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Some diabetes practice guidelines do not reflect all available evidence

Not all clinical practice guidelines on the use of oral medications for type 2 diabetes are consistent with a systematic review of all available scientific evidence funded by AHRQ, according to a new analysis  published in the January 17, 2012, online Annals of Internal Medicine. None of the guidelines, however, included recommendations that contradicted available evidence. The evaluation, conducted by researchers at Johns Hopkins University, found that some diabetes treatment guidelines did not fully reflect evidence identified in a 2007 systematic review on diabetes treatments developed by AHRQ's Effective Health Care Program.

The new analysis, An Evaluation of Guideline Recommendations Related to Oral Medication Treatment for Type 2 Diabetes Mellitus, examined 11 diabetes guidelines that met the study criteria and assessed whether the guidelines agreed with seven evidence-based conclusions from the 2007 systematic review. Seven guidelines, according to the analysis, agreed with the conclusion that "metformin is favored as the first line agent," and 10 agreed that "thiazolidinediones are associated with higher rates of edema and congestive heart failure." The analysis also found variability in guideline quality.  Most guideline development processes did not include a systematic method for determining which evidence to incorporate.

Additional information about type 2 diabetes oral medications, including a 2011 update of AHRQ's 2007 report, can be found at http://www.effectivehealthcare.ahrq.gov.

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