gms | German Medical Science

Background/Purpose: Resources for “de novo” elaboration of high quality guidelines in Low Middle Income Countries (LMIC) are scarce. Local adaptation processes should involve stakeholders and be systematic and transparent.

Objectives: to report the results of applying an evidence-based framework for local adaptation of existing guidelines for the management of DM2 in Argentina.

Methods: a stepwise approach was used:

1.

selection of a priority topic;

2.

formulation and prioritization of structured clinical questions (CQ);

3.

systematic searching of existing CPG and systematic reviews (SR);

4.

quality assessment;

5.

development of the CPG-SR table;

6.

adaptation of recommendations upon established criteria;

7.

external validation;

8.

endorsement by official authorities.

Results: An interdisciplinary team, constituted by representatives of the National Academy of Medicine (NAM), Ministry of Health (MoH), scientific societies, hospitals and social security organizations, defined the scope and 26 CQ. 133 CPG and 106 SR were found but only 3 and 38, respectively, had the minimum quality criteria to be included in the adaptation process. 24 CQ were totally (22 CQ) or partially (2 CQ) answered by CPG and SR; only 2 required “de novo” elaboration, as no evidence was found.

Discussion: This evidence-based and locally adapted CPG was the first one that was successfully produced by a joint effort of the MoH, the NAM and representatives of other Argentine institutions.

Implications for guideline developers/users: First initiatives of systematic guidelines adaptation in the context of LMIC imply not only a methodological change, but mainly a cultural change that requires time, commitment and financing.