Competing interests in development of clinical practice guidelines for diabetes management: Report from a multidisciplinary workshop

Abstract

Objective

To explore the complex issue of competing interests (CIs) in development of clinical practice guidelines (CPGs) in diabetes with stakeholders.

Methods

A multidisciplinary panel of 26 health, methodological, legal, and bioethical experts, trainees, and lay people from across Canada participated in a workshop on CIs in CPGs. Mixed methods were used such that qualitative themes were extracted from the discussions and quantitative survey data were collected.

Results

In the discussions, participants acknowledged that potential competing interests were not uncommon among sponsoring organizations and authors of CPGs. Avoidance of all potential CIs in development of CPGs was emulated as ideal, but considered probably unrealistic, given the paucity of peer-reviewed funding opportunities for development of evidence-informed CPGs and the scarcity of knowledgeable authors without CIs. An optimal approach for management of CIs in CPGs could not be agreed upon by participants. Full disclosure of any financial CIs for authors and sponsoring organizations as well as discouragement of external financial contributors from writing involvement, were endorsed by participants in the workshop and a subsequent survey.

Conclusions

Complete disclosure of financial CIs of sponsoring organizations and authors of CPGs is essential, yet the optimal approach to management of potential CIs is currently undefined.

Keywords:

• conflicts of interest
• clinical practice guidelines
• diabetes
• knowledge translation
• bioethics

Acknowledgments

The authors are indebted to the speakers and participants of this workshop who contributed their time and opinions to this project. This project was funded by workshop support from the Canadian Institutes of Health Research (Institute of Nutrition, Metabolism, and Diabetes). The authors like to thank Ms. Lucy Montana for assisting us with the arrangements for the workshop. The authors would also like to thank Dr. Jeremy Gilbert, Shamila Kamalanathan, Dr. Siarhei Slizeuski, and Dr. Shahryar Murshed for assistance with preparing for the workshop as well as registration of participants.

Disclosure

This workshop was funded by the Canadian Institutes of Health Research (Institute of Nutrition, Metabolism, and Diabetes), Grant # OWK-79938. Anna M Sawka has previously been awarded a Health Economics Fellowship from McMaster University that was funded in part by Hoffman-LaRoche, Ltd. Lilian Magalhães declares no conflicts of interest. Amiram Gafni has consulted to various companies and governments and has received grant support from both government and industry. Gary F Lewis has consulted for Merck Frosst, Pfizer, Eli Lilly, Scherring, Astra Zeneca and has received grant support from Merck Frosst and Amylin Pharmaceuticals.