A multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest in diabetes care, are experts in diabetes care, or have experience with guideline development.
The consensus of the guideline development team was that preventive and screening measures should constitute the main focus of the guideline. There was uniform agreement that the two major complications of type II diabetes were macrovascular and microvascular disease. Preliminary evidence reviewed for guideline development included studies on type II diabetes felt to be important by the members of the guideline team. Consensus statements from expert panels on hypertension, lipids, and diabetes were examined, and the references from these statements were reviewed. Other literature was identified by means of a systematic MEDLINE search with the assistance of a reference librarian. Articles published between January 1976 and December 1996 were examined. The search began with the MeSH terms diabetes mellitus and non-insulin-dependent. The articles identified were then cross-referenced with each of the topics: retinopathy, nephropathy, neuropathy, hypertension, lipids, triglycerides, low-density lipoprotein (LDL), smoking, blood glucose, foot care, self-management, education, and preconception care. These articles were further cross-referenced with each of the topics: prevention, treatment, and control. Lastly, experimental and observational evidence was identified using the identifiers: clinical trial, controlled clinical trial, randomized controlled trial, cohort study, multicenter trial, and meta-analysis. This focused literature search identified more than 500 additional articles relevant to the review.
The abstracts of articles identified were reviewed independently by each of the authors. Criteria for full review of articles included applicability to the topic being evaluated, sample size over 30 patients, and duration of follow-up longer then 3 months. If several articles on the same topic were identified, randomized controlled trials were reviewed preferentially over observational or quasi-experimental study designs. Articles that met these criteria were critically reviewed, and any disagreements were settled by consensus opinion. Agreement between the authors was nearly universal. Bibliographies of relevant articles were scanned for other references; however, few additional articles were identified.
The articles identified for full review were evaluated by each of the authors, and recommendations for the care of diabetes were reached through consensus discussion of the available evidence. Recommendations are depicted in an algorithm format and accompanied by a discussion of the supporting evidence (–). Each recommendation is classified in terms of the level of evidence based on study design (randomized, controlled trials; controlled trials, no randomization; observational studies; and expert opinion). They are further classified by whether they are studies of patients with diabetes or are performed on the general or nondiabetic population. Few of the identified studies investigated appropriate screening intervals for each recommendation; however, suggested screening intervals, based on the consensus opinion of our guideline team, are depicted in .
Screening, prevention, and treatment of cardiovascular risk factors in patients with type II diabetes mellitus: hypertension, hyperlipidemia, and smoking.
Monitoring glycemic control in patients with type II diabetes mellitus.
Suggested Frequency of Type II Diabetes Mellitus Screening Intervals