Advertisement

Nutritional Recommendations for Type 2 Diabetes: An International Review of 15 Guidelines

Published:September 01, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.08.005

      Abstract

      Objectives

      Recommendations for patients with type 2 diabetes mellitus (T2DM) from clinical practice guidelines (CPGs) may be inconsistent, and little is known about their quality. Our aim in this study was to systematically review the consistency of globally available CPGs containing nutritional recommendations for T2DM and to assess the quality of their methodology and reporting.

      Methods

      PubMed, China Biology Medicine and 4 main guideline websites were searched. Four researchers independently assessed quality of the methodology and reporting using the Appraisal of Guidelines for Research and Evaluation, second edition (AGREE II) instrument and the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist.

      Results

      Fifteen CPGs include 65 nutritional recommendations with 6 sections: 1) body weight and energy balance; 2) dietary eating patterns; 3) macronutrients; 4) micronutrients and supplements; 5) alcohol; and 6) specific, functional foods. Current nutritional recommendations for patients with T2DM on specific elements and amounts are not completely consistent in different CPGs and fail to assign the specific supporting evidence and strength of recommendations. To use nutritional recommendations to guide and manage patients with T2DM, it is important to address the current challenges by establishing a solid evidence base and indicating the strength of recommendations. Overall, 8 CPGs classified as recommended for clinical practice used AGREE II. Fifteen CPGs adhere to <60% of RIGHT checklist items.

      Conclusions

      High-quality evidence is needed to potentially close knowledge gaps and strengthen the recommendation. The AGREE II instrument along with the RIGHT checklist should be endorsed and used by CPG developers to ensure higher quality and adequate use of their products.

      Résumé

      Objectifs

      On sait que les recommandations des lignes directrices de pratique clinique (LDPC) destinées aux patients atteints du diabète sucré de type 2 (DST2) peuvent être contradictoires, mais on en sait peu sur leur qualité. L’objectif de notre étude était d’examiner de façon systématique la cohérence des LDPC disponibles dans le monde entier qui contiennent des recommandations nutritionnelles lors de DST2 et d’évaluer la qualité de leur méthodologie et de leurs rapports.

      Méthodes

      Nous avons effectué des recherches dans PubMed, China Biology Medicine et les 4 principaux sites Web de lignes directrices. Quatre chercheurs ont évalué de façon indépendante la qualité de la méthodologie et des rapports à l’aide de l’outil Appraisal of Guidelines for Research and Evaluation, deuxième édition (AGREE II) et de la liste de vérification Reporting Items for Practice Guidelines in HealThcare (RIGHT).

      Résultats

      Quinze LDPC regroupaient 65 recommandations nutritionnelles en 6 sections : 1) le poids corporel et le bilan énergétique; 2) les habitudes de consommation alimentaire; 3) les macronutriments; 4) les micronutriments et les suppléments; 5) l’alcool; 6) les aliments fonctionnels ou particuliers. Les recommandations nutritionnelles actuelles destinées aux patients atteints du DST2 concernant les éléments et les quantités spécifiques ne sont pas entièrement cohérentes entre les différentes LDPC et ne fournissent pas de données probantes à l’appui ni la force des recommandations. En vue d’utiliser les recommandations nutritionnelles pour orienter et prendre en charge les patients atteints du DST2, il est important de surmonter les difficultés actuelles en établissant un corpus de données scientifiques solides et en indiquant la force des recommandations. Dans l’ensemble, 8 LDPC classifiées selon les recommandations de pratique clinique utilisaient AGREE II. Quinze LDPC adhèrent à < 60 % des questions de la liste de vérification RIGHT.

      Conclusions

      Des données probantes de haute qualité sont nécessaires pour potentiellement combler les lacunes en matière de connaissances et renforcer les recommandations. Les auteurs des LDPC devraient approuver et appliquer l’outil AGREE II parallèlement à la liste de vérification RIGHT afin de garantir une qualité accrue et une utilisation adéquate de leurs produits.

      Keywords

      Mots clés

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. International Diabetes Federation. IDF Diabetes Atlas, 9th ed. 2019. https://www.diabetesatlas.org/. Accessed March 25, 2020.

