 71 % of the high-risk patients presenting a HbA1c level >9 %). Adjustment in pharmacological treatment was required in 63.5 % of the patients. After the intervention, we observed a significant 0.46 % decrease in mean HbA1c level (p = 0.0218), particularly among individuals with inadequate glycemic control (0.71 %; p = 0.0136). Additionally, there was an increase in disease knowledge scores and a significant decrease in mean body mass index, waist circumference, and disease impact scores.

Conclusion: The intervention improved glycemic control and disease knowledge, reduced the values of body mass index and waist circumference, and the impact of the disease on patients' lives. This indicates that care and educational measures improve the experience of the patients with DM and control of the disease.

Keywords: Health education; Primary health care; Type 2 diabetes mellitus.