The primary objective of this study is to determine the benefits of interventions from a Multidisciplinary Diabetes Care team involved of diabetes nurse practitioners(DNP) on glucose control, perioperative outcomes and psychosocial outcomes for patients with Diabetes Mellitus
About 50% of diabetic patients will undergo at least one surgical operation, and nearly 20% of surgical patients have diabetes.Compared with non-diabetic patients, diabetic patients face greater risks during the perioperative period. Stress factors such as preoperative preparation, anesthesia, surgical trauma, pain, drugs and negative emotions can induce blood glucose fluctuations, which could lead to complications such as hyperglycemia, diabetic ketosis, and hypoglycemia.Therefore, perioperative management has become an important part of diabetes management. A multidisciplinary collaborative team led by NP can reduce the mortality of patients after inpatient surgery, help patients change their lifestyle, maintain self-management behavior, improve patient experience, and reduce hospitalization costs. This study intends to explore the application effect of NP-led multidisciplinary collaborative team in the perioperative comprehensive management of diabetic patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
170
NP establishes files to evaluate and manage patients before hospital and visits patients after hospitalization. Then set blood glucose control goals with endocrinology and orthopedic doctors together, initiates consultation with endocrinologists for patients with postoperative hyperglycemia, and is responsible for post-hospital follow-up.
EFFICACY: TIR（Time in Range）
Time in range
Time frame: From into the group to the first hospital day; First day in hospital to the day of discharge
EFFICACY: Glycated Serum Protein
Glycated Serum Protein would be conducted to measure glucose control
Time frame: baseline and 1 month after discharged
EFFICACY: Incidence of perioperative hypoglycemia
Incidence of perioperative hypoglycemia would be conducted to measure glucose control
Time frame: From into the grop to 1 month after surgery. And confirmed based on the patient's main complaint and monitoring records.
EFFICACY: Time required for blood glucose standard before surgery
The time from the patient's enrollment to the blood glucose reaching the blood glucose control target
Time frame: the first hospital day
EFFICACY: Diabetes self-management behavior
measured by Summary of Diabetes Self-Care Activities（SDSCA）. SDSCA scores from 0 to 77 and higher score means better self-management behaviors.
Time frame: Measurements were taken at baseline, day of hospitalization, and 1 month after discharge
EFFICACY: Incidence of perioperative adverse events
Adverse events included wound infection, prolonged wound healing time, and death within 1 month after surgery.
Time frame: 1 month after discharge
EFFICACY: Blood pressure
A calibrated electronic blood pressure meter of the same brand was used to measure systolic pressure and diastolic pressure in the same arm at the same time daily
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Time frame: baseline, day of hospitalization, during hospitalization and 1 month after discharge
EFFICACY: Body weight
The same scale was used to measure after patients got up in the morning.
Time frame: baseline, day of hospitalization, during hospitalization and 1 month after discharge
EFFICACY: Anxiety and depression
measured by Hospital Anxiety and Depression Scale (HADS) scale. HADS contains two subscales: anxiety and depression, and each subscale have 7 items. Total scores were from 0 to 42(anxiety: 21 scores; depression: 21 scores), higher score means more severe anxiety and/or depression.
Time frame: Measurements were taken at baseline, day of hospitalization, and 1 month after discharge
QUALITY OF LIFE:living quality
measured by Short Form 36 Health Survey (SF-36) which contains 8 modules with different score formula. Higher total scores mean better living quality.
Time frame: Measurements were taken at baseline, day of hospitalization, and 1 month after discharge