Health Serv Res. 2013 Feb 28. doi: 10.1111/1475-6773.12048. [Epub ahead of print]
Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review.
SourceDivision of General Internal Medicine, Massachussets General Hospital, Boston, MA 02114.
OBJECTIVE:To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients.
DATA SOURCES:MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources.
STUDY DESIGN:Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations.
DATA COLLECTION/EXTRACTION METHODS:Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form.
PRINCIPAL FINDINGS:We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome.
CONCLUSIONS:Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations.
© Health Research and Educational Trust.
- [PubMed - as supplied by publisher]