Abstract
BackgroundConflict of interest (COI) is an important potential source of bias in the development of clinical practice guidelines (CPGs).ObjectivesTo examine rates of disclosure of COI, including financial interests in companies that manufacture drugs that are recommended in CPGs on glycemic control in type 2 diabetes mellitus, and to explore the relationship between recommendations for specific drugs in a guideline and author COI.MethodsWe identified a cohort of relevant guidelines from the National Guideline Clearinghouse (NGC) and abstracted COI disclosures from all guideline authors for this observational, cross-sectional study. We determined which hypoglycemic drugs were recommended in each guideline, and explored the relationship between specific disclosures and whether a drug was recommended.ResultsAmong 13 included guidelines, the percentage of authors with one or more financial disclosures varied from 0 to 94% (mean 44.2%), and was particularly high for two US-based guidelines (91% and 94%). Three guidelines disclosed no author financial COI. The percentage of authors with disclosures of financial interests in manufacturers of recommended drugs was also high (mean 30%). On average, 56% of manufacturers of patented drugs recommended in each guideline had one or more authors with a financial interest in their company. We did not find a significant relationship between financial interests and whether a drug was recommended in our sample; US-based guidelines were more likely to make recommendations for a specific drug compared to non-US based guidelines.DiscussionAuthors of this cohort of guidelines have financial interests directly related to the drugs that they are recommending. Although we did not find an association between author COI and drugs recommended in these guidelines and we cannot draw conclusions about the validity of the recommendations, the credibility of many of these guidelines is in doubt.
Highlights
High quality clinical practice guidelines (CPGs) are an important tool used to optimize patient care: they provide recommendations informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options [1]
The objectives of this study were to examine the prevalence of Conflict of interest (COI) among the authors of CPGs on glycemic control in type 2 diabetes mellitus; to determine if CPG authors disclosed payments from companies that manufacture drugs mentioned in the guideline; and to explore whether financial interests of authors were correlated with specific drugs recommended in a guideline
We identified CPGs listed in the National Guideline Clearinghouse (NGC )[28] on either of the dates of our search (February 15, 2012 and June 6, 2012) that provided guidance on drugs for glycemic control in type 2 diabetes, including adults, children, and pregnant women, in any setting or geographic location
Summary
High quality clinical practice guidelines (CPGs) are an important tool used to optimize patient care: they provide recommendations informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options [1]. Objectives: To examine rates of disclosure of COI, including financial interests in companies that manufacture drugs that are recommended in CPGs on glycemic control in type 2 diabetes mellitus, and to explore the relationship between recommendations for specific drugs in a guideline and author COI. The percentage of authors with disclosures of financial interests in manufacturers of recommended drugs was high (mean 30%). Discussion: Authors of this cohort of guidelines have financial interests directly related to the drugs that they are recommending. We did not find an association between author COI and drugs recommended in these guidelines and we cannot draw conclusions about the validity of the recommendations, the credibility of many of these guidelines is in doubt
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