Control metabólico en pacientes diabéticos tipo 1 chilenos: Rol del estrés psicológico. Diabetes tipo 1: Rol del estrés psicológico

Resumen PROPOSITO: Determinar si diferentes dominios del estres psicologico (estres emocional, estres con el medico, estres con el tratamiento y estres interpersonal) predicen el control metabolico de adolescentes diabeticos tipo 1. Identificar si diferentes dominios del estres psicologico predicen la estabilidad del control metabolico. MATERIAL Y METODO: Una muestra no probabilistica e intencionada de 20 adolescentes diabeticos tipo 1 de la ciudad de Temuco (M edad = 15,15, D.S = 3.8) fueron estudiados por 1 ano. Tres mediciones de hemoglobina glicosilada (HbA1c) y autorreportes de estres fueron obtenidos con la Escala de Estres para Diabeticos de Polonski. RESULTADOS: Analisis de regresion multiple jer a rquica identificaron que tanto el estres con el regimen de tratamiento ( R 2 = 0,505) y el estres con el medico ( R 2 = 0,13) predijeron el control metabolico. Analisis de la varianza de medidas repetidas con factores intersujeto, identificaron que el control metabolico asumio una tendencia lineal negativa ( F = 16,208; p ≤ 0,001; h p 2 = 0,503; poder (1 - b ) = 0,965). Diferencias estadisticamente significativas en el control metabolico fueron encontradas entre los adolescentes con alto y bajo estres con el medico ( F = 4,729; p ≤ 0,05; h p 2 = 0,228; poder (1 - b ) = 0,533), y entre los adolescentes con alto y bajo estres con el tratamiento ( F = 9,804; p ≤ 0,01; h p 2 = 0,380; poder (1 - b ) = 0,836). CONCLUSION: Atencion debe ser puesta a los niveles de estres entre adolescentes diabeticos. Diferentes dominios del estres psicologico predijeron trayectorias del control metabolico de adolescentes diabeticos tipo 1. Palabras claves: Estres psicologico, control metabolico, adolescentes diabeticos tipo 1. ABSTRACT. PURPOSE: To determine whether different psychological stress factors ( emotional burden, physician-related distress , regimen-related distres, diabetes-related interpersonal distress) predict the metabolic control of adolescents with type 1 diabetes , and whether these factors predict the metabolic control stability / non-estability. MATERIALS AND METHODS: An intentional sample (n = 20) of type 1 diabetic adolescents was followed-up for a year ( M age = 15.15; S.D = 3.8 ) Three HbA1c exams were performed and a stress self-report was obtained with the Polonsky’ Diabetes Distress Scale. RESULTS: Hierarchical multiple regression identified two factors (regimen-related distress R 2 = 0.505 ; and physician-related distress R 2 = 0.13) predicting the metabolic control. Within subject ANOVA with blocking factors, shows that the metabolic control assumed a negative linear trend ( F = 16,208; p ≤ 0,001; h p 2 = 0,503; power (1 - b ) = 0,965) . There were differences statistically significant in the metabolic control between adolescents with high and low scores on the physician-related distress ( F = 4,729; p ≤ 0,05; h p 2 = 0,228; power (1 - b ) = 0,533) and those with high and low scores on the regimen-related distress factor ( F = 9,804; p ≤ 0,01; h p 2 = 0,380; power (1 - b ) = 0,836). CONCLUSION: Stress levels in type 1 diabetic adolescents deserve attention. Different psychological stress factors predicting metabolic control trajectories in type 1 diabetic adolescents were found. Key words: Psychological stress, metabolic control, type 1 diabetics adolescents.