O desenvolvimento da neuropatia periférica no Diabetes Mellitus tipo 2 e suas relações com o sofrimento emocional, autocuidado, itinerário terapêutico e educação em saúde.

Abstract

Introduction: Type 2 Diabetes Mellitus (T2DM) is a highly prevalent chronic metabolic disease, accounting for approximately 90% of diabetes cases. Its symptoms are often mild or absent, contributing to late diagnosis and the development of complications such as diabetic peripheral neuropathy, considered the most frequent and concerning chronic complication. This condition causes sensory and motor changes, increasing the risk of foot ulcers and lower-limb amputations. In the Brazilian context, these outcomes represent a significant public health problem, with high hospitalization rates and substantial costs to the health system. Amputations lead to significant physical, social, and emotional impacts, including changes in self-image, social isolation, and psychological distress. Health education, combined with the promotion of self-care, is a key strategy for preventing neuropathy and foot injuries, with the potential to significantly reduce the risk of amputations. From this perspective, the therapeutic itinerary allows for understanding the meanings individuals attribute to the illness process and care practices, considering biomedical, popular, and cultural knowledge. In this context, the present study aims to discuss the interfaces between therapeutic itinerary, depression, anxiety, self-care, and health education in the development of peripheral neuropathy in individuals with T2DM. Objective: To analyze the relationships established between therapeutic itinerary, depression, anxiety, self-care, and health education in the development of peripheral neuropathy in individuals with T2DM. MANUSCRIPT 1: Objective: To investigate the association between dimensions of diabetes self-care, diabetes-related emotional distress, and sociodemographic variables in patients with amputations through bivariate and multivariate analyses. Method: A quantitative, observational, cross-sectional study conducted in a specialized secondary healthcare service in the countryside of Rio Grande do Sul, Brazil. Participants included individuals with peripheral neuropathy resulting from T2DM and a history of amputations. Sociodemographic data were collected, and the validated Brazilian versions of the B-PAID (Problem Areas in Diabetes) scale were used to assess diabetes-related emotional distress, along with the QAD (Diabetes Self-Care Activities Questionnaire) to assess adherence to self-care activities. Results: The sample was predominantly male (78%), aged between 60 and 69 years (36.6%), and had low educational levels (85.4%). Regarding amputations, 39% had undergone one amputation, 31.7% two, and 29.3% three or more. In bivariate analyses, the dimensions of general diet (r = -0.423) and physical activity (r = -0.207) showed significant associations. However, after adjusting for sex, number of amputations, age, and education level, no QAD dimension remained associated with B-PAID scores. Conclusions: Emotional distress in individuals with Diabetes Mellitus is multifactorial and cannot be associated solely with self-care. Sociodemographic, clinical, and psychosocial factors must be considered. Prevention and care strategies should adopt comprehensive, multiprofessional approaches. MANUSCRIPT 2: Objective: This study aimed to understand how emotional distress, self-care practices, health education, and therapeutic itinerary are articulated in the experiences of individuals with T2DM and peripheral neuropathy. Method: This is a qualitative study grounded in Spink’s Meaning Production framework, combined with the application of the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) to 10 participants; five of them also participated in semi-structured interviews. Results and Discussion: Results indicated minimal or mild levels of anxiety and minimal to moderate depressive symptoms. Qualitative analysis was structured into three categories: naturalization of risks and trivialization of bodily signs; work as the organizing axis of life and competing with care; and fragmented circulation within the health system associated with prescriptive health education. Conclusion: Self-care cannot be understood as an individualized process, as it is influenced by emotional distress, social conditions, and the organization of health services. Addressing T2DM complications requires not only clinical management but also consideration of the subjective and sociocultural dimensions of the health–disease process.