Prioritisation of Clinical Research by the Example of Type 2 Diabetes: A Caregiver-Survey on Perceived Relevance and Need for Evidence

BackgroundThe Cochrane Collaboration aims at providing the best available evidence for interventions in health care. We wished to examine to which extent treatments considered relevant by caregivers in type 2 diabetes are covered by Cochrane systematic reviews. Methodology/Principal Findings130 different interventions in type 2 diabetes were identified based on a review of clinical practice guidelines and expert opinion (Table S1). 459 members of the German Diabetes Society (diabetologists, general practitioners, diabetic nurses, nutritionists, podologists, others) were surveyed via e-mail-list to rank a) the perceived clinical relevance and b) the perceived need for evidence of interventions, based on an internet survey. In the Cochrane Library, there were, at the time of this evaluation, 56 reviews on interventions in diabetes. Generally, coverage of topics by Cochrane reviews reflected the perceived clinical relevance and perceived need for evidence. As an example, highly ranked treatments such as lifestyle changes or oral antidiabetics were well covered, while low rank treatments such as complementary approaches were not covered. Discrepancies occurred with new treatments such as amylin-analogues (low relevance, high need for evidence, review not yet completed) and interventions with immediate and dramatic effects such as treating hypoglycemia (high relevance, low need for evidence, no review). Also, there was a relative scarcity of reviews concerning specific problems, in particular, treatment of late diabetic complications. Conclusions/SignificanceFor most interventions, perceived relevance and perceived need for evidence are reflected by the evidence already available. Prioritizing should aim at improving immediacy and consideration of the treatment of complications.

背景
考科蓝协作组织（Cochrane Collaboration）致力于提供医疗卫生干预措施领域现有最高等级的科学证据。本研究旨在探究：2型糖尿病照护者认定的相关干预措施，在多大程度上被考科蓝系统评价所覆盖。

研究方法与主要结果
本研究通过梳理临床实践指南与专家意见，共识别出130种2型糖尿病干预措施（附表S1）。研究通过邮件列表，向德国糖尿病学会的459名成员开展网络问卷调查——这些成员涵盖糖尿病专科医师、全科医师、糖尿病专科护士、营养师、足病医师及其他相关从业者，要求其对两项内容进行排序：a）各干预措施的临床相关性感知度，b）各干预措施的证据需求度。在本次评估时点的考科蓝图书馆（Cochrane Library）中，共收录56篇针对糖尿病干预措施的系统评价。总体而言，考科蓝系统评价对相关主题的覆盖情况，与调研对象感知的临床相关性及证据需求度基本吻合。举例而言，生活方式干预、口服降糖药等评分靠前的治疗手段得到了充分覆盖，而补充疗法等评分靠后的干预措施则未被纳入相关评价。部分干预措施的覆盖情况存在明显差异：如胰淀素类似物（amylin-analogues）这类新型治疗手段，其临床相关性感知度较低但证据需求较高，相关系统评价尚未完成；而低血糖治疗这类具备即时显著疗效的干预措施，临床相关性感知度较高但证据需求较低，暂无对应系统评价。此外，针对糖尿病晚期并发症治疗等特定临床问题的系统评价相对匮乏。

结论与意义
对于绝大多数干预措施而言，现有可获取的证据水平与调研对象感知的临床相关性及证据需求度基本匹配。后续优先级设定工作应着眼于提升评价的时效性，并加强对并发症治疗相关研究的关注与覆盖。