The 2013 Canadian Diabetes Association Clinical Practice Guidelines are coming!
by Alice Y.Y. Cheng, MD, FRCPC
Every 5 years, since 1998, the Clinical & Scientific Section of the Canadian Diabetes Association (CDA) has published comprehensive, evidence-based recommendations for healthcare professionals to consider in the prevention and management of diabetes in Canada. They have served as a helpful resource and aid for anyone caring for people with diabetes and are recognized, not only in Canada, but also internationally, as high quality evidence-based clinical practice guidelines. In fact, a recent systematic review by the Johns Hopkins University Evidence-Based Practice Center demonstrated that the CDA Clinical Practice Guidelines (CPGs) are among the best in the world with respect to quality, rigour and process (1). They reviewed all English-language guidelines published after July 2007 that contained recommendations on oral medication use in type 2 diabetes and conformed to the definition of a guideline as set out by the Institute of Medicine in 1990 (“Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”). Of 1000 screened publications, 11 guidelines met the inclusion criteria. Of these, 6 were from the United States, 2 were jointly produced (American Diabetes Association + European Association for the Study of Diabetes; American Diabetes Association + Egyptian Diabetes Center), 1 was from the International Diabetes Federation, 1 was from the National Institute of Health and Clinical Excellence (NICE) and 1 was from the CDA. The reviewers assessed whether the guidelines agreed with 7 evidence-based conclusions from a peer-reviewed systematic review of oral medication in type 2 diabetes published in 2007 (2). They also rated the quality of the guidelines based on 2 domains (“rigour of development” and “editorial independence”) from the Appraisal of Guidelines Research and Evaluation instrument (AGREE II). The CDA CPGs scored 100% on agreement with the conclusions of the systematic review, 100% on Editorial Independence and 97.6% on the Rigor of Development; second only to the NICE guidelines (see Table 1). This is a true testament to the strength of our guidelines process and the hard work of all those involved!
It is that time again to uphold the proud tradition and the Expert Committee has been working tirelessly to produce the 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Volunteer members of the CPGs Expert Committee are assessing the peer-reviewed evidence published since 2008 relevant to the prevention and management of diabetes, and incorporating the evidence into revised diagnostic, prognostic and therapeutic recommendations.
A number of important changes have taken place in the development of the 2013 clinical practice guidelines:
• Expansion of the Expert Committee to include 115 health care professional volunteers from across Canada. Expert Committee members bring expertise from diverse practice settings and include professionals from family medicine, endocrinology, internal medicine, infectious disease, neurology, nephrology, cardiology, urology, psychology, obstetrics, ophthalmology, paediatrics, nursing, dietetics, pharmacy, exercise physiology and others
• Inclusion and active participation of people with diabetes on the Expert Committee to ensure that their views and preferences informed the guideline development process and the recommendations
• Update and expansion of previous chapters and, in some cases, amalgamation of previous chapters into others to increase utility and relevance
• Inclusion of drug cost within tables listing pharmacologic therapies as a reference for clinicians
• Update and expansion of our Methodology process (eg. updated literature searches throughout the guideline development process, expansion of the Duality of Interest policy)
• Inclusion of a “Practical Tips” box within many chapters to facilitate implementation of the recommendations
• Expanded harmonization of recommendations through collaboration with other organizations such as Canadian Hypertension Education Panel (CHEP), Society of Obstetrics and Gynecology of Canada (SOGC), Canadian Cardiovascular Society (CCS) and C-CHANGE.
• Expanded dissemination and implementation strategy with increased use of technology is planned
The expected timing of official publication is Spring 2013, however, there will be a symposium at the 2012 CDA/CSEM Professional Conference (October 10-13, 2012) in Vancouver, which will provide a “sneak peek” at the 2013 CPGs! It is hoped that primary care physicians and other healthcare professionals who care for people with diabetes or those at risk of diabetes will continue to find the evidence compiled in these upcoming guidelines a vital aid and resource in their efforts.
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