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Interdisciplinary Intervention for Prevention of Diabetes Mellitus under a Psychological Perspective: Benefits in Quality of Life

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Author(s):
Adriana Cezaretto
Total Authors: 1
Document type: Master's Dissertation
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
Defense date:
Examining board members:
Sandra Roberta Gouvea Ferreira Vivolo; Ana Teresa de Abreu Ramos Cerqueira; Ana Maria Cervato Mancuso
Advisor: Sandra Roberta Gouvea Ferreira Vivolo
Abstract

Introduction: Longer life expectancy and high prevalence rates of chronic diseases such as diabetes mellitus (DM) have modified the focus of government health agencies. DM causes severe chronic complications deteriorating quality of life (QoL) and survival; concomitance of DM and psychiatric disorders - such as depression and binge eating (BED) - decreases compliance to treatment and deteriorates prognosis. Management of these disorders may revert in better metabolic control and QoL during programs of lifestyle changes. Objective: To assess whether lifestyle intervention with intensive interdisciplinary approach for individuals at risk for DM results in better QoL that traditional intervention (TI). Methods: 177 individuals with pre-diabetes or metabolic syndrome, seen by Brazilian public health system, were randomly allocated to an IT or intensive intervention (II) in life habits for 9 months. Individuals from TI had medical visits each three months and from II additionally attended 13 psychoeducative group sessions focusing on dietary habits and physical activities. At baseline and after 9 months, they were submitted to clinical examination and laboratory procedures and answered questionnaires: long version of IPAQ, 24-h food recalls, QoL (SF-36), for depression (BDI and PRIME-MD) and binge eating scale. Predictors of compliance defined as attendance >70 per cent of group sessions were analysed by logistic regression. Results: In both interventions, significant improvements in body mass index, waist circumference and HDL-cholesterol levels were observed. After 9 months, only the individuals submitted to II had blood pressure and plasma glucose levels reduced. The same individuals had significant increases in almost all domains and summary measures of the SF-36. Comparing the induced increases in QoL, measures were greater in the domains of physical functioning (II: 11.1 ± 14.0 vs. IT: 13.0 ± 5.3; p = 0.02) and role-emotional (II: 20.4 ± 40.2 vs. IT: 16.2 ± 43.8; p = 0.05) in II in relation to IT. Frequencies of depression reduced in both interventions to 9 months, although of BED decreased only in II (28 to 4 per cent, p <0.001; IT: 13.7 per cent to 8.6 per cent, p = 0.38). Changes in SF-36 correlated inversely and significantly with differences of BMI, waist circumference, systolic blood pressure and glucose levels. Also found was as inverse correlation of QoL scores with depression (r = -0.275, p = 0.001) and BED (r = -0.175, p = 0.043). Logistic regression showed that male gender was independently associated with adherence to II (p = 0.02) but not the presence of BED or depression. Conclusion: Intervention in lifestyle with an interdisciplinary approach induced better benefits for QoL of individuals at risk for DM than the IT, as well as for metabolic profile. The decreased frequencies of the BED and depression following the II may contribute to improvement of QoL, but is not predictive of compliance. Our findings indicate that interdisciplinary intervention for prevention of DM, even not directed to psychiatric disorders, has extrametabolic effects, favoring the control depression and BED and improving QoL (AU)