Current issues of ACP Journal Club are published in Annals of Internal Medicine


Resource Corner

Evidence-Based Diabetes Care

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ACP J Club. 2002 Jan-Feb;136:A15. doi:10.7326/ACPJC-2002-136-1-A15



Evidence-Based Diabetes Care aims to compile evidence from applied clinical research about the diagnosis, prognosis, and therapy of a comprehensive list of diabetes-related medical problems. Although the target audience is primarily health care providers, the editors suggest that the text could also serve as a resource to those developing or evaluating current clinical practice guidelines.

In the first chapter, the editors explicitly define the criteria used throughout the text for seeking and appraising clinical evidence. These criteria are based on those used by the Canadian Diabetes Association in developing their clinical practice guidelines, and they are rational and cogent. Although the editors explicitly state that this resource was not intended to present an exhaustive search of the literature, chapter authors made use of many databases, and the search for evidence appears to have been appropriately comprehensive. Subsequent chapters are authored by individuals who are well-versed both in the relevant clinical area and in methods of rating clinical evidence. Because of the methodologic criteria for retrieval and appraisal of evidence, remarkable consistency exists among chapters in the manner of rating evidence. Summary points titled “Evidence-Based Messages” provide a succinct rating of available evidence after discussions in the text, and these points are repeated as a useful list at the end of each chapter.

The book contains 29 chapters in 7 sections. The first section, titled “Evidence,” clearly defines evidence-based medicine and outlines how available clinical evidence can be used to answer clinically important prognostic, diagnostic, and therapeutic questions and to develop evidence-based clinical practice guidelines. The section titled “Definition and Importance of Diabetes Mellitus” defines diabetes as a risk factor for adverse health outcomes and describes the short-term clinical consequences of diabetes in adults, children, and adolescents. “Etiologic Classification of Diabetes” defines and describes the major categories of diabetes: types 1 and 2 and gestational diabetes. “Prevention and Screening for Diabetes Mellitus” evaluates the evidence for early detection and prevention of diabetes. “Strategies for Lowering Blood Glucose Levels” evaluates evidence for education and home glucose monitoring, weight loss, currently available oral hypoglycemic agents (for type 2 diabetes), alternative therapies, insulin (for types 1 and 2), special considerations of diabetes management in pregnant women and the elderly, and prevention and treatment of hypoglycemia. In “Long-term Consequences of Diabetes,” evidence is evaluated for various preventive and therapeutic approaches to diabetic complications, such as erectile dysfunction and diseases of the eye, kidney, peripheral nerves, cardiovascular system, feet, and musculoskeletal and gastrointestinal systems. “Delivery of Care” evaluates models for organizing the delivery of diabetes care. The book also comes with a CD that includes the complete text of the book in searchable form, along with a separate database of abstracts of clinical studies of diabetes and its management, with some information for patients.

I believe that this resource is highly useful for anyone providing health care to patients with diabetes. Clearly, the effect of appropriate preventive therapies on the ultimate incidence of diabetic complications is very important. Given the variable quality of available evidence for these interventions, such careful ratings of the evidence are helpful. The list of diabetes-related topics presented is appropriate and comprehensive. Clinically useful answers are available for most of the therapeutic questions, and these are straightforward to read and comprehend. The authors did not presume any previous familiarity with evidence-based medicine, and hence, the clear definitions of the rating scales make the text widely accessible for health care providers irrespective of their experience in the appraisal of evidence.

Meredith Hawkins, MD
Albert Einstein College of Medicine
New York, New York, USA

Ratings

Methods/Quality of Information: 5 of 5 stars

Clinical Usefulness: 4 of 5 stars

Evidence-Based Diabetes Care can be purchased online at www.bcdecker.com for U.S. $99.95. The table of contents and a sample chapter can also be viewed at this site.