妊娠期糖尿病血糖监测相关指南的系统评价  

Guidelines for Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus:A Systematic Review

作　　者：王惠仪 邢年路 周英凤[1] 吴晓臣 陈姝宇 WANG Huiyi;XING Nianlu;ZHOU Yingfeng;WU Xiaochen;CHEN Shuyu(Department of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学护理学院,上海200032

出　　处：《军事护理》2025年第4期43-48,共6页MILITARY NURSING

基　　金：复旦大学循证护理中心“循证护理全链条创新研究项目”(FNDGJ202004);复旦大学-复星护理科研基金(FNF202402)。

摘　　要：目的系统评价妊娠期糖尿病(gestational diabetes mellitus,GDM)血糖监测相关指南,比较各指南推荐意见的异同,为GDM患者规范化血糖监测提供依据。方法系统检索国内外指南网、糖尿病和妇产科相关专业协会网站及期刊数据库,检索时限为2009年1月至2023年12月。2名研究者采用临床指南研究与评价工具Ⅱ对指南进行质量评价,汇总分析各指南推荐意见并比较异同。结果最终纳入26篇指南,整体质量较高,其中15篇为A级、8篇为B级、3篇为C级;共提取171条推荐意见,其中62条推荐意见标注了推荐强度及证据等级、61.3%的推荐意见为弱推荐、77.4%证据等级为低或极低;整合后形成22条推荐意见,包括妊娠期、分娩期及产后3个阶段的血糖监测频次、时机和血糖目标值;不同指南对血糖监测频次及血糖目标值的推荐存在明显差异。结论GDM血糖监测相关指南的方法学质量较高,但推荐意见所依据的证据等级多为低或极低,且不同指南在血糖监测方面的推荐存在明显差异。建议未来开展GDM血糖监测相关高质量研究,对不同目标人群的血糖监测频次、目标值提供科学的决策建议。Objective To systematically evaluate guidelines on blood glucose monitoring for women with gestational diabetes mellitus,and compare the similarities and differences of recommendations of guidelines,so as to provide support for the standardization of blood glucose monitoring for GDM.Methods National and international guidelines networks,websites of specialist associations and databases related to diabetes and obstetrics and gynecology were systematically searched from January 2009 to December 2023.The quality of guidelines were evaluated by 2 researchers with the Appraisal of Guidelines for Research and EvaluationⅡ,and the similarities and differences of recommendations in guidelines were synthesized and compared.Results 26 guidelines were included,the overall quality of which was high,containing 15 grouped as grade A,8 as grade B and 3 as grade C.A total of 171 recommendations were extracted,among which 62 were provided with the strength of recommendation and level of evidence.61.3%of recommendations were weak and 77.4%of evidence level were low or very low.22 recommendations were synthesized,including glycemic monitoring frequency,timing,and glycemic target values during pregnancy,delivery and postpartum.Huge differences were showcased on glycemic monitoring frequency and glycemic value targets among guidelines.Conclusions Guidelines on glycemic monitoring for GDM have relatively high quality,but the level of evidence on recommendations are low or very low.There are significant differences in recommendations of glycemic monitoring frequency and target values among guidelines.High-quality studies on GDM glycemic monitoring should be conducted in the future to provide evidence for decision-making regarding glycemic monitoring for such patients.

关 键 词：妊娠期糖尿病 血糖监测 指南 推荐意见 循证护理 

分 类 号：R473.71[医药卫生—护理学]