{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:08:48Z","timestamp":1760746128641,"version":"build-2065373602"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2019s first hierarchical NB risk stratification system. Quantitative analyses incorporated authority weighting (0\u20131 scale), coordination coefficients, and Kendall\u2019s concordance testing across 81 systematically validated clinical indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2019s W: 0.289 vs. 0.391, 35.3% improvement). Secondary and tertiary indicators showed 5.5% and 27.4% increases respectively (all <jats:italic>p<\/jats:italic>&amp;lt;0.01). The final protocol reached a consensus, including 4 primary indicators, 17 secondary indicators, and 60 tertiary indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This consensus-driven framework provides innovative clinical tools for NB risk stratification in diabetes care. Its three-tiered structure\u2014integrating policy recommendations, clinical algorithms, and bedside assessment protocols\u2014significantly improves patient management and outcomes, serving as a valuable resource to guide clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1603905","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T04:14:05Z","timestamp":1760674445000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Construction of a management protocol for high-risk neurogenic bladder in Chinese patients with type 2 diabetes: a Delphi study"],"prefix":"10.3389","volume":"16","author":[{"given":"Senying","family":"Luo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Ren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YingJie","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjuan","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenzhi","family":"Cai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"Idf diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-020-0278-5","article-title":"Genetics of diabetes mellitus and diabetes complications","author":"Cole","year":"2020","journal-title":"Nat Rev Nephrol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(24)00250-0","article-title":"Diabetes in China part 1: epidemiology and risk factors","author":"Xu","year":"2024","journal-title":"Lancet Public Health"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the global burden of disease study 2021","volume":"402","year":"2023","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2009.08.070","article-title":"Diabetic bladder dysfunction: current translational knowledge","author":"Daneshgari","year":"2009","journal-title":"J Urol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"E1098","DOI":"10.1016\/S2468-2667(24)00251-2","article-title":"Diabetes in China part 2: prevention, challenges, and progress","volume":"9","author":"Xu","year":"2024","journal-title":"Lancet Public Health"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/J.Diabres.2025.112152","article-title":"Idf global clinical practice recommendations for managing type 2 diabetes - 2025","author":"Ceriello","year":"2025","journal-title":"Diabetes Res Clin Pract"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2337\/Dc25-S001","article-title":"Standards of care in diabetes\u20142025","volume":"48","year":"2025","journal-title":"Diabetes Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"16","DOI":"10.3760\/Cma.J.Cn115791-20241203-00705","article-title":"Guideline for the prevention and treatment of diabetes mellitus in China (2024 edition)","volume":"17","year":"2025","journal-title":"Chin J Diabetes Mellitus"},{"key":"B10","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1186\/2193-1801-3-549","article-title":"A comprehensive review of urologic complications in patients with diabetes","author":"Arrellano-Valdez","year":"2014","journal-title":"Springerplus"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.urology.2018.10.010","article-title":"Diabetic bladder dysfunction:A review","author":"Wittig","year":"2019","journal-title":"Urology"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2337\/Dc16-2042","article-title":"Diabetic neuropathy: A position statement by the American diabetes association","volume":"40","author":"Pop-Busui","year":"2017","journal-title":"Diabetes Care"},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1111\/1753-0407.12272","article-title":"Diabetic cystopathy: A review","volume":"7","author":"Yuan","year":"2015","journal-title":"J Diabetes"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25278","article-title":"Predictive value of risk factors for bladder dysfunction in Chinese patients with type 2 diabetes mellitus: A case-control study","author":"Wang","year":"2023","journal-title":"Neurourol Urodyn"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2337\/Db16-0480","article-title":"Toll-like receptor 4 activation contributes to diabetic bladder dysfunction in A murine model of type 1 diabetes","volume":"65","author":"Szasz","year":"2016","journal-title":"Diabetes"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1074\/Jbc.M109.040444","article-title":"Endogenous nerve growth factor regulates collagen expression and bladder hypertrophy through akt and mapk pathways during cystitis","volume":"285","author":"Chung","year":"2010","journal-title":"J Biol Chem"},{"key":"B17","article-title":"Therapeutic progress of diabetic neurogenic bladder","volume":"32","author":"Liu","year":"2012","journal-title":"Int J Endocrinol