        • Schellenberg E.S.
        • Dryden D.M.
        • Vandermeer B.
        • Ha C.
        • Korownyk C.
        Lifestyle interventions for patients with and at risk for type 2 diabetes: A systematic review and meta-analysis.
        Ann Intern Med. 2013; 159: 543-551
        • Gillies C.L.
        • Abrams K.R.
        • Lambert P.C.
        • et al.
        Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: Systematic review and meta-analysis.
        BMJ (Clin Res Ed). 2007; 334: 299
        • Yoon U.
        • Kwok L.L.
        • Magkidis A.
        Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: A systematic review of randomized controlled trials.
        Metab Clin Exper. 2013; 62: 303-314
        • Pan B.
        • Ge L.
        • Xun Y.Q.
        • et al.
        Exercise training modalities in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis.
        Int J Behav Nutr Phys Act. 2018; 15: 72
        • Umpierre D.
        • Ribeiro P.A.
        • Kramer C.K.
        • et al.
        Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis.
        JAMA. 2011; 305: 1790-1799
        • Hou L.
        • Ge L.
        • Li Y.
        • et al.
        Physical activity recommendations for patients with type 2 diabetes: A cross-sectional survey.
        Acta Diabetol. 2020; 57: 765-777
        • Sievenpiper J.L.
        • Dworatzek P.D.
        Food and dietary pattern-based recommendations: An emerging approach to clinical practice guidelines for nutrition therapy in diabetes.
        Can J Diabetes. 2013; 37: 51-57
        • Hemmingsen B.
        • Gimenez-Perez G.
        • Mauricio D.
        • Roqué I Figuls M.
        • Metzendorf M.-I.
        • Richter B.
        Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus.
        Cochrane Database Syst Rev. 2017; 12 (CD003054-CD54)
        • Neuenschwander M.
        • Ballon A.
        • Weber K.S.
        • et al.
        Role of diet in type 2 diabetes incidence: Umbrella review of meta-analyses of prospective observational studies.
        BMJ (Clin Res Ed). 2019; 366: l2368
        • Jannasch F.
        • Kröger J.
        • Schulze M.B.
        Dietary patterns and type 2 diabetes: A systematic literature review and meta-analysis of prospective studies.
        J Nutr. 2017; 147: 1174-1182
        • Merlotti C.
        • Morabito A.
        • Pontiroli A.E.
        Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies.
        Diabetes Obes Metab. 2014; 16: 719-727
        • Ley S.H.
        • Hamdy O.
        • Mohan V.
        • Hu F.B.
        Prevention and management of type 2 diabetes: Dietary components and nutritional strategies.
        Lancet. 2014; 383: 1999-2007
        • Pegklidou K.
        • Nicolaou I.
        • Demopoulos V.J.
        Nutritional overview on the management of type 2 diabetes and the prevention of its complications.
        Curr Diabetes Rev. 2010; 6: 400-409
        • Damon S.
        • Schatzer M.
        • Hofler J.
        • Tomasec G.
        • Hoppichler F.
        Nutrition and diabetes mellitus: An overview of the current evidence.
        Wien Med Wochenschr. 2011; 161: 282-288
        • Carter P.
        • Khunti K.
        • Davies M.J.
        Dietary recommendations for the prevention of type 2 diabetes: What are they based on?.
        J Nutr Metab. 2012; 2012847202
        • Muilwijk M.
        • Nicolaou M.
        • Qureshi S.A.
        • t al
        Dietary and physical activity recommendations to prevent type 2 diabetes in South Asian adults: A systematic review.
        PLoS One. 2018; 13e0200681
        • Hale K.
        • Capra S.
        • Bauer J.
        Are nutrition messages lost in transmission? Assessing the quality and consistency of diabetes guideline recommendations on the delivery of nutrition therapy.
        Patient Educ Couns. 2016; 99: 1940-1946
        • Yang K.
        • Chen Y.
        • Li Y.
        • Schunemann H.J.
        Can China master the guideline challenge?.
        Health Res Policy Syst. 2013; 11: 1
        • Khan A.R.
        • Khan S.
        • Zimmerman V.
        • Baddour L.M.
        • Tleyjeh I.M.
        Quality and strength of evidence of the Infectious Diseases Society of America clinical practice guidelines.
        Clin Infect Dis. 2010; 51: 1147-1156
        • Jiang M.
        • Guan W.J.
        • Fang Z.F.
        • et al.
        A critical review of the quality of cough clinical practice guidelines.
        Chest. 2016; 150: 777-788
        • Anwer M.A.
        • Al-Fahed O.B.
        • Arif S.I.
        • Amer Y.S.
        • Titi M.A.
        • Al-Rukban M.O.
        Quality assessment of recent evidence-based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument.
        J Eval Clin Pract. 2018; 24: 166-172
        • Bhatt M.
        • Nahari A.
        • Wang P.W.
        • et al.
        The quality of clinical practice guidelines for management of pediatric type 2 diabetes mellitus: A systematic review using the AGREE II instrument.
        Syst Rev. 2018; 7: 193
        • Holmer H.K.
        • Ogden L.A.
        • Burda B.U.
        • Norris S.L.
        Quality of clinical practice guidelines for glycemic control in type 2 diabetes mellitus.
        PLoS One. 2013; 8e58625
        • Radwan M.
        • Akbari Sari A.
        • Rashidian A.
        • Takian A.
        • Abou-Dagga S.
        • Elsous A.
        Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: A methodological evaluation.
        JRSM Open. 2017; 82054270416682673
        • Wang Q.
        • Duan Y.
        • Liang J.
        • et al.
        Reporting quality of 2014–2018 clinical practice guidelines on diabetes according to the RIGHT checklist.
        Endocrine. 2019; 65: 531-541
      2. Institute of Medicine. In: Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E, editors. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press, 2011, 290 p.

