From VA Boston Healthcare System, West Roxbury, Massachusetts; San Antonio Military Medical Center, Fort Sam Houston, Texas; Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina; San Diego Internal Medicine, San Diego, California; and Veterans Affairs Central Office, Office of Specialty Care Services, Washington, DC.
Ann Intern Med. 2017 Nov 7;167(9):655-663. doi: 10.7326/M17-1362. Epub 2017 Oct 24.
In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus.
The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients.
2017 年 4 月,美国退伍军人事务部(VA)和美国国防部(DoD)批准了 2 型糖尿病管理的联合临床实践指南。
VA/DoD 循证实践工作组召集了一次联合 VA/DoD 指南制定工作,其中包括一个多学科的临床医生利益相关者小组,并符合医学研究所的可信临床实践指南原则。指南小组与 ECRI 研究所合作,共同制定了关键问题,该研究所通过 2016 年 6 月系统地搜索和评估文献,制定了算法,并使用 GRADE(推荐评估、制定与评价)系统对建议进行评级。
本概要总结了指南在 7 个领域的关键特征:以患者为中心的护理和共同决策、血糖生物标志物、糖化血红蛋白目标范围、个体化治疗计划、门诊药物治疗、危重症患者的血糖目标以及住院患者的治疗。