Study On Establishing Nursing Strategies For Type 2 Diabetic Patients With Mild Cognitive Impairment On An Evidence-Based Practice

Objective:1.It is aimed to identify the risk factors in Type 2 diabetic patients with mild cognitive impairment(MCI)by Meta-analysis.2.A systematic evaluation of nursing strategies for Type 2 diabetic patients with MCI,preliminary construction of strategy system in Type 2 diabetic patients with MCI;Secondly using the preliminary construction of the expert questionnaire,expert consultation were submitted to,which can supply reference for clinical nursing practice in Type 2 diabetic patients with mild cognitive impairment to guide nursing practice of clinical nursing.Methods:1.Meta-analysis:Databases including CNKI,WanFang Data,Sinomed,PubMed,EMbase,Medline,ProQuest,CINAH and OVID were electronically searched for the case-control studies and cohort studies about Type 2 diabetic patients(T2DM)with mild cognitive impairment from inception to November 2016.Two reviewers independently screened literature,extracted data and assessed methodological quality of included studies.Analysis of sensitivity and heterogeneity were performed.Cumulative effects were calculated using either fixed or random effects models by RevMan 5.3 software.2.Systematic review:Using the systematic review method to retrieve the computer system such as the CNKI,WanFang Data,Sinomed,Cochrane,PubMed,OVID,Ebsco,ProQuest and www.Clinicaltrials.gov were electronically searched for the studies about Type 2 diabetic patientswith mild cognitive impairment from inception to June 2017,Retrieving the guideline databases such as the National Guideline Clearinghouse(NGC),Registered Nurses'Association of Ontario(RNAO),The Campbell Collaboration from inception to October 2017.The literature review and the classification criteria of the Australian JBI 2008 Evidence-Based Health Care Center and Johns Hopkins were used to summarize the intervention strategies in Type 2 diabetic patients with MCI.The level of the evidence,the quality of the document and the relevant appe for the experts in the letter when the reference.3.Delphi:Using the Delphi method,a total of 20 clinical medical and nursing experts selected from some first-class hospitals participated in the study,which rate the importance and feasibility of the items,and give specific entries to delete,modify and other expert advice.The entry screening criteria for the entry Importance and operability assignment mean?4.0,and the coefficient of variation(CV)<0.3.And then meet the above conditions selected,if only one match,the task group discussed whether to delete or modify the entry in combination with expert opinion.Then ultimately establish the second round of correspondence.The nursing intervention strategies were further screened,supplemented and improved through two rounds of correspondence.Results:1.Twenty case-controlled studies were included involving 1588 in the MCI group and 2029 in the control group.15 risk factors were involved.Significant differences were found in Duration of T2DM(P<0.00001),years of the education(P<0.00001),age(P<0.00001),HbA1c(P<0.00001),adiponectin(P<0.00001),diabetic peripheral neuropathy(P=0.001),previous hypertension(P=0.002),duration of hypertension(P=0.002),previous hypertension drugs(P<0.00001),carotid resistent index(P<0.00001)and previous cardiovascular disease(P<0.00001)between experiment group and control group.While no significant differences was found in education degree>12 years(P=0.12),smoking(P=0.55),intima-media thickness(IMT)(P=0.45)and fasting C-peptide(P=0.43).2.69 articles were included in the systematic review,covering 61 interventional studies,4 systematic reviews and 4 guidelines.Among the 69 articles,35 literatures were grade I,34 literatures were grade II.Through the system evaluation method,three dimensions were included,including"risk assessment","Cognitive intervention"and"education instruction" and 75 entiongies for Type 2 diabetic patients with MCI.3.Followed by two rounds of expert correspondence,adjustment items5,delete the entry 8,and finally establish a 3-dimension 68 items of for Type 2 diabetic patients with MCI.The effective recovery rate of the two rounds of experts was 100%and 100%.The coefficients were 0.87 and 0.90 respectively.The first round CV fluctuated between 0.00-0.49,The coordination coefficient W is 0.21,0.16,the significance test results suggest that P<0.001.The second round CV fluctuated between 0.00?0.43,The coordination coefficient W is 0.31,0.22,the significance test results suggest that P<0.001,indicating that the strategy research method scientific,correspondence results coordinated and reliable.Conclusions:? Duration of T2DM,age,HbA1c,diabetic peripheral neuropathy,previous hypertension,duration of hypertension,previous hypertension drugs carotid resistent index and previous cardiovascular disease are risk factors of Type 2 diabetic patients with MCI.Years of the education,adiponectin are protective factors.While the effects of education degree(>12 years),smoking,fasting C-peptide and intima-media thickness are still inconclusive.2.The interventions for Type 2 diabetic patients with MCI based on evidence were reliable and operable,it can offer objective and feasible strategies for nursing practice of Type 2 diabetic patients with MCI.