AIM:To understand the insulin injection knowledge, attitude and behaviour of nurses and their influencing factors in Guangdong Province.DESIGN:Cross-sectional study.METHODS:A total of 19,853 nurses from 82 hospitals in 15 cities in Guangdong, China, participated in this study. The scores of the nurses' insulin injection knowledge, attitude and behaviour were determined through a questionnaire, and multivariate regression analysis was used to evaluate the influencing factors of insulin injection in different dimensions. STROBE.RESULTS:Among all nurses involved in this study, 22.3% of nurses had good knowledge, 75.9% of nurses had good attitude and 92.7% of nurses had good behaviour. Pearson's correlation analysis showed that knowledge, attitude scores and behaviour scores were significantly correlated. The influencing factors of knowledge, attitude and behaviour included gender, age, education, nurse level, work experience, type of ward, diabetes nursing certification, position held and most recent insulin administration.

Purpose:The relationship between the TIR and mortality may be influenced by the presence of diabetes and other glycemic indicators. The purpose of this study was to investigate the relationship between TIR and in-hospital mortality in diabetic and non-diabetic patients in ICU. Methods:A total of 998 patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9-10.0 mmol/L within 24 h. The relationship between TIR and in-hospital mortality in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. Results:The binary logistic regression model showed that there was a significant association between the TIR and the in-hospital death of severely ill non-diabetic patients. Furthermore, TIR≥70% was significantly associated with in-hospital death (OR = 0.581, P = 0.003). The study found that the coefficient of variation (CV) was significantly associated with the mortality of severely ill diabetic patients (OR = 1.042, P = 0.027). Conclusions:Both diabetic and non-diabetic critically ill patients should control blood glucose fluctuations and maintain blood glucose levels within the target range, it may be beneficial in reducing mortality.

The prevalence of type 2 diabetes, a lifelong progressive disease, is increasing every year, causing it to become a growing public health problem worldwide. Active self-management by patients can slow the development of diabetes and reduce the risk of complications. However, outside of the hospital, in the absence of monitoring by doctors, nurses, etc., patients' self-efficacy in diabetes management is low, and adherence is poor, which seriously affects the effectiveness of diabetes treatment. Objective: The objectives is to investigate the effectiveness of a remote integrated management program based on an integrated health care model in patients with type 2 diabetes mellitus (T2DM). Method: This study utilized its own pre- and postintervention research methodology. Data on sociodemographic characteristics, past disease history, self-management, and laboratory indicators were collected from the study subjects before the intervention. Then, a comprehensive management program (including medical nutrition, exercise, medication, self-monitoring of blood glucose, and health education) using an integrated health care model was used to provide a 3-month teleintervention for the study participants. The main outcome indicator was glycated hemoglobin level; other outcome indicators included self-management behavior, self-efficacy, quality of survival, the results of blood glucose, blood lipid, and urine tests and other indicators. All data were analyzed using SPSS software. Results: A total of 101 study participants with a mean age of 48.46 ± 12.45 years were recruited for this study. The results of pre- and postintervention analyses and comparisons showed that glycated hemoglobin(HbA1c), fasting blood glucose (FBG), 2 h postprandial glucose (2-h PG), total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, and body mass index (BMI) improved in the postintervention period compared with the preintervention period, and the differences were statistically significant (P < 0.05); the self-management behavior scale score, self-efficacy scale score, and quality of survival scale score improved in the postintervention period, and the differences were statistically significant (P < 0.05). Conclusion: Remote integrated management program interventions based on an integrated health care model can improve health outcomes, increase glycemic compliance, and improve self-management behaviors, self-efficacy, and quality of survival in patients with T2DM. This study used a before-and-after controlled study design to provide an interventions for T2DM patients through a 3-month remote integrated management program based on a health care integration model, and assessed the changes in metabolic indices such as HbA1c levels, lipid levels, and self-management behaviors of patients before and after the intervention. The study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2300077466).

