ISABEL SILVA (**)
JOSÉ PAIS-RIBEIRO (***)
HELENA CARDOSO (****)
HELENA RAMOS (****)
RESUMO
O objectivo do presente estudo é analisar o impacto da presença de complicações crónicas específicas na qualidade de vida de indivíduos com diabetes. Foi avaliada uma amostra de conveniência de 316 sujeitos com diabetes, dos quais 44,6% do sexo masculino; com idades compreendidas entre os 16 e os 84 anos (M= 48,39; DP=16,90); 41,8% (n=132) apresenta diagnóstico de diabetes tipo 1 e a duração da doença varia entre 4 meses e 43 anos (M=13,66; DP=9,32).
]]> Destes doentes, 59,8% sofre de complicações crónicas da diabetes. Os resultados sugerem que, entre os indivíduos com diabetes, aqueles que sofrem de complicações crónicas demonstram ter uma qualidade de vida inferior à dos que não sofrem de sequelas. Esta diferença verifica-se quando são analisadas especificamente a microangiopatia, catarata, macroangiopatia, neuropatia autonómica (nomeadamente, disfunção sexual), doença cardíaca coronária, antecedentes de acidente vascular cerebral, hipertensão arterial e doença arterial periférica. Todavia, quando controlada a gravidade de complicações como a retinopatia e a nefropatia, constata-se que não existe uma relação linear entre a gravidade da complicação e o impacto na qualidade de vida, uma vez que, por vezes, doentes com níveis mais graves da complicação apresentam uma qualidade de vida superior à de indivíduos com níveis menos graves desta.
Palavras-chave: Qualidade de vida, diabetes, complicações crónicas.
ABSTRACT
The objective of the present study is to analyse the impact of specific disease chronic complications in quality of life of diabetic patients. A convenience sample include 316 diabetic patients; 44.6% males; aged between 16 and 84 years (M= 48.39; DP=16.90), 41.8% (n=132) with type 1 diabetes and 58.2% (n=184) with type 2 diabetes. Disease duration varies between 4 months e 43 years (M=13.66; DP=9.32) and 59.8% of those patients suffers from diabetes chronic complications. Results suggest that diabetic patients who suffer from chronic complications report lower quality of life than those patients who do not suffer from diabetes sequels. This distinction is present when we analyse specifically microangiopathy, cataract, macroangiopathy, autonomic neuropathy (namely sexual dysfunction), coronary heart disease, previous stroke, hypertension and peripheral arterial disease. However, when we control complications severity, namely retinopathy and nephropathy severity, we verify that there is not a linear association between sequel severity and its impact on quality of life, since, in some cases, patients suffering from a more severe complication level report higher quality of life than patients with less severe levels.
Key words: Quality of life, diabetes, chronic complications.
]]>
Texto completo disponível apenas em PDF.
Full text only available in PDF format.
REFERÊNCIAS
Aalto, A.-M., Uutela, A., & Aro, A. R. (1997). Health related quality of life among insulin-dependent diabetes: disease-related and psychosocial correaates. Patient Education and Counselling, 30, 215-225. [ Links ]
Ashford, R. L., McGee, P., & Kinmond, K. (2000). Perception of quality of life by patients with diabetic foot ulcers. The Diabetic Foot, 3 (4), 150-155. [ Links ]
Bech, P. (1993). Quality of life measurement in chronic disorders. Psychotherapy and Psychosomatics, 59, 1-10. [ Links ]
Berzon, R. A. (2000). Understanding and using health-related quality of life instruments within clinical research studies. In M. J. Staquet, R. D. Hays, & P. M. Fayers (Eds.), Quality of Life Assessment in Clinical Trials (pp.3-15). Great Britain: Oxford University Press. [ Links ]
Bott, U., Mühlhauser, I., Overmann, H., & Berger, M. (1998). Validation of a diabetes-specific quality of life scale for patients with type 1 diabetes. Diabetes Care, 21 (5), 757-769. [ Links ]
Bradley, C (2002). Assessment of health-related quality of life (HRQoL) in people with diabetes. Scientific report: Training session on health-related quality of life assessment and depression in diabetes (pp. 2-3). Budapest: MAPI Research Institute. [ Links ]
Bradley, C., Todd, C., Gorton, T., Symonds, E., Martin, A., & Plowright, R. (1999). The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Quality of Life Research, 8, 79-91. [ Links ]
Brod, M. (1998). Quality of life issues in patients with diabetes and lower extremity ulcers: patients and care givers. Quality of Life Research, 7, 365-372. [ Links ]
Brown, G. C., Brown, M. M., Sharma, S., Brown, H., Gozum, M., & Denton, P. (2000). Quality of life associated with diabetes mellitus in an adult population. Journal of Diabetes Complications, 14 (19), 18-24. [ Links ]
Caditz, J. (1992). An education-support-group program for visually impaired people with diabetes. Journal of Visual Impairment & Blindness, 86 (1), 81-83. [ Links ]
de Berardis, G., Franciosi, M., Belfiglio, M., di Nardo, B., Greenfield, S., Kaplan, S. H., Pellegrini, F., Sacco, M., Tognoni, G., Valentini, M., & Nicolucci, A. (2002). Erectile dysfunction and quality of life in type 2 diabetic patients. Diabetes Care, 25, 284-291. [ Links ]
Elbagir, M. N., Etayeb, N. O., Eltom, M. A., Mahadi, E. O., Wikblad, K., & Berne, C. (1999). Health-related quality of life in insulin-treated diabetic patients in the Sudan. Diabetes Research and Clinical Practice, 46 (1), 65-73. [ Links ]
