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Implementation effect of the clinical practice guideline for type 2 diabetes mellitus in public hospitals in China: a cross-sectional study using the A-GIST tool

Published on Jun. 25, 2025Total Views: 71 timesTotal Downloads: 25 timesDownloadMobile

Author: HE Siyi 1, 2, 3, 4# ZOU Kun 2, 3, 4# YANG Nan 1, 2, 3, 4 ZENG Linan 2, 3, 4, 5 LI Hailong 2, 3, 4 HUANG Liang 2, 3, 4 YI Qiusha 2, 3, 4 ZENG Xiantao 6 DU Liang 7 GAO Xiangyu 8 REN Jiajun 9 HE Miao 10 ZHANG Mingyue 11 WANG Qiang 12 ZHANG Lingli 2, 3, 4, 5, 7

Affiliation: 1. West China School of Pharmacy, Sichuan University, Chengdu 610041, China 2. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University/ Children's Medicine Key Laboratory of Sichuan Province, Chengdu 610041, China 3. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610041, China 4. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China 5. West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China 6. Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China 7. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China 8. Department of Pharmacy, The Fourth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830002, China 9. Department of Pharmacy, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China 10. Department of Pharmacy, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi 435000, Hubei Province, China 11. School of Stomatology, Chinese Medical University, Shenyang 110002, China 12. Medical Management Service Guidance Center, National Health Commission of the People's Republic of China, Beijing 100044, China

Keywords: Clinical practice guidelines Implementation effect Diabetes mellitus Cross-sectional study

DOI: 10.12173/j.issn.1004-5511.202502076

Reference: He SY, Zou K, Yang N, Zeng LN, Li HL, Huang L, Yi QS, Zeng XT, Du L, Gao XY, Ren JY, He M, Zhang MY, Wang Q, Zhang LL. Implementation effect of the clinical practice guideline for type 2 diabetes mellitus in public hospitals in China: a cross-sectional study using the A-GIST tool[J]. Yixue Xinzhi Zazhi, 2025, 35(6): 611-621. DOI: 10.12173/j.issn.1004-5511.202502076. [Article in Chinese]

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Abstract

Objective  To evaluate the implementation effect of the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China, and explore its influencing factors.

Methods  A cross-sectional study was conducted in public hospitals from November 2022 to December 2022. Medical professionals and patients were investigated using the Guideline Implementation Success Assessment Tool (A-GIST). Univariate and multivariate linear regression were conducted to analyze the factors associated with the implementation effect of the guideline.

Results A total of 744 medical professionals and 843 patients from 55 public hospitals across China were included in the survey. The overall A-GIST score of the implementation effect of this guideline was 84.06 (77.04, 89.34). As to each dimension, the scores from the highest to the lowest were: reach [100.00 (100.00, 100.00)], adoption [98.67 (93.33, 100.00)], implementation [90.00 (71.00, 99.00)], effectiveness [75.22 (66.53, 83.63)], and maintenance [70.00 (50.00, 85.00)]. Senior medical professionals, middle region, tertiary hospitals, and medical specialties were associated with the implementation effect of the guideline. 53 medical professionals (8.4%) reported obstacles to the implementation of the guideline, mainly including patients' adherence to the guideline, the impact of health insurance, as well as patients' socioeconomic characteristics, educational level, economic status and family support.

Conclusion The implementation of the T2DM guideline has been generally successful in public hospitals in China. But the dimensions of effectiveness and maintenance warrant improvement. It is necessary to enhance policy support for the middle region, enrich the access to guidelines, promote the integration and collaboration of secondary and tertiary hospitals, strengthen the training and education of primary healthcare professionals, and address specific challenges faced by the nursing workforce. A-GIST is proved to be a useful tool to assess the implementation effect of the guideline across medical professionals, health institutions, and geographic regions.

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References

1.Ahmad E, Lim S, Lamptey R, et al. Type 2 diabetes[J]. Lancet, 2022, 400(10365): 1803-1820. DOI: 10.1016/S0140-6736(22)01655-5.

2.GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2023, 402(10397): 203-234. DOI: 10.1016/s0140-6736(23)01301-6.

3.GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2100-2132. DOI: 10.1016/s0140-6736(24)00367-2.

