Burgers Jako S, Bailey Julia V, Klazinga Niek S, Van Der Bij Akke K, Grol Richard, Feder Gene
Centre for Quality of Care Research, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Diabetes Care. 2002 Nov;25(11):1933-9. doi: 10.2337/diacare.25.11.1933.
To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence.
We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using qualitative methods to compare the recommendations and bibliometric methods to measure the extent of overlap in citations used by different guidelines. A further qualitative analysis of recommendations and cited evidence for two specific issues in diabetes care explored the apparent discrepancy between recommendations and evidence.
The recommendations made in the guidelines were in agreement about the general management of type 2 diabetes, with some important differences in treatment details. There was little overlap in evidence cited by the guidelines, with 18% (185/1,033) of citations shared with any other guideline, and only 10 studies (1%) appearing in six or more guidelines. The measurable overlap in evidence between guidelines increases if multiple publications from the same study and the use of reviews are taken into account. Research originating from the U.S. predominated (40% of citations); however, nearly all (11/12) guidelines were significantly more likely to cite evidence originating from their own countries.
Despite the variation in cited evidence and preferential citation of evidence from a guideline's country of origin, we found a high degree of international consensus in recommendations made for the clinical care of type 2 diabetes. The influence of professional bodies such as the American Diabetes Association may be an important factor in explaining international consensus. Globalization of recommended management of diabetes is not a simple consequence of the globalization of research evidence.
比较不同国家的糖尿病指南，以检验推荐意见的差异是否可由所使用的不同研究证据来解释。
我们采用定性方法分析了来自13个国家的15项2型糖尿病临床指南，以比较推荐意见，并采用文献计量方法来衡量不同指南所使用的参考文献的重叠程度。对糖尿病护理中两个具体问题的推荐意见和引用证据进行的进一步定性分析，探讨了推荐意见与证据之间明显的差异。
指南中的推荐意见在2型糖尿病的总体管理方面是一致的，但在治疗细节上存在一些重要差异。指南所引用的证据几乎没有重叠，仅有18%（185/1033）的参考文献被其他任何指南共享，只有10项研究（1%）出现在6项或更多的指南中。如果考虑同一研究的多篇出版物以及综述的使用，指南之间证据的可测量重叠会增加。来自美国的研究占主导（40%的参考文献）；然而，几乎所有（11/12）的指南都更有可能引用来自其本国的证据。
尽管所引用的证据存在差异，且优先引用指南原产国的证据，但我们发现对于2型糖尿病临床护理的推荐意见存在高度的国际共识。美国糖尿病协会等专业机构的影响可能是解释国际共识的一个重要因素。糖尿病推荐管理的全球化并非研究证据全球化的简单结果。
