Ciardullo A V, Daghio M M, Carapezzi C
Diabetes & Atherosclerosis Unit, Internal Medicine, Ramazzini Hospital, Carpi, Modena, Italy.
Acta Diabetol. 2006 May;43(1):22-5. doi: 10.1007/s00592-006-0206-6.
When the diabetic patient is hospitalised or assisted by a hospital-based home care service, as a rule he/she is not cared for by a diabetologist all day long. The aim of the present work was to perform a RAND assessment of practical schemes to start or change a daily insulin regimen without a diabetologist. We created an expert panel of seven internists and two diabetologists. They judge the appropriateness of each practical scheme using the RAND method. We produced 21 clinical scenarios divided into two groups. The first group of 9 clinical scenarios-i.e., for diabetic patients who 'eat/not-always-eat' and are 'normal-weight/obese/underweight' or with 'renal failure' or 'defedated/end-of-life' or 'vomiting' or on 'parenteral nutrition'-useful for starting a daily insulin regimen without a diabetologist had a median RAND score of 8 (range 7-9). The second one-formed by 12 clinical scenarios useful to change the daily insulin dosage without a diabetologist based on low or high capillary glucose level monitoring-had a median RAND score of 9 (range 7-9). There was a high level of agreement between panellists in judging 'appropriate' the practical schemes to start or change a daily insulin regimen without a diabetologist.
糖尿病患者住院或接受医院家庭护理服务时，通常并非全天都由糖尿病专科医生护理。本研究的目的是对在没有糖尿病专科医生的情况下启动或改变每日胰岛素治疗方案的实用方案进行兰德评估。我们组建了一个由七名内科医生和两名糖尿病专科医生组成的专家小组。他们使用兰德方法判断每个实用方案的适宜性。我们制定了21个临床场景，分为两组。第一组有9个临床场景，即针对“饮食不定”且“体重正常/肥胖/体重过轻”或患有“肾衰竭”或“营养不良/临终”或“呕吐”或接受“肠外营养”的糖尿病患者，这些场景对于在没有糖尿病专科医生的情况下启动每日胰岛素治疗方案很有用，其兰德评分中位数为8（范围7 - 9）。第二组由12个临床场景组成，这些场景有助于在没有糖尿病专科医生的情况下根据毛细血管血糖水平的高低监测来改变每日胰岛素剂量，其兰德评分中位数为9（范围7 - 9）。在判断在没有糖尿病专科医生的情况下启动或改变每日胰岛素治疗方案的实用方案是否“合适”时，专家小组成员之间存在高度一致性。
