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

Abstract

Purpose. Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare the clinical guidelines for T2DM management from the Caribbean to guidelines developed internationally and by high-income countries. Methods. Seven T2DM management clinical guidelines were a priori selected from international and high-income country-specific clinical guidelines and then compared to the country-specific T2DM management clinical guidelines of the Caribbean region. Two reviewers independently assessed content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results. The Caribbean clinical guideline was found to contain similar levels of T2DM management topics when compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have substantially lower levels of content. The clinical guideline from the Caribbean was found to be of low quality and could not be used in practice; however, only three comparator clinical guidelines were found to be of high quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. Conclusion. Although the T2DM management clinical guidelines from the Caribbean region contained high levels of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline, as identified within this study, should be adopted and used within the Caribbean region to manage T2DM until a high-quality region-specific clinical guideline can be developed.

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

“…Overall, the failure to adequately address all of these domains could negatively impact the trustworthiness and implementation of CPGs 4,32 . The RSSDI/ESI CPG, 9 which had a score of 6.75 and was recommended in this systematic review, was as good as CPGs from England, Scotland, Canada and the United States with quality scores of 7, 7, 6 and 5, respectively 13 . The rest of the CPGs included in this systematic review fell short.…”

“…The RSSDI/ESI CPG 9 contained scientific evidence-based recommendations comparable to other high-quality international guidelines. 13 In the CCRAS/WHO CPG published in 2011, 8 the recommendations might have been compiled before the WHO approved the usage of HbA1c to diagnose T2DM in the same year. 21 The CCRAS CPG 11 was published in 2017, and the omission likely reflects a failure to review the current literature as the outdated WHO recommendation was used.…”

“…CPGs on western medicine 7,9 provided more comprehensive recommendations. The RSSDI/ESI CPG 9 contained scientific evidence‐based recommendations comparable to other high‐quality international guidelines 13 . In the CCRAS/WHO CPG published in 2011, 8 the recommendations might have been compiled before the WHO approved the usage of HbA1c to diagnose T2DM in the same year 21 .…”

“…A data extraction tool from a previous study 13 was adapted to extract the content (and related recommendations) of the included CPGs and conducted independently by two reviewers (OPO and MEO) with discrepancies resolved through discussion or with a third reviewer (KC). The broad content headings are as follows: blood glucose assessment and management, blood pressure assessment and management, body weight assessment and management, blood lipid assessment and management, assessment and management of T2DM‐related complications and other related issues and healthcare advice.…”

“…A data extraction tool from a previous study 13 was adapted to extract the content (and related recommendations) of the included…”