, Volume 63, Issue 2, pp 204–212 | Cite as

Critical appraisal and systematic review of guidelines for perioperative diabetes management: 2011–2017

  • Xiaoyang Song
  • Jinjing Wang
  • Yuting Gao
  • Yang Yu
  • Jingyi Zhang
  • Qi Wang
  • Xiaoting Ma
  • Janne Estille
  • Xinye Jin
  • Yaolong ChenEmail author
  • Yiming MuEmail author



To systematically evaluate the quality, consistency and the evidence support of guidelines for perioperative diabetes management.


We retrieved guidelines through systematic search, critically evaluated their quality and compared the recommendations of included guidelines. Five aspects were compared: target level, management of hyper- and hypoglycaemia, frequency of monitoring, management of insulin, and management of oral anti-diabetic drugs (OADs).


Fourteen guidelines met our criteria, and 342 recommendations were extracted, the results of Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation showed that none of the mean score in each domain was higher than 50%. On average, most guidelines had only one domain scored above 50%. Most recommendations (78.9%) did not specify their supporting evidence, 71 (20.8%) were formed using grading criteria, none cited systematic review or meta-analysis. Recommendations were inconsistent across different guidelines.


The existing guidelines about perioperative management of diabetes needs improvement in methodology, as well as the production of evidence with high quality. Evidence-based guidelines are required for the perioperative management of diabetes.


Perioperative management Diabetes Clinical practice guideline Systematic review Quality assessment 



This study is supported by Beijing Municipal Science & Technology Commission (grant no. D141107005314004).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

12020_2018_1786_MOESM1_ESM.docx (19 kb)
Supplementary Appendix1
12020_2018_1786_MOESM2_ESM.docx (23 kb)
Supplementary Appendix2
12020_2018_1786_MOESM3_ESM.docx (22 kb)
Supplementary Appendix3


