gms | German Medical Science

Background: Medical guidelines on type 2 diabetes mellitus (T2DM) are developed to facilitate evidence-based medicine by summarizing the standard of knowledge and giving specific recommendations. Even though there is a trend of international collaboration in the development of medical guidelines, national guidelines are still published.

Aim: Our aim was to examine the availability of guidelines on T2DM and selected late complications in the registers of AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) and NICE (National Institute for Health and Care Excellence). Furthermore, we investigated the degree of agreement of these national guidelines, particularly in the light of increased international collaboration. Hereby, special characteristics of the guideline development and the health care of patients with T2DM in Germany and the UK can be shown.

Methods: A structured comparison of the guidelines of AWMF and NICE on T2DM and its late complications nephropathy, neuropathy, foot syndrome and retinopathy was carried out. The guidelines of AWMF in Germany and NICE in the UK were chosen, as they are developed by interdisciplinary committees.

The comparison was done in a tabular form with predefined parameters. It covered both, the formal aspects as well as the contents of the guidelines. In the latter we looked for discrepancies between the statements and recommendations particularly regarding the prevention and health care management.

Results: Our comparison gives an overview of the existing guidelines on T2DM and a variety of its late complications.

The comparison of the formal aspects had the following findings:

1.

AWMF published a specific guideline for each of the studied diseases, whereas NICE addresses only a selection.

2.

In contrast to NICE guidelines, two of the relevant AWMF guidelines are expired.

3.

AWMF guidelines differ in their versions and structure. Not all guidelines are published in a version for the public, contain research recommendation and consider economic aspects. They also use different schemes for the grade of evidence and strength of recommendation.

4.

In NICE guidelines, the strength of recommendation is only reflected by wording. In contrast to AWMF guidelines, they don’t use a grading scheme for it.

In our comparison of the contents we identified some differences and even contrasting views in the statements and recommendations of AWMF and NICE guidelines. Particularly striking in the comparison were the following discrepancies:

1.

Different diagnostic criteria for intermediate hyperglycemia.

2.

AWMF guideline recommends to treat patients with intermediate hyperglycemia with lifestyle-modification, according to NICE guideline adding metformin or in case of obesity orlistat can be considered.

3.

Screening for diabetic retinopathy is in Germany done by an ophthalmologist, in the UK by an optometrist.

4.

If there is a low risk to develop a diabetic retinopathy, the screening is done every two years according to AWMF and annually according to NICE.

Discussion: As AWMF and NICE guidelines often focused on different aspects of the health care for patient with T2DM and related complications the comparability was challenging. Nevertheless, we were able to identify the differences mentioned above.

Practical Implications: Our results show different approaches in the development of medical guidelines and can thus lead to critical analysis. The differences and even contrasting views in the comparison may identify areas where further research is needed.