2008 Clinical Practice Guidelines - Canadian Diabetes Association

2008 CLINICAL PRACTICE GUIDELINES
S8
was a Grade B recommendation (1).
Varying grades of recommendations, therefore, reflect
varying degrees of certainty regarding the strength of inference
that can be drawn from the evidence in support of the
recommendation. Therefore, these evidence-based guidelines
and their graded recommendations are designed to satisfy
2 important needs: 1) the explicit identification of the
best research upon which the recommendation is based, and
an assessment of its scientific relevance and quality (captured
by the assignment of a level of evidence to each citation); and
2) the explicit assignment of strength of the recommendation
based on this evidence (captured by the grade). In this way,
they provide a convenient summary of the evidence to facilitate
clinicians’ task of “weighting” and incorporating everincreasing
evidence into their daily clinical decision-making.
They also facilitate the ability of clinicians, healthcare planners,
healthcare providers and society in general to critically
examine any recommendation and arrive at their own conclusions
regarding its appropriateness.Thus, these guidelines
facilitate their own scrutiny by others according to the same
principles that they use to scrutinize the literature.
It is important to note that the system chosen for grading
recommendations differs from the approach used in
some other guideline documents, such as the one pertaining
to the periodic health examination in Canada, in which
harmful practices were assigned a grade of D (8). In this
Canadian Diabetes Association guidelines document, recommendation
to avoid any harmful practices would be graded
in the same manner as all other recommendations. However,
it should be noted that the authors of these guidelines
focused on clinical practices that were thought to be potentially
beneficial, and did not seek out evidence regarding the
harmfulness of interventions.
EXTERNAL PEER REVIEW AND INDEPEN-
DENT METHODOLOGICAL REVIEW
In July 2007, a draft document was circulated nationally and
internationally for review by numerous stakeholders and
experts in relevant fields.This input was then considered by
the Executive and Steering Committees and revisions were
made accordingly. Subsequently, a panel of 6 methodologists,
who were not directly involved with the initial review and
assessment of the evidence, independently reviewed each
recommendation, its assigned grade and supportive citations.
Based on this review, the wording, assigned level of evidence
and grade of each recommendation were reassessed and
modified as necessary. Revised recommendations were
reviewed and approved by the Executive and Steering
Committees. Selected recommendations were presented at a
public forum at the Canadian Diabetes Association/Canadian
Society of Endocrinology and Metabolism Professional
Conference and Annual Meetings in Vancouver, British
Columbia, in October 2007.
DISCLOSURE OF DUALITY OF INTEREST
Committee members were volunteers and received no
remuneration or honoraria for their participation. Members
of all committees signed an annual duality of interest form
listing all financial interests or relationships with manufacturer(s)
of any commercial product(s) and/or provider(s) of
commercial services. A full list of committee member disclosures
is available online at http://www.diabetes.ca.
Dualities of interest were also discussed during deliberations
where relevant. In the case of a potential duality or outright
conflict of interest, committee members removed themselves
from discussions. Funding for the development of the
guidelines was provided by the Canadian Diabetes
Association and through unrestricted educational grants provided
by the companies listed in the acknowledgements section
(p. x).These companies were not involved in any aspect
of guideline development, literature interpretation, the decision
to publish or any other aspect related to the publication
of these guidelines, and did not have access to guideline
meetings, guideline drafts or committee deliberations.
GUIDELINE UPDATES
A process to update the full guidelines will commence within
5 years. Updates to individual chapters may be published
sooner in the event of significant changes in evidence supporting
the recommendations.
OTHER RELEVANT GUIDELINES
Introduction, p. S1.
ACKNOWLEDGEMENTS
The clinical practice guidelines Expert Committee thanks
the following individuals, who conducted the independent
methodological review:
Gillian Booth MD MSc FRCPC (Chair)
Assistant Professor of Medicine, University of Toronto,
Division of Endocrinology and Metabolism and Li Ka Shing
Institute, St. Michael’s Hospital,Toronto, Ontario
Denice Feig MD MSc FRCPS
Associate Professor of Medicine, University of Toronto,
Toronto, Staff Endocrinologist, Mount Sinai Hospital,
Toronto, Ontario
Dereck Hunt MD MSc FRCPS
Associate Professor, General Internal Medicine/
Endocrinology, McMaster University, Hamilton, Ontario
Charlotte McDonald MD MSc FRCPS
Assistant Professor, University of Western Ontario, London,
Ontario