Resumen de Efeitos de instrução e de automonitoramento no seguimento de regras ao tratamento do diabetes Tipo 1

Alana dos Anjos Moreira, Eleonora Arnaud Pereira Ferreira, Daniela Lopes Gomes

• English

  Type 1 diabetes mellitus (DM1) is an autoimmune and chronic disease causing complete deficiency in insulin production and usually diagnosed in children and adolescents.

  The treatment requires the daily monitoring of glycemia, the application of daily insulin, following a diet and regular practice of physical activity. Therefore, it requires following an extensive and complex chain of rules. The purpose of this study was to investigate the effects of using instruction and self-monitoring, counterbalancing their order of presentation, on the behavior of following rules for glycemia measurement and insulin application in children with DM1. Two male children (10 years old and 12 years old) with DM1 participated in a longitudinal design with the subject as his own control. The data collection was performed in a waiting room of a university hospital and in the residence of each child. Instruments: Interview script about the use of insulin and blood glucose monitoring, 24-hour Reminder, Manual with instructions on insulin application and Self-monitoring form. The procedure began with an initial interview and three home visits for the application of the 24-hour Reminder (Baseline). Subsequently, each participant was submitted to an experimental condition (Intervention). PA was exposed to the order instruction (Instruction phase) followed by self-monitoring (Self-monitoring phase) and the reverse order was performed with PB. Finally, three more home visits were made, in both conditions, only for the application of the 24-hour Reminder (Maintenance).

  The interval between visits was two days on average and all the interviews were audio recorded. In the initial interview, both participants described the differences between the insulins that they used, identifying which was the long-acting one (basal) and which was the one with ultrafast effect (bolus). However, they did not use the preprandial glycemia result as a discriminative stimulus for the selection of the bolus insulin unit to be used before the main meals, regardless of the data collection phase.

  In addition, the results point to the selection of an average value of ultrafast insulin by each participant, indicating that both formulated self-corrections, regarding the value of the unit that could be used, based on the history of exposure to the effects observed after the application of this insulin. On the application of basal insulin, the results found with the two participants showed a higher frequency in the emission of adherence to treatment behavior. As for the behavior of measuring glycemia, during the intervention, both with the Self-Monitoring and the Instruction phases, there was an increase in its percentage of correct answers emitted by both participants (PA= 100% in both phases; PB= 55% in Self-monitoring phase and 67% in Instruction phase) in relation to the value obtained in the Baseline phase. Therefore, the research may contribute with new evidence on adherence to treatment behavior in children with T1DM regarding following rules on glycemia measurement and insulin application, suggesting the use of individualized instructions with justifications, followed by self-monitoring forms as behavioral technology in the promotion of treatment compliance behaviors in this population.

• português

  O Diabetes mellitus Tipo 1 (DM1) é uma doença crônica diagnosticada em crianças e adolescentes, cujo tratamento requer o seguimento de uma cadeia extensa e complexa de regras. Foram investigados os efeitos do uso de instrução e de automonitoramento, contrabalanceando sua ordem de apresentação, sobre o seguimento de regras para mensurar a glicemia e aplicar insulina em crianças com DM1. Participaram dois meninos (10 e 12 anos) com DM1, distribuídos em duas condições: Instrução seguida de automonitoramento e Automonitoramento seguido de instrução. Foram utilizados: a) um Roteiro de Entrevista sobre aplicação de insulina e monitoramento da glicemia, b) um recordatório 24 horas, c) um manual com instruções sobre aplicação de insulina e d) um formulário de automonitoramento. Após a intervenção, o participante submetido à condição Instrução seguida de automonitoramento apresentou mais acertos na mensuração da glicemia ao ser comparado com o participante submetido à condição inversa. Os valores da glicemia pré-prandial não foram utilizados pelos participantes como dica para selecionar a unidade de insulina a ser utilizada antes das refeições, independentemente da ordem em que as variáveis (instrução e automonitoramento) foram apresentadas. Discute-se a utilização de instruções com justificativas associadas ao uso de formulários de automonitoramento como tecnologia comportamental na promoção da adesão ao tratamento do DM1.