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

Abstract Objectives To assess the quality of diabetic eye disease clinical practice guidelines Study design and setting A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A ‘good quality’ guideline was one with ≥60% score for ‘rigour of development’ and in at least two other domains. Results Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for ‘scope and purpose’, ‘stakeholder involvement’, ‘rigour of development’, ‘clarity of presentation’, ‘applicability’ and ‘editorial independence’ were 73.6% (54.2%-80.6%), 48.6% (29.2%-71.5%), 60.2% (30.9%-78.1%), 86.6% (76.7%-94.4%), 28.6% (18.0%-37.8%) and 60.2% (30.9%-78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7-5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n=9) of the guidelines (all evidence-based) were of ‘good quality’. Conclusion A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating ‘good quality’. Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.