Efeito do ILIB transcutâneo na perfusão tissular periférica de pessoas com diabetes mellitus tipo 2: Um estudo quase experimental

Abstract

This study aimed to evaluate the effect of transcutaneous Intravascular Laser Irradiation of Blood (ILIB) photobiomodulation therapy on the peripheral circulation of people with type 2 diabetes mellitus (DM2) who have a nursing diagnosis of Ineffective Peripheral Tissue Perfusion (IPTP). This is a quasi-experimental study, conducted in four primary health care units with 20 people with DM2, diagnosed with IPTP and without contraindications for transcutaneous ILIB therapy. Before the start of the interventions, a questionnaire was applied to characterize the sociodemographic and clinical characteristics of the participants. The intervention consisted of applying transcutaneous ILIB to the vascular bundle in the radial artery region, in 25-minute sessions, performed daily for ten days, with a two-day break at the weekend. At the end of the 10 sessions, there was a 23-day break before repeating the protocol, totaling two intervention cycles. In each cycle, on the first and tenth day, instruments were applied to assess the diagnosis of PTPI, screen for diabetic neuropathy, and evaluate the nursing outcome of NOC (Peripheral Tissue Perfusion). On the fifth day, a new assessment of the NOC outcome was performed. Descriptive statistical analysis of sociodemographic and clinical variables was conducted. McNemar's exact test was used to assess NANDA-I and neuropathy; Friedman's test with Dunn's post-hoc test and Bonferroni correction for the NOC outcome; Wilcoxon test for inter-cycle comparisons; and paired t-test for daily parameters. The research was approved by the Research Ethics Committee. The sample was composed mainly of women (70%), adults (55%), with a mean age of 57 years and a DM2 diagnosis time equal to or greater than 10 years (55%). In the integrated intra-cycle and inter-cycle analysis of the defining characteristics of the PTPI diagnosis, a favorable response to the intervention was observed, with a reduction in the following defining characteristics: cold extremities, extremity pain, paresthesia, extremity sweating, altered motor function, and intermittent claudication, as well as an associated condition, dyslipidemia. In the intra-cycle analysis of the NOC result, significant overall differences were observed in the systolic blood pressure of the right upper limb (RUL) and left upper limb (LUL), in the pedal pulse strength in the left lower limb (LLL), and in the mean arterial pressure of the LUL. In the inter-cycle NOC evaluation, significant differences were identified in the diastolic blood pressure indicators of the RUL and skin rupture of the LLL, both with a large magnitude of effect. In the daily follow-up, in cycle 1 there was a significant increase in peripheral oxygen saturation of the LLL and a reduction in arterial pulse in the right and left lower limbs. In cycle 2, a significant reduction in diastolic blood pressure of the RUL and arterial pulse of the right and LLL was identified. Although not statistically significant, a reduction in cases suggestive of neuropathy was observed in diabetic neuropathy screening, along with improvement in circulatory deficit and generalized asthenia. The findings suggest that transcutaneous ILIB may act as a safe adjuvant therapy, with the potential to improve peripheral tissue perfusion in people with type 2 diabetes, contributing to clinical management and the prevention of peripheral vascular complications.