Metab"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2017.04.003","article-title":"Long-term complications of the neurogenic bladder","author":"Nseyo","year":"2017","journal-title":"Urol Clin North Am"},{"key":"B19","article-title":"Application value of American urological association symptom index score in female patients with type 2 diabetic neurogenic bladder","volume":"50","author":"Peng","year":"2019","journal-title":"Sichuan Da Xue Xue Bao Yi Xue Ban"},{"key":"B20","doi-asserted-by":"publisher","first-page":"E18872","DOI":"10.7717\/Peerj.18872","article-title":"A nomogram for predicting bladder dysfunction in patients with type 2 diabetes mellitus: A retrospective study","volume":"13","author":"Hu","year":"2025","journal-title":"Peerj"},{"key":"B21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2147\/DMSO.S335957","article-title":"Platelet-to-lymphocyte ratio predicts the presence of diabetic neurogenic bladder","author":"Liu","year":"2022","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.47391\/JPMA.23-77","article-title":"Bladder drainage options for people with spinal cord injury: A mini-review","author":"Engkasan","year":"2023","journal-title":"J Pak Med Assoc"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/S00520-007-0348-2","article-title":"Applying the delphi process to palliative care tool development: lessons learned","volume":"16","author":"Biondo","year":"2008","journal-title":"Support Care Cancer"},{"key":"B24","doi-asserted-by":"publisher","first-page":"27","DOI":"10.3138\/cjpe.07.002","article-title":"The delphi method: A review of methodology and an application in the evaluation of A higher education program","volume":"7","author":"Boberg","year":"1992","journal-title":"Can J Program Eval"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/J.Evalprogplan.2009.06.006","article-title":"Using the delphi method to engage stakeholders: A comparison of two studies","volume":"33","author":"Geist","year":"2010","journal-title":"Eval Program Plann"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.12.002","article-title":"Defining consensus: A systematic review recommends methodologic criteria for reporting of delphi studies","author":"Diamond","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1177\/0269216317690685","article-title":"Guidance on conducting and reporting delphi studies (Credes) in palliative care: recommendations based on A methodological systematic review","author":"J\u00fcnger","year":"2017","journal-title":"Palliat Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/Fpubh.2022.841345","article-title":"Linking safety-specific leader reward and punishment omission to safety compliance behavior: the role of distributive justice and role ambiguity","volume":"10","author":"Liu","year":"2022","journal-title":"Front Public Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"E0267470","DOI":"10.1371\/journal.pone.0267470","article-title":"A comprehensive mobility discharge assessment framework for older adults transitioning from hospital-to-home in the community-what mobility factors are critical to include? Protocol for an international E-delphi study","author":"Kalu","year":"2022","journal-title":"PloS One"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.884514","article-title":"Identifying the service capability of long-term care facilities in China: an E-delphi study","volume":"10","author":"Liu","year":"","journal-title":"Front Public Health"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.17219\/Acem\/104532","article-title":"Urinary bladder hypertrophy and overactive bladder determine urinary continence after radical prostatectomy","volume":"28","author":"Juszczak","year":"2019","journal-title":"Adv Clin Exp Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0020476","article-title":"Using and reporting the delphi method for selecting healthcare quality indicators: A systematic review","author":"Boulkedid","year":"2011","journal-title":"PloS One"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2998","DOI":"10.1002\/Cjce.25279","article-title":"A mechanistic model for industrial workplace design based on inherent safety and health concepts","volume":"102","author":"Gao","year":"2024","journal-title":"Can J Chem Eng"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3581","article-title":"Performance evaluation index system in public hospitals: the delphi technique in nursing","author":"Li","year":"2023","journal-title":"Int J Health Plann Manage"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1403637","article-title":"Development of an indicator framework for assessing nursing quality in interventional therapy for intracranial aneurysms in China","author":"Yang","year":"2024","journal-title":"Front Neurol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1186\/s12909-024-06312-2","article-title":"Construction of the medical virtual teaching and research office evaluation system in China based on the context, input, process, product model: A delphi study","author":"Xiao","year":"2024","journal-title":"BMC Med Educ"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmac072","article-title":"Building A personalized patient education model for general practice by delphi method","author":"Li","year":"2023","journal-title":"Fam Pract"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/jan.16266","article-title":"Construction of nursing-sensitive quality indicators for acute poisoning in emergency departments: an E-delphi