Background: To alleviate discrepancies between evidence and practice, the Korean Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system has been developed and applied to clinical practice guideline on diabetes mellitus.
Objectives: To review the determinants for grading system used in Korean clinical practice guidelines (CPGs) and identify the strong recommendations with low quality evidence, and apply the Korean Modified GRADE system.
Methods: To review the grading factors of recommendations in Korean CPGs, 43 guidelines from the Korean Medical Guideline Information Center were classified according to a variety of categories. Based on the classification, the Korean Modified GRADE system is developed by reflecting the opinion of end-users like clinical physicians. The Korean Modified GRADE system is then applied to 2014 Evidence-based recommendations for type 2 diabetes in primary care developed with the Korean Academy of Medical Science and the Korean Centers for Disease Control & Prevention, and an online survey was conducted by 30 doctors through the Delphi process.
Results: The determinants to be considered in 43 Korean guidelines were ‘balance of benefits and harms’, ‘patient’s value and preference’, ‘quality of evidence’, ‘cost’, ‘expert opinion’ and ‘health setting’. Strong recommendations with low evidence constituted 47 of 215 recommendations, accounting for about 21.9%. After applying the Korean Modified GRADE system, about 12.6% of the total recommendations of ‘2014 Evidence-based recommendations for type 2 diabetes in primary care’ have been adjusted to up-grading.
Conclusions: The Korean Modified GRADE system can be utilized as an effective tool to better reflect the opinion of the physicians at medical field.