Ethical approval

The study was under the approval of the Ethics Committee of Zhongshan Hospital, Xiamen University and followed the tenets of the Declaration of Helsinki. Written informed consent was acquired from all subjects.

Study participants

Using convenience sampling, 100 patients with DM combined with ICI admitted to Zhongshan Hospital, Xiamen University from February 2022 to April 2023 were selected as study participants.

Inclusion criteria

(i) All patients met the diagnostic criteria of type II diabetes mellitus [16]; (ii) All patients were diagnosed with combined mild to moderate ICI after admission to the hospital by routine imaging examination combined with clinical manifestations; (iii) After treatment, the patients were in stable condition, clear consciousness, with certain self-care ability, and able to cooperate with the medical staff to complete self-management education, diet and exercise treatment, regular blood glucose monitoring and related program evaluation; (iv) The patients’ clinical data were complete; (v) After the ethical approval of the hospital, the patients and their family members agreed to the use of insulin pump treatment, were informed of the study, and signed the informed consent form.

Exclusion criteria

These patients were excluded: (i) type I diabetes mellitus; (ii) combined with other brain diseases such as cerebral hemorrhage, brain tumor, encephalitis, etc.; (iii) complicated by systemic infectious diseases; (iv) complicated by multiple organ dysfunction, liver and kidney diseases or other autoimmune diseases; (v) combined with other critical illnesses such as diabetic ketoacidosis, etc.; (vi) combined with impaired consciousness, mental retardation, communication disorders or psychiatric illnesses; (vii) poor compliance or reasons for not being able to cooperate with nursing intervention or insulin pump blood glucose management workers.

Randomization process and blinding method

Patients were randomly divided into a control group and an observation group, with 50 patients in each group, using the random number table method. Specifically, the 100 patients who met the inclusion and exclusion criteria were numbered in the order of admission from 1 to 100. Starting from the fifth column of the second row of the random number table, three-digit numbers were sequentially read and recorded below the corresponding patient numbers. All selected random numbers were then numbered from smallest to largest, with numbers 1–50 designated as the control group and 51–100 as the observation group.

This study adopted a single-blind method, meaning that after recruiting patients, their enrollment information was kept by the researchers. Neither the patients nor the result assessors were aware of the group assignments to avoid contamination and bias. However, members of the nursing intervention team were aware of the patients’ information.

