Construction of a management protocol for high-risk neurogenic bladder in Chinese patients with type 2 diabetes: a Delphi study.

OBJECTIVES

The objective of this study is to establish an evidence-based protocol for managing high-risk neurogenic bladder (NB) in Chinese patients with T2DM, integrating risk stratification to standardize clinical practice in China region.

METHODS

Through a two-round Delphi consensus process involving 20 national experts and evidence synthesis from 13 clinical guidelines and a systematic review, we developed China's first hierarchical NB risk stratification system. Quantitative analyses incorporated authority weighting (0-1 scale), coordination coefficients, and Kendall's concordance testing across 81 systematically validated clinical indicators.

RESULTS

High expert engagement persisted through both rounds (Round 1: 90% response rate; Round 2: 94.7%). Consensus levels demonstrated progressive improvement, with primary indicators achieving the most substantial enhancement (Kendall's W: 0.289 vs. 0.391, 35.3% improvement). Secondary and tertiary indicators showed 5.5% and 27.4% increases respectively (all p<0.01). The final protocol reached a consensus, including 4 primary indicators, 17 secondary indicators, and 60 tertiary indicators.

CONCLUSION

This consensus-driven framework provides innovative clinical tools for NB risk stratification in diabetes care. Its three-tiered structure-integrating policy recommendations, clinical algorithms, and bedside assessment protocols-significantly improves patient management and outcomes, serving as a valuable resource to guide clinical practice.