Conflicting guidelines for patient care can be confusing for practitioners.
Yet, many disease states cross specialty lines and lead to multiple different answers: on age-related screening guidelines, cholesterol or lipid goals, breast cancer screening guidelines, managing heart disease risk factors and blood pressure, etc. What guidelines do we follow if the recommendations conflict? Studies have shown that practitioners are likely to follow guidelines related to experiences they have had with family, friends and/or patients.1 IE: if you have seen breast cancer in early age patients, you are more likely to recommend mammograms at an earlier age.
Diabetes is the number one cause of kidney failure and nearly 50% of all patients with diabetes will develop kidney disease.2 Even still, there are different guidelines developed by endocrine experts and those developed by kidney experts. Although they are complementary, these guidelines do not match. With this conundrum in mind, the American Diabetes Association (ADA) and the Kidney Disease Improving Global Outcomes (KDIGO) experts have come together to ‘match’ guidelines. In a recent expert consensus statement, the ADA and KDIGO combined their expertise and developed a practical, easily followed set of guidelines for patient with diabetes (Type 1 (T1DM) or Type 2 (T2DM)) and chronic kidney disease (CKD).3
There were a couple of surprises in the updated and combined expert guidelines:
Managing patients with complex, multiple issues is challenging and frustrating. This is made more so when guidelines conflict.Societies coming together to combine and coordinate national guidelines is essential for quality patient care. The ADA and KDIGO have taken a major step forward in combining guidelines and hopefully this step previews future coordinated efforts between specialty organizations.