Recommendations on digital care in Dutch diabetes guidelines

Ingrid Hendriksen, Suzanne Weijs-Schavemaker, Jako Burgers

Keywords: digital care, clinical practice guidelines, diabetes

Background:

Facilities to provide digital care have increased in general practice during the COVID-19 pandemic. Digital care seems especially attractive for patients with diabetes, because their care and self-management with glycaemic control at home can largely be planned. However, most existing guidelines do not contain any recommendations on digital care.

Research questions:

• Which specific recommendations on effective digital care can be included in existing Dutch guidelines on diabetes mellitus type 1 and type 2?
• What lessons can be learned from this project for other conditions and guidelines?

Method:

In the Digital care for Diabetes (DiDia) study, we conducted an exploratory literature study selecting reviews and studies of digital care interventions for adults with diabetes from PubMed. In addition, experiences with digital care were reported through focus groups with care providers (n=3) and patients (n=2). Both the evidence from literature, and professional and patient experiences were discussed in the working groups responsible for diabetes type 1 and 2 guidelines. The GRADE Evidence to Decision framework was used to formulate recommendations. Process evaluation using the Plan Do Check Act gained insight into how to include digital care in guidelines on other topics.

Results:

Evidence from literature showed that digital care can be considered for patients with diabetes and can lead to a significant decrease in HbA1c. This finding was confirmed in the focus groups, provided that one face to face contact should be planned at least annually. It is important to discuss the patient's needs and preferences for digital care. In general, it is recommended to consider digital care in different phases of the care pathway (e.g., diagnosis, treatment and monitoring) to optimise its use.

Conclusions:

We introduced recommendations on digital care in diabetes guidelines. Different scenarios have been proposed for including digital care in other conditions and guidelines.

Points for discussion:

Method for selecting and prioritizing recommendations for inclusion of digital care in guidelines

Inclusion of digital care in guidelines in other countries

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