Methods

This toolkit was developed using a methodology that takes advantage of the existence of a body of published, quality-assured, international, evidence-based guidelines. The output of this approach is a toolkit that provides health and care practitioners with quick and easy access at point of care to evidence-based recommendations and additional resources on optimising glycaemic control in people with type 1 diabetes.

A multidisciplinary development group was confirmed following consultation with the member organisations of SIGN. The group membership is available on the SIGN website.

All members of the development group made declarations of interests. Further details of these are available in the register of interests on the SIGN website.

Five key questions were prioritised to support the development of this toolkit and can be viewed here. 

Systematic searches were carried out to identify guidelines published on type 1 diabetes between 2019 and 2022. Manual searches were also carried out on the outputs of selected UK agencies that publish evidence-based recommendations (eg The National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Scottish Health Technologies Group). Guidelines were screened by title or abstract against the topic and to exclude non-English publications. Further screening was completed on the remaining guidelines to exclude publications which did not have at least one recommendation that could be linked to one of the key questions. 

Final screening was conducted by appraising remaining guidelines using the Rigour of Development and Editorial Independence domains of the AGREE II tool. Guidelines which received ratings lower than 75% on either domain were excluded. The Stakeholder Involvement domain was also appraised and used in reporting but not as a screening criterion. 

All relevant recommendations matching the key questions were extracted and themed. Following discussion by four researchers, a final set of recommendations was shortlisted based on provision of non-overlapping advice (ie duplicates or near duplicates were reduced to a single recommendation and recommendations were approved if covering different aspects within the remit of the key question). Recommendations from UK-based guidelines and more recently published guidelines were prioritised.  

Using a modified Delphi approach, members of the development group voted individually on the acceptability and implementability of shortlisted recommendations and provided comments and/or adaptations for each, where they felt these were required. A threshold of 70% was established in advance as the level of consensus. All recommendations were voted as acceptable, with a number receiving minor adaptations to align them with the context in NHSScotland. Further details are available on the SIGN website.

The development group worked in subgroups to discuss the recommendations linked to each key question and to provide additional information to support implementation.

The draft toolkit was provided to invited peer reviewers and made available for public open consultation for three weeks from 31 October to 21 November 2023. All comments received were recorded and considered by the development group and a report which includes submitted feedback and the responses of the group is available from the SIGN website.

This toolkit was issued in 2024 and will be considered for review in three years. The review history, and any updates in the interim period, will be noted in the update report, which is available in the supporting material section for this toolkit on the SIGN website: www.sign.ac.uk

Comments on new recommendations that would update this guideline are welcome and should be sent to the SIGN Executive (email: sign@sign.ac.uk).

Technical maintenance and updating of the app is carried out by Tactuum Ltd and funded through the National Decision Support Programme.