sábado, 28 de enero de 2012

Evaluation of guideline recommendations on or... [Ann Intern Med. 2012] - PubMed - NCBI

Some Diabetes Practice Guidelines Do Not Reflect All Available Evidence

Not all clinical practice guidelines on the use of oral medications for type 2 diabetes are consistent with a systematic review of the available scientific evidence funded by AHRQ, according to a new analysis published on January 3 in the Annals of Internal Medicine. None of the guidelines, however, included recommendations that contradicted available evidence. The evaluation, conducted by researchers at Johns Hopkins University, found that some diabetes treatment guidelines did not fully reflect evidence identified in a 2007 systematic review on diabetes treatments developed by AHRQ’s Effective Health Care Program. The analysis, An Evaluation of Guideline Recommendations Related to Oral Medication Treatment for Type 2 Diabetes Mellitus, examined 11 diabetes guidelines that met the study criteria and assessed whether the guidelines agreed with seven evidence-based conclusions from the 2007 systematic review. Seven guidelines agreed with the conclusion that “metformin is favored as the first line agent,” and 10 agreed that “thiazolidinediones are associated with higher rates of edema and congestive heart failure.” The analysis also found variability in guideline quality. Most guideline development processes did not include a systematic method for determining which evidence to incorporate. Select for additional information about type 2 diabetes oral medications, including a 2011 update of AHRQ’s 2007 report. Select to access the abstract on PubMed.®

Research Review - Final – Mar. 15, 2011 (Update)

Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update

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Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus: a systematic review.

Bennett WL, Odelola OA, Wilson LM, Bolen S, Selvaraj S, Robinson KA, Bass EB, Puhan MA.

Source

The Johns Hopkins University School of Medicine and The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Albert Einstein Medical Center, Philadelphia, Pennsylvania; and Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.

Abstract

Background: Clinical practice guidelines have an important role in guiding choices among the numerous medications available to treat type 2 diabetes mellitus, but little is known about their quality. Purpose: To assess whether guidelines on oral medications for type 2 diabetes are consistent with a systematic review of the current evidence and whether the consistency of the guidelines depends on the quality of guideline development. Data Sources: MEDLINE, CINAHL, and guideline-specific databases were searched between July 2007 and August 2011, after the 2007 publication of a peer-reviewed systematic review on oral diabetes medications. Study Selection: Two reviewers independently screened citations to identify English-language guidelines on oral medications to treat type 2 diabetes that were applied in the United States, United Kingdom, and Canada. Data Extraction: Reviewers assessed whether the guidelines addressed and agreed with 7 evidence-based conclusions from the 2007 systematic review. Two reviewers independently rated guideline quality by using 2 domains from the Appraisal of Guidelines Research and Evaluation instrument. Data Synthesis: Of the 1000 screened citations, 11 guidelines met the inclusion criteria. Seven guidelines agreed with the conclusion that metformin is favored as the first-line agent. Ten guidelines agreed that thiazolidinediones are associated with higher rates of edema and congestive heart failure compared with other oral medications to treat type 2 diabetes. One guideline addressed no evidence-based conclusions, and 5 guidelines agreed with all 7 conclusions. The summary scores of the rigor of development (median, 28.6% [range, 16.7% to 100.0%]) and editorial independence (median, 75.0% [range, 8.3% to 100.0%]) domains varied greatly across guidelines. Guidelines that received higher quality scores contained more recommendations that were consistent with the evidence-based conclusions. Limitation: Only English-language guidelines targeting users in the United States, United Kingdom, and Canada that contained recommendations on oral medications were included. Conclusion: Not all practice guidelines on oral treatment of type 2 diabetes were consistent with available evidence from a systematic review. Guidelines judged to be of higher quality contained more recommendations consistent with evidence-based conclusions. The quality of guideline development processes varied substantially. Primary Funding Source: Agency for Healthcare Research and Quality.