Abstract
To present an evidence map for explicating research trends and gaps, we systematically review clinical practice guidelines (CPGs) on diabetic retinopathy (DR) and assess the quality of CPGs and consistency of recommendations. A literature search was performed in PubMed, Embase, Web of Science, CPG databases, and website of diabetes society to include the CPGs. The basic information, methodological quality, and reporting quality of CPGs, recommendations for DR were exacted by the Excel 2013. Methodological and reporting quality of DR CPGs were evaluated by AGREE II instrument and RIGHT checklist. The bubble plot format of evidence map was made by Excel 2013. Nineteen CPGs proved eligible, which included eight DR CPGs and 11 comprehensive diabetic CPGs. The identified CPGs were of mixed quality and they scored poorly in the rigor of development, applicability domains by AGREE II. Field two (background) had the highest reporting rate (86.31%) and field five (review and quality assurance) obtained the lowest reporting rate (31.58%) among the seven domains of RIGHT checklist. According to the recommendations of CPGs, there were three inconsistencies in the screening of DR, and CPGs recommendations for treatment were consistent on the whole. At the same time, recommendations for laser therapy were not accurate. Some recommendations were not specific and clear in some DR CPGs. This evidence map could collect and evaluate the characteristics of published CPGs, add to our knowledge and promote the development of trustworthy CPGs for DR.
摘要
我们对糖尿病视网膜病变 (diabetic retinopathy, DR) 的临床实践指南 (clinical practice guidelines, CPGs) 进行了系统回顾, 并评估了CPGs的质量和建议的一致性, 旨在呈现一份详细阐述研究趋势和差距的证据图。我们对PubMed、Embase、科学网、CPG数据库和糖尿病协会网进行了文献检索。采用2013版Excel对CPGs的基本信息、方法学质量、报告质量以及DR指南推荐进行整理, 采用评价工具AGREE-II和 RIGHT检查表对DR CPGs的方法学和报告质量进行评估, 采用2013版Excel制作证据图的气泡图。结果表明19个CPGs是合格的, 其中包括8个DR CPGs和11个综合性糖尿病CPGs。这些CPGs质量参差不齐, 在AGREE II的严格的开发和其领域的适用性很低。在RIGHT检查表的七项评估内容中, 第二项 (背景) 的报告率最高 (86.31%), 第五项 (综述和质量保证) 的报告率最低 (31.58%) 。根据CPGs推荐, 在DR的筛查上存在三项不一致, CPGs在治疗方面的推荐总体上是一致的。同时, 激光治疗的建议并不精准。在某些DR CPGs中一些推荐并不明确。这份证据图收集了并且针对已发表的CPGs特征进行了评价, 增加了我们对DR的认识, 促进了DR的CPGs的可靠性的不断进步。
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Acknowledgements
The authors appreciate Xiaoqing Wang and Nan Yang (Chinese GRADE Center) for their methodological support and assistance with the final editing of the article.
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Y.S., and J.H.-T., did the study design. Y.T.-C., and J.H.-T. performed literature search. Y.S and J.C. contributed to the data acquisition. Y.S., and J.C. contributed to data interpretation and statistical analysis. L.G., and J.H.-Z., supervised and provide mentorship. Y.S., and Y.T.-C. wrote the first draft of the report. Y.S., and J.B.-X., edited the report and all authors contributed to revision of the report. All authors reviewed the paper, approved the final draft, and agreed to submit it for publication.
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Sun, Y., Cai, Yt., Chen, J. et al. An evidence map of clinical practice guideline recommendations and quality on diabetic retinopathy. Eye 34, 1989–2000 (2020). https://doi.org/10.1038/s41433-020-1010-1
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DOI: https://doi.org/10.1038/s41433-020-1010-1
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