Amparito Del Rocio Vintimilla Castro

Diabetes Mellitus, with its acute and chronic complications, is considered a public health issue which compromises the productivity, quality of life and the individual survival, involving high costs for its control and therapeutic. The lack of material supply leads to the practice of reusing the discarded syringes in the insulin application. A study aiming at describing socio-demographic characteristics of the population, evaluating the practice of insulin application, analyzing the practice of the reuse, describing the most frequent alterations in the site of the application and associating these alterations with the size of the needle and the number of doses of daily fixed insulin between patients who reused the syringes and the ones who did not reuse them and associate the most frequent alterations in the site with the number of reuses, was performed in order to better know this practice. The study is comparative, analytical, transversal with a quantitative approach, and it was developed at the diabetes outpatient, Childs Institute, Clinics Hospital, School of Medicine, University of São Paulo. The population was composed by 199 patients who were divided into two groups; Group A was composed by the ones that reused the syringes and Group B were the ones that did not reuse the syringes. The comparison of age, time of disease and family income medians between the groups was possible with the Mann-Whitney non parametric test. The nodules and lipohypertrophies were compared with Fisher test and the Chi-Square (2) test was used to associate the size of the needle and daily fixed insulin. The significance level of 5% was adopted in the statistical analysis. The female gender was predominant with 65.3%, majority of which comes from the city of São Paulo (53.8%). The average age was 11 years from Group A, and 9 years from Group B. A number of 51.3% of the patients had regular background and 40.2% of the responsible ones had an incomplete background, and the predominant average income family was from 1 to 2 minimum salaries 48.8%. The preference for the syringe with coupled needle was of 75.9%, bought at drugstores (65.3%) with monthly expenses between R$ 20 and R$ 79 (82.4%). A percentage of 55.8% of the patients self-applies the insulin, prefer the alcohol from supermarkets in order to decontaminate the cover of the bottle (58.3%) and perform the antisepsis of the skin (57.3%). They wash their hands before the preparation and the insulin application (97.5%). The preferable places to apply the insulin were the arms (92%) and the thighs (82%), and there was a mean of three applications in the same place in one week. The common strategy to reuse the syringe was the recap without a previous cleaning (60.1%), keep inside (50.4%) or outside the refrigerator (49.7%) in a closed recipient (64.7%). The pain (39.2%) and other motives were the cause for changing the syringe (38.6%). The hospital was the main site responsible for orienting the reuse in 52.3% and the nurse in 34.6%. The most reported place for complications was the arm due to the presence of nodules (61.3%) and lipohypertrophies (52.8%). There was neither statistical association of these complications between Groups A and B nor relation of the size of the needle and number of daily fixed insulin. There was also no statistical association between the number of reusing with nodules (p=0.185) and lipohypertrophies (p=0.841). The results of this research corroborate with the results of the literature, which point out the low evidence of risks of complications by the practice of reuse. Other investigations involving greater number of patients are necessary.

"Reutilização de seringas descartáveis para aplicação de insulina: uma prática comum no domicílio de pacientes com diabetes Mellitus" / Reuse of discarded syringes in the insulin application: A common practice in the residence of patients with diabetes mellitus

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