Implementation of physiotherapeutic shares in the prevention of diabetes complications in a Family Health Strategy

Introduction In the Family Health Strategy (FHS), the treatment of Diabetes Mellitus (DM) includes education and lifestyle change strategies. Physiotherapists have a key role in this health setting. Objectives To implement actions of evaluation and guidelines for patients with type 2 DM who attend a Family Health Strategy (FHS), regarding diabetic foot and the practice of regular physical exercise in the control and prevention of the complications of Diabetes Mellitus. Methods 17 individuals from an FHS were evaluated, with the following procedures: clinical and anthropometric parameters, inspection, a questionnaire on diabetic neuropathy, tests of vibratory and tactile sensitivity, muscle function, range of motion, functional analysis, questions about exercise practice and guidance regarding controlling blood glucose and foot care. Results Deformities, dry skin, calluses, dehydration, ulceration, cracking and brittle nails were found. Peripheral neuropathy was not observed; tactile sensitivity was altered in the heel region and the vibratory sense was absent in 5% of individuals. A decrease in functionality of ankle movements was verified. Of the participants, 76% were sedentary, 24% knew about the benefits of practicing regular exercise, 25% had undergone a medical evaluation prior to performing physical exercise and, of these, 25% were supervised by a qualified professional. Discussion The implementation of physiotherapy actions in diabetics from an FHS was important for highlighting the presence of risk factors for diabetic complications. Conclusions Individuals attending the FHS need more information and programs for the prevention of diabetic complications.引言 家庭健康策略（Family Health Strategy, FHS）框架下，糖尿病（Diabetes Mellitus, DM）的临床管理包含健康教育与生活方式干预策略。物理治疗师在该医疗场景中承担核心职能。 研究目的 针对就诊于家庭健康策略（FHS）的2型糖尿病（type 2 DM）患者，围绕糖尿病足（diabetic foot）、规律体育运动在糖尿病并发症防控中的实践，开展评估与指导相关工作。 研究方法 纳入17名来自家庭健康策略机构的受试者，通过以下流程开展评估：临床与人体测量学参数检测、足部视诊、糖尿病周围神经病变（diabetic neuropathy）调查问卷、振动觉与触觉灵敏度测试、肌肉功能评估、关节活动度（range of motion）测量、功能分析、运动习惯相关问题调研，以及血糖控制与足部护理相关指导咨询。 研究结果 本次研究检出足部畸形、皮肤干燥、胼胝、足部脱水、溃疡、皲裂及甲质脆化等异常表现。未观察到周围神经病变；5%的受试者足跟区域触觉灵敏度异常，且振动觉缺失。踝关节活动功能出现减退。受试者中76%为久坐不动人群，24%知晓规律运动的健康获益，25%在开展体育运动前接受过医学评估，其中25%的受试者获得了专业资质人员的运动指导。 讨论 在家庭健康策略机构内针对糖尿病患者实施物理治疗相关行动，有助于明确糖尿病并发症相关危险因素的存在情况。 结论 就诊于家庭健康策略机构的糖尿病患者亟需更多糖尿病并发症防控相关的健康教育与干预项目。