Abstract
AimsPediatric type 2 diabetes mellitus (T2DM) is a relatively new disease with increasing incidence corresponding to the obesity epidemic among youth. It is important for clinicians to have access to high-quality clinical practice guidelines (CPGs) for appropriate management of pediatric patients with T2DM. The objective of this systematic review was to evaluate overall quality of CPGs for the management of pediatric T2DM using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.MethodsWe searched MEDLINE, Embase, CINAHL, Trip, National Guideline Clearinghouse, and grey literature to identify eligible CPGs. We also searched the webpages of national and international diabetes and pediatric organizations globally. We included CPGs from national and international diabetes and pediatric associations that were published as standalone guidelines for T2DM in children and adolescents (2–18 years of age). We also included pediatric and adult guidelines for type 1 diabetes if they included a section addressing T2DM management in children and adolescents. We retrieved the two most recent guidelines from each organization when available to assess change in quality over time. We excluded individual studies and systematic reviews that made treatment recommendations as well as CPGs that were developed for a single institution.ResultsWe included 21 unique CPGs in this systematic review. Of the included guidelines, 12 were developed or updated between 2012 and 2014. Five of all included CPGs were specific to pediatric populations. The analysis revealed that “Rigour of Development” (mean 45%, SD 28.68) and “Editorial Independence” (mean 45%, SD 35.19) were the lowest scoring domains on the AGREE II for the majority of guidelines, whereas “Clarity of Presentation” was the highest scoring domain (mean 72%, SD 18.89).ConclusionsOverall, two thirds of the pediatric T2DM guidelines were moderate to low quality and the remaining third ranked higher in quality. Low quality was especially due to the scores for the “Rigour of Development” domain, which directly measures guideline development methodology. It is important that future guidelines and updates of existing guidelines improve the methodology of development and quality of reporting in order to appropriately guide physicians managing children and adolescents with T2DM.Systematic review registrationPROSPERO CRD42016034187
Highlights
Pediatric type 2 diabetes mellitus (T2DM) is a relatively new disease that is escalating due to the global rise in childhood obesity [1]
Many adults present with risk factors for T2DM in the early years of life, and while genetics likely play a role in this diabetes risk, environmental and epigenetic factors lead the way in the development of diabetes in youth and young adults [4]
We further extended our search by contacting the organizations in July 2017 to inquire about the two latest clinical practice guidelines (CPGs) issued for pediatric T2DM, when it was unclear if they had earlier versions of guidelines from the webpage
Summary
Pediatric type 2 diabetes mellitus (T2DM) is a relatively new disease that is escalating due to the global rise in childhood obesity [1]. Pediatric T2DM often occurs among those who have existing medical conditions, e.g., transplant patients, and is associated with the development of comorbidities early in the course of the disease. While pediatric T2DM has been reported most frequently among certain ethnic groups (e.g., Indigenous North American communities, South Asians, and Latinos), a global spread of the condition has been reported [2]. This highlights the need for guidance on management developed for various populations. Assessing the quality of CPGs for pediatric T2DM management will help determine areas requiring improvement in future guidelines and updates, in addition to providing information about overall quality to clinicians who consult these guidelines
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