Quantity and quality of complementary and alternative medicine recommendations in clinical practice guidelines for type 2 diabetes mellitus: A systematic review.

AIMS: Approximately 70% of Americans with diabetes have used complementary and alternative medicine (CAM) in the past year. Healthcare providers often receive minimal training on these therapies and subsequently rely on clinical practice guidelines (CPGs) to supplement their knowledge about the safe and effective use of CAM for the treatment/management of type 2 diabetes mellitus (T2DM). The purpose of this systematic review is to determine the quantity and assess the quality of CAM recommendations in CPGs for the treatment and/or management of T2DM. DATA SYNTHESIS: MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to 2020, in addition to the Guidelines International Network and the National Center for Complementary and Integrative Health websites. CPGs containing treatment and/or management recommendations for T2DM were eligible; those with CAM recommendations were quality-assessed with the AGREE II instrument twice, once for the overall CPG and once for the CAM sections. Twenty-seven CPGs were deemed eligible, of which 7 made CAM recommendations. Mean scaled domain percentages were (overall, CAM): scope and purpose (89.7%, 79.8%), clarity of presentation (85.7%, 48.4%), stakeholder involvement (67.9%, 28.2%), applicability (54.8%, 20.2%), rigour of development (49.7%, 35.7%), and editorial independence (44.1%, 44.1%). CONCLUSIONS: Quality varied within and across CPGs; domain scores across CAM sections generally scored lower than the overall CPG. Given that CAM therapies for T2DM are only represented in one-quarter of eligible CPGs and are of lower quality, a knowledge gap exists for healthcare providers who seek evidence-based information on this topic in order to effectively counsel inquiring patients.

Identifying the quantity and assessing the quality of clinical practice guidelines for the treatment and management of type 2 diabetes: A systematic review.

AIMS: Type 2 diabetes (T2D) is a condition where the body becomes insulin resistant and cannot use insulin made by the pancreas or is relatively insulin deficient causing high blood glucose levels. Assessing the quality of clinical practice guidelines (CPGs) for T2D is important to identify knowledge gaps and where improvements can be made. The purpose of this review was to identify the quantity and assess the quality of CPGs for the treatment and/or management of T2D. METHODS: A systematic review was conducted to identify T2D CPGs. MEDLINE, EMBASE, CINAHL and GIN were searched from 2008 to 2018. Eligible guidelines published on the treatment and/or management of T2D were assessed with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS: Seventeen CPGs were found to be eligible. Scaled domain percentages (highest to lowest) were: clarity of presentation (81.2%), scope and purpose (77.1%), stakeholder involvement (52.8%), applicability (42.9%), rigour of development (41.5%), and editorial independence (35.1%). CONCLUSIONS: CPGs that achieved higher AGREE II scores and favourable overall recommendations could be used by healthcare providers to facilitate informed discussions surrounding T2D therapies. CPGs that received lower scaled domain percentages or overall recommendations could be improved by using the AGREE II instrument.