The quality of clinical practice guidelines for management of pediatric type 2 diabetes mellitus: a systematic review using the AGREE II instrument

Abstract

AimsPediatric type 2 diabetes mellitus (T2DM) is a relatively new disease with increasing incidence corresponding to the obesity epidemic among youth. It is important for clinicians to have access to high-quality clinical practice guidelines (CPGs) for appropriate management of pediatric patients with T2DM. The objective of this systematic review was to evaluate overall quality of CPGs for the management of pediatric T2DM using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.MethodsWe searched MEDLINE, Embase, CINAHL, Trip, National Guideline Clearinghouse, and grey literature to identify eligible CPGs. We also searched the webpages of national and international diabetes and pediatric organizations globally. We included CPGs from national and international diabetes and pediatric associations that were published as standalone guidelines for T2DM in children and adolescents (2–18 years of age). We also included pediatric and adult guidelines for type 1 diabetes if they included a section addressing T2DM management in children and adolescents. We retrieved the two most recent guidelines from each organization when available to assess change in quality over time. We excluded individual studies and systematic reviews that made treatment recommendations as well as CPGs that were developed for a single institution.ResultsWe included 21 unique CPGs in this systematic review. Of the included guidelines, 12 were developed or updated between 2012 and 2014. Five of all included CPGs were specific to pediatric populations. The analysis revealed that “Rigour of Development” (mean 45%, SD 28.68) and “Editorial Independence” (mean 45%, SD 35.19) were the lowest scoring domains on the AGREE II for the majority of guidelines, whereas “Clarity of Presentation” was the highest scoring domain (mean 72%, SD 18.89).ConclusionsOverall, two thirds of the pediatric T2DM guidelines were moderate to low quality and the remaining third ranked higher in quality. Low quality was especially due to the scores for the “Rigour of Development” domain, which directly measures guideline development methodology. It is important that future guidelines and updates of existing guidelines improve the methodology of development and quality of reporting in order to appropriately guide physicians managing children and adolescents with T2DM.Systematic review registrationPROSPERO CRD42016034187Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0843-1) contains supplementary material, which is available to authorized users.

A quality assessment of evidence-based guidelines for the prevention and management of ventilator-associated pneumonia: a systematic review

“…Based on the analysis of the AGREE II quality score, the highest-scoring domain was found with the scope and purpose followed by clarity of presentation domains ( Table 2), which indicated that most guidelines fully satisfied these criteria. Most guidelines could fully describe the overall objective, target population and their specific clinical issues (33). Guidelines with well adherence to these key information appeared to be more easily accepted and accessed by its intended users (34).…”

Country-Specific Prevalence and Incidence of Youth-Onset Type 2 Diabetes: A Narrative Literature Review

“…In 2018, Bhatt et al [33] completed a comprehensive systematic quality review of clinical practice guidelines for the management of T2D in children and adolescents aged 2–18 years. Of the 21 unique published guidelines identified, they found only 5 that were specific to pediatric populations.…”

“…A common theme among the guidelines was that HbA 1c should not be used alone for the diagnosis of pediatric patients, and most recommended screening every 2 years via fasting or random glucose tests when in the presence of certain risk factors (obesity, family history, high-risk race/ethnicity, and signs of insulin resistance). They also found that two-thirds of the guidelines were moderate to low in quality, which was particularly evident within the guideline development methodology [33].…”

“…Additionally, not all countries have national guidelines allowing differentiation between T1D and T2D, an important issue in this field. While several developed countries have their own screening recommendations in place [10, 33, 48-56], this is not the case for all countries. In many cases where national guidelines are missing, global guidelines or other national guidelines, such as those from the American Diabetes Association, are followed instead.…”

Quality assessment of clinical practice guidelines using the AGREE instrument in Japan: A time trend analysis

“…In a comparison of versions of CPGs before and after revision using a small sample, Bhatt et al reported an increasing trend in median scores of revised versions in all domains, but this result was not statistically significant for four domains (#3 rigor of development, #4 clarity of presentation, #5 applicability, and #6 editorial independence) [24]. In the present study, a comparison of first- and second-edition CPGs (n = 64) showed that, after revision, scores improved significantly in all domains.…”