| Objectives:This study explores the nutritional status of elderly patients with type 2 diabetes(T2DM)and the relationship between nutritional status and quality of life,then the nutrition management scheme for elderly patients with T2DM was developed based on the evidence-based and Delphi expert consultation method and followed by clinical practice,which try to explore the effective interventions to improve the nutritional status and quality of life of elderly Patients with T2DM,control and delay the progression of diabetes and its complications.Methods:1.Nutritional status of elderly T2DM patients and its impact on quality of life:The general demographic characteristics and clinical characteristics of hospitalized elderly patients with T2DM were investigated using the self-designed "Patient General Data Questionnaire",and the nutritional status and quality of life of patients were evaluated using the"Micro-nutrition Evaluation Scale" and "Diabetes Quality of Life Specific Scale"respectively.The relationship between nutritional status and quality of life of hospitalized elderly patients with T2DM was analyzed to provide a basis for formulating targeted nutrition management programs for hospitalized elderly patients with T2DM.2.Construction of a nutritional management program for patients with T2DM:Based on the evidence and following the 6s pyramid model of evidence resources,literatures related to nutrition management of T2DM in the elderly were searched,analyzed and evaluated,and the best evidence related to nutrition management of T2DM in the elderly was integrated to form a preliminary nutrition management plan for T2DM in the elderly.With the help of Delphi expert letter consultation,the preliminary plan was revised to form a nutrition management plan for elderly patients with T2DM suitable for clinical practice in China.3.Application of a nutrition management program for elderly patients with T2DM:A total of 64 elderly inpatients with T2DM in the Department of Endocrinology of a university affiliated hospital were selected as the research objects by random grouping and single-blind method.There were 32 cases in the control group,30 cases in the experimental group,and 2 cases lost contact.The Patients in control group were received routine medical treatment and care,and patients in experimental group were practiced the nutritional management program constructed in this study.The intervention duration was 3 months from admission to discharge.The general information,relevant measurement indicators and laboratory indicators on the day of admission,1 month and 3 months after discharge of patients from two groups were collected,and the effect of the nutrition program was evaluated according to the final results,which provide supporting basis for verifying the effectiveness of the established nutrition program.Results:1.A total of 372 elderly patients with T2DM were included in a cross-sectional survey using a questionnaire,and 361 effective questionnaires were collected,with an effective recovery of 97.04%.The average age of respondents was 71.62±6.08 years old.Among them,84(23.27%)were malnourished and 248(68.70%)were at risk of nutrition and health.The quality of life of the Patients was evaluated according to the score of the quality of life specificity scale.The results showed that the score was more than 1/2 of the total score of the scale,and the overall quality of life of the surveyed patients was lower than the medium level.According to the scores of each dimension,the physiological function dimension was the most affected,followed by the psychological/spiritual,treatment,and social relationship successively.Univariate analysis of the factors affecting the quality of life showed that the degree of peripheral edema and nutritional status had an negative impact on the quality of life of elderly patients with T2DM(P<0.05,P<0.01).After correlation analysis of the dimensions of Micro-Nutrition Evaluation Scale and Diabetes Quality of Life Specific Scale,the data showed that nutritional status was negatively correlated with quality of life in elderly patients with T2DM(all P<0.01).Multiple stepwise regression analysis showed that the influencing factors of patients’quality of life included nutritional status,marital status and whether patients had cardiovascular disease,and these factors could explain 46.00%of the variation of patients’ quality of life.2.A total of 29 literatures were included in the preliminary construction of nutrition management plans for elderly patients with T2DM,including 1 clinical decision,8 guidelines,10 expert consensus,2 evidence summaries,and 8 systematic reviews.The nutrition management scheme of T2DM in the elderly was preliminatively constructed,which consisted of 8 items of primary leve,25 items of secondary level and 37 items of tertiary leve.Through two rounds of expert letter consultation,the nutrition management scheme for elderly T2DM patients with 8 items of primary level,29 items of secondary level and 50 items of tertiary level was finally established.The effective recoveries of the first and second round of expert letter consultation questionnaires were 100%,and the recommended rates were 52.17%and 17.39%.The authority coefficient of expert correspondence consultation was 0.88,and the coordination coefficient was 0.11 and 0.15 and the pvalues of the significance test were under 0.05.3.Clinical application results of nutrition management scheme for elderly patients with T2DM demonstrated:①There was no statistical significance in the comparison of general data between the two groups(P>0.05),indicating that the data of the two groups were comparable.②At the end of three months after discharge,fasting,2-hour postprandial blood glucose,total protein and low density lipoprotein cholesterol were significantly different between the two groups(P<0.05),and the total score of MNA micronutrient assessment and the total score of diabetes quality of life specificity scale were significantly different between the two groups(P<0.05).The results suggested that the long-term implementation of nutrition management program for elderly patients with T2DM based on evidence-based and Delphi expert consultation might be beneficial to effectively control fasting and 2 hours postprandial blood glucose,regulate total protein and low density lipoprotein cholesterol,and improve the nutritional status and quality of life of patients with T2DM.Conclusions:1.The data analysis of cross-sectional survey demonstrated that the quality of life of elderly hospitalized patients with T2DM is generally low,and the nutritional status has a significant negative impact on the quality of life.2.Based on evidence-based nursing and evidence-based medicine,a nutrition management program for elderly T2DM patients suitable for clinical practice in China was constructed through Delphi expert correspondence.This scheme consists of 8 primary items,29 secondary items,and 50 tertiary items.A 3-month randomized,single-blind intervention study showed that the established nutrition management scheme for elderly T2DM patients was helpful to improve the nutritional status and quality of life of the patients. |
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