Comparison of the guideline development processes used for type 2 diabetes dietetic practice guidelines

Abstract

Objective: To compare procedures used for the development of three sets of dietetic practice guidelines for type 2 diabetes: the Queensland Best Practice Guidelines (Queensland Guidelines), New Zealand Standards of Care (New Zealand Guidelines) (unpublished, 2003) and American Nutrition Practice Guidelines (American Guidelines) against National Health and Medical Research Council (NHMRC) standards for development of clinical practice guidelines. Design: The Queensland, New Zealand and American guidelines were audited against a checklist based on the NHMRC clinical practice guideline development standards, accounting for the recommended tasks and the order in which they should be completed. Additional information regarding the development processes was obtained from development coordinators of the existing dietetic practice guidelines for type 2 diabetes. Results: The American guidelines addressed more of the components of development recommended by the NHMRC than the Queensland and New Zealand guidelines. Most importantly the American guidelines were tested for clinical and cost effectiveness. Conclusion or application: The data presented show that the American Guidelines came closest to meeting the NHMRC criteria. These results suggest that the American Guidelines may best suit Australian requirements.

Clinical practice guidelines. A dilemma for dietitians?

“…Consequently, objective criteria by which to determine quickly and accurately which guideline best meets our needs would be a great advantage. It is therefore with great interest that I read the paper by Knights and Tapsell 14 in this issue of the journal comparing procedures used for the development of three sets of dietetic practice guidelines for type 2 diabetes, using the National Health and Medical Research Council CPG Standards 22 . This study usefully highlights the importance of canvassing the views of all stakeholders (not just dietitians) and considering not only the evidence and its relationship to treatment outcomes but also cost‐effectiveness and ‘adaptability of the guidelines in different settings’.…”

“…The time between the initial exposure to the nutrient of interest and the development of an illness may be years or decades, 11,12 and (with some notable exceptions) 13 many nutrition‐related RCTs are concerned with manipulations of a single nutrient and for this reason may yield results that are not generalisable to the foods that people eat in everyday life 11 . Furthermore, as noted by Knights and Tapsell 14 in this issue of the journal, blinding in nutrition studies is often impractical 15 . It has therefore been suggested that a modified system be developed, which addresses the differences between nutritional and pharmacological studies 12 …”

Practice guidelines: Adopting existing guidelines or developing our own

“…Questions that arise for the dietetics profession in Australia include: ‘Should we adopt guidelines that have been developed overseas or should we develop our own?’ and ‘How useful are guidelines to practitioners—is it just another example of telling us things we already know and do?’ Knights and Tapsell in the following two papers attempt to answer these questions using the example of diabetes management 5,6 …”

“…Knights and Tapsell in the following two papers attempt to answer these questions using the example of diabetes management. 5,6 Developing guidelines to a high standard is both costly and time-consuming. Guidelines also require constant updating.…”