Inside Guidelines
Comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries
- Jako S. Burgers, MD1,
- Julia V. Bailey, MBBS, MRCGP2,
- Niek S. Klazinga, MD, PHD3,
- Akke K. Van der Bij, MSC1,
- Richard Grol, PHD1,
- Gene Feder, MD, FRCGP2 and
- for the AGREE Collaboration
- 1Centre for Quality of Care Research, University Medical Centre Nijmegen, Nijmegen, the Netherlands
- 2Department of General Practice and Primary Care, Barts and The London, Queen Mary’s School of Medicine and Dentistry, University of London, London, U.K
- 3Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Abstract
OBJECTIVE—To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence.
RESEARCH DESIGN AND METHODS—We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using qualitative methods to compare the recommendations and bibliometric methods to measure the extent of overlap in citations used by different guidelines. A further qualitative analysis of recommendations and cited evidence for two specific issues in diabetes care explored the apparent discrepancy between recommendations and evidence.
RESULTS—The recommendations made in the guidelines were in agreement about the general management of type 2 diabetes, with some important differences in treatment details. There was little overlap in evidence cited by the guidelines, with 18% (185/1,033) of citations shared with any other guideline, and only 10 studies (1%) appearing in six or more guidelines. The measurable overlap in evidence between guidelines increases if multiple publications from the same study and the use of reviews are taken into account. Research originating from the U.S. predominated (40% of citations); however, nearly all (11/12) guidelines were significantly more likely to cite evidence originating from their own countries.
CONCLUSIONS—Despite the variation in cited evidence and preferential citation of evidence from a guideline’s country of origin, we found a high degree of international consensus in recommendations made for the clinical care of type 2 diabetes. The influence of professional bodies such as the American Diabetes Association may be an important factor in explaining international consensus. Globalization of recommended management of diabetes is not a simple consequence of the globalization of research evidence.
- ADA, American Diabetes Association
- AGREE, Appraisal of Guidelines for Research and Evaluation
- DCCT, Diabetes Control and Complications Trial
- UKPDS, U.K. Prospective Diabetes Study
Footnotes
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Address correspondence and reprint requests to Jako S. Burgers, MD, Centre for Quality of Care Research, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: burgersj{at}knmg.nl.
Received for publication 21 April 2002 and accepted in revised form 5 August 2002.
The AGREE Collaboration coordinating center is the Department of Public Health Sciences, St. George’s Hospital Medical School, University of London, London, U.K. (see appendix).
Additional information for the article can be found in an online appendix at http://care.diabetesjournals.org.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
