Neuropatia diabetica periferica: triagem precoce e complicações clínico-funcionais

Abstract

Peripheral Diabetic Neuropathy (PDN) causes sensorimotor changes such as impairment of tactile, painful, vibratory, thermal sensibility, muscle weakness and atrophy, leading to deformities, ulceration, amputations, as well as deficits in postural control and instability, increasing the risk of falls even in younger individuals. The dissertation was organized in the form of two scientific articles, each with its own methodology. The first, a retrospective longitudinal study with 86 medical records of diabetics, followed for 3 years, divided into three groups: Group with PDN (G1), group that developed during the follow-up (G2) and group of diabetics without PDN (G3). It was observed using the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS), that there is a difference between the groups in the NSS and initial NDS (F = 66,618, p = 0,000) and final (F = 52,357, p = 0,000). It is possible to perform an early screening of individuals and identify not only the diagnosis of PDN, but the prognosis of its development when the NDS is greater than 1.5, and the NSS is greater than 6.5. The second article is a prospective cross-sectional study with 51 individuals, divided into three groups (with 17 individuals each), G1 with Peripheral Diabetic Neuropathy, G2 for diabetics without Peripheral Diabetic Neuropathy and G3 for individuals from the community, without Diabetes Mellitus. Deficits in postural control and G1 balance were identified, but also in some more challenging situations for G2 through the two balance tests used, the Modified Clinical Trial of Sensory Integration of Balance mCTSIB (p = 0,000) and the MiniBEST (p = 0,001). There is a statistical difference between the groups in the domains, anticipatory postural adjustment (p = 0,000), reactive postural response (p = 0,000), sensory orientation (p = 0,003) and gait stability (p = 0,000). PDN causes a worsening of postural balance and control, generating greater instability in individuals. Thus, through this dissertation, it was identified that it is possible to make an early diagnosis of PDN When the NDS is greater than 1,5 points and the NSS is greater than 6,5. The identification of possibility of developing PDN aims to avoid or minimize the complications and deficiencies caused by neuropathy, such as those related to decreased anticipatory and reaction postural control, as well as dificulties in sensory guidance due to sensory changes and greater gait instability with a increased risk of falling for these diabetics.