A review of the quality of current diabetes clinical practice guidelines

Abstract

Objective To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%–100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions Based on this study’s findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

Content and quality of clinical practice guidelines for the management of type 2 diabetes in India: A systematic review

“…30 CPGs scored poorly in the 'stakeholder involvement' and 'rigour of development' domains, and the findings are similar to those in other studies. 30,31 The first one is a failure to appreciate the relevance of stakeholders' and patients' views and preferences in CPG development. 32 The prohibitive cost of assembling all the relevant stakeholders or poor reporting of stakeholder involvement in CPG development could be other reasons.…”

Comparison of Content and Quality of Caribbean, International, and High-Income Country-Specific Clinical Guidelines for Managing Type 2 Diabetes Mellitus

“…A strength of this study is that a recognised and validated tool was used to assess the quality of the clinical guidelines. The AGREE II tool was developed to address variability in guideline quality [ 10 , 19 , 21 , 23 , 36 ] and is recommended by the World Health Organization (WHO), the Guidelines International Network (GIN), and the Council of Europe for its reliability in appraising clinical guidelines [ 37 ]. We decided to compare the existing Caribbean clinical guideline with clinical guidelines from high-income countries as the latter would set a benchmark.…”

Avaliação de diretrizes clínicas brasileiras em oncologia: carências no rigor do desenvolvimento, aplicabilidade e independência editorial

“…Também é necessário mencionar que é notória a variabilidade de parâmetros na definição de um ponto de corte aceitável, ou sua ausência 45 , para a classificação da qualidade global encontrada na literatura, variando, por exemplo, 70% ou 4 17 . Por isso, optou-se por não adotar valor preestabelecido.…”

“…tuais SurveyMonkey (https://pt.surveymonkey.com/), com base na transcrição do instrumento validado 16 e links de armazenamento em nuvem das diretrizes e respectivos documentos de suporte. Como sugerido pelo manual do instrumento 16 e realizado por alguns dos estudos publicados 17,18 , avaliadores pertencentes a diferentes grupos de interesse em oncologia realizaram as avaliações em triplicata. Participaram anonimamente cinco pesquisadores(as)/metodologistas, dois médicos(as) oncologistas e cinco gestores(as), sendo mantida a proporção média de profissionais de 56%, 22% e 22%, respectivamente, para cada grupo de diretrizes por tipo de câncer avaliado.…”