        • Ouzzani M.
        • Hammady H.
        • Fedorowicz Z.
        • Elmagarmid A.
        Rayyan---A web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Brouwers M.C.
        • Kho M.E.
        • Browman G.P.
        • et al.
        AGREE II: Advancing guideline development, reporting and evaluation in health care.
        CMAJ. 2010; 182: E839-E842
        • Chen Y.
        • Yang K.
        • Marusic A.
        • et al.
        A reporting tool for practice guidelines in health care: The RIGHT statement.
        Ann Intern Med. 2017; 166: 128-132
        • AGREE Collaboration
        Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: The AGREE project.
        Quality Safety Health Care. 2003; 12: 18-23
        • Wayant C.
        • Cooper C.
        • Turner D.
        • Vassar M.
        Evaluation of the NCCN guidelines using the RIGHT statement and AGREE-II instrument: A cross-sectional review.
        BMJ Evid Based Med. 2019; 24: 219-226
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Kramer M.S.
        • Feinstein A.R.
        Clinical biostatistics. LIV. The biostatistics of concordance.
        Clin Pharmacol Ther. 1981; 29: 111-123
        • Bajaj S.
        RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017.
        Int J Diabetes Dev Ctries. 2018; 38: 1-115
        • International Diabetes Federation Guideline Development Group
        Global guideline for type 2 diabetes.
        Diabetes Res Clin Pract. 2014; 104: 1-52
        • Handelsman Y.
        • Mechanick J.I.
        • Blonde L.
        • et al.
        American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan.
        Endocr Pract. 2011; 17: 1-53
      3. National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: Management (NG28).
        (2015)
        https://www.nice.org.uk/guidance/ng28
        Date accessed: March 25, 2020
        • Haneda M.
        • Noda M.
        • Origasa H.
        • et al.
        Japanese clinical practice guideline for diabetes 2016.
        Diabetol Int. 2018; 9: 1-45
        • Goh S.Y.
        • Ang S.B.
        • Bee Y.M.
        • et al.
        Ministry of Health clinical practice guidelines: Diabetes mellitus.
        Singapore Med J. 2014; 55: 334-347
        • Sievenpiper J.L.
        • Chan C.B.
        • Dworatzek P.D.
        • Freeze C.
        • Williams S.L.
        Nutrition therapy.
        Can J Diabetes. 2018; 42 (S64–79)
        • Evert A.B.
        • Dennison M.
        • Gardner C.D.
        • et al.
        Nutrition therapy for adults with diabetes or prediabetes: A consensus report.
        Diabetes Care. 2019; 42: 731-754
      4. US Department of Veteran Affairs, US Department of Defense. VA/DoD clinical practice guideline for the management of type 2 diabetes mellitus in primary care. 2017.
        • Araszkiewicz A.
        • Bandurska-Stankiewicz E.
        • Budzyński A.
        • et al.
        2019 Guidelines on the management of diabetic patients. A position of Diabetes Poland.
        Clin Diabetol. 2019; 8: 1-95
      5. Ministry of Health Malaysia. Clinical practice guidelines—Management of type 2 diabetes 2015.
        • Dyson P.A.
        • Twenefour D.
        • Breen C.
        • et al.
        Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.
        Diabet Med. 2018; 35: 541-547
        • Chinese Diabetes Society
        China medical nutrition therapy guideline for diabetes (2013).
        Chinese J Diabetes Mellitus. 2015; 7: 73-88
        • Ge S.
        • Zhang P.
        • Ma A.
        • et al.
        China Dietary guidelines in type 2 diabetes (in Chinese).
        Acta Nutrimenta Sinica. 2017; 39: 521-529
      6. Scottish Intercollegiate Guidelines Network (SIGN). Management of diabetes---a national clinical guideline (SIGN CPG 116). 2010.
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        GRADE: An emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ (Clin Res Ed). 2008; 336: 924-926
        • Yao L.
        • Sun R.
        • Chen Y.L.
        • et al.
        The quality of evidence in Chinese meta-analyses needs to be improved.
        J Clin Epidemiol. 2016; 74: 73-79
        • Norris S.L.
        • Meerpohl J.J.
        • Akl E.A.
        • et al.
        The skills and experience of GRADE methodologists can be assessed with a simple tool.
        J Clin Epidemiol. 2016; 79: 150-158.e1
        • Ge L.
        • Tian J.H.
        • Li Y.N.
        • et al.
        Association between prospective registration and overall reporting and methodological quality of systematic reviews: A meta-epidemiological study.
        J Clin Epidemiol. 2018; 93: 45-55
        • Tian J.
        • Zhang J.
        • Ge L.
        • Yang K.
        • Song F.
        The methodological and reporting quality of systematic reviews from China and the USA are similar.
        J Clin Epidemiol. 2017; 85: 50-58