study","author":"Li","year":"2024","journal-title":"J Adv Nurs"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1525\/jer.2011.6.1.21","article-title":"A delphi study to establish important aspects of ethics review","author":"Geisser","year":"2011","journal-title":"J Empir Res Hum Res Ethics"},{"key":"B40","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/s0020-7489(00)00044-4","article-title":"A critical review of the delphi technique as A research methodology for nursing","author":"Keeney","year":"2001","journal-title":"Int J Nurs Stud"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1080\/10580530.2010.493839","article-title":"A qualitative study of hard decision making in managing global software development teams","author":"Garc\u00eda-Crespo","year":"2010","journal-title":"Inf Syst Management"},{"key":"B42","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1504\/ijssoc.2018.10015691","article-title":"Development of quality indicators for multi-family residential buildings in India\u2013A delphi analysis","author":"Sinha","year":"2018","journal-title":"Int J Of Sustain Society"},{"key":"B43","doi-asserted-by":"publisher","first-page":"I","DOI":"10.3310\/hta2030","article-title":"Consensus development methods, and their use in clinical guideline development","volume":"2","author":"Murphy","year":"1998","journal-title":"Health Technol Assess"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1491311","article-title":"Development of A complex intervention to prevent complications in patients recovering at home after transcatheter aortic valve replacement by optimizing home-based cardiac rehabilitation processes: A delphi study","author":"Jia","year":"2024","journal-title":"Front Public Health"},{"key":"B45","first-page":"S1","article-title":"Kdigo 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"100","year":"2024","journal-title":"Kidney Int"},{"key":"B46","unstructured":"Eau guidelines on neuro-urology\n          \n          \n          \n          2024"},{"key":"B47","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/NUR.0b013e3181a42373","article-title":"Integrated theory of health behavior change: background and intervention development","author":"Ryan","year":"2009","journal-title":"Clin Nurse Spec"},{"key":"B48","doi-asserted-by":"publisher","first-page":"5178","DOI":"10.3390\/nu14235178","article-title":"Self-reported dietary management behaviors and dietary intake among Chinese adults with diabetes: A population-based study","author":"Liu","year":"2022","journal-title":"Nutrients"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2021.09.012","article-title":"The future of prevention and treatment of diabetes with nutrition in China","author":"Wei","year":"2021","journal-title":"Cell Metab"},{"key":"B50","volume-title":"National Guideline for Primary Diabetes Prevention and Management (2022)","year":"2022"},{"key":"B51","doi-asserted-by":"publisher","first-page":"E25040","DOI":"10.37766\/inplasy2021.2.0021","article-title":"Effectiveness of traditional Chinese medicine music therapy on anxiety and depression emotions of lung cancer patients: A protocol for systematic review and meta-analysis","author":"Jiang","year":"2021","journal-title":"Med (Baltimore)"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.11.027","article-title":"Effects of acupuncture, Tuina, Tai Chi, Qigong, and traditional Chinese medicine five-element music therapy on symptom management and quality of life for cancer patients: A meta-analysis","author":"Tao","year":"2016","journal-title":"J Pain Symptom Manage"},{"key":"B53","doi-asserted-by":"publisher","first-page":"E41050","DOI":"10.1097\/MD.0000000000041050","article-title":"Impact of nursing interventions on hemodialysis patients using the integrated theory of health behavior change","author":"Chen","year":"2025","journal-title":"Med (Baltimore)"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1007\/S11892-024-01537-3","article-title":"Diabetes, sglt-2 inhibitors, and urinary tract infection: A review","volume":"24","author":"Pishdad","year":"2024","journal-title":"Curr Diabetes Rep"},{"key":"B55","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1016\/S0140-6736(21)01528-2","article-title":"The prevalence and risk factors of urinary incontinence among women with type 2 diabetes in the North West bank: A cross-sectional study","author":"Nazzal","year":"2021","journal-title":"Lancet"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1016\/J.Diabres.2025.112324","article-title":"Glp-1 receptor agonists and hospitalization due to infections in patients with type 2 diabetes: A nationwide cohort study","volume":"226","author":"Wang","year":"2025","journal-title":"Diabetes Res Clin Pract"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.2337\/Dc24-2169","article-title":"Risk of urogenital infections in people with type 2 diabetes initiating sglt2is versus glp-1ras in routine clinical care: A Danish cohort study","volume":"48","author":"Ljungberg","year":"2025","journal-title":"Diabetes Care"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1603905\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T04:14:08Z","timestamp":1760674448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1603905\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":57,"alternative-id":["10.3389\/fendo.2025.1603905"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1603905","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]},"article-number":"1603905"}}