Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed

Diabetes is projected to affect over 578 million people by 2030, and one third of them will likely develop some form of diabetic eye disease, a leading cause of vision loss among middle-aged adults in Australia and around the world. As one of the most frequently visited health care providers, eye care practitioners are placed in a prime position to contribute to the multidisciplinary management of diabetes and diabetic eye diseases. For eye care practitioners to provide appropriate diabetic eye care, it is essential that the clinical practice guidelines they use are of high quality. To the best of our knowledge, this study provides the first systematic review and quality appraisal of all clinical practice guidelines on diabetic eye disease management. The findings of the study will inform busy service providers in selecting a high-quality guideline suitable for their context, as well as assist guideline developers in future iteration of these guidelines. Using a systematic search of literature and standard instrument for guideline appraisal (AGREE-II), the study evaluated the methodological and reporting quality of 18 existing guidelines. The appraisal identified nine ‘good quality’ diabetic eye disease guidelines including the Australian NHMRC guidelines which were rated high for rigorous development and other quality domains. The paper also discusses key weaknesses in the existing guidelines and suggests improvements needed in the areas of editorial transparency, appropriate stakeholder involvement, rigorous development, and implementation support to translate recommendations into clinical practice in the future iteration of these guidelines. The findings of the study are expected to aid in further dissemination and translation of high-quality guidelines into optimal clinical practice for diabetic eyecare around the world to help prevent vision loss due to diabetes.

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