ueda2011 egyptian and canadian guidelines-d.emad

1. Guidelines In Diabetes
Canadian & Egyptian
“Practical Considerations”
By
Dr. Emad Hamed

4. ‫الكواكبي‬ ‫الرحمن‬ ‫عبد‬
)1854-1902(‫م‬
‫رواد‬ ‫ومن‬ ‫التعليم‬ ‫رواد‬ ‫من‬ ‫رائد‬ ‫سوري‬ ‫وعلمة‬ ‫مفكر‬
‫ومحامي‬ ‫ومؤلف‬ ‫وكاتب‬ ‫العربية‬ ‫اللصليحية‬ ‫الحركة‬
‫شأن‬ ‫لعائلتة‬ ‫كانت‬ ‫سوريا‬ - ‫يحلب‬ ‫في‬ ‫ولد‬ ، ‫شهير‬ ‫وفقيه‬
‫يحلب‬ ‫في‬ ‫كبير‬

5. ‫تعرييف‬ ‫كان‬ ‫ميا‬ّ‫ا‬ ‫ول‬‫سياياسة‬ّ‫ا‬ ‫ال‬ ‫عليم‬‫»إدارة‬ ‫هو‬ ‫ني ه‬ّ‫ا‬‫بأ‬
‫المشتركة‬ ‫شوؤون‬ّ‫ا‬ ‫ال‬‫الحكمة‬ ‫بمقتضى‬«
‫أما‬‫الستبداد‬‫”فهو‬‫المشتركة‬ ‫شوؤون‬ّ‫ا‬ ‫ال‬ ‫في‬ ‫رف ف‬ُّ ‫ترص‬ّ‫ا‬‫ال‬
‫الهوى‬ ‫بمقتضى‬“.
........‫ما‬‫هيو‬‫على‬ ‫ديين؟‬ّ‫ا‬‫ال‬ ‫عليى‬ ‫السيتبداد‬ ‫تأثايير‬
‫على‬ ‫اللخل؟ق؟‬ ‫على‬ ‫المال؟‬ ‫على‬ ‫المجد؟‬ ‫على‬ ‫العلم؟‬
‫العمران؟‬ ‫على‬ ‫ترباية؟‬ّ‫ا‬‫ال‬ ‫على‬ ‫قي؟‬ِّ‫تر‬َّ‫ال‬
‫دواؤه؟‬ ‫هو‬ ‫وما‬ ‫شر؟ق‬ّ‫ا‬ ‫ال‬ ‫داء‬ ‫هو‬ ‫ما‬

9. ‫نعيش‬ ‫وطنا‬ ‫ليست‬ ‫مصر‬‫فيه‬
‫فينا‬ ‫يعيش‬ ‫وطن‬ ‫لكنها‬ ‫و‬
Egypt is not a home in which we live...
But rather, a home that lives within us.

10. ‫فيه‬ ‫نعيش‬ ‫وطنا‬ ‫مصر‬ ‫نجعل‬ ‫ل ن‬ ‫الوا ن‬ ‫آ ن‬ ‫لقد‬

11. ‫ل‬ُ ‫قلو‬ُ ‫ي‬َ‫ق‬ ‫م‬َ‫ق‬‫ل‬َّ‫م‬‫س‬َ‫ق‬ ‫و‬َ‫ق‬ ‫ه‬ِ ‫و‬ ‫ي‬ْ‫ِه‬‫ل‬َ‫ق‬‫ع‬َ‫ق‬ ‫لل‬َّ‫م‬ُ ‫ا‬ ‫لا ى‬َّ‫م‬‫ص‬َ‫ق‬ ‫لل‬َّ‫م‬ِ ‫و‬ ‫ا‬ ‫ل‬ُ ‫سلو‬ُ ‫ر‬َ‫ق‬ ‫ ن‬َ‫ق‬ ‫كا‬َ‫ق‬
‫ك‬َ‫ق‬ ‫ب‬ِ ‫و‬ ‫ذ‬ُ ‫علو‬ُ ‫أ‬َ‫ق‬ ‫نأ ي‬ِّ‫ي‬‫إ‬ِ ‫و‬ ‫م‬َّ‫م‬‫ه‬ُ ‫ل‬َّ‫م‬‫ل‬‫"...........ا‬ ‫عو‬ُ ‫و‬ ‫ف‬َ‫ُع‬‫ن‬ْ‫َف‬‫ي‬َ‫ُع‬ ‫لو‬َ‫ُع‬ ‫مو‬ٍ ‫ل‬ ‫ل‬ْ‫َف‬‫ع‬ِ‫ل‬ ‫نو‬ْ‫َف‬ ‫م‬ِ‫ل‬
‫ن‬ْ‫ِه‬ ‫م‬ِ ‫و‬ ‫و‬َ‫ق‬ ‫ع‬ُ ‫ب‬َ‫ق‬‫ش‬ْ‫ِه‬ ‫ت‬َ‫ق‬ ‫ل‬َ‫ق‬ ‫س‬ٍ ‫ل‬ ‫ف‬ْ‫ِه‬‫ن‬َ‫ق‬ ‫ن‬ْ‫ِه‬ ‫م‬ِ ‫و‬ ‫و‬َ‫ق‬ ‫ع‬ُ ‫ش‬َ‫ق‬ ‫خ‬ْ‫ِه‬ ‫ي‬َ‫ق‬ ‫ل‬َ‫ق‬ ‫ب‬ٍ ‫ل‬ ‫ل‬ْ‫ِه‬‫ق‬َ‫ق‬ ‫ن‬ْ‫ِه‬ ‫م‬ِ ‫و‬ ‫و‬َ‫ق‬
”‫ها‬َ‫ق‬ ‫ل‬َ‫ق‬ ‫ب‬ُ ‫جا‬َ‫ق‬ ‫ت‬َ‫ق‬‫س‬ْ‫ِه‬ ‫ي‬ُ ‫ل‬َ‫ق‬ ‫ة‬ٍ ‫ل‬‫لو‬َ‫ق‬ ‫ع‬ْ‫ِه‬ ‫د‬َ‫ق‬
( ‫مسلم‬ ‫صحيح‬ )

