Clinical Practice Guideline

Part 1

High-quality clinical practice guidelines have been shown to influence care delivery and improve outcomes of patients in the healthcare system. The quality of CPG is therefore important. This essay gives an appraisal of the CPG for Type 2 Diabetes (T2D) authored by the Veteran Health Administration. 

The literature on the CPG for T2D collected evidence from electronic databases and unpublished data. The research team identified key questions following the PICOT framework. Then they narrowed down on the evidence gathered and conducted a systematic review. The team recommended several approaches to T2D care. These are shared decision-making to improve patient knowledge as well as satisfaction, individualized diabetes self-management education and the use of various bidirectional telehealth interventions. The CPG also recommended having glycemic control targets and monitoring as well as non-pharmacological treatment.  

The guidelines that have been recommended are valid. The CPG identified whether the evidence supporting the recommendation was strong or weak. The CPG also considered all the relevant outcomes associated with diabetes. The outcomes considered ranged from inpatient care, complications and conditions, non-pharmacological treatment, glycemic control, and monitoring and general care of T2D. The outcomes touch on diabetes-specific survival, quality of life and complications relevant to diabetes and therapy-related adverse events. Moreover, the use of relevant  studies was complete. CPG should be based on the systematic review of the current best evidence. Though the CPG used studies dating back to the 19902, the majority were published within 10 years of the CPG. The studies were largely randomized controlled trials.

The CPG also successfully managed conflict of interest by precluding the DOD Champion who revealed a conflict of interest at an in-person meeting. He was replaced and necessary steps were initiated to guarantee no biases were introduced at the initial work with him. Future updates on the CPG for T2D should seek to introduce recent evidence. Given the strength of the recommendations and their applicability to the patient, there is no need of revising of the CPG. 

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Part 2

In implementing the VA/DoD type 2 diabetes CPG I will utilize the shared-decision making recommendation. By engaging in a brief dialogue with the patient, they can be able to express their values and needs. Using the SHARE approach, I will involve other nurses to engage the patient. The patient will also talk to the pharmacists and the dietician. This ensures that the whole relevant team contributes to SHARE decision making. I would then explore the benefits and risks of any course taken using available aids. I will consider the patient’s current health literacy, numeracy, and other limitations. Moreover, I would enroll them in patient education.

The CPG would also guide the series of medications that I would administer. For example, I would avoid insulin and sulfonylureas since they have the highest risk of hypoglycemia. To improve a patient’s experience and their engagement, I would choose a healthcare team that is knowledgeable and compassionate and has a consistent approach to the management of T2D. Given the emphasis of the CGP on non-pharmacological treatment, I would advise my patient on lifestyle modifications and targets for diabetes. However, this will be coupled with the appropriate and enough medication. Overall, the plan I will adopt will help the patient take full control of his condition from the diet, lifestyle changes, and medication,

References

Veterans Health Administration, Department of Veterans Affairs, & Department of Defense. (2017). VA/DoD clinical practice guideline for the management of type 2 diabetes mellitus in primary care. Government Printing Office.