Fallowfield, L. (1990). The quality of life: The missing measurement in health care. Canada: A Condor Book Souvenir Press (E & A) Ltd. [ Links ]
Glasgow, R. E., & Anderson, R. M. (1999). In diabetes care, moving from compliance to adherence is not enough. Diabetes Care, 22 (12), 2090-2091. [ Links ]
Glasgow, R. E., Ruggiero, L., Eakin, E. G., Dryfoos, J., & Chobanian, L. (1997). Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care, 20 (4), 562-567. [ Links ]
Grégoire, J. (1995). Introduction: l - evaluation de la qualité de vie. Revue Européenne de Psychologie Appliquée, 45 (4), 243-244. [ Links ]
Gross, C. R., Limwattanon, C., Mathees, B., Zehrer, J. L., & Savik, K. (2000). Impact of transplantation on quality of life in patients with diabetes and renal dysfunction. Transplantation, 27 (12), 1736-1746. [ Links ]
Hahl, J., Hämäläinen, H., Sintonen, H., Simell, T., Ariren, S., & Simell, O. (2002). Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications. Quality of Life Research, 11 (5), 427-436. [ Links ]
Hanestad, B. R. (1993). Self-reported quality of life and the effect of different clinical and demographic characteristics in people with type 1 diabetes. Diabetes Research and Clinical Practice, 19, 139-149. [ Links ]
Hathaway, D. K., Hartwig, M. S., Milstead, J., Elmer, D., Evans, S., & Gaber, A. O. (1994). Improvement in quality of life reported by diabetic recipients of kidney-only and pancreas-kidney allografts. Transplantation Proceedings, 26, 512-514. [ Links ]
Jacobson, A. M. (2002). Depression & HRQoL in diabetes: From research to clinical care. Scientific report: Training session on health-related quality of life assessment and depression in diabetes (pp. 9-10). Budapest: MAPI Research Institute. [ Links ]
Klein, B. E. K., Klein, R., & Moss, S. E. (1998). Self-rated health and diabetes retinopathy. Diabetes Care, 21 (2), 236-240. [ Links ]
Lee, J. E., Fos, P. J., Zuniga, M. A., Kastl, P. R., & Sung, J. H. (2001). Assessing health-related quality of life in cataract patients: the relationship between utility and health-related quality of life measurement. Quality of Life Research, 9, 1127-1135. [ Links ]
Lloyd, C. E., Matthews, K. A., Wing, R. R., & Orchard, T. J. (1992). Psychosocial factors and complications of IDDM: The Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care, 15, 166-172. [ Links ]
Nakache, R., Tyden, G., & Groth, C. G. (1989). Quality of life in diabetic patients after combined pancreas-kidney or kidney transplantation. Diabetes, 38, 40-42. [ Links ]
Piehlmeier, W., Bullinger, M., Kirchberger, I., Land, W., & Landgraf, R. (1996). Evaluation of the quality of life of patients with insulin-dependent diabetes mellitus before and after organ transplantation with the SF-36 Health Survey. European Journal of Surgery, 162, 933-940. [ Links ]
Ragnarson-Tennvall, G., & Apelqvist, J. (2000). Health-related quality of life in patients with diabetes mellitus and foot ulcers. Journal of Diabetes Complications, 14 (59), 235-241. [ Links ]
Ribeiro, J. L. P. (1994). A importância da qualidade de vida para a psicologia da saúde. Análise Psicológica, 12 (2-3), 179-91. [ Links ]
Ribeiro, J. L. P., Meneses, R. F., Meneses, I., & Grupo-QDV (1998). Avaliação da qualidade de vida em crianças com diabetes tipo 1. Análise Psicológica, 16 (1), 91-100. [ Links ]
Ryan, C. M. (1997). Psychological factors and diabetes mellitus. In J. Pickup Pickup, & G. Williams (Eds.), Textbook of Diabetes (pp. 66.1-66.13). Oxford: Blackwell Science. [ Links ]
Symister, P., & Friend, R. (1996). Quality of life and adjustment in renal disease: a health psychology perspective. In R. J. Resnick, & R. H. Rosensky (Eds.), Health Psychology Through the Life Span (pp. 265-287). USA: American Psychological Association. [ Links ]
Talley, N. J., Young, L., Bytzer, P., Hammer, J., Leemon, M., Jones, M., & Horowitz, M. (2001). Impact of gastrointestinal symptoms in diabetes mellitus on health-related quality of life. American Journal of Gastroenterology, 96 (1), 71-76. [ Links ]
Testa, M. A., Simonson, D. C., & Turner, R. R. (1998). Valuing quality of life and improvements in glycemic control in people with type 2 diabetes. Diabetes Care, 21 (3), 44-52. [ Links ]
United Kingdom Prospective Diabetes Study Group (1999). Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control. Diabetes Care, 22, 1125-1136. [ Links ]
Visser, C. L., Bilo, H. J. G., Groenier, K. H., Visser, W., & Jong, B. M. (2002). The influence of cardiovascular disease on quality of life in type 2 diabetics. Quality of Life Research, 11 (3), 249-261. [ Links ]
Voruganti, L. N. P., & Sells, R. A. (1989). Quality of life of diabetic patients after combined pancreatic-renal transplantation. Clinical Transplantation, 3, 78-82. [ Links ]
Wikblad, K., Leksell, J., & Wibell, L. (1996). Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus. Quality of Life Research, 5, 123-130. [ Links ]
(*) Trabalho realizado com o apoio da bolsa Praxis XXI BD/21804/9 da Fundação para a Ciência e a Tecnologia.
(**) Psicóloga.
(***) Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto.
(****) Hospital Geral de Santo António - Serviço de Endocrinologia, Porto.
]]>