What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes.
OBJECTIVE
To evaluate systematically the review literature on type 2 diabetes to assess transmission of the findings of the United Kingdom prospective diabetes study (UKPDS), an important source of recent valid patient oriented evidence that matters (POEMs).


METHODS
Inception cohort analysis of the recent medical literature.


METHODS
Thirty five reviews on treatment of type 2 diabetes.


METHODS
Presentation of three types of information from UKPDS in review articles: recommendations based on patient oriented outcomes of study; recommendations contradicted by patient oriented outcomes of study; and recommendations based on disease oriented outcomes for which no patient oriented evidence exists.


RESULTS
Only six of the reviews included the POEM that tight blood glucose control had no effect on diabetes related or overall mortality. Just seven mentioned that metformin treatment was associated with decreased mortality. Most (30) of the reviews did not report that diabetic patients with hypertension benefit more from good blood pressure control than good blood glucose control. No review pointed out that treatment of overweight patients with type 2 diabetes with insulin or sulphonylurea drugs had no effect on microvascular or macrovascular outcomes. Thirteen reviews recommended drugs as first line treatment for which we do not have patient oriented outcomes data. The average validity assessment score was 1.3 out of a possible score of 15 (95% confidence interval 0.9 to 1.8).


CONCLUSIONS
Review articles on the treatment of type 2 diabetes have not accurately transmitted the valid POEM results of the UKPDS to clinicians. Clinicians relying on review articles written by experts as a source of valid POEMs may be misled.
Shaughnessy
Allen F
AF
Harrisburg Family Practice Residency, Harrisburg, Pennsylvania, USA. ashaughnessy@PinnacleHealth.org
Slawson
David C
DC
D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000209:etiology; D003928:Diabetic Nephropathies / Q000209:etiology; D003930:Diabetic Retinopathy / Q000209:etiology; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015201:Meta-Analysis as Topic; D009765:Obesity / Q000150:complications; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin