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Development of Evidence-Based Clinical Practice Guidelines for Diabetes

The Department of Veterans Affairs/Department of Defense Guidelines Initiative

¹ VA New Jersey Health Care System, East Orange, New Jersey
² The Uniformed Services University of the Health Sciences, Bethesda, Maryland
³ Washington VA Medical Center, Washington, D.C
⁴ Boston VA Health Care System, Boston, Massachusetts
⁵ Office of Quality and Performance, Department of Veterans Affairs, Washington, D.C
⁶ Office of the Medical Inspector, Department of Veterans Affairs, Washington, D.C

Address correspondence and reprint requests to Leonard M. Pogach, MD, Medical Service (111), 385 Tremont St., East Orange, NJ 07019. E-mail: leonard.pogach{at}med.va.gov

OBJECTIVE—To describe the Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guidelines for diabetes and contrast selected recommendations with those of the American Diabetes Association (ADA).

RESEARCH DESIGN AND METHODS—We summarize the general structure of the VA/DoD Guidelines and describe the rationale for recommendations issued in 2003 for glycemic control, management of hypertension, and retinopathy screening. We compare the synthesis of evidence and resulting recommendations for these content areas with the 2004 American Diabetes Association Clinical Practice Recommendations.

RESULTS—The VA/DoD Guidelines and the ADA Clinical Practice Recommendations reported similar strength of evidence findings by content area, but clinical recommendations varied. The VA/DoD Guidelines and practice recommendations emphasize the use of data on absolute risk reduction from available published randomized clinical trials rather than relative risk reduction from observational analyses. The VA/DoD Guidelines employ an algorithm-based methodology to guide clinicians through a risk-stratified approach to managing individual patients rather than promoting a single standard for most or all patients without explicit consideration of competing comorbidities.

CONCLUSIONS—The VA/DoD Guidelines are intended to guide diabetes care by providing Internet-ready, evidence-based annotations in algorithmic form to help clinicians set and revise individual treatment goals for their patients.

Abbreviations: ADA, American Diabetes Association • DBP, diastolic blood pressure • DoD, Department of Defense • SBP, systolic blood pressure • UKPDS • U.K. Prospective Diabetes Study • VA, Veterans Affairs

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