The Study Of Acupuncture Therapeutic Strategy Development For Pre-diabetes Based On Evidence-based Evidence And Delphi Method

ObjectiveThis study draws on the principles and methods of establishing clinical guidelines for evidence-based acupuncture,focusing on key clinical issues that need to be resolved in the process of acupuncture intervention in pre-diabetes diagnosis and treatment,combining the characteristics of pre-diabetic diseases,combining evidence-based methods and Delphi methods,and studying diabetes through literature research.Preliminary acupuncture and moxibustion syndrome diagnosis,treatment plan,curative effect evaluation 3 aspects of multi-dimensional evidence integration,preliminary construction of acupuncture intervention pre-diabetes diagnosis and treatment plan draft,on this basis,using multiple rounds of expert questionnaire consultation to revise and supplement the draft plan to form the final The consensus plan aims to formulate a scientific,standardized,and maneuverable"Acupuncture Intervention Pre-diabetes Clinical Diagnosis and Treatment Plan",which provides a reference for the selection of treatment plans in the clinical and scientific research of acupuncture intervention in pre-diabetes,and also provides clinical and scientific research for other diseases Provide methodological exploration in constructing a reasonable and effective acupuncture diagnosis and treatment plan.method1.Identify key clinical issuesThrough literature search and social research,we collected the key issues that need to be solved in the pre-diabetes intervention of acupuncture and moxibustion,and formed the"Questionnaire on Key Issues of Acupuncture and Moxibustion Intervention in Pre-Diabetes".The questionnaire was issued to 15 first-line clinical acupuncture experts,and the results of the questionnaire were collected and collected.Determine the key clinical questions to be answered by this program and construct the program framework.2.Evidence-based evidence researchThe literature search was carried out on the clinical issues of acupuncture intervention in pre-diabetes syndrome diagnosis,treatment plan,and efficacy evaluation:focusing on searching the English database represented by Pub Med and EMbase,the Chinese database represented by CNKI,Wanfang,and VIP,and the Chinese Medical Dictionary.The database of ancient Chinese medicine books,clinical trial registration websites such as the China Clinical Trial Registration Center and Clinical Trial,as well as the official websites of the Diabetes Branch of the Chinese Medical Association,the State Administration of Traditional Chinese Medicine and other official websites,comprehensively collect ancient documents,modern documents and modern doctors’experience related to the treatment of prediabetes with acupuncture and moxibustion,Carry out evidence extraction:(1)Use AGREE II guideline evaluation tool to screen high-quality clinical guidelines and extract evidence to form current guideline evidence;(2)Use statistical description and correlation analysis methods to analyze pre-diabetes TCM syndrome research literature,and extract pre-diabetes TCM syndrome types Distribution rules,forming evidence for syndrome-type research;(3)Using the modified Jadad scale and AMSTAR scale to evaluate the literature quality of randomized controlled studies and Meta-analysis respectively,and including high-quality literature to form high-quality intervention research evidence;(4)Using correlation analysis Methods Analyze the randomized controlled experiment of acupuncture intervention in the pre-diabetes period to explore the rules of acupoint selection and point allocation,and form the core acupoint group evidence;(5)through the retrieval of related ancient books in the pre-diabetes period,form the evidence of ancient books;(6)through the collection of modern famous doctors’experience,form the modern famous doctor’s experience evidence.Based on the two major clinical problems of pre-diabetes syndrome diagnosis and acupuncture treatment,the above multiple independent evidences are organically integrated to form a diagnostic evidence body and basis consisting of four types of evidence from current guidelines,evidence from syndrome studies,evidence from ancient books,and evidence from modern famous doctors.Current guideline evidence,core acupoint group evidence,high-quality intervention research evidence,and modern famous doctor experience evidence constitute the body of acupuncture treatment evidence;the evaluation criteria of acupuncture efficacy refer to the current guideline evidence.Evidence integration criteria are:among the 4types of evidence,items that meet the requirements of≥3 sources of evidence can be included in the first draft of the plan.3.Delphi method implementationThrough the integration of multi-dimensional evidence,the first draft of the plan is formed.Based on the content of the first draft,the first round of expert consultation questionnaires are formulated.The questionnaire structure adopts a combination