DMP for diabetes type 1: guidelines indicate some need for revision

On 22 August 2011, the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a literature search for evidence-based clinical practice guidelines on the treatment of people with diabetes mellitus type 1. The aim of the report is to identify those recommendations from current guidelines of high methodological quality that may be relevant for the planned revision of the corresponding disease management programme (DMP). According to the results of the report, there is no compelling need for revision of any part of the DMP. However, IQWiG identified various aspects that could be supplemented and specified.

Evidence was documented in detail

One of the responsibilities of IQWiG specified by law (Social Code Book V) is to develop and issue recommendations for DMPs. In the commission now completed, which was awarded by the Federal Joint Committee (G-BA), IQWiG systematically searched for new guidelines, assessed their methodological quality, and extracted relevant recommendations on the diagnosis and treatment of diabetes mellitus type 1, its accompanying diseases and late complications, as well as on the cooperation of health care sectors. In addition, the Institute documented how highly the guideline authors graded the robustness of the recommendations. However, the sources of the recommendations were not examined again; this is where IQWiG's guideline appraisals and benefit assessments differ.

No contradictions between the DMP and current recommendations

A total of 23 German and international guidelines containing recommendations on the treatment of diabetes type 1 were included. As the analysis showed, the recommendations in the guidelines are, by and large, consistent with the specifications of the DMP. No contradictions in content concerning the DMP requirements were found. The Director of IQWiG, Professor Dr med. Jürgen Windeler, stresses that "patients with diabetes mellitus type 1 can thus be sure that the current DMP is consistent with the current status of medical knowledge on all main points.”

Research questions
The aim of this study was to specify a potential need for updating and supplementation of the existing DMP "diabetes mellitus type 1" by systematically searching for new, topic-relevant, evidence-based guidelines and by synthesizing the guideline recommendations.

The study was organized according to the following working steps:

• Literature search for and selection of current guidelines on diabetes mellitus type 1
• Appraisal of the methodological quality of selected guidelines
• Extraction and synthesis of guideline recommendations relevant to the existing DMP diabetes mellitus type 1