Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument.

Gao, Yuting; Wang, Jinjing; Luo, Xufei; Song, Xiaoyang; Liu, Lian; Ke, Lixin; Liao, Zhihong; Wang, Dongke; Mu, Yiming; Chen, Yaolong; Estill, Janne Anton Markus (2019). Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument. BMJ open, 9(9), e022392. BMJ Publishing Group 10.1136/bmjopen-2018-022392

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The aim of this study was to systematically evaluate the quality of the clinical practice guidelines (CPGs) for diabetes mellitus published in China over the period of January 2007 to April 2017.


We searched the China National Knowledge Infrastructure, Chinese Biomedical Literature database, VIP database and WanFang databases and guideline websites for CPGs for diabetes mellitus published between January 2007 and April 2017 in China. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and extracted data. We used the the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool (Canadian Institutes of Health Research, Ottawa, Canada) to evaluate the quality of the included guidelines, calculated the scores of each domain and evaluated the consistency among the assessors via use of the intragroup correlation coefficient. And then we compared the results with Chinese CPGs and international CPGs. We conducted a subgroup analysis based on different classification criteria and compared scores of each domain subgroup analyses.


A total of 98 guidelines were identified. The correlation coefficient within the group was 0.93, suggesting that the consistency between the evaluators was good. The scores of the six domains of AGREE II were described in median (IQR) as follows: scope and purpose 53.7 (50.0-59.7), stakeholder involvement 31.5 (27.3-37.0), rigour of development 19.1 (15.3-22.2), clarity of presentation 59.3 (50.0-64.8), applicability 18.1 (13.9-25.7) and editorial independence 0.0 (0.0-0.0). The mean score in each domain of quality of Chinese diabetes CPGs was lower than that of CPGs published worldwide but higher than the mean score of Chinese guidelines of all topics. A funding source, the updated version, organisation and publishers of the guidelines and target fields are all the factors influencing the quality of CPGs to a certain degree.


A large number of Chinese diabetes CPGs have been produced. Their quality remain unsatisfactorily low compared with CPGs worldwide, there is still room for improvement. Chinese guideline developers should pay more attention to the transparency of methodology, and use the AGREE II instrument to develop and report guidelines.

Item Type:

Journal Article (Original Article)


08 Faculty of Science > Department of Mathematics and Statistics > Institute of Mathematical Statistics and Actuarial Science

UniBE Contributor:

Estill, Janne Anton Markus


300 Social sciences, sociology & anthropology > 360 Social problems & social services
500 Science > 510 Mathematics




BMJ Publishing Group




Janne Anton Markus Estill

Date Deposited:

02 Apr 2020 08:48

Last Modified:

05 Dec 2022 15:38

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

agree Ii clinical practice guidelines diabetes mellitus quality assessment





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