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Guidelines for Endorsement

There are a number of stakeholders in the promotion of health and the care of people living with diabetes. The Canadian Diabetes Association (CDA) recognizes the importance of working collaboratively with these stakeholders to improve the care of those with diabetes. CDA is an organization with an existing Clinical Practice Guideline (CPG) process, complete with expert subcommittees and methodology working groups to ensure that the guidelines are comprehensive, that the evidence review is systematic, and that there is a rigorous evaluation and grading of recommendations. We acknowledge that, concurrent to CDA, other expert groups develop recommendations and guidelines that are relevant to people with diabetes. Consistency between guidelines and harmonization of existing recommendations regarding the care of persons with diabetes is of clear importance to ensure timely and appropriate implementation. This document outlines proposed procedures for the review, evaluation, and endorsement of guidelines, programs, and products.

Key issues that need to be addressed in the review of other guidelines are issues of transparency, conflicts of interest, and ownership. 

Guidelines

Recognizing the importance of recommendations that are clear, consistent, and based upon rigorously reviewed evidence, the CDA will partner with other organizations to develop guidelines. 
When possible, CDA would prefer to be involved early in any guideline development process to ensure that there are similar standards with respect to review of evidence. However, in some cases, endorsement of a developed guideline can occur if the following conditions are met:

Drafted Guidelines

1) A formal request for endorsement of a CPG must be made to the chair of the CDA CPGs and the chair must deem the guideline to be of “added value” to the existing guidelines to the extent that it is not redundant in the context of current CDA guidelines and has clinical significance.

2) The literature review process to identify relevant evidence to support CPGs is disclosed to the CDA CPG methodology working group to ensure the literature search is reasonably comprehensive, systematic, and free of bias.

3) The method of scientific review of identified evidence is disclosed to the CDA CPG methodology working group and is deemed to be appropriate.

4) The drafted CPG is reviewed by the chair of the CPGs, the methodology working group, and the relevant CDA CPG expert subcommittee (if one can be identified); and the drafted guideline is felt to be focused, clear, and implementable.

5) All participants in the CPG process external to CDA must disclose conflicts of interest and CDA.

If these conditions are met, a guideline may receive endorsement from the CDA CPG chair. 

In the event the group seeking endorsement is proposing a new guideline that contradicts or is inconsistent with an existing CDA guideline, the new guideline may still be endorsed by the CDA. If all of the above conditions are met, the CDA CPG chair will present the guideline to the CDA’s Clinical & Scientific Section (C&SS) and discuss the rationale for the guideline and CDA endorsement. The C&SS and the CPG chair will then decide how to translate knowledge regarding the new guideline (position paper or interim guideline).  It should be noted that, in this process, the ownership of the guideline will be with the organization that requested collaboration with CDA. CDA will share ownership of a guideline when there has been evidence of active involvement of CDA in guideline development as indicated by one or more of the following:

1) There is an explicit agreement between parties that the guideline will be jointly owned by the CDA and the other party.

2) The CDA CPG chair, methodology chair, or expert subcommittee chair are actively involved with guideline development by assisting in the formulation of clinical questions; development of literature search strategies; identification of relevant evidence; scientific review of evidence; drafting or editing of the CPG.

3) CDA CPG resources are used in the guideline development process. 

4) There is significant shared membership of the CPG methodology or expert subcommittee with that of CDA’s methodology and expert subcommittee.

The CDA can withdraw or refuse endorsement if there is a lack of transparency or non-receptivity on behalf of the requesting organization to CDA input. 

Guidelines in Development

Whenever possible, requests for CDA endorsement should be accompanied by a request for CDA participation in the guideline development process. There would be shared ownership of any guideline developed collaboratively. Principles of collaborative guideline development would include the following:

1) There is a formal invitation to the CDA CPG chair to collaborate on guideline development.

2) There is joint assessment (by CDA and requesting organization) to ensure the guideline to be developed is clinically relevant and not redundant in the context of existing guidelines within the two organizations. 

3) Members of relevant CDA expert subcommittees are invited to participate in the evidence review and drafting of the guideline(s). 

4) There is an explicit agreement between CDA and the requesting organization to harmonize evidence review and grading processes. This may or may not include active involvement of the CDA CPG methodology working group; but would involve complete disclosure of evidence review and grading process to the methodology working group.

5) There is disclosure of conflict of interest by all parties.

6) There is shared authorship of the guideline. If the guideline is published in advance of the CDA CPGs, the chair of the CDA CPGs will present the guideline to the CDA CS&S to determine what knowledge translation and implementation activities are required to place this newly developed guideline in the context of existing guidelines.

C-CHANGE
The Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE) is an initiative to ensure that stakeholder organizations in cardiovascular disease (CVD) have guidelines that are succinct, distinct, and concordant to promote implementation and better health outcomes for persons with, or at risk for, CVD. CDA is an active participant in the C-CHANGE initiative and processes for engagement and collaboration within this process exist. The procedures described herein would not apply to guidelines relevant to C-CHANGE. The decision on the relevance to C-CHANGE would be at the discretion of the CDA CPG chair.