Not all practice guidelines on oral medications for type 2 diabetes (T2DM) are consistent with available evidence, and guideline quality varies widely, according to the results of a systematic review reported in the January issue of the Annals of Internal Medicine.

-Team@CMHF

• Since 1995, there have been 11 classes of medications introduced to treat patients with T2DM.
• The goals of this review were to determine whether guidelines on oral medications for T2DM are consistent with evidence from a peer-reviewed systematic review published in 2007, and whether guideline consistency is associated with the quality of guideline development.
• The reviewers searched MEDLINE, CINAHL, and guideline-specific databases between July 2007 and August 2011, reflecting the time post publication of the 2007 peer-reviewed systematic review on oral diabetes medications.
• The reviewers determined whether the selected guidelines concurred with 7 evidence-based conclusions from the 2007 systematic review.
• Using 2 domains (rigor of development and editorial independence) from the Appraisal of Guidelines Research and Evaluation (AGREE) tool, 2 reviewers independently evaluated guideline quality based on 7 key elements of systematic review and reporting.
• The search retrieved 1000 citations but screening identified only 11 guidelines meeting the inclusion criteria.
• Of these, 7 guidelines agreed that metformin is the preferred first-line agent, and 10 guidelines agreed that thiazolidinediones compared with other oral medications are linked to increased rates of edema and congestive heart failure.
• One of the 11 guidelines addressed no evidence-based conclusions, and at the other extreme, 5 guidelines agreed with all 7 evidence-based conclusions.
• According to AGREE criteria, the overall quality of all of the guidelines was poor, particularly in use of systematic methods to identify evidence.
• The guidelines varied greatly in domain summary scores for the rigor of development (median, 28.6%; range, 16.7% – 100.0%) and editorial independence (median, 75.0%; range, 8.3% – 100.0%).
• Higher-quality scores were associated with a greater number of recommendations consistent with the evidence-based conclusions.

Not all practice guidelines on oral treatment of type 2 diabetes were consistent with available evidence from a systematic review, the study authors write.

• Guidelines judged to be of higher quality contained more recommendations consistent with evidence-based conclusions.
• The quality of guideline development processes varied substantially.

For further reading log on to
http://www.medscape.com/viewarticle/756289