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

Liangying Hou; Long Ge; Qi Wang; Juanjuan He; Tianzhu Qin; Liujiao Cao; Changhao Cao; Diru Liu; Xingrong Liu; Kehu Yang

doi:10.1016/j.jcjd.2022.08.005

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

Can J Diabetes. 2023 Mar;47(2):197-206. doi: 10.1016/j.jcjd.2022.08.005. Epub 2022 Sep 2.

Authors

Liangying Hou¹, Long Ge², Qi Wang², Juanjuan He³, Tianzhu Qin³, Liujiao Cao⁴, Changhao Cao³, Diru Liu⁵, Xingrong Liu³, Kehu Yang⁶

Affiliations

¹ Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
² Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
³ Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
⁴ West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Nutrition and Healthy Food, School of Public Health, Lanzhou University, Lanzhou, China.
⁶ Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China. Electronic address: kehuyangebm2006@126.com.

PMID: 36184370
DOI: 10.1016/j.jcjd.2022.08.005

Abstract

Objectives: Recommendations from clinical practice guidelines (CPGs) for individuals with type 2 diabetes mellitus (T2DM) 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 individuals 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 individuals 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.

Keywords: AGREE II; RIGHT; clinical practice guidelines; diabète de type 2; lignes directrices de pratique clinique; nutritional recommendations; recommandations nutritionnelles; type 2 diabetes.

Publication types

Review

MeSH terms

China
Diabetes Mellitus, Type 2*
Humans