Comparison of Content and Quality of Caribbean, International, and High-Income Country-Specific Clinical Guidelines for Managing Type 2 Diabetes Mellitus.

Amy Latifah Nixon,Jo Leonardi-Bee,Kaushik Chattopadhyay

doi:10.3390/ijerph182412868

Abstract

Purpose. Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare the clinical guidelines for T2DM management from the Caribbean to guidelines developed internationally and by high-income countries. Methods. Seven T2DM management clinical guidelines were a priori selected from international and high-income country-specific clinical guidelines and then compared to the country-specific T2DM management clinical guidelines of the Caribbean region. Two reviewers independently assessed content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results. The Caribbean clinical guideline was found to contain similar levels of T2DM management topics when compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have substantially lower levels of content. The clinical guideline from the Caribbean was found to be of low quality and could not be used in practice; however, only three comparator clinical guidelines were found to be of high quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. Conclusion. Although the T2DM management clinical guidelines from the Caribbean region contained high levels of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline, as identified within this study, should be adopted and used within the Caribbean region to manage T2DM until a high-quality region-specific clinical guideline can be developed.

Highlights

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition that has major health, social, and economic consequences [1]
Relevant websites were searched on 29 January 2021 to identify the most recent published versions from the National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), International Diabetes Federation (IDF), American Diabetes Association (ADA), The Royal Australian College of General Practitioners (RACGP), New Zealand Guidelines Group (NZGD), and Canadian Diabetes Association (CDA)
Whilst all of the comparative clinical guidelines focused on primary care as the setting, only three clearly stated the setting

Summary

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition that has major health, social, and economic consequences [1]. 90% of people with diabetes mellitus have T2DM. In 2019, approximately 463 million adults were living with T2DM [3]. In 2015, the prevalence of T2DM in the Caribbean region was approximately 9%, and T2DM accounted for about 14% of all deaths [4]. This may be due to the Caribbean’s ethnic makeup, which is predominantly Black or Afro-Caribbean with

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