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Endocrine. 2019 Feb;63(2):204-212. doi: 10.1007/s12020-018-1786-y. Epub 2018 Nov 16.

Critical appraisal and systematic review of guidelines for perioperative diabetes management: 2011-2017.

Song X1, Wang J2,3, Gao Y1,4, Yu Y5, Zhang J6,7, Wang Q7,8,9, Ma X6, Estille J10,11, Jin X3,12, Chen Y13,14, Mu Y15.

Author information

1
The First Clinical Medical College, Lanzhou University, Donggang West Road, 730000, Lanzhou, China.
2
Fifth Medical Center of Chinese PLA General Hospital, East Avenue, 100000, Beijing, China.
3
Department of Endocrinology, Chinese PLA General Hospital, Fuxing Road, 100000, Beijing, China.
4
Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan ErLu, Guangzhou, 510080, China.
5
The Second Clinical Medical College, Lanzhou University, Cuiyingmen, 730000, Lanzhou, China.
6
School of Public Health, Lanzhou University, Donggang West Road, 730000, Lanzhou, China.
7
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Donggang West Road, 730000, Lanzhou, China.
8
Health Policy PhD Program, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada.
9
McMaster Health Forum, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada.
10
Institute of Global Health, University of Geneva, Rue du Général-Dufour, 1211, Geneva, Switzerland.
11
Institute of Mathematical Statistics and Actuarial Science, University of Bern, Hochschulstrasse, 3012, Bern, Switzerland.
12
Department of Endocrinology, Hainan Branch of Chinese PLA General Hospital, Haitangwan, 572000, Sanya, China.
13
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Donggang West Road, 730000, Lanzhou, China. chenyaolong21@163.com.
14
WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, 730000, China. chenyaolong21@163.com.
15
Department of Endocrinology, Chinese PLA General Hospital, Fuxing Road, 100000, Beijing, China. muyiming@301hospital.com.cn.

Abstract

PURPOSE:

To systematically evaluate the quality, consistency and the evidence support of guidelines for perioperative diabetes management.

METHODS:

We retrieved guidelines through systematic search, critically evaluated their quality and compared the recommendations of included guidelines. Five aspects were compared: target level, management of hyper- and hypoglycaemia, frequency of monitoring, management of insulin, and management of oral anti-diabetic drugs (OADs).

RESULTS:

Fourteen guidelines met our criteria, and 342 recommendations were extracted, the results of Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation showed that none of the mean score in each domain was higher than 50%. On average, most guidelines had only one domain scored above 50%. Most recommendations (78.9%) did not specify their supporting evidence, 71 (20.8%) were formed using grading criteria, none cited systematic review or meta-analysis. Recommendations were inconsistent across different guidelines.

CONCLUSIONS:

The existing guidelines about perioperative management of diabetes needs improvement in methodology, as well as the production of evidence with high quality. Evidence-based guidelines are required for the perioperative management of diabetes.

KEYWORDS:

Clinical practice guideline; Diabetes; Perioperative management; Quality assessment; Systematic review

PMID:
30446970
DOI:
10.1007/s12020-018-1786-y

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