Percepción alterada del tacto y factores de riesgo asociados en individuos con diabetes mellitus

Noronha, Juliana Andreia Fernandes; Azevedo, Cissa; Moura, Caroline de Castro; Gusmão, Elaine Custódio Rodrigues; Cardoso, Ana Carolina Lima Ramos; Chianca, Tânia Couto Machado

doi:10.1590/0034-7167-2019-0473

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0473 linkcopiar

Percepción alterada del tacto y factores de riesgo asociados en individuos con diabetes mellitus

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: Evaluar la prevalencia de la percepción alterada del tacto en los pies de individuos con diabetes mellitus y los factores de riesgo asociados.

Método: Estudio transversal con 224 individuos con diabetes mellitus conducido en ambulatorio de endocrinología del hospital público de Campina Grande, Paraíba. Testes de sensibilidad y percepción del tacto han sido empleados en la evaluación; y ha sido realizado análisis descriptivo y multivariado con regresión de Poisson.

Resultados: Ha sido encontrado prevalencia de la percepción alterada del tacto de 53,1%. Los factores de riesgo que tuvieron impacto de forma significativa y conjunta en su ocurrencia han sido: sexo femenino; úlcera previa; diabetes mellitus tipo 2; irritación, rajaduras, fisuras, callosidades y pies de Charcot.

Conclusiones: Alta prevalencia de la percepción alterada del tacto ha sido encontrada, y esta debe subsidiar el planeamiento de acciones vueltas para la prevención del problema. El estudio evidenció la relevancia del fenómeno en cuanto un diagnóstico de enfermaría pasible de inclusión en la NANDA International.

Descriptores: Percepción del Tato; Neuropatías Diabéticas; Diabetes Mellitus; Factores de Riesgo; Cuidados de Enfermaría

	Altered Touch Perception		p value^* * Bivariate Poisson model; PR = prevalence ratio; 95% CI = 95% confidence interval. **Reference.	PR (95% CI)
	No	Yes		PR (95% CI)
Gender
Male	31 (40.8%)	45 (59.2%)	0.180	1.00
Female	74 (50.0%)	74 (50.0%)		0.84 [0.66; 1.08]
Schooling
Illiterate	6 (27.3%)	16 (72.7%)	-	1.00
Primary	50 (40.0%)	75 (60.0%)	0.199	0.83 [0.61; 1.11]
Secondary	34 (59.6%)	23 (40.4%)	0.005	0.55 [0.37; 0.83]
Higher	15 (75.5%)	5 (25.0%)	0.009	0.34 [0.15; 0.77]
Age
Mean ± Standard Deviation	43.9 ± 19.8	59.8 ± 13.4	< 0.001	1.03 [1.02; 1.03]
Median (minimum - maximum)	47.0 (8 - 91)	62.0 (22 - 88)
Body mass index
Mean ± Standard Deviation	27.3 ± 5.6	29.7 ± 5.5	< 0.001	1.03 [1.01; 1.05]
Median (minimum - maximum)	27.0 (15.1 - 46.3)	28.8 (18.1 - 50.3)
Abdominal circumference
Mean ± Standard Deviation	92.9 ± 15.4	101.0 ± 12.4	< 0.001	1.02 [1.01; 1.03]
Median (minimum - maximum)	95.0 (56 - 148)	99 (70 - 148)
Systolic blood pressure
Mean ± Standard Deviation	125.8 ± 21.5	135.9 ± 24.3	< 0.001	1.01 [1.00; 1.01]
Median (minimum - maximum)	120 (80 - 200)	130 (90 - 220)
Systemic arterial hypertension
No	53 (60.9%)	34 (39.1%)	0.002	1.00
Yes	52 (38.0%)	85 (62.0%)		1.59 [1.18; 2.13]
Smoking
Never smoker	69 (53.1%)	61 (46.9%)	0.027	1.00
Smoker / ex-smoker	36 (38.3%)	58 (61.7%)		1.31 [1.03; 1.68]
Type of diabetes
Type 1	36 (80.0%)	9 (20.0%)	< 0.001	1.00
Type 2	69 (38.5%)	110 (61.5%)		3.07 [1.69; 5.58]
Diagnostic time
Mean ± Standard Deviation	9.0 ± 7.6	12.8 ± 9.0	< 0.001	1.02 [1.01; 1.04]
Median (minimum - maximum)	8.0 (0 - 46)	10.0 (0 - 45)
Glycated hemoglobin
Mean ± Standard Deviation	8.3 ± 1.3	8.8 ± 2.0	0.031	1.92 [1.85; 1.99]
Median (minimum - maximum)	8.4 (5.5 - 12.2)	8.4 (5.1 - 15.8)
Diabetes complications
No	85 (53.5%)	74 (46.5%)	< 0.001	1.00
Yes	20 (30.8%)	45 (69.2%)		1.49 [1.18; 1.88]

