口服糖皮质激素的非糖尿病化疗病人血糖管理的证据总结

Evidence summary of blood glucose management in patients with non-diabetic chemotherapy undergoing oral glucocorticoids

[目的]检索和分析口服糖皮质激素的非糖尿病化疗病人血糖管理的最佳证据,并对证据进行总结与评价。[方法]计算机检索Cochrane Library、JBI循证卫生保健国际合作中心图书馆、美国指南网(NGC)、苏格兰学院间指南网(SIGN)、新西兰指南协作组、PubMed、NICE、NCCN、ONS、RNAO、万方数据库及中国生物医学文献数据库有关口服糖皮质激素的非糖尿病化疗病人血糖控制的指南、证据总结、推荐实践、系统评价及专家共识,检索时限为建库至2017年7月。由2名经过循证培训的研究人员分别对文献质量进行评价和资料提取,对符合质量标准的文献进行证据提取。[结果]共纳入3篇文献,包括2篇证据总结和1篇系统评价。经过评价,总结得出口服糖皮质激素的非糖尿病化疗病人血糖管理的证据:①医护人员应知晓口服糖皮质激素的化疗病人有发生高血糖的风险(B级推荐);②医护人员应告知病人高血糖的症状及危险(B级推荐);③医护人员应对使用糖皮质激素的肿瘤病人进行血糖的筛查和监测(B级推荐);④通过多学科介入形成医疗保健专业人员对高血糖识别与处理的共识(B级推荐);⑤医疗保健专业人员应教育(血糖≥7.8 mmol/L)病人通过饮食调整控制糖类的摄入(B级推荐);⑥医疗保健专业人员应知晓每周2次下午和晚间血糖的监测比空腹血糖更能反映非糖尿病病人的血糖代谢情况(B级推荐)。[结论]护理人员可遵循循证医学证据来规范临床血糖监测的管理现状,为临床提供最佳证据及制定大剂量糖皮质激素所致高血糖的监测流程提供参考。

Objective: To retrieve and analyze the best evidence of glycemic management in patients with non-diabetic chemotherapy undergoing oral glucocorticoids,and to summarize and evaluate the evidence. Methods: The guidelines,evidence summaries,recommended practices,systematic evaluations and expert consensuses on glycemic control in patients with non-diabetic chemotherapy undergoing oral glucocorticoids were retrieved from Cochrane Library,JBI Evidence- Based Health Care International Cooperation Center Library,US Guide Network (NGC),Scottish Inter-Academic Guide Network (SIGN),New Zealand Guideline Collaboration Group,PubMed,NICE,NCCN,ONS,RNAO,Wanfang Database and Chinese biomedical literature database (CBM),from the establishment of the library to July 2017.Two evidence-based researchers evaluated the quality of the literature and extracted the data,and extracted evidence from the documents that met the quality standards. Results: A total of 3 articles were included,involving 2 evidence summaries and 1 systematic review.After evaluation,the evidence of glycemic management in patients with non-diabetic chemotherapy undergoing oral glucocorticoids were summarized:①Health care personnel should be aware of that patients with chemotherapy undergoing oral glucocorticoids had a risk of developing hyperglycemia (Class B recommendation);②Medical staff should inform patients about the symptoms and risks of hyperglycemia (Class B recommendation);③Health care providers should screen and monitor blood glucose in patients with glucocorticoids (Class B recommendation);④Identify and treat hyperglycemia by medical staff through multidisciplinary intervention consensus (Class B recommendation);⑤Health care professionals should educate patients with blood glucose ≥ 7.8 mmol/L through dietary adjustment to control sugar intake (Class B recommendation);⑥Health care professionals should know twice monitoring of blood glucose in the afternoon and evening was more indicative than fasting blood glucose in blood glucose metabolism among non-diabetic patients (Class B recommendation). Conclusions: Nursing staff could follow the evidence-based medical evidences to regulate the management status of clinical blood glucose monitoring and provide a reference for providing the best evidence for clinical and formulating the monitoring process of high-glucose induced by high dose glucocorticoids.