4.International Diabetes Federation. IDF Diabetes Atlas 10th Edition (2021). https://diabetesatlas.org/atlas/diabetes-and-kidney-disease/.Accessed 24 Jul 2024

5.李赞, 刘喜洋, 贺卓佳, 等. 1999—2019年中国糖尿病疾病负担的调查研究[J]. 解放军医学杂志, 2024, 49(7): 776-782. [Li Z, Liu XY, He ZJ, et al. A survey study on the disease burden of diabetes in China from 1999 to 2019[J]. Medical Journal of Chinese People's Liberation Army, 2024, 49(7): 776-782.] DOI: 10.11855/j.issn.0577-7402.0602.2024.0516.

6.Graham R, Mancher M, Wolman DM, et al. Clinical practice guidelines we can trust[M]. Washington (DC): National Academies Press (US), 2011.

7.Chen Y, Wang C, Shang H, et al. Clinical practice guidelines in China[J]. BMJ, 2018, 360: j5158. DOI: 10.1136/bmj.j5158.

8.Molyneux E, Weber MW. Applying the right standards to improve hospital performance in Africa[J]. Lancet, 2004, 364(9445): 1560-1561. DOI: 10.1016/s0140-6736(04)17326-1.

9.中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. [Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chinese Journal of Diabetes, 2021, 13(4): 315-409.] DOI: 10.3760/cma.j.cn115791-20210221-00095.

10.Shen M, Chen D, Zhao R, et al. Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus[J]. Front Endocrinol (Lausanne), 2023, 14: 1213225. DOI: 10.3389/fendo.2023.1213225.

11.Wang X, Luo JF, Qi L, et al. Adherence to self-monitoring of blood glucose in Chinese patients with type 2 diabetes: current status and influential factors based on electronic questionnaires[J]. Patient Prefer Adherence, 2019, 13: 1269-1282. DOI: 10.2147/ppa.S211668.

12.Higuchi KS, Davies BL, Edwards N, et al. Implementation of clinical guidelines for adults with asthma and diabetes: a three-year follow-up evaluation of nursing care[J]. J Clin Nurs, 2011, 20(9-10): 1329-1338. DOI: 10.1111/j.1365-2702.2010.03590.x.

13.Lian J, Liang Y. Diabetes management in the real world and the impact of adherence to guideline recommendations[J]. Curr Med Res Opin, 2014, 30(11): 2233-2240. DOI: 10.1185/03007995.2014.952716.

14.Jameson K, D'Oca K, Leigh P, et al. Adherence to NICE guidance on glucagon-like peptide-1 receptor agonists among patients with type 2 diabetes mellitus: an evaluation using the clinical practice research datalink[J]. Curr Med Res Opin, 2016, 1(1): 49-60. DOI: 10.1185/03007995.2015.1101372.

15.Parcero AF, Yaeger T, Bienkowski RS. Frequency of monitoring hemoglobin A1C and achieving diabetes control[J]. J Prim Care Community Health, 2011, 2(3): 205-208. DOI: 10.1177/2150131911403932.

16.刘书红, 杨丹, 胡细玲, 等. 2型糖尿病患者及家属饮食知信行调查问卷的编制与信效度检验[J]. 新医学, 2024, 55(11): 885-893. [Liu SH, Yang D, Hu XL, et al. Development of dietary KAP (knowledge, attitude and practice) questionnaires for patients with type 2 diabetes mellitus and their family members and assessment of reliability and validity[J]. New Medicine, 2024, 55(11): 885-893.] DOI: 10.3969/j.issn.0253-9802.2024.11.005.

17.Zou K, Yang N, He S, et al. Development of a generalised tool for evaluating success of clinical practice guidelines implementation (A-GIST)[J]. BMJ Evid Based Med, 2025: bmjebm-2024-113308. DOI: 10.1136/bmjebm-2024-113308.

18.von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies[J]. PLoS Med, 2007, 4(10): e296. DOI: 10.1371/journal.pmed.0040296.