12. Guidelines .. Why????

14. Guide for Guidelines
• The Guide for Guidelines has been prepared to
assist countries, organizations and individuals
who wish to develop such guidelines.
• The document draws on the worldwide
experience of many who have already been
through this process, and emphasizes other
essential aspects of guidelines including
implementation and evaluation.

15. The publication includes:
• An overview of guidelines
• Planning and preparation issues which need to be
considered before embarking on the process of
guideline development
• Step-by-step advice on developing, implementing
and evaluating guidelines, taking into
consideration varying resource limitations in
different settings around the world
• Sources of further information (mostly in English)
which may be useful

16. Expenditure on a diabetes guideline has the
potential to be one of the most cost-effective
forms of healthcare expenditure, provided
the result is properly implemented.

17. Guidelines
• 1- Developing Guidelines.
• 2- Outline comparison between
Egyptian & Canadian guidelines.
• 3- Implementation & Dissemination
of Guidelines.

18. 1- Developing Guidelines

19. There are two basic approaches to
developing an evidence-based guideline:
● Full-process guideline
● Derived guideline.

20. Derived guideline
A guideline which develops clinical questions, but
then seeks out and adapts previously developed full-
process guidelines, updating the evidence base and
seeking supporting evidence to develop
recommendations for local circumstances.
Full-process guideline
A guideline which involves a full and systematic
development of the clinical questions to be addressed,
and develops recommendations supported by
complete and formal evidence searching and review,
using primary sources.

21. Useful sources of full-process guidelines for diabetes care

22. The IDF does not recommend ‘reinventing
the wheel’, but does strongly encourage
the redesign of the wheel to suit local
circumstances.

23. A number of organizations have devoted
considerable effort and spent large sums of
money to develop full-process guidelines using
personnel skilled in literature search and
systematic review, people and resources not
available in many countries.

24. Accordingly, it is strongly recommended
that most new guideline developments
will be derived guidelines.

25. 2- Canadian versus Egyptian
Guidelines

26. Canadian
Guidelines
Egyptian
Recommendations
Type Full Process Derived
Size 200 A4 Pages 44 A4 Pages
Contributors 105 39
Level of
Evidence
1- Studies of Diagnosis
Levels 1(a :e) , 2 , 3 ,4
2- Studies of Treatment
Levels 1 (A-B) , 2 , 3, 4
3- Studies of Prognosis
Levels 1(a :e) , 2 3 ,4
1- Evidence Levels
Type I : VI
2- Recommendation Strength
Strength A : E
Dissemination
and
implementation
Is an important Issue that
has a comprehensive plan.
Not mentioned

27. Canadian Guidelines
Egyptian
Recommendations
Sponsorship
Primary Sponsors
GlaxoSmithKline Inc.
Novo Nordisk Canada Inc.
Sanofi-aventis Canada Inc.
Servier Canada Inc.
Secondary Sponsors
AstraZeneca Canada Inc.
Bayer Inc.
Eli Lilly Canada Inc.
Merck Frosst Canada Ltd.
Pfizer Canada Inc.
Hoffmann-La Roche Ltd.
Not Known

28. 3- Dissemination and Implementation
of Guidelines

29. DISSEMINATION AND IMPLEMENTATION
“Canadian Diabetes Association Guideline, 2008”
• The challenges of effective dissemination and
implementation of the 2 previous clinical
practice guidelines were assessed prior to the
launch of the 2008 Clinical Practice Guidelines
for the Prevention and Management of
Diabetes in Canada.
• In response, strategies were developed to
increase practitioner implementation and to
improve patient care and health outcomes.

30. DISSEMINATION AND IMPLEMENTATION
“Canadian Diabetes Association Guideline, 2008”
• A Dissemination & Implementation
Committee was established to develop a
strategic plan to be implemented at the
launch of the guidelines.
• More than 80 volunteers from across Canada
were involved in creating a 3-year plan to
translate the evidence compiled in the
guidelines into community practice .

31. Plan to translate the evidence
compiled in the guidelines
into community practice.

32. DISSEMINATION AND IMPLEMENTATION
“Canadian Diabetes Association Guideline, 2008”
• The guidelines will continue to be available on the web,
and summary articles will be placed in journals and
newsletters.
• In addition, key messages and tools supporting specific
themes from the guidelines will be highlighted in focused
awareness campaigns over the next 3 years.
• Primary care physicians, healthcare providers,
government officials, Canadians living with diabetes and
the general public continue to be the audiences for these
campaigns.