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Critical appraisal and systematic review of guidelines for perioperative diabetes management: 2011–2017

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Abstract

Purpose

To systematically evaluate the quality, consistency and the evidence support of guidelines for perioperative diabetes management.

Methods

We retrieved guidelines through systematic search, critically evaluated their quality and compared the recommendations of included guidelines. Five aspects were compared: target level, management of hyper- and hypoglycaemia, frequency of monitoring, management of insulin, and management of oral anti-diabetic drugs (OADs).

Results

Fourteen guidelines met our criteria, and 342 recommendations were extracted, the results of Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation showed that none of the mean score in each domain was higher than 50%. On average, most guidelines had only one domain scored above 50%. Most recommendations (78.9%) did not specify their supporting evidence, 71 (20.8%) were formed using grading criteria, none cited systematic review or meta-analysis. Recommendations were inconsistent across different guidelines.

Conclusions

The existing guidelines about perioperative management of diabetes needs improvement in methodology, as well as the production of evidence with high quality. Evidence-based guidelines are required for the perioperative management of diabetes.

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Acknowledgements

This study is supported by Beijing Municipal Science & Technology Commission (grant no. D141107005314004).

Author information

Author notes

    Authors and Affiliations

    1. The First Clinical Medical College, Lanzhou University, Donggang West Road, 730000, Lanzhou, China

      Xiaoyang Song & Yuting Gao

    2. Fifth Medical Center of Chinese PLA General Hospital, East Avenue, 100000, Beijing, China

      Jinjing Wang

    3. Department of Endocrinology, Chinese PLA General Hospital, Fuxing Road, 100000, Beijing, China

      Jinjing Wang, Xinye Jin & Yiming Mu

    4. Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan ErLu, Guangzhou, 510080, China

      Yuting Gao

    5. The Second Clinical Medical College, Lanzhou University, Cuiyingmen, 730000, Lanzhou, China

      Yang Yu

    6. School of Public Health, Lanzhou University, Donggang West Road, 730000, Lanzhou, China

      Jingyi Zhang & Xiaoting Ma

    7. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Donggang West Road, 730000, Lanzhou, China

      Jingyi Zhang, Qi Wang & Yaolong Chen

    8. Health Policy PhD Program, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada

      Qi Wang

    9. McMaster Health Forum, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada

      Qi Wang

    10. Institute of Global Health, University of Geneva, Rue du Général-Dufour, 1211, Geneva, Switzerland

      Janne Estille

    11. Institute of Mathematical Statistics and Actuarial Science, University of Bern, Hochschulstrasse, 3012, Bern, Switzerland

      Janne Estille

    12. Department of Endocrinology, Hainan Branch of Chinese PLA General Hospital, Haitangwan, 572000, Sanya, China

      Xinye Jin

    13. WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, 730000, China

      Yaolong Chen

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    1. Xiaoyang Song
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    Correspondence to Yaolong Chen or Yiming Mu.

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    This article does not contain any studies with human participants or animals performed by any of the authors.

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    These authors contributed equally: Xiaoyang Song, Jinjing Wang.

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    Song, X., Wang, J., Gao, Y. et al. Critical appraisal and systematic review of guidelines for perioperative diabetes management: 2011–2017. Endocrine 63, 204–212 (2019). https://doi.org/10.1007/s12020-018-1786-y

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