成人2型糖尿病住院患者低血糖管理及预防的最佳证据总结
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摘要
目的检索和分析成人2型糖尿病住院患者低血糖管理及预防的相关证据,并对最佳证据进行总结。方法计算机检索Up To Date、JBI循证卫生保健数据库、美国指南网(NGC)、加拿大安大略注册护士协会(RNAO)、苏格兰校际指南网(SIGN)、Cochrane Library、PubMed、CINAHL数据库、NICE、中国知网、中国生物医学文献数据库(CBM)等数据库中关于成人2型糖尿病住院患者低血糖的指南、证据总结(ES)、推荐实践(RP)、系统评价(SR)。结果共纳入11篇文献,其中指南1篇、证据总结4篇、推荐实践4篇、系统评价2篇。最终形成最佳证据21条,包括识别、危险因素、应急处理、后续管理、预防、健康教育、心理护理等7个方面。结论本研究所遴选的低血糖管理及预防的证据总结内容较为全面具体,医务人员可基于此建立低血糖评估表、更新应急处理流程和规范实践标准以减少和预防低血糖的发生,确保患者安全。
Objective To retrieve and analyze the available evidence about hypoglycemia management and prevention among the hospitalized type 2 diabetes mellitus patients and summarize the best available evidences.Methods We searched up to date, Joanna Briggs institute library, national guideline clearinghouse, registered nurses' qssociation of Ontario, Scottish Intercollegiate Guideline Network(SIGN), Cochrane Library, PubMed, CINAHL,and CNKI,NICE, CBM to collect literatures including guideline, evidence summary, best practice information sheet, recommended practice, systematic review and original research related to this study.Results 11 references were selected including 1 guidelines, 4 evidence summaries, 4 recommended practices, 2 systematic reviews.Finally, 21 items of best evidence concerning seven aspects were summarized,including identification, risk factor, emergency processing, follow-up management, prevention, education, mental nursing.Conclusion The evidence summary of the hypoglycemia management and prevention in this study is relatively comprehensive and unambiguous. Thus, medical staff can establish a hypoglycemia assessment form, emergency treatment procedures and standard practice standards to reduce and prevent the occurrence of hypoglycemia and ensure patients safety.
Objective To retrieve and analyze the available evidence about hypoglycemia management and prevention among the hospitalized type 2 diabetes mellitus patients and summarize the best available evidences.Methods We searched up to date, Joanna Briggs institute library, national guideline clearinghouse, registered nurses' qssociation of Ontario, Scottish Intercollegiate Guideline Network(SIGN), Cochrane Library, PubMed, CINAHL,and CNKI,NICE, CBM to collect literatures including guideline, evidence summary, best practice information sheet, recommended practice, systematic review and original research related to this study.Results 11 references were selected including 1 guidelines, 4 evidence summaries, 4 recommended practices, 2 systematic reviews.Finally, 21 items of best evidence concerning seven aspects were summarized,including identification, risk factor, emergency processing, follow-up management, prevention, education, mental nursing.Conclusion The evidence summary of the hypoglycemia management and prevention in this study is relatively comprehensive and unambiguous. Thus, medical staff can establish a hypoglycemia assessment form, emergency treatment procedures and standard practice standards to reduce and prevent the occurrence of hypoglycemia and ensure patients safety.
引文
[1] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-344.
[2] Association Diabetes Association.Standards of medical care in diabetes--2014[J].Diabetes Care,2013,37(Supplement_1):S14-S80.
[3] Edridge C L,Dunkley A J,Bodicoat D H,et al.Prevalence and incidence of hypoglycaemia in 532,542 people with type 2 diabetes on oral therapies and insulin:A systematic review and meta-analysis of population based studies[J].PLoS One,2015,10(6):e126427.
[4] 沈莉莉,张宁.住院糖尿病患者低血糖发病状况分析[J].护理研究,2012,26(13):1212-1213.
[5] 查伍培.糖尿病患者低血糖的原因分析及护理干预[J].糖尿病新世界,2017,20(1):154-155.
[6] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):81-117.
[7] 冯晨秋,杨晶,赵芳.对北京五家三甲医院内分泌科医务人员低血糖护理流程的知晓情况现状调查[J].中华现代护理杂志,2017,23(13):1749-1752.
[8] 左红霞,牛玉明,程艳丽.循证护理证据资源的检索[J].循证护理,2015,1(4):145-151.
[9] 谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.
[10] Dearholt S L,Dang D.Johns hopkins nursing evidence-based practice:Model and guidelines[M].2nd ed.Indianapolis:Sigma Theta Tau International,2012.
