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Systematic Survey of Guidelines With Recommendations Related to Concordant Multimorbidity: Diabetes, Coronary Heart
Zijun Wang1,2,3, Jie Zhang1,2,3, Bingyi Wang1,2,3
1Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
Insights
Guidelines for managing multiple conditions like diabetes, coronary heart disease (CHD), and stroke often lack evidence from multimorbid patients. More research is needed to improve treatment recommendations for these complex cases.
Area of Science:
- Medical Guidelines
- Clinical Practice
- Multimorbidity Research
Background:
- Existing guidelines primarily address single diseases, with limited focus on common comorbidity combinations.
- Dedicated guidelines for conditions like diabetes, coronary heart disease (CHD), and stroke are emerging but require evaluation.
- This study examines the status and quality of guidelines for managing patients with at least two of these prevalent diseases.
Purpose of the Study:
- To assess the current landscape and quality of guidelines addressing common comorbidities, specifically diabetes, CHD, and stroke.
- To identify the origin, focus, and methodological quality of existing guidelines.
- To analyze the evidence base supporting drug therapy recommendations for patients with multiple chronic conditions.
Main Methods:
- Systematic literature search across databases, guideline platforms, and organizational websites.
- Inclusion of guidelines published 2020-2024, addressing at least two target diseases and including drug therapy.
- Quality assessment using AGREE II and RIGHT tools, aided by a large language model.
Main Results:
- 82 guidelines were identified; 18 specifically addressed disease combinations, while 64 focused on single diseases with comorbidity recommendations.
- Chinese guidelines were most prevalent. Methodological and reporting quality were moderate on average.
- Most recommendations focused on anti-diabetic, antihypertensive, lipid-lowering, and anticoagulant therapies, primarily supported by RCTs, but rarely by studies on multimorbid patients.
Conclusions:
- Recommendations for multimorbidity are predominantly found within single-disease guidelines.
- There is a significant scarcity of supporting evidence derived from studies involving multimorbid patients.
- Primary research focusing on patients with multiple comorbidities is crucial for enhancing guideline development.
Background:
Although guidelines focus predominantly on individual diseases, some dedicated guidelines and recommendations exist for common combinations of comorbidities. Using diabetes, coronary heart disease (CHD) and stroke as an example, we aimed to assess the current status and quality of such guidelines.
Methods:
We systematically searched literature databases, Google, guideline platforms, and websites of relevant organizations. We included guidelines published between 2020 and 2024 that addressed at least two of the following diseases: diabetes, CHD, and stroke; and included drug therapy interventions. We extracted the recommendations on drug therapy and sources of the supporting evidence, and assessed the quality of the guidelines using AGREE II and RIGHT with the help of a large language model based tool.
Results:
We identified 82 guidelines: 64 focused on one disease with recommendations on comorbidities, and 18 specifically addressed a combination of diseases. China was the most frequent country of origin (n = 50, 61.0%). The methodological and reporting quality of these guidelines was moderate on average. For most guidelines (n = 54, 65.9%), the primary focus was on diabetes. We grouped the recommended drug therapies for patients with combinations of these diseases into four main categories: anti-diabetic therapy, antihypertensive therapy, lipid-lowering therapy, and anticoagulant therapy. Most recommendations were supported by RCTs, but only a third of the guidelines referred to studies done in multimorbid patients.
Conclusion:
Most recommendations related to multimorbidity were found in guidelines focusing on a single target disease, and supporting evidence from multimorbid patients was rare. More primary evidence from multimorbid patients is needed.
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