AHRQ Effective Health Care Program Research

• August 25, 2010: Treatment Options for Diabetes - Depression - Osteoarthritis - and More

AHRQ Comparative Effectiveness Review (CER) Guides

SACME and AHRQ (Agency for Healthcare Research and Quality) have established a partnership in the dissemination of Comparative Effectiveness Review Guides to SACME members to inform practice gap analysis and for wider distribution to clinicians in our own organizations.

• AHRQ is pleased to offer to SACME members up to 500 printed copies.
• Please provide Amanda.Brodt@academyhealth.org with your name, shipping address, email address, phone number, and number of copies (up to 500 each) you would like.

Current AHRQ Comparative Effectiveness Review Guides:

1. Gestational Diabetes: Caring for Women During and After Pregnancy
Clinician Summary Guide published 5 Aug 2009

This guide summarizes clinical evidence about prenatal treatment and delivery management for women with gestational diabetes.

Clinical Bottom Line:

• Insulin, glyburide, and metformin are each effective for lowering blood sugar in women with gestational diabetes, and all appear to be safe for use in pregnancy.
• Women with gestational diabetes who have a higher prepregnancy body mass index (BMI) or who gain more weight during pregnancy are more likely to develop type 2 diabetes following pregnancy.
• Women diagnosed with gestational diabetes earlier in pregnancy are more likely to develop type 2 diabetes than those diagnosed later in pregnancy.

2. Premixed Insulin Analogues: A Comparison With Other Treatments for Type 2 Diabetes
Clinician Summary Guide published 25 Mar 2009

This guide summarizes clinical evidence comparing the effectiveness and safety of premixed insulin analogues with other insulin preparations and oral diabetes drugs.

Clinical Bottom Line:

• Premixed insulin analogues and premixed human insulin have similar effects on glycosylated hemoglobin (A1c), and rates of hypoglycemia are similar. Level of confidence: 3 out of 3
• Premixed insulin analogues help achieve lower postprandial glucose levels than premixed human insulin. Level of confidence: 3 out of 3
• Premixed insulin analogues help achieve lower A1c levels than long-acting insulin analogues used alone, but rates of hypoglycemia are higher. Level of confidence: 3 out of 3
• Premixed insulin analogues are linked with more episodes of hypoglycemia than oral diabetes drugs. Level of confidence: 3 out of 3
• Premixed insulin analogues help achieve lower A1c levels than oral diabetes drugs used alone. Level of confidence: 2 out of 3

3. Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit.
Clinician Summary Guide published 6 Apr 2009

This guide summarizes evidence on the effectiveness and safety of three treatments for osteoarthritis of the knee: use of the supplements glucosamine, chondroitin, or both combined; viscosupplementation (injection of hyaluronan into the knee); and arthroscopic lavage and debridement of the knee joint. The evidence evaluated comes primarily from comparisons of each treatment approach with a placebo

Clinical Bottom Line:

For people with osteoarthritis of the knee, the following treatments do not lead to clinically meaningful improvement.

• Glucosamine hydrochloride and chondroitin sulfate: Level of confidence: 2 out of 3
• Viscosupplementation (intra-articular injection of hyaluronan products): Level of confidence: 2 out of 3
• Arthroscopic lavage with or without debridement: Level of confidence: 2 out of 3

To view all Comparative Effectiveness Review Guides: Click Here