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Diabetes Care. 2018 May;41(5):1097-1105. doi: 10.2337/dc17-1795.

Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries-A Systematic Review.

Author information

1
University of Ibadan, Ibadan, Nigeria mayowaowolabi@yahoo.com.
2
University College Hospital, Ibadan, Nigeria.
3
Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
4
Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
5
University College London, London, U.K.
6
The University of Melbourne, Melbourne, Australia.
7
Icahn School of Medicine at Mount Sinai, New York, NY.
8
University of the Witwatersrand, Johannesburg, South Africa.
9
Federal Teaching Hospital, Ido-Ekiti, Nigeria.
10
Medical University of South Carolina, Charleston, SC.
11
Fundación Santa Fe de Bogotá Hospital, University of the Andes, Bogota, Colombia.
12
Public Health Foundation of India, New Delhi, India.
13
The George Institute for Global Health, The University of New South Wales, Sydney, Australia.
14
South African Medical Research Council, Cape Town, South Africa.
15
Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania.
16
Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
17
The George Institute for Global Health, New Delhi, India.
18
Universidad Peruana Cayetano Heredia, Lima, Peru.
19
University of Cape Town, Cape Town, South Africa.
20
Monash University, Melbourne, Australia.
21
National and Kapodistrian University of Athens, Athens, Greece.
22
Harokopio University, Athens, Greece.

Abstract

OBJECTIVE:

The extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation.

RESEARCH DESIGN AND METHODS:

Eligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences.

RESULTS:

Most LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001).

CONCLUSIONS:

A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.

PMID:
29678866
PMCID:
PMC5911785
[Available on 2019-05-01]
DOI:
10.2337/dc17-1795
[Indexed for MEDLINE]

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