对低血糖的危险因素和低血糖风险评估预测模型进行综述,以期为临床预防低血糖事件建立预测模型提供参考.

noxious stressor (infection, trauma, surgery, acute inflammation, ischemia or reperfusion, or cancer, to name a few) to pinpoint and then eradicate the endogenous or external source of the insult. Even while the cytokine storm serves a defence role, it can trigger a huge inflammatory cascade that results in reversible or permanent end-organ failure and even death. Objective: The regulation of glucose levels in ICU patients is intimately connected to the occurrence of SIRS. Also to investigate the effect of glucose management level on the incidence of systemic inflammatory response syndrome (SIRS) in intensive care. Methods: The study was carried out on 200 patients who were admitted to our hospital's intensive care unit (ICU) for treatment. Inclusion and exclusion criteria were recorded. According to their blood glucose control levels, they were separated into 3 groups. After 28 days following ICU admission, differences in serum inflammation level, blood glucose level, SIRS incidence, and death rate were compared. Results: On the first day, there were no considerable variations in HR, RR, or T across the 3 groups. Only on the 7th day statistically significant variations (P<0.05) were observed in group C. Group A's average blood glucose level was substantially reduced than groups B and C. Group A had much greater hypoglycemia than groups B and C. Insulin levels were substantially greater in groups A and B than in group C. Group A had a considerably reduced duration of stay and mechanical ventilation time than groups B and C. CRP, IL-6, TNF-, and insulin levels did not differ significantly between groups A and B. Group C had a considerably higher incidence of SIRS, MODS, and 28-day mortality. Group C had a high prevalence of nosocomial infection than groups A and B, while group B had a higher incidence than group A. The differences were statistically significant (P<0.05), and the logistic results showed that blood glucose levels and insulin dosage were risk factors for SIRS incidence (P0.05). Conclusion: Active control of blood glucose levels in ICU patients is beneficial to reduce the incidence of SIRS, according to the standard range. [Ethiop. J. Health Dev.2022;36(3):00-00]

Diabetic high-risk feet are defined as diabetic patients without active ulcers but with peripheral neuropathy, with or without foot deformity or peripheral arterial disease, or with a history of foot ulcers, or with a history of (or partial) amputation of the lower extremity or foot. The protection direction of high-risk diabetic foot is to control the risk factors of diabetic foot and delay the progression of diabetic foot. This article reviews the definition, identification, and protective measures of diabetic high-risk foot, so as to provide a basis for nursing practice.

对2型糖尿病并发症模型进行综述,对疾病预测模型的发展概况和目前国内外2型糖尿病并发症预测模型相关研究进展进行归纳和展望,以期为未来糖尿病管理工作提供一定的参考.

Diabetic foot is one of the main complications of diabetes with the characteristics of high incidence and difficulty in treatment. Diabetic patients with peripheral neuropathy may develop foot ulcers, and in severe cases amputations are required and some may even die. Plantar pressure can be used to assess the risk of developing diabetic foot, but the existing plantar pressure monitoring methods are not suitable for long-term monitoring in daily life. This study presents a novel low-cost shoe system for daily monitoring of plantar pressure in diabetics. It includes an insole with pressure sensor array, which can dynamically monitor the plantar pressure and display the changes of plantar pressure in real time in the mobile phone to provide early warning for patients with high risk of diabetic foot. As for the sensor, copper and carbon black were adopted as the electrode and conductive filler respectively, enabling a mass production with low price. It was soft and bendable, meeting the performance needs of daily plantar pressure monitoring. All devices were encapsulated in shoes, and the data was transmitted wirelessly through Bluetooth, which did not affect the user's walking. After using random forest for feature selection, five classifiers were used to classify the plantar pressure of healthy people, diabetic patients without peripheral neuropathy, and diabetic patients with peripheral neuropathy collected by this system. The experimental results showed that the accuracy of the random forest classifier was the highest, reaching 94.7%, which indicated that the system could be useful for daily plantar pressure monitoring of diabetic patients.

