Diabetes: táticas e tecnologias para o controle adequado – Blog Famara

Não é novidade para ninguém: o Brasil vivencia uma das piores crises econômicas da sua história. Uma das consequências inevitáveis desse processo é o atual recorde de 14 milhões de desempregados. Mas outro problemão ronda o país e passa um tanto despercebido. Esse mesmo número de 14 milhões é a quantidade de brasileiros com diabetes, quadro marcado por dificuldades no controle dos níveis de açúcar no sangue. Com um detalhe bem sórdido nessa estatística: metade dessas pessoas nunca recebeu o diagnóstico e segue a vida como se nada tivesse acontecido.

Falta de acesso à informação e a ausência de políticas públicas robustas impedem que muitos saibam de sua condição e iniciem o tratamento adequado. “Todos os indivíduos com mais de 40 anos e aqueles que são hipertensos, estão acima do peso ou possuem histórico familiar de diabetes deveriam verificar a glicemia regularmente”, diz o clínico geral Augusto Pimazoni-Netto, do Hospital do Rim da Universidade Federal de São Paulo.

No exame de sangue, resultados superiores a 100 miligramas por decilitro (mg/dl) após jejum de oito horas já preocupam. Se eles ultrapassam os 126 mg/dl, o diabetes está praticamente confirmado. É necessário ratificar os achados por outros métodos, como o teste de tolerância à glicose, que envolve beber um líquido açucarado e ver como o corpo reage, e a hemoglobina glicada, uma média dessas taxas nos últimos três meses.

A partir do momento em que ela é detectada, o médico prescreve remédios e propõe mudanças no estilo de vida – tudo com o objetivo de manter a glicose na meta. Para acompanhar e corrigir desvios de rota, é importante vigiar de perto o sobe e desce do açúcar. Isso geralmente é realizado por meio de um furo na ponta do dedo e uma gota de sangue. O glicosímetro, um aparelhinho portátil, é capaz de fazer a análise desse material em questão de minutos.

Diversos estudos demonstram que o controle rígido evita encrencas bastante comuns. Uma pesquisa da australiana Universidade de Sydney, publicada no reputado periódico The Lancet, reuniu dados de 27 mil diabéticos e concluiu que a monitorização constante diminui em 20% o risco de danos aos rins e em 13% as lesões oculares, duas temidas repercussões da doença.

Mas quantas vezes ao dia o indivíduo deveria repetir a picada no dedo em casa? Não existe uma fórmula mágica. Em linhas gerais, quando o diabetes (seja o tipo 1, seja o tipo 2) exige tratamento com insulina, se recomenda checar até sete vezes ao longo das 24 horas: antes e depois das refeições e inclusive na madrugada. “Nos diabéticos do tipo 2 que usam medicações orais e estão com a condição balanceada, não há recomendação de medidas tão fixas”, afirma o médico Airton Golbert, da Sociedade Brasileira de Endocrinologia e Metabologia. Só não dá pra se esquecer de conferir de tempos em tempos.

Mas a estreia de uma nova tecnologia vem mudando pra valer a forma como o diabetes pode ser acompanhado. O Free-Style Libre, da Abbott, inaugurou a categoria dos sistemas de monitorização contínua da glicemia. Em vez de furos nos dedos, o diabético gruda um sensor do tamanho de uma moeda de 1 real na parte traseira do braço, que fica ali por 14 dias seguidos.

Caso ele queira saber a taxa, basta aproximar ao sensor um dispositivo parecido com um celular, que aponta o saldo na tela. Mais do que isso, o apetrecho, vendido há cerca de um ano por aqui, indica a tendência de queda ou alta do açúcar nas próximas horas, o que ajuda a evitar quadros de excesso ou falta de glicose, as famigeradas hiper e hipoglicemia.

Estudos vêm mapeando como a novidade traz vantagens na prática. A análise de 50 mil usuários revela um acréscimo de quase cinco horas no tempo de permanência dentro da faixa ideal de glicemia estabelecida. “Eles ainda checam a glicose 16 vezes ao dia, número muito superior ao que vemos normalmente”, observa Sandro Rodrigues, gerente da Divisão de Cuidados para Diabetes da Abbott Brasil.