19.World Health Organization. The world health organization quality of life (WHOQOL)[EB/OL]. (2012-03-01) [2025-01-09]. https://www.who.int/publications/i/item/WHO-HIS-HSI-Rev.2012.03

20.广东医科大学生命质量与应用心理研究中心. 世界卫生组织生存质量测定量表简表(QOL-BREF)中文版[EB/OL]. (2018-05-03) [2024-07-24]. [Research Center for Quality of Life and Applied Psychology of Guangdong Medical University. The Chinese version of the brief form of the World Health Organization Quality of Life Assessment Scale (QOL-BREF) [EB/ OL]. (2018-05-03) [2024-07-24]. https://qolpsy.gdmu.edu.cn/info/1099/1296.htm

21.杨楠, 邹锟, 何思颐, 等. 临床实践指南实施效果评价工具的信效度分析[J]. 中国循证医学杂志, 2024, 24(8): 904-909. [Yang N, Zou K, He SY, et al. Reliability and validity analysis of guideline implementation success assessment tool(A-GIST)[J]. Chinese Journal of Evidence-Based Medicine, 2024, 24(8): 904-909.] DOI: 10.7507/1672-2531.202308066.

22.Tabachnick BG, Fidell LS. Using multivariate statistics (5th edtion)[M]. New York: Allyn and Bacon, 2007.

23.Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis[J]. J Clin Epidemiol, 1996, 49(12): 1373-1379. DOI: 10.1016/s0895-4356(96)00236-3.

24.Peduzzi P, Concato J, Feinstein AR, et al. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates[J]. J Clin Epidemiol, 1995, 48(12): 1503-1510. DOI: 10.1016/0895-4356(95)00048-8.

25.孙振球, 徐勇勇. 医学统计学[M]. 北京: 人民卫生出版社, 2020. [Sun ZQ, Xu YY. Medical statistics[M]. Beijing: People's Medical Publishing House, 2020.]

26.邹锟, 何思颐, 杨楠, 等. 临床实践指南实施效果评价工具的系统评价[J]. 中国循证医学杂志. 2024, 24: 693-699. [Zou K, He SY, Yang N, et al. Tools for evaluating the implementation effect of clinical practice guidelines: a systematic review[J]. Chinese Journal of Evidence-Based Medicine. 2024, 24: 693-699.] DOI: 10.7507/1672-2531.202308060.

27.Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010, 182(18): E839-E842. DOI: 10.1503/cmaj.090449.

28.王吉耀, 王强, 王小钦, 等. 中国临床实践指南评价体系的制定与初步验证[J]. 中华医学杂志, 2018, 98(20): 1544-1548. [Wang GY, Wang Q, Wang XQ, et al. Establishment and preliminary validation of evaluation system for clinical practice guidelines in China[J]. National Medical Journal of China, 2018, 98(20): 1544-1548.] DOI: 10.3760/cma.j.issn.0376-2491.2018.20.004.

29.曾力楠, 易秋莎, 张川, 等. 制订指南临床适用性评价工具 [J]. 中国循证医学杂志, 2020, 20(4): 466-475. [Zeng LN, Yi  QS, Zhang C, et al. Establishment of a tool for evaluating clinical applicability of guidelines[J]. Chinese Journal of Evidence-Based Medicine, 2020, 20(4): 466-475.] DOI: 10.7507/1672-2531.201904131.

30.靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价[J]. 中国循证医学杂志, 2022, 22(1): 111-119. [Jin YH, Zhao ZH, Huang CR, et al. Development and validation for evaluation of an evaluation tool for guideline implementation[J]. Chinese Journal of Evidence-Based Medicine, 2022, 22(1): 111-119.] DOI: 10.7507/1672-2531.202106002.

31.Shiffman RN, Dixon J, Brandt C, et al. The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation[J]. BMC Med Inform Decis Mak, 2005, 5: 23. DOI: 10.1186/1472-6947-5-23.

32.Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework[J]. Am J Public Health, 1999, 89(9): 1322-1327. DOI: 10.2105/ajph.89.9.1322.

33.Liu M, Zhang C, Zha Q, et al. A national survey of Chinese medicine doctors and clinical practice guidelines in China[J]. BMC Complement Altern Med, 2017, 17(1): 451. DOI: 10.1186/s12906-017-1946-2.

34.Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time[J]. Am J Public Health, 2013, 103(6): e38-e46. DOI: 10.2105/ajph.2013.301299.

35.Holtrop JS, Estabrooks PA, Gaglio B, et al. Understanding and applying the RE-AIM framework: Clarifications and resources[J]. J Clin Transl Sci, 2021, 5(1): e126. DOI: 10.1017/cts.2021.789.

36.Alonso-Coello P, Martínez García L, Carrasco JM, et al. The updating of clinical practice guidelines: insights from an international survey[J]. Implement Sci, 2011, 6: 107. DOI: 10.1186/1748-5908-6-107.

