For instance, in the first round of Delphi, the item “The use of insulin is the natural progression of diabetes and does not imply the aggravation of the disease” was deleted because it repeated the item “The initiation of insulin therapy is determined by a combination of factors such as my blood sugar level, pancreatic function, complications, and other factors, and does not represent the severity of the disease”, and the expression of former item was less professional than the latter. Here, INS is linked to diabetes mellitus.