Are guidelines for monitoring chronic disease in primary care evidence based?

What you need to know Current UK guidelines for monitoring type 2 diabetes, chronic kidney disease, and hypertension are largely based on expert opinion; robust evidence for optimal monitoring strategies and testing intervals is lacking Unnecessary testing in primary care can lead to false positive and false negative results, increased workload for clinicians, and increased costs for the health service Patients and healthcare professionals should be aware of these uncertainties when making shared decisions about chronic disease monitoring Pathology tests have a unique place in management of chronic diseases. National Institute for Health and Care Excellence (NICE) Scottish Intercollegiate Guidelines Network (SIGN) Royal Colleges of Pathologists (RCPath), Physicians, and General Practitioners Quality Outcomes Framework (QOF) The following guidelines are included in this review: SIGN 116 Management of diabetes (2017)2 NICE CG127 Hypertension, the clinical management of primary hypertension in adults (2011)3 NICE CG182 Chronic kidney disease (partial update) (2014)4 NICE NG28 Type 2 diabetes in adults (2015)5 NICE PH38 Evidence reviews (Type 2 diabetes: prevention in people at high risk) (2017)6 RCPath: National minimum retesting intervals in pathology (2015)7 We extracted any guidance on the use of laboratory tests for disease monitoring, the recommended frequency of testing, and the level of evidence on which the guidance was based. [...]clinicians need to read an entire guideline to get an overview of all recommended tests. [...]SIGN recommends annual testing of renal function in patients with diabetes,2 whereas NICE suggest that test intervals should be determined by previous renal function results.4 NICE recommends that individual needs are taken into account when determining the frequency of monitoring, although it is not specified how testing intervals should be adjusted.5 “Blood glucose” should be tested routinely in patients with hypertension to screen for diabetes, according to NICE, but the frequency of such routine testing is not stated.3 Robust evidence for optimal monitoring strategies and testing intervals is lacking Most of these recommendations are based on expert opinion, provided by the respective guideline development groups.