Development process of a clinical guideline to manage type 2 diabetes in adults by Ayurvedic practitioners.
Development process of a clinical guideline to manage type 2 diabetes in adults by Ayurvedic practitioners.
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DOI：
10.3389/fmed.2023.1043715
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发表时间：
2023
影响因子：
3.9
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中科院分区：
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2 型糖尿病 (T2DM) 是一种常见的慢性健康状况，具有重大的健康和社会经济后果。在印度次大陆，这是一种健康状况，人们通常会咨询阿育吠陀（传统医疗系统）医生并使用他们的药物。然而，迄今为止，还没有基于现有最佳科学证据的针对阿育吠陀从业者的高质量 T2DM 临床指南。因此，该研究旨在系统地为阿育吠陀从业者制定治疗成人 T2DM 的临床指南。开发工作受到英国国家健康与护理卓越研究所 (NICE) 指南制定手册、建议分级、评估、开发和评估 (GRADE) 方法以及研究和评估指南评估 (AGREE) II 工具的指导。首先，进行了全面的系统评价，评估了阿育吠陀药物在治疗 T2DM 方面的有效性和安全性。此外，GRADE方法用于评估研究结果的确定性。接下来，使用 GRADE 方法，开发了证据到决策框架，我们重点关注血糖控制和不良事件。随后，由 17 名国际成员组成的指南制定小组根据证据到决策框架，就阿育吠陀药物治疗 T2DM 的有效性和安全性提出了建议。这些建议构成了临床指南的基础，其他通用内容和建议改编自 Clarity Informatics（英国）的 T2DM 临床知识摘要。指南制定小组对草案版本提供的反馈用于修改和最终确定临床指南。阿育吠陀从业者制定了治疗成人 T2DM 的临床指南，重点关注从业者如何为 T2DM 患者（及其护理人员和家人）提供适当的护理、教育和支持。临床指南提供有关 T2DM 的信息，例如其定义、危险因素、患病率、预后和并发症；如何通过饮食、身体活动和阿育吠陀药物等生活方式的改变来诊断和管理；应如何检测和管理 T2DM 的急性和慢性并发症（包括转诊至专家）；以及有关驾驶、工作和禁食（包括宗教/社会文化节日期间）等主题的建议。我们系统地为阿育吠陀从业者制定了治疗成人 T2DM 的临床指南。
Type 2 diabetes mellitus (T2DM), a common chronic health condition, has major health and socioeconomic consequences. In the Indian subcontinent, it is a health condition for which individuals commonly consult Ayurvedic (traditional medical system) practitioners and use their medicines. However, to date, a good quality T2DM clinical guideline for Ayurvedic practitioners, grounded on the best available scientific evidence, is not available. Therefore, the study aimed to systematically develop a clinical guideline for Ayurvedic practitioners to manage T2DM in adults. The development work was guided by the UK’s National Institute for Health and Care Excellence (NICE) manual for developing guidelines, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. First, a comprehensive systematic review was conducted which evaluated Ayurvedic medicines’ effectiveness and safety in managing T2DM. In addition, the GRADE approach was used for assessing the certainty of the findings. Next, using the GRADE approach, the Evidence-to-Decision framework was developed, and we focused on glycemic control and adverse events. Subsequently, based on the Evidence-to-Decision framework, a Guideline Development Group of 17 international members made recommendations on Ayurvedic medicines’ effectiveness and safety in T2DM. These recommendations formed the basis of the clinical guideline, and additional generic content and recommendations were adapted from the T2DM Clinical Knowledge Summaries of the Clarity Informatics (UK). The feedback given by the Guideline Development Group on the draft version was used to amend and finalize the clinical guideline. A clinical guideline for managing T2DM in adults by Ayurvedic practitioners was developed, which focuses on how practitioners can provide appropriate care, education, and support for people with T2DM (and their carers and family). The clinical guideline provides information on T2DM, such as its definition, risk factors, prevalence, prognosis, and complications; how it should be diagnosed and managed through lifestyle changes like diet and physical activity and Ayurvedic medicines; how the acute and chronic complications of T2DM should be detected and managed (including referral to specialists); and advice on topics like driving, work, and fasting including during religious/socio-cultural festivals. We systematically developed a clinical guideline for Ayurvedic practitioners to manage T2DM in adults.
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