  1. 1.
    World Health Organization, Global report on diabetes. 2016, Accessed 31 Dec 2017
  2. 2.
    C.M. Levesque, Perioperative care of patients with diabetes. Crit. Care. Nurs. Clin. North. Am. 25, 21–29 (2013)CrossRefGoogle Scholar
  3. 3.
    A.K. Lipshutz, M.A. Gropper, Perioperative glycemic control: an evidence-based review. Anesthesiology 110, 408–421 (2009)Google Scholar
  4. 4.
    L.F. Meneghini, Perioperative management of diabetes: translating evidence into practice. Clev Clin. J. Med. 76(Suppl 4), S53–S59 (2009)CrossRefGoogle Scholar
  5. 5.
    Australian Diabetes Society, Perioperative diabetes management guidelines. 2012, Accessed 31 Dec 2017
  6. 6.
    P. Barker, P.E. Creasey, K. Dhatariya et al. Peri-operative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 70, 1427–1440 (2015)CrossRefGoogle Scholar
  7. 7.
    Joslin Diabetes Center and Joslin Clinic, 2015, Guideline for inpatient management of surgical and icu patients with diabetes. 2015, Accessed 22 Dec 2017
  8. 8.
    K. Dhatariya, D. Flanagan, L. Hilton, et al., Management of adults with diabetes undergoing surgery and elective procedures: improving standards. 2016, Accessed 22 Dec 2017
  9. 9.
    Y. Huang, H. Gao, X. Guo et al. Consensus on the perioperative glycaemic control (in Chinese). J. Clin. Anesthesiol. 32, 93–95 (2016)Google Scholar
  10. 10.
    M.C. Brouwers, M.E. Kho, G.P. Browman et al., AGREE II: advancing guideline development, reporting, and evaluation in health care. Can. Med. Assoc. J. 63, 1308–1311 (2011)Google Scholar
  11. 11.
    Australian Diabetes Society, Guidelines for routine glucose control in hospital. 2012, Accessed 31 Dec 2017
  12. 12.
    M.E. Boyle, K.M. Seifert, K.A. Beer et al., Guidelines for application of continuous subcutaneous insulin infusion (insulin pump) therapy in the perioperative period. J. Diabetes Sci. Technol. 6, 184–190 (2012)CrossRefGoogle Scholar
  13. 13.
    G.E. Umpierrez, R. Hellman, M.T. Korytkowski et al., Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97, 16–38 (2012)CrossRefGoogle Scholar
  14. 14.
    J.I. Mechanick, A. Youdim, B. Daniel et al., Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update. Surg. Obes. Relat. Dis. 9, 159–191 (2013)CrossRefGoogle Scholar
  15. 15.
    M. Hornum, J.P. Lindahl, B.V. Zur-Mühlen et al., Diagnosis, management and treatment of glucometabolic disorders emerging after kidney transplantation. Transpl. Int. 26, 1049–1060 (2013)CrossRefGoogle Scholar
  16. 16.
    L.M. Jones, C. Rebecca, K. Sorabh et al., A clinician’s guide to the treatment of foot burns occurring in diabetic patients. Burns 40, 1696–1701 (2014)CrossRefGoogle Scholar
  17. 17.
    A. Ahluwalia, A.K. Baliarsinha, S.B. Gupta et al., Consensus evidence-based guidelines for management of hyperglycaemia in patients undergoing coronary artery bypass grafting in patients with diabetes in India. J. Assoc. Physicians India 62(Suppl 7), 42–48 (2014)Google Scholar
  18. 18.
    Chinese Diabetes Society, China guideline for type 2 diabetes 2013 edition (in Chinese). Chin. J. Endocrinol. Metab. 88, 26–89 (2014)Google Scholar
  19. 19.
    Chinese Society for Metabolic & Bariatric Surgery, China obesity and type 2 diabetes mellitus surgical treatment guideline 2014 edition (in Chinese). Chin. J. Pract. Surg. 8, 1005–1010 (2014).Google Scholar
  20. 20.
    The Grading of Recommendations Assessment, Development and Evaluation. 2016. Accessed 31 Dec 2017
  21. 21.
    Y. Handelsman, J.I. Mechanick, L. Blonde et al., American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr. Pract. 17(Suppl 2), 1 (2011)CrossRefGoogle Scholar
  22. 22.
    P. Alonso-Coello, A. Irfan, I. Sola et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual. Saf. Health Care. 19, e58 (2010)Google Scholar
  23. 23.
    I. Anzola, P.C. Gomez, G.E. Umpierrez et al., Management of diabetic ketoacidosis and hyperglycemic hyperosmolar state in adults. Expert Rev. Endocr. Metab. 11, 177–185 (2016)CrossRefGoogle Scholar
  24. 24.
    J. Upadhyay, S.A. Polyzos, N. Perakakis et al., Pharmacotherapy of type 2 diabetes: an update. Metabolism 78, 13–42 (2018)CrossRefGoogle Scholar
  25. 25.
    A. Frisch, P. Chandra, D. Smiley et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 33, 1783–1788 (2010)CrossRefGoogle Scholar
  26. 26.
    A.M. Buchleitner, M. Martínez-Alonso, M. Hernández et al. Perioperative glycaemic control for diabetic patients undergoing surgery. Cochrane Database Syst. Rev. 9, 381–381 (2012)Google Scholar
  27. 27.
    T.C. Li, S.L. Kardia, C.I. Li et al., Glycemic control paradox: poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes. Metabolism 64, 1013–1021 (2015)CrossRefGoogle Scholar
  28. 28.
    M. Radwan, A.A. Sari, A. Rashidian et al., Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: a methodological evaluation. J. R. Soc. Med Open. 8, 1–8 (2017)Google Scholar
  29. 29.
    L. Mosca, E.J. Benjamin, K. Berra et al., Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the american heart association. J. Am. Coll. Cardiol. 57, 1404 (2011)CrossRefGoogle Scholar
  30. 30.
    IOM, Clinical Practice Guidelines We Can Trust. (The National Academies Press, Washington, DC, 2011)Google Scholar
  31. 31.
    J.M. Hazlehurst, M.J. Armstrong, M. Sherlock et al. A comparative quality assessment of evidence-based clinical guidelines in endocrinology. Clin. Endocrinol. 78, 183 (2013)CrossRefGoogle Scholar
  32. 32.
    World Health Organization. WHO Handbook for Guideline Development. (WHO Press, Geneva: 2012)Google Scholar
  33. 33.
    N. Mathioudakis, S.H. Golden, A comparison of inpatient glucose management guidelines: implications for patient safety and quality. Curr. Diab. Rep. 15, 583 (2015)CrossRefGoogle Scholar
  34. 34.
    M.A. Puskarich, M.S. Runyon, T. Stephen et al. Effect of glucose-insulin-potassium infusion on mortality in critical care settings: a systematic review and meta-analysis. J. Clin. Pharmacol. 49, 758–767 (2009)CrossRefGoogle Scholar
  35. 35.
    K. Dhatariya, Should inpatient hyperglycaemia be treated? BMJ 346, f134 (2013)CrossRefGoogle Scholar
  36. 36.
    J. Makarski, M.C. Brouwers, The AGREE enterprise: a decade of advancing clinical practice guidelines. Implement. Sci. 9, 1–3 (2014)CrossRefGoogle Scholar
  37. 37.
    M.C. Brouwers, K. Kerkvliet, K. Spithoff et al., The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ 354, i1152 (2016)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Xiaoyang Song
    • 1
  • Jinjing Wang
    • 2
    • 3
  • Yuting Gao
    • 1
    • 4
  • Yang Yu
    • 5
  • Jingyi Zhang
    • 6
    • 7
  • Qi Wang
    • 7
    • 8
    • 9
  • Xiaoting Ma
    • 6
  • Janne Estille
    • 10
    • 11
  • Xinye Jin
    • 3
    • 12
  • Yaolong Chen
    • 7
    • 13
    Email author
  • Yiming Mu
    • 3
    Email author
  1. 1.The First Clinical Medical CollegeLanzhou UniversityLanzhouChina
  2. 2.Fifth Medical Center of Chinese PLA General HospitalBeijingChina
  3. 3.Department of EndocrinologyChinese PLA General HospitalBeijingChina
  4. 4.Endocrinology DepartmentThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  5. 5.The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
  6. 6.School of Public HealthLanzhou UniversityLanzhouChina
  7. 7.Evidence-Based Medicine Center, School of Basic Medical SciencesLanzhou UniversityLanzhouChina
  8. 8.Health Policy PhD ProgramMcMaster UniversityHamiltonCanada
  9. 9.McMaster Health ForumMcMaster UniversityHamiltonCanada
  10. 10.Institute of Global HealthUniversity of GenevaGenevaSwitzerland
  11. 11.Institute of Mathematical Statistics and Actuarial ScienceUniversity of BernBernSwitzerland
  12. 12.Department of EndocrinologyHainan Branch of Chinese PLA General HospitalSanyaChina
  13. 13.WHO Collaborating Centre for Guideline Implementation and Knowledge TranslationLanzhou UniversityLanzhouChina

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