of semi-closed and free-filling methods,and the importance of items is evaluated by the Likert 5-level scoring method.The questionnaire was compiled through the"Tencent Questionnaire"platform and distributed to 30 experts and scholars in the field of acupuncture and massage in the form of an electronic questionnaire.Recover the first round of questionnaires,form the expert positive coefficient based on the questionnaire’s recovery rate,and form the expert’s authority coefficient based on the expert’s self-assessment of personal academic level,item judgment basis,and item familiarity,using two expert positive coefficients and expert authority coefficients Statistics evaluate the enthusiasm and authority of experts in this round of questionnaires.Using Excel 2010 and SPSS 25.0software,the importance of each item is assigned the mean(M_j),full score ratio(K_j),Kendall’s W and coefficient of variation(CV)for statistics,among which M_j,K_jreflects the importance of each item and the degree of concentration of expert opinions.Kendall’s W and CV reflect the degree of coordination of expert opinions.After statistical analysis,the results of the first round of expert consultation questionnaires were formed.Based on the statistical results of the first round of questionnaires and the correction opinions proposed by experts,select or supplement items to form the second round of expert consultation questionnaires.After repeating the above process,after the third round of questionnaires,the final consensus plan was obtained and the text of"Acupuncture Intervention Pre-diabetes Clinical Diagnosis and Treatment Plan"was formed.resultJudging from the questionnaire responses,the positive coefficients of experts in the three rounds of questionnaires are all 100%,indicating that experts are highly motivated to participate in this research;from the distribution of experts,the experts in the three rounds of questionnaires come from 17 provinces and municipalities,among which professors account for The total number of experts is 76.67%,associate professors account for23.33%,those who have been engaged in acupuncture and moxibustion clinical work for 30 to 45 years account for 16.67%,and those for 15 to 30years account for 80.00%,indicating that the participating experts have good subject representativeness and authority;three rounds of questionnaires Items with low importance(M_j≤3.50 and K_j≤0.60)and poor coordination of expert opinions(CV≥0.3)were deleted.After three rounds of questionnaires,the statistical value range of retained items is M_jbetween 4.51 and 5.00,and K_jis between 0.73 and 1.00,indicating that experts agree that the importance of all retained items after the third round of questionnaire is high,and V_jis between 0.00 and 0.28.Experts Good coordination of opinions.The coordination degree coefficients of the three rounds of questionnaires were0.412,0.582,and 0.56 respectively,P<0.001,and the difference was statistically significant,which also shows that the coordination of expert opinions in the three rounds of questionnaires is better.The selection of experts for correspondence in this research is ideal,and the research results are reliable.Conclusions1.A consensus was reached through three rounds of expert questionnaire surveys,and the"Acupuncture Intervention Pre-Diabetes Clinical Diagnosis and Treatment Program"was formed,in which the syndrome differentiation types were 4 types of spleen deficiency and phlegm-dampness,damp-heat accumulation of spleen,liver stagnation and qi stagnation,and qi and yin deficiency;commonly used acupuncture and moxibustion therapy Five types of acupuncture,electroacupuncture,catgut embedding at auricular points,and moxibustion are recommended.The core group of acupuncture and moxibustion is Zusanli,Sanyinjiao,Pishu,Weiwanxiashu,Shenshu,Zhongwan,and Guanyuan.The main curative effect evaluation indicators are four items:fasting blood glucose value,blood glucose value 2 hours after glucose load,glycosylated hemoglobin value and pre-diabetes TCM symptom score evaluation.2.The evidence-based body of evidence constructed based on the principles of evidence-based medicine is the basis of the content of the"Acupuncture Intervention Pre-diabetes Clinical Diagnosis and Treatment Plan".The Delphi method is an important method that can effectively,objectively and extensively gather expert opinions and reach the final consensus of the cost plan.,The combined use of evidence-based method and Delphi method in the formulation of the plan not only guarantees that the plan is scientific and reasonable in clinical and scientific research applications,there is evidence to follow,but also that it is close to clinical reality,rather than just empty talk.The formulation of this plan can provide a reference for future acupuncture intervention in pre-diabetes clinical and scientific research for the selection of treatment plans,and provide methodological reference for the formulation of acupuncture diagnosis and treatment plans for other diseases.