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[12] Chen C,Chang Yeh M.The experiences of diabetics on self-monitoring of blood glucose:A qualitative metasynthesis[J].Journal of Clinical Nursing,2015,24(5-6):614-626.
[13] Bergenstal R M,Klonoff D C,Garg S K,et al.Threshold-based insulin-pump interruption for reduction of hypoglycemia[J].N Engl J Med,2013,369(3):224-232.
[14] Mathisen A L,Aronoff S,Schneider R L,et al.Pioglitazone hydrochloride monotherapy improves glycemic control in the treatment of patients with type 2 diabetes[J].Diabetes Care,2000,23(11):1605.
[15] Kahn S E,Haffner S M.Glycemic durability of rosiglitazone,metformin,or glyburide monotherapy[J].The New England Journal of Medicine,2006(355):2427-2443.
[16] Grimm J J,Ybarra J,Berne C,et al.A new table for prevention of hypoglycaemia during physical activity in type 1 diabetic patients[J].Diabetes Metab,2004,30(5):465-470.
[17] Soo K,Furler S M,Samaras K,et al.Glycemic responses to exercise in IDDM after simple and complex carbohydrate supplementation[J].Diabetes Care,1996,19(6):575-579.
[18] Koivisto V A,Felig P.Effects of leg exercise on insulin absorption in diabetic patients[J].The New England Journal of Medicine,1978,298(2):79-83.
[19] The Joanna Briggs Institute.Standards of medical care in diabetes--2007[J].Diabetes Care,2007,30 (Suppl 1):S4-S41.
[20] Seley J J,Hondt N D,Longo R.AADE position statement diabetes inpatient management[J].The Diabetes Educator,2012,38(1):142-146.
[21] Seaquist E R,Anderson J,Childs B,et al.Hypoglycemia and diabetes:A report of a workgroup of the american diabetes association and the endocrine society[J].The Journal of Clinical Endocrinology & Metabolism,2013,98(5):1845-1859.
[22] Cryer P E.Preventing hypoglycaemia:What is the appropriate glucose alert value?[J].Diabetologia,2009,52(1):35-37.
[23] Klonoff D C.Continuous glucose monitoring:roadmap for 21st century diabetes therapy[J].Diabetes Care,2005,28(5):1231-1239.
[24] Hirsch I B.Realistic expectations and practical use of continuous glucose monitoring for the endocrinologist[J].The Journal of Clinical Endocrinology & Metabolism,2009,94(7):2232-2238.
[25] 张秀英,蒋红,徐雲,等.脑卒中后经口进食困难护理管理的证据总结[J].护士进修杂志,2017,32(17):1539-1543.
[26] Redmon B,Caccamo D.Diagnosis and management of type 2 diabetes mellitus inadults[EB/OL].[2019-01-08].http:www.alabmed.com/uploadfile/2015/1111/20151111071351685.pdf.
[27] Chu W H.Blood Glucose Levels:Self-Monitoring[Z].The Joanna Briggs Institute,2016.
[28] Stephenson M.Diabetes (Type 2):Education[Z].The Joanna Briggs Institutee,2016.
[29] Bellman S.Diabetes:Self-Monitoring Blood Glucose (Experiences)[Z].The Joanna Briggs Institute,2017.
[30] Lizarondo L.Hypoglycemia in diabetes:Management[Z].The Joanna Briggs Institute,2016.
[31] Cryer P E.Hypoglycemia in adults with diabetes mellitus[EB/OL].(2019-01-03)[2019-04-13].https://www.uptodate.com/contents/hypoglycemia-in-adults-with-diabetes-mellitus?search=adult%20type%202%20diabetes%20hypoglycemia &source=search_result&selectedTitle=1～150&usage_type=default&display_rank=1#.
[32] Mcculloch D K.Thiazolidinediones in the treatment of diabetes mellitus[EB/OL].(2017-06-09)[2019-04-13].https://www.uptodate.com/contents/thiazolidinediones-in-the-treatment-of-diabetes-mellitus?search=Management%20of%20hypoglycemia%20during%20treatment%20of%20diabe tes%20%20mellitus&source=search_result&selectedTitle=20～150&usage_type=default&display_rank=20#H27.
[33] Mcculloch D K.Effects of exercise in adults with diabetes mellitus[EB/OL].(2019-03-27)[2019-04-13].https://www.uptodatecom/contents/effects-of-exercise-in-adults-with- diabetes-mellitus?search=Management%20of%20hypogl ycemia%20during%20treatment%20of%20diabetes%20%20mellitus&source=search_result&selectedTitle=18～150&usage_type=default&display_rank=18#H8492005.