目的 探讨糖尿病患者病耻感与心理性胰岛素抵抗的现状及其影响因素.方法 2019年2-10月,便利抽样法选取广州市某三级甲等医院住院糖尿病患者170例为研究对象,采用一般资料调查表、慢性疾病患者病耻感评估量表和胰岛素治疗评估量表对其进行调查.结果 糖尿病患者的病耻感得分为(53.38±24.05)分,心理性胰岛素抵抗得分为(63.25±14.79)分.糖尿病患者病耻感水平与心理性胰岛素抵抗呈正相关(P<0.01),多元回归分析显示,病耻感水平、性别、病程、治疗方式、是否接受糖尿病相关教育是糖尿病患者心理性胰岛素抵抗的影响因素(均P<0.05),共解释回归方程总变异的39.1％.结论 糖尿病患者病耻感水平越高,心理性胰岛素抵抗程度越重.医护人员应加强患者的病耻感评估,降低病耻感水平,改善胰岛素治疗态度.

Objective: To identify the effects and related factors of extended nursing management for (1) newly diagnosed diabetes patients, (2) patients admitted with acute complications from diabetes mellitus, and (3) patients with glycated hemoglobin (HbA1c) levels of ≥9.0%, to suggest adjustments to the case continuation care plan. Methods: This study adopted a cohort design. Convenience sampling was used to select diabetes patients hospitalized between October 2017 and March 2019 for the control group, and between April 2019 and September 2019 for the study group. Patients in the control group received routine nursing management, these in the study group were visited by a case manager within 48 hours of admission, the diabetes case management record data sheet was established, and a care plan was constructed according to the evaluation results. One telephone call or WeChat voice conversation (which can be carried out any time and any place) follow-up oc-curred 1, 4, and 12 weeks after discharge from the hospital (the number of follow-up visits was increased according to the needs of individuals), which included home self-care, diet, blood sugar control index, and outpatient review. Results: The HbA1c level was significantly lower in the study group than in the control group (7.18±1.65% vs 8.46±2.02%, mean ± Standard deviation; p< 0.05), as was the cholesterol level (4.57±0.85mmol/L vs 5.24±1.95mmol/L, p< 0.05). The hypoglycemia incidence rates were 10.9% and 23.5% in the study and control groups, respectively, while the rates of HbA1c compliance were47.8% and 40.9%. There were no significant differences between the two groups in the total scores for triglycerides, low-density lipoprotein, uric acid, and pain. Conclusion: Intensive case management can improve the blood glucose levels of diabetes patients, but is not ideal in reducing their pain and or the rate of reaching standard blood glucose levels. After the intensive phase, it is recommended that a case manager continues to manage patients in the life-long maintenance phase, with appropriate alterations to the intensity and frequency of interventions. The Internet should be used for flexible communications with patients, combining empowerment and education to help patients in a timely manner, increasing attention to reducing their distress, and improving blood glucose check-up compliance rates.

总结成本效果分析的内涵及其在应用胰岛素泵治疗病人中的应用研究,并针对成本指标、效果指标、敏感度分析等要素进行阐述,以期为胰岛素泵治疗的合理决策和成本效果分析的实施提供参考.

Peripheral arterialdisease (PAD) can result in diabetic foot ulcers, gangrene, and even amputation. Since most cases of PAD in diabetic patients are associated with peripheral neuropathy, the symptoms of vascular disease are easily concealed by the symptoms of neuropathy and are ignored by people, so it is critical for health care providers to screen PAD for the diabetes patients. This study was carried out to identify theprevalence and related factors of PAD in diabetes mellitus inpatients. This was a cross-sectional observational study. A total of 855 patients were enrolled in the study from December 2018 to December 2019. The patients were divided into a non-PAD group (ABI = 0.9-1.3) and a PAD group (ABI <0.9). Logistic multivariate regression analysis showed that age, LDL-C, dorsalis pedis artery pulsation (left foot), and sensory-current threshold (right foot) were related factors for peripheral arterial disease. Patients who are older and have a higher LDL-C level, abnormal dorsal foot pulse, and abnormal sensory-current threshold must be vigilant, and receive early screening for PAD diagnosis and treatment to avoid a malignant outcome. In clinical work, medical staff should actively apply PAD screening to diabetic patients, identify risk factors as early as possible, conduct early interventions, reduce the risk of PAD in patients, and avoid the occurrence of adverse outcomes.

