2008 Clinical Practice Guidelines - Canadian Diabetes Association

More documents

Recommendations

Info

2008 CLINICAL PRACTICE GUIDELINES S4 AB: Institute for Health Economics; 2007:113-126. 8. Why Health Care Reform Matters. Ottawa, ON: Health Council of Canada; 2007. 9. Highlights 2006–2007: Inpatient Hospitalizations and Emergency Department Visits. Ottawa, ON: Canadian Institute for Health Information; 2007. 10. Hux JE, Booth GL, Slaughter PM, et al, eds. Diabetes in Ontario. An ICES Practice Atlas. Toronto, ON: Institute for Clinical Evaluative Sciences; 2003. 11. Dawson KG, Gomes D, Gerstein H, et al.The economic cost of diabetes in Canada, 1998. Diabetes Care. 2002;25:1303-1307. 12. O’Brien JA, Caro I, Getsios D, et al. Diabetes in Canada: direct medical costs of major macrovascular complications. Value Health. 2001;4:258-265. 13. Pagano E, Brunetti M, Tediosi F, et al. Costs of diabetes. A methodological analysis of the literature. Pharmacoeconomics. 1999;15:583-595. 14. Ray JA,Valentine WJ, Secnik K, et al. Review of the cost of diabetes complications in Australia, Canada, France, Germany, Italy and Spain. Curr Med Res Opin. 2005;21:1617-1629. 15. Simpson SH, Corabian P, Jacobs P, et al. The cost of major comorbidity in people with diabetes mellitus. CMAJ. 2003; 168:1661-1667. 16. 2008 Report on Ontario’s Health System. Toronto, ON: Ontario Health Quality Council; 2008. 17. Shields M, Tjepkema M. Nutrition: Findings from the Canadian Community Health Survey. Ottawa, ON: Statistics Canada; 2005. 18. The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Engl Med J. 2002;346:393-403.
Methods Canadian Diabetes Association Clinical Practice Guidelines Expert Committee The initial draft of this chapter was prepared by Gillian Booth MD MSc FRCPC, Sarah Capes MD MSc FRCPC and Vincent Woo MD FRCPC PROCESS Following the process used to develop previous Canadian Diabetes Association clinical practice guidelines (1,2), an Executive Committee, Steering Committee and Expert Committee with broad expertise and geographic representation were assembled. In total, 99 volunteer physicians and allied health professionals (including endocrinologists, family doctors, pediatricians, nephrologists, cardiologists, ophthalmologists, neurologists, urologists, diabetes nurse educators, dietitians, pharmacists, podiatrists, psychologists and other professionals, as well as researchers in a variety of disciplines) participated in the guideline development process. The following basic principles were adopted to ensure that the values and empirical basis underlying each recommendation were explicitly identified, and to facilitate the critical scrutiny and analysis of each recommendation by other organizations and individuals. • Each recommendation had to address a clinically important question related to 1 or more of the following: detection, prognosis, prevention or management of diabetes and its sequelae. Health benefits, risks and side effects of interventions were considered in formulating the recommendations. •Whenever possible, each recommendation had to be justified by the strongest clinically relevant, empirical evidence that could be identified; the citation(s) reporting this evidence had to be noted adjacent to the relevant guideline. • The strength of this evidence, based on prespecified criteria from the epidemiologic literature and other guidelines processes, had to be noted (3-8). • This evidence had to be incorporated into a recommendation that was assigned a grade based on the available evidence, its methodological strength and its applicability to the Canadian population. • Each recommendation had to be approved by the Steering Committee and Executive Committee, with 100% consensus. • Guidelines based on biological or mechanistic reasoning, expert opinion or consensus had to be explicitly identified and graded as such. IDENTIFYING AND APPRAISING THE EVIDENCE At the outset of the process, and in order to ensure a consistent approach to the development of recommendations, committee members from each section of the guidelines attended a workshop on evidence-based methodology. Committee members identified clinically important questions related to diagnosis, prognosis, prevention and treatment of diabetes and its complications. Authors were to explicitly define a) the population to which a guideline would apply; b) the test, risk factor or intervention being addressed; c) the “gold standard” test or relevant intervention to which the test or intervention in question was compared; and d) clinically relevant outcomes being targeted.This information was used to develop specific, clinically relevant questions that were the focus of literature searching. For each question, individual strategies were developed combining diabetes terms with methodological terms.A librarian with expertise in literature reviews performed a comprehensive search of the relevant English-language, published, peer-reviewed literature using validated search strategies (http://hiru.mcmaster.ca/hedges/indexHIRU.htm) of electronic databases (MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Trials and PsycINFO [where appropriate]).This was complemented by authors’ own manual and electronic searches. For topics that were covered in the 2003 guidelines, the literature searches focused on new evidence published since those guidelines. For new topics, the search time frame included the literature published since 1990, or earlier where relevant. Key citations retrieved from the literature searches were then reviewed. Each citation that was used to formulate or revise a recommendation was assigned a level of evidence according to the prespecified criteria in Table 1, reflecting the methodological quality of the paper.When evaluating papers, authors were required to use standardized checklists that highlighted the most important elements of a well-conducted study.The level of evidence was then determined by the cited paper’s objectives, methodological rigour, susceptibility to bias and generalizability (Table 1). Because they could not be critically appraised, meeting abstracts, narrative review articles, news reports and other sources could not be used to support recommendations. Papers evaluating the cost-effectiveness of therapies or diagnostic tests were not included. S5 METHODS
Page 1: Canadian Publication Mail Agreement
Page 4 and 5: 2008 CLINICAL PRACTICE GUIDELINES i
Page 6 and 7: 2008 CLINICAL PRACTICE GUIDELINES i
Page 8 and 9: 2008 CLINICAL PRACTICE GUIDELINES v
Page 10 and 11: 2008 CLINICAL PRACTICE GUIDELINES v
Page 12: 2008 CLINICAL PRACTICE GUIDELINES x
Page 16 and 17: 2008 CLINICAL PRACTICE GUIDELINES S
Page 68 and 69:
2008 CLINICAL PRACTICE GUIDELINES S
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 176 and 177:
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
show all

2008 Clinical Practice Guidelines - Canadian Diabetes Association

Create successful ePaper yourself

Delete template?

Save as template?