[34] Mcculloch D K.Self-monitoring of blood glucose in management of adults with diabetes mellitus[EB/OL].(2018-04-02) [2019-04-13].https://www.uptodate.com/contents/self-monitoring-of-blood-glucose-in-management-of-adults-with-diabetes-mellitus?search=Management%20of%20hypogly cemia%20during%20treatment%20of%20diabetes%20%20mellitus&source=search_result&selectedTitle=80～150&usage_type=default&display_rank=80.
[35] Goldman J,White J J.New insulin glargine 300 U/mL for the treatment of type 1 and type 2 diabetes mellitus[J].Ann Pharmacother,2015,49(10):1153-1161.
[36] Hemmingsen B,Lund S S,Gluud C,et al.Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus[J].Cochrane Database Syst Rev,2013(11):CD008143.
[37] 王青春,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[38] The Action to Control Cardiovascular Risk in Diabetes Study Group.Effects of intensive glucose lowering in type 2 diabetes[J].New England Journal of Medicine,2008,358(24):2545-2559.
[39] Duckworth W,Abraira C,Moritz T,et al.Glucose control and vascular complications in veterans with type 2 diabetes.[J].Journal of Vascular Surgery,2009,49(4):129-139.
[40] Clement S,Braithwaite S S,Magee M F,et al.Management of diabetes and hyperglycemia in hospitals[J].Diabetes Care,2004,27(2):553-591.
[2] Association Diabetes Association.Standards of medical care in diabetes--2014[J].Diabetes Care,2013,37(Supplement_1):S14-S80.
[3] Edridge C L,Dunkley A J,Bodicoat D H,et al.Prevalence and incidence of hypoglycaemia in 532,542 people with type 2 diabetes on oral therapies and insulin:A systematic review and meta-analysis of population based studies[J].PLoS One,2015,10(6):e126427.
[4] 沈莉莉,张宁.住院糖尿病患者低血糖发病状况分析[J].护理研究,2012,26(13):1212-1213.
[5] 查伍培.糖尿病患者低血糖的原因分析及护理干预[J].糖尿病新世界,2017,20(1):154-155.
[6] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):81-117.
[7] 冯晨秋,杨晶,赵芳.对北京五家三甲医院内分泌科医务人员低血糖护理流程的知晓情况现状调查[J].中华现代护理杂志,2017,23(13):1749-1752.
[8] 左红霞,牛玉明,程艳丽.循证护理证据资源的检索[J].循证护理,2015,1(4):145-151.
[9] 谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.
[10] Dearholt S L,Dang D.Johns hopkins nursing evidence-based practice:Model and guidelines[M].2nd ed.Indianapolis:Sigma Theta Tau International,2012.
[11] Stanisstreet D,Walden E,Jones C,et al.The hospital management of hypoglycaemia in adults with diabetesmellitus[EB/OL].[2019-01-08].http://drketandhatariya.com/publications/original_articles/JBDS_-_hypoglycemia.pdf.
[12] Chen C,Chang Yeh M.The experiences of diabetics on self-monitoring of blood glucose:A qualitative metasynthesis[J].Journal of Clinical Nursing,2015,24(5-6):614-626.
[13] Bergenstal R M,Klonoff D C,Garg S K,et al.Threshold-based insulin-pump interruption for reduction of hypoglycemia[J].N Engl J Med,2013,369(3):224-232.
[14] Mathisen A L,Aronoff S,Schneider R L,et al.Pioglitazone hydrochloride monotherapy improves glycemic control in the treatment of patients with type 2 diabetes[J].Diabetes Care,2000,23(11):1605.
[15] Kahn S E,Haffner S M.Glycemic durability of rosiglitazone,metformin,or glyburide monotherapy[J].The New England Journal of Medicine,2006(355):2427-2443.
[16] Grimm J J,Ybarra J,Berne C,et al.A new table for prevention of hypoglycaemia during physical activity in type 1 diabetic patients[J].Diabetes Metab,2004,30(5):465-470.
[17] Soo K,Furler S M,Samaras K,et al.Glycemic responses to exercise in IDDM after simple and complex carbohydrate supplementation[J].Diabetes Care,1996,19(6):575-579.
[18] Koivisto V A,Felig P.Effects of leg exercise on insulin absorption in diabetic patients[J].The New England Journal of Medicine,1978,298(2):79-83.
[19] The Joanna Briggs Institute.Standards of medical care in diabetes--2007[J].Diabetes Care,2007,30 (Suppl 1):S4-S41.
