There is no doubt that society-specific guidelines have greatly advanced diabetes care, yet some critiques and challenges can be identified:
- Lack of Individualization: Guidelines often provide generalized recommendations that may not account for individual differences, such as unique medical histories, preferences or comorbid conditions. This ‘one-size-fits-all’ approach can sometimes lead to treatment that is less effective or even harmful for certain individuals.
- Conflicting Recommendations: Different organizations and experts may publish seemingly conflicting guidelines for the same condition, leading to confusion for healthcare providers. These discrepancies can arise due to differences in the interpretation of evidence, priorities, or patient populations. To date, our local SEMDSA guidelines are now 8 years ‘old’!
- Over-reliance on Guidelines: Some practitioners may become overly reliant on guidelines and apply them rigidly without considering the context of the individual person. This can undermine clinical judgment and stifle the flexibility that is often needed in complex or uncertain cases.
- Lack of Real-World Evidence: Many guidelines are based on clinical trials that are conducted under controlled conditions, which may not reflect the complexities of real-world practice. Populations in clinical trials can be selective, and the trials often have strict inclusion/exclusion criteria that do not mirror the diversity of the general population, making the guidelines less applicable in certain settings.
- Complexity and Accessibility: Modern guidelines can be highly complex and difficult to interpret, especially for busy clinicians. The technical language and length can make it challenging for healthcare providers to quickly apply the recommendations in practice, potentially resulting in suboptimal care.
- Health Inequities: Guidelines may not always adequately address disparities in healthcare access or outcomes across different populations. In some cases, they might overlook the specific needs of underrepresented groups such as those with low socioeconomic status or people in rural areas. These gaps can perpetuate or even worsen health inequities. Consider the access/lack of access to continuous glucose monitoring (CGM).
While medical guidelines are an essential part of modern healthcare, they are not without limitations. These limitations can affect the personalization of care, their responsiveness to new research, and their applicability in real-world situations. Addressing these challenges is important to ensure that medical guidelines continue to support high-quality, person-centred care.