Adolopment of adult diabetes mellitus management guidelines for a Pakistani context: Methodology and challenges

Authors

Russell Seth Martins, Aga Khan UniversityFollow
Qamar Masood, Aga Khan UniversityFollow
Omar Mahmud, Aga Khan UniversityFollow
Nashia Ali Rizvi, Aga Khan UniversityFollow
Aisha Sheikh, Aga Khan UniversityFollow
Najmul Islam, Aga Khan UniversityFollow
Anum Naushad Ali Khowaja, Aga Khan University
Nanik Ram, Aga Khan UniversityFollow
Saira Furqan, Aga Khan UniversityFollow
Mohsin Ali Mohsin, Aga Khan University
Salima Saleem Aamdani, Aga Khan University
Alina Pervez, Aga Khan University
Adil H. Haider, Aga Khan UniversityFollow
Sarah Nadeem, Aga Khan UniversityFollow

Document Type

Article

Department

Medical College Pakistan; Medicine

Abstract

Introduction: Pakistan has the highest national prevalence of type 2 diabetes mellitus (T2DM) in the world. Most high-quality T2DM clinical practice guidelines (CPGs) used internationally originate from high-income countries in the West. Local T2DM CPGs in Pakistan are not backed by transparent methodologies. We aimed to produce comprehensive, high-quality CPGs for the management of adult DM in Pakistan.
Methods: We employed the GRADE-ADOLOPMENT approach utilizing the T2DM CPG of the American Diabetes Association (ADA) Standards of Medical Care in Diabetes - 2021 as the source CPG. Recommendations from the source guideline were either adopted as is, excluded, or adapted according to our local context.
Results: The source document contained 243 recommendations, 219 of which were adopted without change, 5 with minor changes, and 18 of which were excluded in the newly created Pakistani guidelines. One recommendation was adapted: the recommended age to begin screening all individuals for T2DM/pre-diabetes was lowered from 45 to 30 years, due to the higher prevalence of T2DM in younger Pakistanis. Exclusion of recommendations were primarily due to differences in the healthcare systems of Pakistan and the US, or the unavailability of certain drugs in Pakistan.
Conclusion: A CPG for the management of T2DM in Pakistan was created. Our newly developed guideline recommends earlier screening for T2DM in Pakistan, primarily due to the higher prevalence of T2DM amongst younger individuals in Pakistan. Moreover, the systematic methodology used is a significant improvement on pre-existing T2DM CPGs in Pakistan. Once these evidence based CGPs are officially published, their nationwide uptake should be top priority. Our findings also highlight the need for rigorous expanded research exploring the effectiveness of earlier screening for T2DM in Pakistan

Comments

Volume, issue, and pagination are not provided by the author/publisher

Publication (Name of Journal)

Frontiers in endocrinology

Recommended Citation

Martins, R. S., Masood, Q., Mahmud, O., Rizvi, N. A., Sheikh, A., Islam, N., Khowaja, A. N., Ram, N., Furqan, S., Mohsin, M. A., Aamdani, S. S., Pervez, A., Haider, A. H., Nadeem, S. (2023). Adolopment of adult diabetes mellitus management guidelines for a Pakistani context: Methodology and challenges. Frontiers in endocrinology.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_mc/325