Table 3

Evidence for the missing links in existing cardiovascular diseases guidelines for low and middle income countries: the diabetes mellitus scenario from three continents

Country/regionMalaysia/AsiaBrazil/South AmericaSouth Africa/Africa
Publication details
 TitleManagement of type 2 diabetes mellitus (5th edition)6Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society5The 2012 SEMDSA guideline for the management of type 2 diabetes (revised)7
 AuthorsMinistry of Health, MalaysiaLerario AC, et alSEMDSA
 Basis of recommendationModified from Scottish Intercollegiate guidelines network, systematic reviews, meta-analysis, local practice considerationsInternational literature, ADA/EASD algorithm. Joslin Diabetes CenterUpdate literature and the Department of Health's draft type 2 diabetes guideline document.
 Specialties of the members of task forceEndocrinologists
Family medicine specialists
General physicians.
Paediatric endocrinologists
Public health physicians.
NSEndocrinologists Family Practitioners Diabetes Educators Department of Health representatives. Medical Council representatives
 Methods in detailMembers of the task force were assigned topics. Articles retrieved were graded. Draft guideline was posted on the Malaysian Endocrine and Metabolic Society, Ministry of Health Malaysia websites for comment and feedback.
Guideline presented to the Technical Advisory Committee and the Health Technology Assessment and Clinical Practice Guidelines Council, Ministry of Health for review and approval.
Brazilian Diabetes Society obtained opinions of a panel of renowned Brazilian specialist about recommendations and controversial arguments on the treatment of T2DM in international literature.
Arguments were presented to the panel with each member scoring each argument on a Likert scale.
Broad topic of management was divided into smaller sections and allocated to experts to lead.
Information on each section was presented to the general committee and amendments and additions suggested best on ‘best practice’.
Clinical issues addressed (components of the cardiovascular quadrangle)
 Primordial preventionNoNoYes
 Age-specific treatmentNoNoYes
 Acute care/emergenciesYesNoYes
 Conventional careYesNoNo
Target population (the 6Ps)
 Primary caregiversYesNSYes
Patients and populaceNoNSNo
 Implementation partnersNoNoNo
Other considerations (including translatability and ELSE)
 Translatability ratingNoNoNo
 Quality indicatorYesYesNo
 Dissemination channelsNoNoNo
 Renewal date2019NSNS
  • ADA, American Diabetes Association; EASD, European Association for the Study of Diabetes; ELSE, ethical, legal, sociocultural and economic; NS, not stated; SEMDSA, Society for Endocrinology, Metabolism and Diabetes of South Africa; T2DM, type 2 diabetes mellitus.