Diabetic retinopathy (DR) is the most frequent complication of Diabetes mellitus and the
main cause of legal blindness in working populations in industrialized countries.
A diagnosis of diabetes has important implications for individuals, not only for their
health, but also because of the stigma that a diagnosis can bring, i.e., it can affect
employment, quality of life, mental health, social opportunities, and other cultural
aspects. These changes in the lives of diabetics can lead to stress. It is known that
diabetes has a social and family connotation that leads to depression and anxiety
appearing in parallel, which can influence the self-management that people must do in
their daily lives. It is necessary to incorporate and integrate mental health care into
all diabetic care.
Individuals with diabetes have difficulties: diagnosis, adherence to treatment, fear of
complications and hypoglycemia, which can result in suffering, thus making
self-management difficult.
In diabetic patients, the prevalence of symptoms of depression and anxiety is about two
to four times higher than in the general population. Metabolic dysregulation influences
brain function and disturbances in glucose regulation may be associated with depression.
These emotions that arise can be disabling and very strong, leading the individual to
often acquire behaviors that do not help in fighting the disease. There may be changes in
eating behavior, or alcoholic beverages that are not favorable to glycemic control, that
is, glycaemia rises proportionally to the most negative events in life, thus, stress
leads to an increase in corticosteroids and consequently increases glycaemia. It is known
that physical activity can reduce disease rates, namely diabetes, hypertension, obesity,
among others. There are studies that show that physical activity is beneficial, whatever
its intensity. It reduces the admission of chronically ill patients to hospitals, reduces
pain and increases mental health and quality of life. With the development of physical
activity programs applied to chronically ill patients, they are beneficial to promote the
management of their disease, physical and mental health, and reduce the appearance of
other comorbidities. In Diabetes Mellitus, the causes are complex, and its complications
can be prevented with a healthy diet, normal blood glucose, adequate weight, and physical
activity. For health professionals, who deal with these chronically ill patients, they
have a huge challenge, since these people present risk behaviors (unhealthy eating and/or
sedentary lifestyle). To assess the disease, there is glycosylated hemoglobin (HbA1c),
which reflects the average blood glucose. It is used as a risk parameter and considered
the gold standard for assessing glycemic control. The American Diabetes Association (ADA)
sets HbA1c < 7% as the threshold of good control for most people with diabetes. To
improve glycemic control, nutritional monitoring is important. Nutrition education is
considered a preventive and treatment strategy to provide diabetic people with the
necessary tools to face the change in lifestyle and achieve self-management of the
disease. For this, it is necessary to increase knowledge, acquisition of skills, as well
as promote the modification of attitudes and behaviors. It is important to increase
people's active participation in the control and treatment of their disease.
Diabetics should participate in self-care education actions with the body, to improve the
knowledge, skills, and abilities necessary for the self-care of this pathology.
Based on the evidence collected at the EYEMARKER (NCT02500862), CEC/009/17 study
"Characterization of potential biomarkers of Eye Disease and Vision Loss", (ongoing at
AIBILI), and STAR screening program "Development of a Model for Advanced Screening for
Timely Treatment of Age-Related Eye Diseases", CEC/008/16, it was observed from the
beginning the existence of individuals with DM who need clarification and education about
their condition and about the care and behaviors to adopt to have a better management of
their disease and avoid possible complications. With this study, it is intended to
identify, in EYEMARKER patients who also participate in the STAR screening program, which
individuals with Diabetes Mellitus are at greater risk of progression/development of
Diabetic Retinopathy (DR), to better direct health education plans to reduce disease
complications. The identification of patients at higher risk, who will be the target of
health promotion actions, will be done through the "RetinaRisk" mobile phone application.
After this analysis, 27 individuals who are at greater risk will be chosen. Self-care,
knowledge about Diabetes Mellitus disease, emotional state, and metabolic control will be
evaluated, before and after the health education sessions.