糖尿病肾病患者血糖管理的最佳证据总结

Summary of best evidence on glycemic management in patients with diabetic nephropathies

目的总结糖尿病肾病患者血糖管理的最佳证据,为临床开展血糖管理提供理论依据。方法系统检索BMJ Best Practice、UpToDate、澳大利亚Joanna Briggs Institute(JBI)循征卫生保健中心数据库、美国国立临床诊疗指南数据库、国际指南协作网、英国国家卫生与临床优化研究所、Cochrane Library、PubMed、Web of Science、医脉通、中国知网、维普网、万方数据库中糖尿病肾病患者血糖管理相关的指南、临床决策、系统评价、专家共识和最佳证据总结,检索时限为建库至2022年11月30日。由2名研究者进行证据检索、质量评价和总结。按照JBI证据预分级及证据推荐级别系统(2014版)进行证据分级及推荐级别评定。结果共纳入文献15篇。最终从血糖监测、血糖控制、药物选择、护理管理4个方面汇总16条证据。结论血糖管理有助于延缓糖尿病肾病的发生和发展。医护人员应根据糖尿病肾病患者的年龄、病程、低血糖风险、肾功能等多项因素制订血糖控制目标,并选择适宜的药物。医疗机构应构建科学、系统的血糖管理体系,增强血糖控制的健康教育。

Objective To summarize the best evidence on glycemic management in patients with diabetic nephropathies,and provide a theoretical basis for glycemic management in clinical practice.Methods Guidelines,clinical decision-making,systematic reviews,expert consensus and best evidence summaries related to the glycemic management in patients with diabetic nephropathies were searched through BMJ Best Practice,UpToDate,Austratian Joanna Briggs Institute(JBI)Center for Evidence-Based Health Care database,National Guideline Clearinghouse,Guidelines International Network,National Institute for Health and Care Excellence,Cochrane Library,PubMed,Web of Science,Medlive,China National Knowledge Infrastructure,VIP and Wanfang Data.The search period was from the establishment of the database to November 30,2022.Evidence retrieval,quality assessment and evidence extraction were performed by 2 researchers.Evidence was graded and recommended according to the JBI evidence pre-grading system(2014 edition).Results A total of 15 articles were included.A total of 16 pieces of evidence were summarized from 4 aspects,including glycemic monitoring,glycemic control,drug selection and nursing management.Conclusions Glycemic management can help delay the onset and progression of diabetic nephropathies.Medical and nursing staff should set glycemic control goals and choose appropriate drugs according to multiple factors such as age,course of disease,risk of hypoglycemia,and renal function of patients with diabetic kidney disease.Medical institutions should build a scientific and systematic glycemic management system and strengthen health education on glycemic control.