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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2022.tde-10042023-160636
Document
Author
Full name
Amanda Maria Barradas Monteiro de Santana
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2022
Supervisor
Committee
Liberatore Junior, Raphael Del Roio (President)
Gomes, Patricia Moreira
Miranda, Wallace Rodrigues de Holanda
Title in Portuguese
Perfil clínico e laboratorial das crianças e adolescentes com diabetes mellitus: experiência de um centro terciário
Keywords in Portuguese
Diabetes mellitus
Hemoglobina glicada
Insulinoterapia
Abstract in Portuguese
O termo diabetes mellitus (DM) descreve uma complexa desordem metabólica caracterizada por hiperglicemia crônica resultante da interação de fatores genéticos, biológicos e ambientais que levam a defeitos na secreção e/ou ação da insulina. A hiperglicemia persistente está associada a complicações crônicas micro e macrovasculares, aumento da morbidade, redução da qualidade de vida e elevação da taxa de mortalidade. O presente estudo teve como objetivo avaliar o perfil clínico e laboratorial dos pacientes portadores de diabetes mellitus em seguimento regular no ambulatório de diabetes infantil (ENDI) do Hospital das Clínicas de Ribeirão Preto (HCFMRP-USP). Trata-se de um estudo descritivo transversal realizado a partir de levantamento de dados em prontuário das crianças e adolescentes com diagnóstico de diabetes mellitus em seguimento regular no ambulatório de endocrinologia infantil do HC-FMRP-USP. Dados médicos de 334 pacientes foram revisados. Pacientes com diagnóstico de diabetes mellitus foram incluídos, 45 foram excluídos por terem outros diagnósticos e 28 foram excluídos por não estarem mais em seguimento no ENDI nos últimos dois anos. Dos 261 pacientes incluídos foram avaliadas variáveis clínicas relacionadas ao paciente, ao tratamento, ao seguimento e controle. A amostra foi composta por 50,57% pacientes do sexo masculino. A média da idade foi de 12,5 anos (2-19). A idade ao diagnóstico de diabetes variou de 0 a 17 anos, com média de 7,2 anos. E o tempo médio de doença foi de 5,4 anos. A maioria dos pacientes foram classificados nutricionalmente como eutróficos no momento do diagnóstico (63,5%). Quanto à etiologia, 86,2% foram classificados como portadores de diabetes mellitus tipo 1 (DM1). A abertura do quadro em cetoacidose diabética (CAD) foi observada em 44,4% dos casos e 36,2% foram classificados como CAD grave. Dentre os pacientes em uso de insulinoterapia foi observado predomínio do uso do esquema basal-bolus com análogos de insulina (46,1%). A média da hemoglobina glicada (HbA1c) foi de 9,3% (5,0-16,2%). A menor mediana da média das HbA1c foi observada nos usuários de bomba de infusão de insulina (8,6%).
Title in English
Clinical and laboratory profile of children and adolescents with diabetes mellitus: experience of a tertiary center
Keywords in English
Diabetes mellitus
Glycated hemoglobin
Insulin therapy
Abstract in English
The term diabetes mellitus (DM) describes a complex metabolic disorder characterized by chronic hyperglycemia resulting from the interaction of genetic, biological and environmental factors that lead to defects in insulin secretion and/or action. Persistent hyperglycemia is associated with chronic micro and macrovascular complications, increased morbidity, reduced quality of life and increased mortality rate. This study aimed to evaluate the clinical and laboratory profile of patients with diabetes mellitus undergoing regular follow-up at the pediatric diabetes outpatient clinic (ENDI) of the Hospital das Clínicas in Ribeirão Preto (HCFMRP-USP). This is a descriptive cross-sectional study carried out based on data collection from medical records of children and adolescents diagnosed with diabetes mellitus in regular follow-up at the Children's Endocrinology Outpatient Clinic of HC-FMRP-USP. Medical data from 334 patients were reviewed. Patients diagnosed with diabetes mellitus were included, 45 were excluded for having other diagnoses, and 28 were excluded for no longer being followed up by ENDI in the last two years. Of the 261 patients included so far, clinical variables related to the patient, treatment, follow-up and control were evaluated. The sample consisted of 50.8% male patients. The mean age was 12.55 years (2-19). Age at diagnosis of diabetes ranged from 0 to 17 years, with a mean of 7.2 years. And the average time of illness was 5.4 years. Most patients were nutritionally classified as eutrophic at diagnosis (63.5%). As for the etiology, 86.2% were classified as having type 1 diabetes mellitus (T1DM). Presence of diabetic ketoacidosis (DKA) was observed in 44.4% of cases and 36.2% were classified as severe DKA. Among patients using insulin therapy, a predominance of basal bolus regimen with insulin analogues was observed (46.1%). Mean glycated hemoglobin (HbA1c) was 9.3% (5.0-16.2%). The lowest median mean HbA1c was observed in insulin infusion pump users (8.6%).
 
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Publishing Date
2023-04-17
 
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