Estudo das relações entre resiliência dos cuidadores de crianças e adolescentes com diabetes Mellitus tipo 1 e controle metabólico

Abstract

INTRODUCTION: Diabetes Mellitus 1 (DM1) is a chronic metabolic disease, which occurs with hyperglycemia as a result of absolute or relative insulin deficiency. When it appears in the child or diabetic adolescent it generates in the caregivers anguish, fear, stress and many challenges in the search of the adequate management of the disease. Therefore, the caregivers through positive adaptations can overcome these challenges by resilience. OBJECTIVES: This work aims to study the relationships of resilience of caregivers with metabolic variables of children and adolescents with DM1 under their care. METHODS: transversal study of quantitative approach, conducted in the Diabetes Ambulatory of the Federal University of Triangulo Mineiro (HC-UFTM). The following instruments were used for data collection: identification sheet, laboratory exams sheet, economic classification questionnaire and resilience scale. The data analysis was performed by the SPSS software version 21, which used the "t" student test or Mann Whitney to compare 2 independent groups and ANOVA followed by Tukey or Kruskal-Wallis test followed by Dunn test, for 3 or more groups. Association between the variables was verified by the Pearson or Spearman coefficient. The significance level adopted for all tests was 5% (p ≤ 0.05) or between 5 and 6% (borderline - 0.05 ≥ p ≤ 0.06) RESULTS: 59 caregivers were analyzed concerning the resilience and metabolic control of 59 children and adolescents with DM1. Regarding the caregivers, there was a predominance of mothers with moderate to high resilience (n= 47), with a average of total resilience score of 140.6 ± 14.2. As for children and adolescents, 67.7% (n= 40) were aged between 10 and 19 years and 50.8% (n= 30) were male. From the comparisons of the metabolic control of children and adolescents in relation to the score of the resilience factors, the results are: Factor 1: the post prandial blood glucose (264.9 mg/dL ± 65.5) of the group of children and adolescents, whose caregivers had F1 below the average, was significantly higher than the post prandial blood glucose (186,3 mg/dL ± 64.8) of children and adolescents in the group of caregivers who had F1 above the average. (p= 0.036). Factor 3 - fasting glycemia (228.8 mg/dL ± 52.4) of the group of children and adolescents whose caregivers had F3 - below the average was significantly higher than the children (178 mg/dL ± 49.4) of the group of caregivers on average. (p= 0,026). Regarding the comparisons of the caregivers' resilience factors with the variables of the children and adolescents by age group, the average of the Z BMI score of those with less than 10 years old (0.25 ± 0.45) referring to the group of caregivers with F2 below the average is higher than the Z BMI score of the children and adolescents (-0.4 ± 0.5) belonging to the group of caregivers who had F2 in the average, although they presented p= 0.060. Factor 2 - The average percentile of BMI of children under 10 years old (58.9 ± 15.5) and referring to the group of caregivers with F2 below the average, was significantly higher (37.8 ± 17.3) than those referring to the group of caregivers F2 in the average (p= 0.051). The HbA1c of participants with age above 10 years old (7.8% ± 0.8) of the group of caregivers F2 below the average was higher than the HbA1c of children and adolescents (8.9% ± 1.0) of the group of caregivers F2 above the average (p= 0.051) although it presented a p= 0.055. Mean TG concentrations in those with less than 10 years old (47.0 mg/dL ± 11.4) and referring to the group of caregivers that had F2 in the mean were less than TG of children and adolescents (65 mg/dL ± 12.9) of the group of caregivers F2 below the mean (p= 0, 029). Factor 3 - the AC of children and adolescents older than 10 years old (88.6 cm ± 6.6) of the group of caregivers F3 below the average was higher than the AC of children and adolescents (65 cm ± 12.9) of the group of caregivers F3 above the average (p= 0, 049). Factor 3 - the FBGL of children and adolescents older than 10 years (178 mg/dL ± 54.2) of group of caregivers F3 in the average was higher than the FBGL of children and adolescents (232.4 mg/dL ± 55.3) of group of caregivers F3 above the average (p= 0, 028), with p= 0, 56, borderline. Factor 3 - the PPBG of children and adolescents older than 10 years (291.3 mg/dL ± 81.4) in the group of caregivers F3 below the average was higher than the PPBG of children and adolescents (214.8 mg/dL ± 63.2) in the group of caregivers F3 on average (p= 0, 009). Regarding the correlations it was observed an inverse correlation between PPBG with F1 and F2 (r= -0.260; p= 0.047) (r= -0.277; p= 0.033); it was also observed an inverse relationship between TG and F3 (r= -0.261; p= 0.046). CONCLUSION: Although we did not find quantitative influence among all the factors of resilience and metabolic control, those related to the resolution of actions and values (F1) and independence and determination (F2) were associated to better glycemic control, and F3 (self-confidence and capacity of adaptation) influenced the lipid profile. Other basic characteristics of resilient behavior may not be accessible to a quantitative approach, and may also contribute to the clear management of diabetes in children and adolescents, with less psychological distress to the caregivers.