A review and critical analysis of professional societies' guidelines for pharmacologic management of type 2 diabetes mellitus.

The development of clinical practice guidelines (CPGs), which are promulgated by various sponsoring organizations to provide direction to clinicians for management of complex problems, generally adhere to a set of key principles. To reassure the users of their scientific and ethical validity, these include the use of a system to rate the quality of evidence on which the guideline is based and the divulgence of any conflicts of interest (COI) among members of the panel developing the guidelines. I analyzed the CPGs for pharmacologic management of patients with type 2 diabetes written by the two US professional societies that developed such guidelines (American Association of Clinical Endocrinologists [AACE] and the American Diabetes Association/European Association for the Study of Diabetes [ADA/EASD]) to assess their adherence to these principles of guideline development and to compare them with regard to simplicity, consideration of costs, and peer review status. To put the existence of COIs in these guidelines into context, I also reviewed the COIs from government-sponsored panels that developed diabetes CPGs. The results of this analysis suggest that both the AACE and ADA/EASD guidelines should be regarded as consensus documents rather than true CPGs, since neither guideline employed evidence grading. COI was extremely common among the members of both CPG panels from professional organizations, as well in the CPG panels with government sponsorship. In addition, the nature and extent of external peer review of these guidelines is unclear. Given these limitations, the AACE and ADA/EASD CPGs for diabetes management should be regarded as advisory at best, rather than prescriptive or authoritative, especially in view of their noncompliance with key principles of guideline development.