Representações identitárias, representações sociais da alimentação das pessoas com diabetes mellitus tipo 2: implicações no controle glicêmico

Abstract

Type 2 mellitus diabetes (DM 2) is a chronic disease characterized by inadequate insulin levels resulting in hyperglycemia. In order to reduce glucose levels and avoid the complications of the disease, self-carepractices are adopted as healthy eating, exercise and medication. Self-care actions are not an easy task for most people with DM2. Once the disease is discovered people usually experience identity disruptionsand changes in behavior especially regarding food. The identification of the limiting aspects and the unique way people articulate the different aspects that lead to self-care and self-control is favored by the knowledge of the subjectivity and the meaning attributed to illness. One way to deepen our understanding on the subjective view of people with type 2 diabetes is to search for their social representations. Social representations provide the relatively stable cognitive structures that contribute to the definition of identity. From this perspective, social representations can be understood as identity representations, a dynamic phenomenon composed of both the representation of the self and of the groups. The social representations focused in this study are those shared by people with type 2 diabetes and are related to the objects in their environment, their social identity and their eating habits. This study examined the relationship between identity and social representations in the diet of people with DM2 and their glycemicself-control. We used socio-demographic, clinical, anthropometric and biochemical data from 34 patients with type 2 diabetes in a primary care unit in Belo Horizonte, Minas Gerais, Brazil. We used the techniqueof free association of words with explanations of issues relating to the identity and eating habits. The speeches were recorded, transcribed, categorized and interpreted according to the content categorical analysis technique. The theoretical framework were the theories of social representation and identity representation as well as identity processes. To analyze the relationship between the identity and social representations in feeding practices and glycemic control, we used the values of glycated hemoglobin. The interactions mediated by identity processes, social comparison, social attribution and categorization,provided the social construction of identity representations. The participants of the study were classified according to four categories, normal, accepting the disease, a life with difficulties and discontent. The normal participants declared that they eat healthy, eat little, eat vegetables and avoid candies. This group has positive attitudes towards health with healthy eating habits which contributes to normal blood glucose. Do not eat too much, not eating whatever food and avoiding candies is the way in which participants of the group accepting the disease represents their feeding habits. They have hope in that health care professionals and God would cure their type 2 diabetes. This attitude of non-responsibility for their health leads to inadequate eating habits causing the loss of glycemic control in this group. The group categorized as having difficulties represents their feeding habits as not eating whatever food, not eating much, not following the diet and eating vegetables and fruits. The behavior of this group results in poor glycemic control. Participants in the discontent group report not eating much, not eating whatever food and eating vegetables and fruits. They are guided by unfavorable and negative attitudes, by the difficulties in accepting the DM2, and by dietary restrictions that lead to unhealthy eating practices and the consequent loss of glycemic control. Some participants accepting the disease, and some having difficulties have normal blood glucose because they keep healthy food practices. The identity and social representations in feeding practices may produce healthy or unhealthy eating habits, which may affect the glycemic control of the participants. This study draws attention to the fact that the obstacles encountered by patients in their self-care should be taken into account by the multidisciplinary health team engaged in primary health care.