Development of Evidence-Based Clinical Practice Guidelines for Diabetes
The Department of Veterans Affairs/Department of Defense Guidelines Initiative
- Leonard M. Pogach, MD, MBA1,
- Stephen A. Brietzke, COL, MC, USAF2,
- Claude L. Cowan, Jr., MD3,
- Paul Conlin, MD4,
- Debby J. Walder, RN, MSN5,
- Clark T. Sawin, MD6 and
- for the VA/DoD Diabetes Guideline Development Group*
- 1VA New Jersey Health Care System, East Orange, New Jersey
- 2The Uniformed Services University of the Health Sciences, Bethesda, Maryland
- 3Washington VA Medical Center, Washington, D.C
- 4Boston VA Health Care System, Boston, Massachusetts
- 5Office of Quality and Performance, Department of Veterans Affairs, Washington, D.C
- 6Office 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
Abstract
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.
- 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
Footnotes
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*The members of the 2002 Diabetes Guideline Development Group are listed in the appendix.
The views expressed in this article are those of the authors and do not necessarily represent the views of the agencies providing support.
Funding for this supplement was provided by The Seattle Epidemiologic Research and Information Center and the VA Cooperative Studies Program.
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- Accepted July 25, 2003.
- Received July 1, 2003.
- DIABETES CARE
