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2MSc, RN, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
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to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International.
an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015.
altered levels of glycated hemoglobin, body mass index>31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia.
risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation.
Risk for unstable blood glucose level (00179) is a NANDA International, Inc. (NANDA-I) nursing diagnosis (ND), defined as "" 1 .
In the latest NANDA-I diagnostic classification edition, 16 risk factors for this ND are described: alteration in mental status, average daily physical activity is less than recommended for gender and age; compromised physical health status; delay in cognitive development; does not accept diagnosis; excessive stress; excessive weight gain; excessive weight loss, inadequate blood glucose monitoring; ineffective medication management; insufficient diabetes management; insufficient dietary intake; insufficient knowledge of disease management; nonadherence to diabetes management plan; pregnancy; and rapid growth period 2 - 3 ) , which are used to identify this diagnosis in patients of different clinical profiles or health-disease conditions.
Among these conditions, a special interest in type 2 diabetes mellitus (DM2) is demonstrated in this study. In a study that investigated 30 people during home nursing for 1 last update 14 Jul 2020 consultations, 60% had unstable glycemic risk 4 . In another study with diabetic patients in outpatient care, 28.6% of the participants had this ND 5 .Among these conditions, a special interest in type 2 diabetes mellitus (DM2) is demonstrated in this study. In a study that investigated 30 people during home nursing consultations, 60% had unstable glycemic risk 4 . In another study with diabetic patients in outpatient care, 28.6% of the participants had this ND 5 .
Studies demonstrate that variation in glycemic levels may: increase the rate of complications and mortality in hospitalized patients with acute coronary syndrome 6 , compromise renal function and structure 7 , and lead to endothelial dysfunction 8 . These consequences can have negative impact on productivity, quality of life and survival, and involve high costs related to treatment 9 . Thus, the recognition of risk factors for unstable glycemia and the institution of preventive measures can contribute to positive results for which nurses have responsibility.
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