Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries

Stone, M.A.; Wilkinson, J.C.; Charpentier, G.; Clochard, N.; Grassi, G.; Lindblad, U.; Müller, U.A.; Nolan, J.; Rutten, G.E.; Khunti, K.; on behalf of the GUIDANCE Study Group,

doi:10.1016/j.diabres.2009.10.020

« Previous Next »Diabetes Research and Clinical Practice
Volume 87, Issue 2 , Pages 252-260, February 2010

Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries

M.A. Stone
- University of Leicester, Leicester, United Kingdom
J.C. Wilkinson
- University of Leicester, Leicester, United Kingdom
G. Charpentier
- Center Hospitalier Sud Francilien, Corbeil, France
N. Clochard
- Scientific Institute of Public Health, Brussels, Belgium
G. Grassi
- Department of Internal Medicine, University of Turin, Turin, Italy
U. Lindblad
- Göteborg University, Göteborg, Sweden
U.A. Müller
- Universitätsklinikum Jena, Jena, Germany
J. Nolan
- St James Hospital, Dublin, Ireland
G.E. Rutten
- University Medical Centre, Utrecht, Netherlands
K. Khunti
- University of Leicester, Leicester, United Kingdom
- Corresponding author at: Department of Health Sciences, University of Leicester, 22-28 Princess Road, West Leicester LE1 6TP, United Kingdom. Tel.: +44 0 116 252 5445; fax: +44 0 116 252 5413.
on behalf of the GUIDANCE Study Group

Received 13 August 2009; received in revised form 8 October 2009; accepted 26 October 2009. published online 23 November 2009.

Abstract

Methods

The most recent nationally recognised guidelines for type 2 diabetes from eight European countries (Belgium, England/Wales, France, Germany, Ireland, Italy, the Netherlands and Sweden) were compared. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was used for quality assessment. Details of recommendations for key process and outcome indicators were also extracted. Appraisal and data extraction were conducted independently by two researchers.

Results

AGREE domain scores varied between guidelines, including a range of 31–95% for rigour of development. The highest mean domain scores were for Scope and Purpose (81%) and Clarity and Presentation (85%); the lowest was for Stakeholder Involvement (49%). Specific recommendations, including targets relating to intermediate outcomes, were broadly similar. However, at detailed level, there were variations, particularly in terms of the level of information provided, for example, only two countries’ guidelines provided cut-off points in relation to risk associated with waist circumference.

Implications

Our findings suggest that there are some areas of good practice relating to guideline development where more attention is needed. Despite a substantial degree of consensus for specified targets, observed differences at detailed level suggest a lack of consistency in relation to some aspects of the information provided to clinicians across Europe.

Keywords: Type 2 diabetes, Guidelines, Europe