	Altered Touch Perception		p value^* * Bivariate Poisson model; PR = prevalence ratio; 95% CI = 95% confidence interval.	PR (95% CI)
	No	Yes		PR (95% CI)
injured feet without noticing
No	99 (52.7%)	89 (47.3%)	< 0.001	1.00
Yes	6 (16.7%)	30 (83.3%)		1.76 [1.43; 2.17]
Previous ulcer
No	97 (52.4%)	88 (47.6%)	< 0.001	1.00
Yes	8 (20.5%)	31 (79.5%)		1.67 [1.34; 2.08]
Prayer sign
No	74 (54.8%)	61 (45.2%)	0.003	1.00
Yes	31 (34.8%)	58 (65.2%)		1.44 [1.13; 1.83]
Numbness
No	63 (54.8%)	52 (45.2%)	0.016	1.00
Yes	42 (38.5%)	67 (61.5%)		1.36 [1.06; 1.75]
Burning sensation
No	79 (56.0%)	62 (44.0%)	< 0.001	1.00
Yes	26 (31.3%)	57 (68.7%)		1.56 [1.23; 1.98]
Fatigue
No	55 (57.3%)	41 (42.7%)	0.010	1.00
Yes	50 (39.1%)	78 (60.9%)		1.43 [1.09; 1.87]
Claudication
No	77 (52.4%)	70 (47.6%)	0.018	1.00
Yes	28 (36.4%)	49 (63.6%)		1.34 [1.05; 1.70]
Loss of motor strength
No	84 (51.2%)	80 (48.8%)	0.021	1.00
Yes	21 (35.0%)	39 (65.0%)		1.33 [1.04; 1.70]
Dry skin
No	25 (83.3%)	5 (16.7%)	0.002	1.00
Yes	80 (41.2%)	114 (58.8%)		3.53 [1.57; 7.93]
Cracks and fissures
No	53 (69.7%)	23 (30.3%)	< 0.001	1.00
Yes	52 (35.1%)	96 (64.9%)		2.14 [1.49; 3.08]
Interdigital mycosis
No	93 (51.1%)	89 (48.9%)	0.002	1.00
Yes	12 (28.6%)	30 (71.4%)		1.46 [1.15; 1.86]
Nail fungus
No	60 (66.7%)	30 (33.3%)	< 0.001	1.00
Yes	45 (33.6%)	89 (66.4%)		1.99 [1.45; 2.73]
Absent hair
No	79 (52.7%)	71 (47.3%)	0.010	1.00
Yes	26 (35.1%)	48 (64.9%)		1.37 [1.08; 1.74]

	Altered Touch Perception		p value^* * Bivariate Poisson model; PR = prevalence ratio; 95% CI = 95% confidence interval.	PR (95% CI)
	No	Yes		PR (95% CI)
Cyanosis
No	95 (51.4%)	90 (48.6%)	< 0.001	1.00
Yes	10 (25.6%)	29 (74.4%)		1.53 [1.21; 1.94]
Calluses
No	65 (65.7%)	34 (34.3%)	< 0.001	1.00
Proprioception loss
No	87 (52.7%)	78 (47.3%)	< 0.001	1.00
Yes	18 (30.5%)	41 (69.5%)		1.47 [1.16; 1.86]
Subcutaneous hemorrhage
No	103 (49.0%)	107 (51.0%)	< 0.001	1.00
Yes	2 (14.3%)	12 (85.7%)		1.68 [1.31; 2.16]
Claw toes
No	95 (50.0%)	95 (50.0%)	0.009	1.00
Yes	10 (29.4%)	24 (70.6%)		1.41 [1.09; 1.83]
Charcot foot
No	105 (47.9%)	114 (52.1%)	< 0.001	1.00
Yes	0 (0.0%)	5 (100.0%)		1.92 [1.69; 2.18]
Overlapping toes
No	83 (51.6%)	78 (48.4%)	0.017	1.00
Yes	22 (34.9%)	41 (65.1%)		1.34 [1.05; 1.71]
Hammer toes
No	95 (52.2%)	87 (47.8%)	< 0.001	1.00
Yes	10 (23.8%)	32 (76.2%)		1.59 [1.27; 2.00]
Right foot posterior tibial pulse
No	6 (22.2%)	21 (77.8%)	< 0.001	1.00
Yes	99 (50.3%)	98 (49.7%)		0.64 [0.50; 0.82]
Left foot posterior tibial pulse
No	7 (28.0%)	18 (72.0%)	0.015	1.00
Yes	98 (49.2%)	101 (50.8%)		0.70 [0.53; 0.93]

	p value^* * Multivariate Poisson model; PR = prevalence ratio; 95% CI = 95% confidence interval p value Statistics Deviance = 0.999.	PR (95% CI)
Gender
Male	0.019	1.00
Female		0.77 [0.62; 0.96]
Type of diabetes
Type 1	0.002	1.00
Type 2		2.36 [1.37; 4.06]
Previous ulcer
No	< 0.001	1.00
Yes		1.43 [1.15; 1.77]
Burning sensation
No	0.003	1.00
Yes		1.39 [1.12; 1.74]
Cracks and fissures
No	0.017	1.00
Yes		1.56 [1.08; 2.25]
Calluses
No	0.033	1.00
Yes		1.39 [1.03; 1.87]
Chacort Foot
No	0.019	1.00
Yes		1.66 [1.09; 2.53]

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[TFN1] Notes:

[TFN2] ^*
Bivariate Poisson model; PR = prevalence ratio; 95% CI = 95% confidence interval. **Reference.