膳食疗法的确有助於控制糖尿病.ppt

Evidence-Based Medicine E-Da Hospital / I-Shou University Procedure in EBM Step 1: Formulating the management question to be answered (PICO) Step 2: Searching the literature and on-line databases for evidence to answer the question Step 3: Appraising the evidence Step 4: Integrating this appraisal with knowledge about the unique aspects of the patient (including preferences) Step 5: Evaluating our effectiveness and efficiency in executing steps 1 - 4 and seek ways to improve them 1. Clinical scenario: 2. Question by PICO: P: An eighty years old male with DM foot. I : Diet control of DM for 30 years. C: OHA control; insulin control O: Blood sugar levels, complications rate of DM. Q: Is [diet control] more effective than [OHA or insulin] in optimizing [blood sugar levels] and minimizing [complications rate in DM] patients? 3. Search strategy: Via PubMed: P: [80 years old OR male OR DM foot] AND I: [Diet control OR 30 years] AND C: [Oral hypoglycemic agents OR insulin] AND O: [Blood sugar control OR complication rate of DM] 4. Search outcome: ( ) papers found of which ( ) were found to be relevant. ( ) papers were discarded as either irrelevant or of insufficient quality for inclusion. 5. Citations: Mathew V., Frye RL., Lennon R., Barsness GW., Holmes DR Jr. Comparison of survival after successful percutaneous coronary intervention of patients with diabetes mellitus receiving insulin versus those receiving only diet and/or oral hypoglycemic agents. American Journal of Cardiology. 93(4):399-403, 2004 Feb 15. Nicholson AS., Sklar M., Barnard ND., Gore S., Sullivan R., Browning S. Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a low-fat, vegetarian diet. Preventive Medicine. 29(2):87-91, 1999 Aug. Gutierrez M., Akhavan M., Jovanovic L., Peterson CM. Utility of a short-term 25% carbohydrate diet on improving glycemic control in type 2 diabetes mellitus. Journal of the American College of Nutrition. 17(6):595-