Intervention methods

The control group received routine nursing combined with insulin subcutaneous injection treatment. Routine nursing content mainly includes routine blood glucose, vital signs and neurological function monitoring; medication guidance and adverse reaction supervision; diet, exercise and early rehabilitation training guidance; and completing routine nursing operations in accordance with the doctor’s instructions. Insulin subcutaneous injection treatment is to implement the subcutaneous injection of insulin aspart injection, within 15 min before three meals, 3 times/d, the specific dosage is decided by the doctor according to the individual blood glucose level and dietary arrangements. The observation group received the whole course fine nursing combined with insulin pump blood glucose management. The whole course fine nursing includes: (i) establishment of a whole course fine nursing team: The head nurse of the department served as the team leader, and nurses with strong responsibility and rich experience were selected as team members. All members jointly studied relevant knowledge on cerebral infarction and diabetes, consulted relevant domestic and international literature, and formulated refined nursing intervention plans based on the actual situation of the patients, ensuring the high quality and scientific nature of the nursing content. (ii) admission assessment and individualized care plan development: patients are admitted to the hospital for a detailed and comprehensive assessment, including blood glucose level, neurological function, motor function, dietary habits, psychological state, etc., and individualized care plans are developed. At the same time, the patient’s comorbidities and underlying diseases are assessed to provide the basis for subsequent nursing interventions. (iii) Health education: health education on knowledge related to DM and cerebrovascular disease is provided to patients and their families through various forms, such as verbal notification and distribution of publicity brochures. Nursing staff instructs patients on the use of insulin pump, operation precautions and risks, and also instructs them to keep a blood glucose monitoring diary to understand and control their diet, exercise and insulin treatment, diet management and daily care, as well as the importance of diet control, regular exercise, and mood stabilization in blood glucose control. (iv) Glucose management: nursing staff use insulin pumps to record patients’ daily blood glucose, insulin use and diet, analyze the data to identify problems and make adjustments, and optimize the settings on a regular basis, among other things. Setting blood glucose control goals and adjusting insulin or glucose-lowering drug dosage according to the patient’s condition to avoid hypoglycemia. Nursing staff instructs patients to learn to operate the pump and adjust basal rates in advance based on exercise intensity, sleep, etc., and to master carbohydrate content calculation and insulin dose matching to ensure that the patient’s insulin dose remains reasonable with the change of condition or lifestyle adjustment. (v) Neurological function nursing: Nursing staff regularly monitors the patient’s consciousness state, speech ability, limb activity, and other neurological function indices, and observe the progress of the condition. Combined with the treatment of rehabilitation department, they carry out the rehabilitation training of limbs, speech and swallowing function to prevent functional degradation. (vi) Dietary care: Nursing staff formulates a scientific and reasonable dietary plan, control the total energy intake, and choose a diet with low sugar, low salt, low fat, and high fiber. According to the principles of dietary management, combine with patients’ tastes and dietary habits, they rationally arrange the number of meals and food types. (vii) Complication prevention: nursing staff instructs patients and family members to do a good job of pump protection, avoid collision damage, and avoid going to places with large magnetic fields. A strict handover system is implemented, the handover includes insulin pump operation status, battery power, the skin condition of the patient’s infusion site, whether the dressing is loose, and whether the needle cannula is dislodged. They instructs patients to keep the skin of the puncture site clean to avoid infection and inform patients and families about the necessity and time of blood glucose monitoring. In addition, nursing staff instructs patients how to recognize and deal with complications such as hypoglycemia, hypoglycemic coma, ketoacidosis, etc., and take emergency countermeasures immediately to deal with them if they occur. Nursing staff also need to instruct patients to turn over regularly, use anti-pressure sore pads, and keep skin clean and dry to prevent pressure sores, also, strengthen oral care, keep the respiratory tract open, and prevent lung infection. Moreover, they should pay attention to urinary tract infection, and encourage patients to move around early, perform passive lower limb exercises and massage to prevent deep vein thrombosis, etc. (viii) Psychological care: Nursing staff should pay attention to the patient’s psychological state, help relieve anxiety and depression, and give emotional support. Meanwhile, they should communicate with patients and their families on a regular basis to understand the psychological needs and provide psychological counseling when necessary. (ix) Rehabilitation training and functional maintenance: Nursing staff should formulate different training programs according to the patient’s rehabilitation stage, including passive activities, active exercise, daily life activities training, and gradually improve self-care ability. They should also regularly assess the progress of rehabilitation and adjust the rehabilitation program to help patients gradually restore their ability to live. Note that the fixation of puncture needles and catheters should be checked before and after rehabilitation training. Insulin pump (Medtronic MiniMed 712E) blood glucose management includes: (i) Setting up the insulin pump: personal parameters such as target glucose range and insulin sensitivity coefficient are entered according to the physician’s recommendations, and the basal rate is set for 24-h continuous infusion to simulate basal pancreatic secretion, with the preprandial dose adjusted according to blood glucose and carbohydrate intake. (ii) Blood glucose monitoring and adjustment: Blood glucose monitoring are conducted several times a day. Combined with Continuous Glucose Monitoring (CGM) system, real-time monitoring and insulin adjustment are performed, followed by flexible adjustment of basal rate and preprandial dosage based on factors such as activity, diet, sleep and stress. (iii) Handling of high and low blood glucose: automatic insulin supplementation by correction factor in case of high blood glucose, automatic suspension of infusion in case of low blood glucose. (iv) Treatment goal: Fasting blood glucose (FBG) 4.4–7.0 mmol/L and 2-h postprandial blood glucose (2hPG) < 10.0 mmol/L are considered to be achieved. (v) Device maintenance: the sensor and infusion device are replaced every 3 ~ 7 d. The CGM is regularly calibrated according to the device prompts to ensure the accuracy of blood glucose data. The effect is assessed after 2 weeks of continuous intervention in both groups. The nursing interventions in both groups were carried out by experienced nurses.

