Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries

Diabetes Res Clin Pract. 2010 Feb;87(2):252-60. doi: 10.1016/j.diabres.2009.10.020. Epub 2009 Nov 22.


Methods: The most recent nationally recognised guidelines for type 2 diabetes from eight European countries (Belgium, England/Wales, France, Germany, Ireland, Italy, the Netherlands and Sweden) were compared. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was used for quality assessment. Details of recommendations for key process and outcome indicators were also extracted. Appraisal and data extraction were conducted independently by two researchers.

Results: AGREE domain scores varied between guidelines, including a range of 31-95% for rigour of development. The highest mean domain scores were for Scope and Purpose (81%) and Clarity and Presentation (85%); the lowest was for Stakeholder Involvement (49%). Specific recommendations, including targets relating to intermediate outcomes, were broadly similar. However, at detailed level, there were variations, particularly in terms of the level of information provided, for example, only two countries' guidelines provided cut-off points in relation to risk associated with waist circumference.

Implications: Our findings suggest that there are some areas of good practice relating to guideline development where more attention is needed. Despite a substantial degree of consensus for specified targets, observed differences at detailed level suggest a lack of consistency in relation to some aspects of the information provided to clinicians across Europe.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Weight
  • Cholesterol / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / therapy*
  • Europe
  • Glycated Hemoglobin A / analysis*
  • Humans
  • Life Style
  • Needs Assessment / standards
  • Practice Guidelines as Topic / standards*
  • Quality Assurance, Health Care
  • Self Care
  • Weight Loss


  • Glycated Hemoglobin A
  • Cholesterol