Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed

• Published in: Journal of clinical epidemiology Vol. 140; pp. 56 - 68
• Main Authors: Gyawali, Rajendra, Toomey, Melinda, Stapleton, Fiona, Zangerl, Barbara, Dillon, Lisa, Ho, Kam Chun, Keay, Lisa, Alkhawajah, Sally Marwan M, Liew, Gerald, Jalbert, Isabelle
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021; Elsevier Limited
• Subjects: AGREE II; Clinical medicine; Clinical practice guidelines; Diabetes; Diabetes Complications - therapy; Diabetes mellitus; Diabetic eye disease; Diabetic retinopathy; Diabetic Retinopathy - therapy; Disease management; Domains; Edema; Epidemiology; Eye diseases; Eye Diseases - etiology; Eye Diseases - therapy; Guidelines; Humans; Macular Edema - etiology; Macular Edema - therapy; Ophthalmology; Practice Guidelines as Topic - standards; Quality; Quality assessment; Quality control; Systematic review; Websites; Clinical practice guidelines; Diabetic retinopathy; AGREE II; Quality; Diabetic eye disease
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2021.08.031

To assess the quality of diabetic eye disease clinical practice guidelines. A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A “good quality” guideline was one with ≥60% score for “rigor of development” and in at least two other domains. Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for “scope and purpose,” “stakeholder involvement,” “rigor of development,” “clarity of presentation,” “applicability” and “editorial independence” were 73.6% (54.2%–80.6%), 48.6% (29.2%–71.5%), 60.2% (30.9%–78.1%), 86.6% (76.7%–94.4%), 28.6% (18.0%–37.8%) and 60.2% (30.9%–78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7–5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n = 9) of the guidelines (all evidence-based) were of “good quality.” A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating “good quality.” Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.