成人糖尿病患者低血糖管理的指南质量评价及内容分析

Quality evaluation and content analysis of guidelines for hypoglycemia management in adults with diabetes

目的评价成人糖尿病患者低血糖管理相关指南,为临床工作实践提供参考意见。方法检索国内外数据库、指南和相关学会网站。2名研究者独立提取资料,3名研究者运用临床指南研究与评价工具Ⅱ(Appraisal of Guidelines for Research&EvaluationⅡ,AGREEⅡ)对临床实践指南进行质量评价并汇总分析推荐意见。结果共纳入17部指南,其中10部临床实践指南和7部专家共识,指南总体质量评价较高。共提取低血糖分级、意识清醒和意识不清或无意识患者低血糖处理、血糖恢复后处理、肠内营养者和佩戴胰岛素泵者低血糖处理、低血糖预防7个方面意见。结论纳入的指南总体质量较高,可以为我国糖尿病成人低血糖管理的临床实践提供循证证据支持,但是将国外指南应用于我国临床情境需经过严格的本土化过程。

Objective To evaluate the guidelines related to hypoglycemia management in adults with diabetes and provide reference for clinical practice.Methods Domestic and international databases,guidelines and websites of relevant societies were searched.Two researchers independently extracted data,and three researchers used Appraisal of Guidelines for Research&EvaluationⅡ(AGREEⅡ)to evaluate the quality of clinical practice guidelines and summarize and analyze the recommended opinions.Results A total of 17 guidelines were included,including 10 clinical practice guidelines and 7 expert consensuses.The overall quality evaluation of the guidelines was relatively high.Seven opinions were extracted regarding the classification of hypoglycemia,the management of hypoglycemia in conscious,unconscious or unresponsive patients,the management of hypoglycemia after blood glucose recovery,the management of hypoglycemia in enteral nutrition recipients and insulin pump wearers and the prevention of hypoglycemia.Conclusion The included guidelines are generally of high quality,which can provide evidence-based support for the clinical practice of hypoglycemia management for adults with diabetes in China.However,a strict localization of foreign guidelines is required before being applied to the clinical environment in China.