Article type
Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is the most common chronic metabolic disease in the world. The development of the Clinical Practice Guideline (CPG) for Management of Antidiabetic Drugs in Patients with T2DM, funded by the Spanish Ministry of Health, is coordinated by the Institute for Health Sciences of Aragon (IACS).
Objectives: IACS has conducted a living Systematic Review (SR) to provide a continuously updated summary to formulate living recommendations on the efficacy and safety of intensifying basal insulin therapy in Type 2 Diabetes Mellitus (T2DM), comparing Glucagon-like peptide-1 Receptor Agonists (GLP-1 RA) and rapid-acting insulin.
Methods: In 2021, IACS joined the "Living Evidence for Inform Health Decisions'' project, funded by the European Union’s Horizon 2020 research and innovation programme. It includes the use of technological tools for identifying early emerging evidence on a defined topic. We conducted searches in the centralized repository L·OVE platform and Epistemonikos database. We applied the GRADE approach to rate the certainty of evidence and to develop clinical practice recommendations.
Results: The initial baseline report included 6 RCTs. We have continuously monitored the evidence and performed a monthly screening. 1 RCT was identified in the first update. The Guideline Development Group (GDG) decided to formulate a strong recommendation in favour of GLP-1 RA. The GDG considered particularly significant the reduction in the risk of severe hypoglycemia events for patients treated with GLP-1 RA compared to rapid insulin, as well as the greater benefit in patients' quality of life. Since it was formulated, no new evidence has been identified that would change the recommendations. The living SR will be kept active until the final draft is sent out.
Conclusions: The dynamism of a living SR combined with a rigorous evaluation of the evidence, underlines the commitment to providing robust and updated CPGs. Utilizing the GRADE approach, the Guideline Development Group decided to formulate a strong recommendation for GLP-1 RA over rapid insulin. Importantly, no new evidence emerged to alter these recommendations since their formulation. The living SR will remain active, ensuring continuous monitoring until the final draft is disseminated.
Objectives: IACS has conducted a living Systematic Review (SR) to provide a continuously updated summary to formulate living recommendations on the efficacy and safety of intensifying basal insulin therapy in Type 2 Diabetes Mellitus (T2DM), comparing Glucagon-like peptide-1 Receptor Agonists (GLP-1 RA) and rapid-acting insulin.
Methods: In 2021, IACS joined the "Living Evidence for Inform Health Decisions'' project, funded by the European Union’s Horizon 2020 research and innovation programme. It includes the use of technological tools for identifying early emerging evidence on a defined topic. We conducted searches in the centralized repository L·OVE platform and Epistemonikos database. We applied the GRADE approach to rate the certainty of evidence and to develop clinical practice recommendations.
Results: The initial baseline report included 6 RCTs. We have continuously monitored the evidence and performed a monthly screening. 1 RCT was identified in the first update. The Guideline Development Group (GDG) decided to formulate a strong recommendation in favour of GLP-1 RA. The GDG considered particularly significant the reduction in the risk of severe hypoglycemia events for patients treated with GLP-1 RA compared to rapid insulin, as well as the greater benefit in patients' quality of life. Since it was formulated, no new evidence has been identified that would change the recommendations. The living SR will be kept active until the final draft is sent out.
Conclusions: The dynamism of a living SR combined with a rigorous evaluation of the evidence, underlines the commitment to providing robust and updated CPGs. Utilizing the GRADE approach, the Guideline Development Group decided to formulate a strong recommendation for GLP-1 RA over rapid insulin. Importantly, no new evidence emerged to alter these recommendations since their formulation. The living SR will remain active, ensuring continuous monitoring until the final draft is disseminated.