| Objectives1.The best evidence to improve the hypoglycemic perception ability of patients with impaired awareness hypoglycemic was summarized through evidence-based nursing research methods,and on this basis,the Delphi expert letter consultation method was adopted to construct a management plan for patients with impaired awareness hypoglycemic of type 1 diabetes.2.To explore the influence of management plan of impaired awareness hypoglycemic based on the best evidence on hypoglycemia awareness ability,hypoglycemia attitude and behavior,and diabetes distress in patients with type 1 diabetes.MethodsThis study is divided into two parts:1.Construction of management scheme: The research method of evidence-based nursing was adopted,relevant literature at home and abroad was comprehensively and systematically retrieved,and the first draft of the management plan for patients with type 1 diabetes mellitus with impaired awareness hypoglycemic was constructed on the basis of summarizing the relevant evidence of improving the management plan for patients with impaired awareness hypoglycemic.The Delphi expert letter consultation method was adopted to conduct two rounds of expert letter consultation for the plan,and the management plan was modified according to the expert opinions.Finally,a management program for patients with impaired awareness hypoglycemic in type 1 diabetes was developed;2.Management program implementation: From February to November 2022,80 patients with impaired awareness hypoglycemic of type 1 diabetes who met the inclusion and exclusion criteria were selected from a third-level A hospital in Zhenjiang City to conduct a quasiexperimental study.40 patients hospitalized from February 2022 to June 2022 were selected as the control group.A total of 40 patients hospitalized from July 2022 to November 2022 were selected as the experimental group.Both groups received routine health education for diabetic patients in the department,and the experimental group received the hypoglycemia perception impaired management program based on the best evidence summary.The improvement of hypoglycemic perception,hypoglycemic attitude and behavior and diabetes distress in the two groups were compared before intervention,1 month after intervention and 3 months after intervention,respectively.Results1.Construction of management plan: A total of 13 relevant studies were included,and 19 evidences related to the management of patients with impaired awareness hypoglycemic from 6 aspects were analyzed and extracted.Based on this,the draft of management plan was constructed.Fifteen experts were invited to conduct two rounds of letter consultation.The positive coefficient of the two rounds of letter consultation was 100%,and the coefficient of expert authority was 0.91.Finally,a management scheme was formed,involving 2 first-level items,12 second-level items and 26 third-level items,including the assessment of impaired awareness hypoglycemic and target management.2.Implementation of the management plan: A total of 80 patients were included,75 patients received complete intervention and 5 patients fell off.In the end,38 patients were included in the control group and 37 in the experimental group.At 1 month and 3 months after intervention,the hypoglycemic perception ability and diabetes distress scores of the experimental group were better than those of the control group,and the differences between the groups were statistically significant(P < 0.05).The total score of hypoglycemic attitude and behavior and the score of anxiety dimension in experimental group and control group were improved over time,but there was no statistical significance between groups(P > 0.05).Compared with the control group,the experimental group showed a significant improvement trend in other dimensions of hypoglycemic attitude and behavior,such as avoidance dimension and confidence dimension,and the difference between groups was statistically significant(P > 0.05).Conclusion1.Through the analysis and summary of the best evidence,it is found that the management mode of patients with impaired awareness hypoglycemic in China is in the exploratory stage.Domestic clinical medical workers should pay attention to the hypoglycemia perception ability of patients with type 1 diabetes,learn from the mature management experience of other countries according to the actual needs of patients.To develop a management plan for impaired perception of hypoglycemia in type 1 diabetes in line with Chinese cultural background.2.The management plan of impaired hypoglycemia perception based on the best evidence is conducive to improving the hypoglycemia perception ability of patients with type 1 diabetes,reducing the occurrence of unhealthy avoidance behaviors to avoid hypoglycemia,and enhancing their confidence in avoiding severe hypoglycemia.To some extent,it can alleviate the distress of diabetes,but its feasibility in reducing the anxiety of patients with hypoglycemia remains to be discussed. |
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