Analisar de perto as curvas glicêmicas do diabético – especialmente o tipo 1 e o tipo 2 que demanda insulina – é o sonho de qualquer profissional de saúde. Isso permite flagrar alterações que antes eram imperceptíveis. “Vamos imaginar dois sujeitos com uma média de glicemia de 120 mg/dl no dia, que é um valor bom. Um deles tem variação de 110 a 130 mg/dl e outro de 30 a 300 mg/dl.

Qual deles está realmente controlado?”, questiona o endocrinologista Carlos Eduardo Barra Couri, da Universidade de São Paulo em Ribeirão Preto. Em outras palavras, por mais que o valor mediano esteja ok – como até acusa o exame de hemoglobina glicada -, a inconstância provoca estresse no organismo e leva a uma série de encrencas.

Detalhe: na maioria das vezes, essas subidas e descidas não dão sintoma algum! E olha que a hipoglicemia pode desembocar em desmaios, coma e até morte súbita. A hiperglicemia, por sua vez, lesa os vasos sanguíneos, propiciando, com o tempo, cegueira, falência dos rins, infarto e AVC. “O diabetes não é uma doença que se sente, mas uma doença que se mede”, sentencia Couri.

A diabetes no mundo high tech

O FreeStyle Libre é pioneiro em um segmento que vai se expandir nos próximos anos. Várias empresas estão trabalhando em suas versões. É o caso da americana GlySens Incorporated. Eles desenvolveram um sensor implantado debaixo da pele que dura até 12 meses.

As pesquisas com seres humanos estão em andamento e, por enquanto, não há previsão de lançamento. Outra opção vem da Dexcom, também dos Estados Unidos. O invento deles apresentou boas performances em testes iniciais.

Até os clássicos glicosímetros foram repaginados e ficaram mais modernos. A Johnson & Johnson, por exemplo, acaba de disponibilizar um aparelho que trabalha com um sistema de cores: o visor fica verde se o valor estiver nos limites, vermelho quando se mostra acima e azul quando fica abaixo. É possível personalizar as metas de acordo com cada perfil. “Essa inovação possibilita ao usuário entender melhor o significado daqueles dados”, explica Manoela Cordeiro, gerente de produto da companhia.

Há ainda aplicativos de celular disponíveis que facilitam a vida de quem tem o sangue adocicado. Alguns calculam o carboidrato ingerido durante a refeição e a dose de insulina a ser injetada. “Muitos trazem informações relevantes e auxiliam, desde que tenham o aval do especialista que faz o seguimento”, pondera o endocrinologista Luiz Turatti, presidente da Sociedade Brasileira de Diabetes.

Não tem volta: a tecnologia vai mudar muita coisa no controle dessa condição. Mas nunca vai substituir o contato entre médico e paciente. Essa parceria e a adesão ao plano proposto continuarão determinantes para o sucesso do tratamento.

 

A escalada do açúcar no sangue

Ficar no intervalo seguro de glicemia minimiza várias enrascadas

Hipoglicemia

Abaixo de 70 mg/dl. Desmaio, náusea, fraqueza, coma e morte súbita.

Faixa normal

Entre 70 e 140 mg/dl.

Hiperglicemia

Acima de 140 mg/dl. Doenças cardíacas, renais, oculares e neurológicas.

 

Medidas extras

Outras avaliações são essenciais para se adiantar às complicações

Perfil lipídico

É comum que diabéticos tenham colesterol alto, o que eleva o risco de panes cardiovasculares.

Função renal e hepática

O aumento de certas partículas sinaliza que algo não vai bem no fígado ou nos rins. É pra ficar atento!

Fundo de olho

Tem o objetivo de ver se está tudo bem na retina e antecipar danos à visão, como a retinopatia.

Avaliação neurológica

Realizada por meio de questionários no consultório, observa se o sistema nervoso não foi afetado.

Exame dos pés

Esquadrinha a pele para ver frieiras e feridas, que infeccionam e podem até exigir amputação.

 

Fonte: Saúde Abril

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CommScope intends to list its common stock on the Nasdaqunder the symbol “COMM”. JPMorgan, Deutsche Bank Securities andBofA Merrill Lynch are the lead underwriters to the offering. (Reporting by Aman Shah in Bangalore; Editing by Maju Samuel)

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