The First Clinical Medical College, Lanzhou University, Donggang West Road, 730000, Lanzhou, China.
Fifth Medical Center of Chinese PLA General Hospital, East Avenue, 100000, Beijing, China.
Endocrine. 2019 Feb;63(2):204-212. doi: 10.1007/s12020-018-1786-y. Epub 2018 Nov 16.
To systematically evaluate the quality, consistency and the evidence support of guidelines for perioperative diabetes management.
We retrieved guidelines through systematic search, critically evaluated their quality and compared the recommendations of included guidelines. Five aspects were compared: target level, management of hyper- and hypoglycaemia, frequency of monitoring, management of insulin, and management of oral anti-diabetic drugs (OADs).
Fourteen guidelines met our criteria, and 342 recommendations were extracted, the results of Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation showed that none of the mean score in each domain was higher than 50%. On average, most guidelines had only one domain scored above 50%. Most recommendations (78.9%) did not specify their supporting evidence, 71 (20.8%) were formed using grading criteria, none cited systematic review or meta-analysis. Recommendations were inconsistent across different guidelines.
The existing guidelines about perioperative management of diabetes needs improvement in methodology, as well as the production of evidence with high quality. Evidence-based guidelines are required for the perioperative management of diabetes.
系统评估围手术期糖尿病管理指南的质量、一致性和证据支持。
我们通过系统搜索检索了指南，并对其质量进行了严格评估，比较了纳入指南的建议。比较了五个方面：目标水平、高血糖和低血糖的管理、监测频率、胰岛素管理和口服降糖药（OAD）管理。
符合标准的指南有 14 条，共提取了 342 条建议。评估工具 Appraisal of Guidelines for Research and Evaluation II（AGREE II）的评估结果显示，每个领域的平均得分均没有超过 50%。平均而言，大多数指南只有一个领域的得分超过 50%。大多数建议（78.9%）没有明确说明其支持证据，71 条（20.8%）是使用分级标准制定的，没有一条引用了系统评价或荟萃分析。不同指南的建议不一致。
现有的围手术期糖尿病管理指南在方法学以及高质量证据的产生方面需要改进。需要制定基于循证的围手术期糖尿病管理指南。
