SAT124 GRADE-adolopment Of Adult Diabetes Mellitus Management Guidelines For A Pakistani Context
Authors: Pervez Alina , Martins Russell Seth , Masood Muhammad Qamar , Mahmud Omar , Rizvi Nashia Ali , Sheikh Aisha , Islam Najmul , Ali Khowaja Anum Naushad , Ram Nanik , Furqan Saira , Mustafa Mohsin Ali , Aamdani Salima Saleem , Haider Adil H , Nadeem Sarah 
Published: October 2023

Abstract
Disclosure: A. Pervez: None. R. Martins: None. M. Masood: None. O. Mahmud: None. N. Rizvi: None. A. Sheikh: None. N. Islam: None. A. Khowaja: None. N. Ram: None. S. Furqan: None. M. Mustafa: None. S. Aamdani: None. A. Haider: None. S. Nadeem: None.
Background: Pakistan has the highest national prevalence (1 in 4 adults) of type 2 diabetes mellitus (T2DM) in the world. Most T2DM clinical practice guidelines (CPGs) originate from high-income countries and are evidence based. Due to the lack of research infrastructure and financial resources, lower-middle income countries face challenges in the de novo creation of CPGs. Thus, we aimed to develop a comprehensive, high-quality CPG with a local context for adult outpatient T2DM management in Pakistan based on the GRADE-ADOLOPMENT process. Methods: In collaboration with the GRADE working group, an adaptation of the GRADE-ADOLOPMENT approach was followed. Adolopment is a combination of adoption, adaptation, and de novo development. The American Diabetes Association (ADA) Standards of Medical Care in Diabetes - 2021 was utilized as the source CPG by local endocrinology experts in Pakistan. Recommendations from the source CPG were either adopted as is, excluded, or adapted. Adaptation was done using the evidence-to-decision framework with a panel of experts. Results: The source CPG contained 243 recommendations, 219 of which were adopted without change. 5 recommendations were adopted with minor changes related to cost effectiveness to minimize cost-related nonadherence. 18 recommendations were excluded due to reasons including but not limited to the scope being beyond the initial aim of our guideline centers’ objective (such as recommendations related to pediatric or inpatient care), unavailability of medication, or inapplicability to the existing health-care system of Pakistan. One recommendation was adapted pertaining to the screening age for the diagnosis of T2DM. This was recommended to be lowered from the age of 45 years to 30 years due to the higher prevalence of T2DM in younger Pakistanis. This will enable the early detection and management of T2DM. Earlier screening highlights the opportunity to intervene early on and reduce complications. This, coincidentally, was also addressed by the ADA in their 2022 guideline, where the screening age was revised from 45 years to 35 years. Conclusion: Our GRADE-ADOLOPED CPG for T2DM management comprises of 225 recommendations. We recommend earlier screening for T2DM in Pakistan. We additionally suggest careful consideration of cost to promote adherence while also recommending CGM use in the management plan of people with T2DM who can afford it. Our modified methodology provides an excellent resource efficient method to create locally contextualized evidence-based CPGs. Our goal is to publish and disseminate this CPG to improve the quality of T2DM care in Pakistan. Rigorous expanded research exploring the effectiveness of earlier screening for T2DM in Pakistan should be conducted in the future.
Presentation: Saturday, June 17, 2023