37.Jin YH, Tan LM, Khan KS, et al. Determinants of successful guideline implementation: a national cross-sectional survey[J]. BMC Med Inform Decis Mak, 2021, 21(1): 19. DOI: 10.1186/s12911-020-01382-w.

38.Zeng L, Li Y, Zhang L, et al. Guideline use behaviours and needs of primary care practitioners in China: a cross-sectional survey[J]. BMJ Open, 2017, 7(9): e015379. DOI: 10.1136/bmjopen-2016-015379.

39.Kovacs E, Strobl R, Phillips A, et al. Systematic review and Meta-analysis of the effectiveness of implementation strategies for non-communicable disease guidelines in primary health care[J]. J Gen Intern Med, 2018, 33(7): 1142-1154. DOI: 10.1007/s11606-018-4435-5.

40.Ebben RHA, Siqeca F, Madsen UR, et al. Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review[J]. BMJ Open, 2018, 8(11): e017572. DOI: 10.1136/bmjopen-2017-017572.

41.李丽清, 杨苏乐, 杨威, 等. 我国中部六省医疗资源配置与经济耦合协调发展的时空演变及影响因素分析[J]. 中国卫生经济, 2023, 42(7): 30-35. [Li LQ, Yang SL, Yang W, et  al. Empirical research on spatial-temporal evolution rules and influencing factors of coupling and coordinated development of medical resource allocation and economy in six provinces of central China[J]. China Health Economy, 2023, 42(7): 30-35.] https://d.wanfangdata.com.cn/periodical/CiNQZXJpb2RpY2FsQ0hJMjAyNTA1MjIyMDI1MDUyNzE3MTU0NhIPemd3c2pqMjAyMzA3MDA5Ggh4a2RpbWpldA%3D%3D

42.Tian C, Xu M, Wang Y, et al. Barriers and strategies of clinical practice guideline implementation in China: aggregated analysis of 16 cross-sectional surveys[J]. J Public Health, 2023, 32(10): 1891-1904. DOI: 10.1007/s10389-023-01949-7.

43.Crissinger ME, Marchionda KM, Dunlap ME. Adherence to clinical guidelines in heart failure (HF) outpatients: Impact of an interprofessional HF team on evidence-based medication use[J]. J Interprof Care, 2015, 29(5): 483-487. DOI: 10.3109/13561820.2015.1027334.

44.黄超, 李海龙, 张川, 等. 指南临床适用性评价实证研究: 以糖尿病指南临床适用性评价为例[J]. 中国循证医学杂志, 2020, 20(5): 536-542. [Huang C, Li HL, Zhang C, et al. An empirical study on the evaluation of the clinical applicability of the guideline for diabetes[J]. Chinese Journal of Evidence-Based Medicine, 2020, 20(5): 536-542.] DOI: 10.7507/1672-2531.201909126.

45.张川, 李海龙, 黄超, 等. 指南临床适用性评价实证研究: 以肾移植指南临床适用性评价为例[J]. 中国循证医学杂志, 2020, 20(5): 543-550. [Zhang C, Li HL, Huang C, et al. An empirical study on evaluation of clinical applicability of kidney transplantation guideline[J]. Chinese Journal of Evidence-Based Medicine, 2020, 20(5): 543-550.] DOI: 10.7507/1672-2531.201909125.

46.Jin YH, Li ZM, Han F, et al. Barriers and enablers for the implementation of clinical practice guidelines in China: a mixed-method study[J]. BMJ Open, 2019, 9(9): e026328. DOI: 10.1136/bmjopen-2018-026328.

47.Stander J, Grimmer K, Brink Y. Factors influencing clinical practice guideline uptake by South African physiotherapists: a qualitative investigation of barriers and facilitators[J]. J Eval Clin Pract, 2020, 26(3): 728-737. DOI: 10.1111/jep.13182.

48.Mayberry LS, Osborn CY. Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: a framework for intervention[J]. Diabetes Care, 2014, 37(5): 1246-1253. DOI: 10.2337/dc13-1828.

49.Saheb Kashaf M, McGill ET, Berger ZD. Shared decision-making and outcomes in type 2 diabetes: a systematic review and Meta-analysis[J]. Patient Educ Couns, 2017, 100(12): 2159-2171. DOI: 10.1016/j.pec.2017.06.030.

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