对信息-动机-行为技巧模型的理论背景、理论框架进行概述,探讨在慢性病病人护理中的应用现状,以期为慢性病病人的健康行为干预提供参考依据.

Aims Dysglycemia, including the three domains hyperglycemia, hypoglycemia, and increased glycemic variability (GV), is associated with high mortality among critically ill patients. However, this association differs by diabetes status, and reports in this regard are limited. This study aimed to evaluate the associations between the three dysglycemia domains and mortality in critically ill patients by diabetes status and determined the contributing factors for dysglycemia. Methods This retrospective study included 958 critically ill patients (admitted to the ICU) with or without DM. Dysglycemia was defined as abnormality of any of the three dimensions. We evaluated the effects of the three domains of glucose control on mortality using binary logistic regression and then adjusted for confounders. The associations between dysglycemia and other variables were investigated using cumulative logistic regression analysis. Result GV independently and similarly affected mortality in both groups after adjustment for confounders (DM: odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.03-1.08; p <0.001; non-DM: OR, 1.07; 95% CI, 1.03-1.11; p = 0.002). Hypoglycemia was strongly associated with ICU mortality among patients without DM (3.12; 1.76-5.53; p <0.001) and less so among those with DM (1.18; 0.49-2.83; p = 0.72). Hyperglycemia was non-significantly associated with mortality in both groups. However, the effects of dysglycemia seemed cumulative. The factors contributing to dysglycemia included disease severity, insulin treatment, glucocorticoid use, serum albumin level, total parenteral nutrition, duration of diabetes, elevated procalcitonin level, and need for mechanical ventilation and renal replacement therapy. Conclusion The association between the three dimensions of dysglycemia and mortality varied by diabetes status. Dysglycemia in critical patients is associated with excess mortality; however, glucose management in patients should be specific to the patient’s need considering the diabetes status and broader dimensions. The identified factors for dysglycemia could be used for risk assessment in glucose management requirement in critically ill patients, which may improve clinical outcomes.

目的:探讨我国糖尿病生活质量领域的研究热点与研究趋势.方法:检索CNKI数据库建库至2019年糖尿病生活质量相关文献,以BICOMB2.0、SPSS22.0和UCINET6.0作为数据处理工具,采用共词分析、聚类分析以及社会网络分析的方法进行糖尿病生活质量的护理研究热点及研究趋势分析.结果:共纳入5064篇文献,得到3216个关键词,35个高频关键词,聚类分析结果显示,我国糖尿病延续护理的研究热点围绕在糖尿病并发症的护理问题、不同护理干预方式对2型糖尿病患者的血糖的影响、健康教育对糖尿病患者的血糖影响、老年糖尿病患者的延续护理问题四个方面.结论:共词-聚类-社会网络分析结果较为客观地反映了糖尿病生活质量的研究热点及其趋势,可为相关研究人员及临床工作者提供相关领域信息支持,为科研选题及临床实践提供参考依据.

目的 探讨通过使用足部高危因素智能分级管理平台对糖尿病患者进行足部高危因素及足部自我护理行为进行管理后的应用效果研究.方法 采取便利抽样方法,对符合纳入标准的97例糖尿病患者进行足部高危因素筛查和足部自我护理知识进行调查,借助智能分级管理平台对患者采取远程管理,干预6个月后比较2组患者的足部高危因素、知识、行为及破损情况.结果 干预前2组患者足部护理知识总得分处于中等水平,干预6个月后,干预组总得分标准得分处于"良好水平(≥80分)"从22％上升至94％,2组患者足部护理得分情况(总得分、足部检查、足部日常护理、足部干燥处理)比较差异具有统计学意义(P<0.05),同时干预组患者鞋型选择、趾甲修剪、皮肤干燥情况都较对照组有明显改善(P<0.05),干预组患者足部破损率低于对照组(P<0.05).结论 借助足部高危因素智能分级管理平台对存在高危足的糖尿病患者进行管理后,可以提高患者的知识,改善足部日常自我护理行为.