Observation indicators (1)

Glucose control effect: Before and after the intervention, 3 mL of fasting venous blood was acquired from patients in the two groups who had fasted for at least 8 h (usually overnight fasting) for the measurement of serum FBG and glycosylated hemoglobin (HbA1c), and 2 mL of venous blood from patients who had timed out for 2 h after drinking a solution containing 75 g of glucose, respectively, for the evaluation of serum 2hPG. After routine anticoagulation, the blood was centrifuged at about 3000 rpm for 10 min, and the supernatant was extracted. The serum FBG and 2hPG levels were determined by glucose oxidase test kits purchased from Fuyu Biotechnology Co., Ltd. (Shanghai, China). Serum HbA1c levels were tested by high performance liquid chromatography, and the kits were available from Telesis Medical Technology Co., Ltd. (Shandong, China).

(2)

Neurologic function: Before and after the intervention, the degree of neurologic recovery in both groups was quantified by the National Institutes of Health Stroke Scale (NIHSS), which consists of 11 items including visual fields, upper extremity movements, and lower extremity movements, with scores ranging from 0 (no impairment) to 42 (most severe).

(3)

Motor function: Before and after the intervention, the degree of recovery of upper and lower limb motor function was assessed by Fugl-Meyer Assessment (FMA) in both groups, and the scores ranged from 0 to 49, 50 to 84, 85 to 95, and 96 to 100 to represent severe, obvious, moderate, and mild motor dysfunction, respectively.

(4)

Self-care ability: Before and after the intervention, the ability of the two groups of patients to care for themselves in daily life was evaluated by the Exercise of Self-Care Agency Scale (ESCA), which includes four dimensions: self-concept, self-care responsibility, health knowledge level, and self-care skills, with a total score of 0–172, and the higher the score, the stronger the self-care ability.

(5)

Health behavior: Before and after the intervention, the self-management behaviors of patients in both groups were evaluated by the 2-Diabetes Self-Care Scale (2-DSCS), which includes six dimensions, including dietary control, regular exercise, medication compliance, and blood glucose monitoring, with a total score of 26–130, and the higher the score, the better the self-management was performed.

(6)

Quality of life: Before and after the intervention, the quality of life of patients in both groups was evaluated by the health questionnaire (SF-36) in four dimensions: physical function, emotional function, general health, and energy, and the scores of the single dimensions were 100 points, and the higher the score, the higher the quality of life.

(7)

Satisfaction: 1d before the discharge of the two groups of patients, the hospital’s own satisfaction questionnaire was adopted to assess the content of the survey, including the nurse’s service attitude, glucose monitoring and feedback, insulin injection, insulin precautions tutorials, health knowledge education, rehabilitation guidance, skin observation, the disposal of unforeseen circumstances, treatment effect, and comprehensive evaluation of a total of 10 entries, each item using a very satisfied (5 points), satisfied (4 points), general (3 points), dissatisfied (2 points), very dissatisfied (1 point) for evaluation. The total score is 50 points, and each item ≥ 4 is the satisfaction of the project.

(8)

Incidence of adverse events: the incidence of adverse events during hospitalization was counted in both groups.

Statistical analysis

Statistical analysis was implemented using SPSS 26.0 software. Qualitative data were described by [n (%)] and analyzed by the χ2 test. Normal distribution quantitative data were described by \(\overline\) ± s and independent or paired samples t-test was performed, and skewed distribution quantitative data were described by M (P25, P75) and Mann–Whitney U-test was performed. P < 0.05 was considered as statistically significant difference.