[20] Seley J J,Hondt N D,Longo R.AADE position statement diabetes inpatient management[J].The Diabetes Educator,2012,38(1):142-146.
[21] Seaquist E R,Anderson J,Childs B,et al.Hypoglycemia and diabetes:A report of a workgroup of the american diabetes association and the endocrine society[J].The Journal of Clinical Endocrinology & Metabolism,2013,98(5):1845-1859.
[22] Cryer P E.Preventing hypoglycaemia:What is the appropriate glucose alert value?[J].Diabetologia,2009,52(1):35-37.
[23] Klonoff D C.Continuous glucose monitoring:roadmap for 21st century diabetes therapy[J].Diabetes Care,2005,28(5):1231-1239.
[24] Hirsch I B.Realistic expectations and practical use of continuous glucose monitoring for the endocrinologist[J].The Journal of Clinical Endocrinology & Metabolism,2009,94(7):2232-2238.
[25] 张秀英,蒋红,徐雲,等.脑卒中后经口进食困难护理管理的证据总结[J].护士进修杂志,2017,32(17):1539-1543.
[26] Redmon B,Caccamo D.Diagnosis and management of type 2 diabetes mellitus inadults[EB/OL].[2019-01-08].http:www.alabmed.com/uploadfile/2015/1111/20151111071351685.pdf.
[27] Chu W H.Blood Glucose Levels:Self-Monitoring[Z].The Joanna Briggs Institute,2016.
[28] Stephenson M.Diabetes (Type 2):Education[Z].The Joanna Briggs Institutee,2016.
[29] Bellman S.Diabetes:Self-Monitoring Blood Glucose (Experiences)[Z].The Joanna Briggs Institute,2017.
[30] Lizarondo L.Hypoglycemia in diabetes:Management[Z].The Joanna Briggs Institute,2016.
[31] Cryer P E.Hypoglycemia in adults with diabetes mellitus[EB/OL].(2019-01-03)[2019-04-13].https://www.uptodate.com/contents/hypoglycemia-in-adults-with-diabetes-mellitus?search=adult%20type%202%20diabetes%20hypoglycemia &source=search_result&selectedTitle=1～150&usage_type=default&display_rank=1#.
[32] Mcculloch D K.Thiazolidinediones in the treatment of diabetes mellitus[EB/OL].(2017-06-09)[2019-04-13].https://www.uptodate.com/contents/thiazolidinediones-in-the-treatment-of-diabetes-mellitus?search=Management%20of%20hypoglycemia%20during%20treatment%20of%20diabe tes%20%20mellitus&source=search_result&selectedTitle=20～150&usage_type=default&display_rank=20#H27.
[33] Mcculloch D K.Effects of exercise in adults with diabetes mellitus[EB/OL].(2019-03-27)[2019-04-13].https://www.uptodatecom/contents/effects-of-exercise-in-adults-with- diabetes-mellitus?search=Management%20of%20hypogl ycemia%20during%20treatment%20of%20diabetes%20%20mellitus&source=search_result&selectedTitle=18～150&usage_type=default&display_rank=18#H8492005.
[34] Mcculloch D K.Self-monitoring of blood glucose in management of adults with diabetes mellitus[EB/OL].(2018-04-02) [2019-04-13].https://www.uptodate.com/contents/self-monitoring-of-blood-glucose-in-management-of-adults-with-diabetes-mellitus?search=Management%20of%20hypogly cemia%20during%20treatment%20of%20diabetes%20%20mellitus&source=search_result&selectedTitle=80～150&usage_type=default&display_rank=80.
[35] Goldman J,White J J.New insulin glargine 300 U/mL for the treatment of type 1 and type 2 diabetes mellitus[J].Ann Pharmacother,2015,49(10):1153-1161.
[36] Hemmingsen B,Lund S S,Gluud C,et al.Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus[J].Cochrane Database Syst Rev,2013(11):CD008143.
[37] 王青春,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[38] The Action to Control Cardiovascular Risk in Diabetes Study Group.Effects of intensive glucose lowering in type 2 diabetes[J].New England Journal of Medicine,2008,358(24):2545-2559.
[39] Duckworth W,Abraira C,Moritz T,et al.Glucose control and vascular complications in veterans with type 2 diabetes.[J].Journal of Vascular Surgery,2009,49(4):129-139.
[40] Clement S,Braithwaite S S,Magee M F,et al.Management of diabetes and hyperglycemia in hospitals[J].Diabetes Care,2004,27(2):553-591.