目的 构建参与胰岛素泵调节的糖尿病专科护士核心能力的指标体系.方法 基于文献研究法、理论分析法等构建参与胰岛素调节的糖尿病专科护士核心能力指标体系初稿,按纳入标准选择26名专家进入德尔菲专家咨询.结果 共进行3轮咨询,第3轮咨询专家的权威系数为0.91,判断系数为0.92,熟悉程度为0.90,专家意见肯德尔和谐系数为0.299(P＜0.001).参与胰岛素泵调节的糖尿病专科护士核心能力Ⅰ级指标4个,包括临床专科护理实践能力、专业发展能力、评判性思维能力、专业人文素养实践,Ⅱ级指标18个,Ⅲ级指标64个.结论 参与胰岛素泵调节的糖尿病专科护士核心能力指标体系具有较高的权威性和科学性,为相关医院或学会制订胰岛素泵管理规范提供参考依据.

目的 介绍胰岛泵素师培训情况及评价培训效果.方法 通过课堂集中授课、临床实训等方式,对33名学员进行系统培训,以《中国胰岛素泵治疗护理管理规范》为蓝本开发了教材,并以理论考试、实践操作考试及调查问卷形式评价该次培训效果.结果 调查问卷显示,学员对胰岛素泵的相关知识掌握较好,对培训的满意度高.87.9％的学员通过了笔试,97.0％的学员通过了操作考试,操作考试成绩高于笔试成绩.结论 胰岛素泵师培训增加了学员的胰岛素泵相关理论知识,提高了学员对胰岛素泵应用的理论与实践能力.

目的 了解围手术期应用胰岛素泵治疗的2型糖尿病患者血糖波动情况.方法 选取2018年1月至2019年4月于暨南大学附属第一医院住院行择期手术并应用胰岛素泵治疗的126例2型糖尿病患者作为研究对象,采用便携式血糖仪监测患者血糖值,以血糖水平的标准差(SDBG)、餐后血糖波动幅度(PPGE)、最大血糖波动幅度(LAGE)作为血糖波动评估指标.结果 126例患者血糖波动幅度均超过正常值,SDBG为(2.81±1.37)mmol/L,PPGE为(4.64±2.66)mmol/L,LAGE为(7.85±4.06)mmol/L.术前血糖波动幅度高于术后(P<0.05);上泵当天患者血糖波动幅度最大,随后逐渐下降,至术后1 d趋于稳定,术后2～3 d血糖波动幅度再度增大,之后逐渐降低并趋于稳定.患者术后低血糖发生率高于术前(P<0.05).结论 围手术期应用胰岛素泵治疗患者血糖波动较大,且波动幅度呈规律变化,术前:较大-减小-稳定,术后:稳定-增大-减小-稳定,因此医护人员需根据患者血糖波动规律,密切监测患者血糖变化,及时调整胰岛素剂量,促进血糖控制平稳.

总结1例多学科协作下糖尿病合并多种急危重症患者(糖尿病酮症、乳酸酸中毒合并急性心肌炎及大面积脑梗患者的)血糖管理的护理经验.通过院内内分泌血糖管理团队多学科协作模式对该重症糖尿病患者不同血糖波动阶段采用静脉泵入胰岛素的血糖管理阶段、胰岛素泵持续皮下输注、胰岛素泵联合动态血糖监测阶段的不同血糖管理方式.每日医护查房,评估患者血糖控制情况及存在的问题,及时调整降糖治疗方案,经过26 d的治疗,患者血糖波动平稳,顺利出院.