Article type
Year
Abstract
Background: In Germany, the number of prescriptions for rapid-acting insulin analogues (RAIs) is increasing. The Institute for Quality and Efficiency in Health Care was commissioned to produce a systematic review (SR) on RAIs versus regular insulin in patients with diabetes mellitus Type II (DMT2); this SR concluded that there was insufficient evidence to support the superiority of RAIs in DMT2 therapy.
Objectives: Our aim was to assess if guideline recommendations on RAI therapy in DMT2 were consistent with the SR conclusions, and whether there was any association between guideline quality and consistency with these conclusions.
Methods: A systematic search for DMT2 guidelines was conducted in EMBASE, MEDLINE, Guidelines International Network (GIN), and via www.leitlinien.de. We assessed methodological quality using AGREE (Appraisal of Guidelines for Research and Education) criteria, evaluated information on patient-relevant outcomes (e.g. hyper- and hypoglycaemia rates), evaluated the evidence base of guideline recommendations on RAIs, and compared the recommendations with the SR conclusions.
Results: Eighty-nine DMT2 guidelines were identified. Twenty-one guidelines included statements on RAIs: 10 recommended RAIs; nine did not (consistent with the SR conclusions); two made unspecific statements (three of the ten, five of the nine, and none of the two guidelines were of good quality). With regard to patient-relevant outcomes, 15 guidelines made statements on hyper- and hypoglycaemia rates under RAI therapy: five guidelines were of good quality; ten were of inferior quality (two of the five, and three of the ten made statements on the effects of RAIs on hyper- and hypoglycaemia rates that were consistent with the respective SR statements 'insufficient evidence to support the superiority of RAIs').
Conclusions: About half of the guidelines that assess RAI therapy in patients with DMT2 recommend the use of RAIs, which stands in contrast to current best evidence. There is no clear association between guideline quality and consistency with SR conclusions.
Objectives: Our aim was to assess if guideline recommendations on RAI therapy in DMT2 were consistent with the SR conclusions, and whether there was any association between guideline quality and consistency with these conclusions.
Methods: A systematic search for DMT2 guidelines was conducted in EMBASE, MEDLINE, Guidelines International Network (GIN), and via www.leitlinien.de. We assessed methodological quality using AGREE (Appraisal of Guidelines for Research and Education) criteria, evaluated information on patient-relevant outcomes (e.g. hyper- and hypoglycaemia rates), evaluated the evidence base of guideline recommendations on RAIs, and compared the recommendations with the SR conclusions.
Results: Eighty-nine DMT2 guidelines were identified. Twenty-one guidelines included statements on RAIs: 10 recommended RAIs; nine did not (consistent with the SR conclusions); two made unspecific statements (three of the ten, five of the nine, and none of the two guidelines were of good quality). With regard to patient-relevant outcomes, 15 guidelines made statements on hyper- and hypoglycaemia rates under RAI therapy: five guidelines were of good quality; ten were of inferior quality (two of the five, and three of the ten made statements on the effects of RAIs on hyper- and hypoglycaemia rates that were consistent with the respective SR statements 'insufficient evidence to support the superiority of RAIs').
Conclusions: About half of the guidelines that assess RAI therapy in patients with DMT2 recommend the use of RAIs, which stands in contrast to current best evidence. There is no clear association between guideline quality and consistency with SR conclusions.