Clinical Practice Guidelines and Quality Improvement

The CSEM is active in the areas of reviewing and facilitating the development of clinical practice guidelines and of developing quality improvement recommendations.

CSEM Guidelines Committee

The goal of the CSEM Guidelines Committee is to promote evidence-based practice and decision-making in Canada. This goal will be achieved through the following efforts:

1. CSEM endorsement of those clinical practice guidelines that pass our review of the methodological quality, endocrine validity and general appropriateness for Canada.
2. Facilitation of the creation of new Canadian clinical practice guidelines on endocrine topics that are identified as necessary by the membership.
3. CSEM endorsement of documents created by professional organizations to set “standard of care” or “best practices” of endocrinology topics that may not be clinical practice guidelines per se.

The evaluation of CPGs will be done using the AGREE II instrument for assessment of guidelines. Majority vote of the committee on guidelines will then determine the endorsement by CSEM.

Please email all requests for endorsement to This email address is being protected from spambots. You need JavaScript enabled to view it. and include the following:

1. Entire CPG document
2. Completed AGREE II self-assessment on CPG
3. In the case of a “best practices” document by a professional organization, only the document is required and not the AGREE II self-assessment

To date, the Committee has reviewed a number of clinical practice guidelines and has endorsed the following:

• CARES Foundation: Emergency Medical Services Protocol for Adrenal Insufficiency.
• Canadian Addison’s Society: Patient Emergency Medical Information Cards. This email address is being protected from spambots. You need JavaScript enabled to view it. to receive copies of the cards that you can distribute to patients.
• Obesity Canada: 2020 Canadian Adult Obesity Clinical Practice Guidelines
• 2019 Standards of Care for Hypoparathyroidism in Adults: a Canadian and International Consensus
• The Centre For Research Excellence In Women’s Health And Reproductive Life, in partnership with the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine, developed in collaboration with professional societies, including the CSEM and consumer advocacy groups: International Evidence-Based Guidelines for the Assessment and Management of Polycystic Ovary Syndrome 2018
• Canadian Men’s Health Foundation Multidisciplinary Guidelines Task Force on Testosterone Deficiency: Diagnosis and Management of Testosterone Deficiency Syndrome in Men: Clinical Practice Guideline
• International Society for Clinical Densitometry: 2013 ISCD Official Positions – Pediatric
• International Society for Clinical Densitometry: 2013 ISCD Official Positions – Adult
• International Working Group: Updated Practice Guideline for Dual‑Energy X‑ray Absorptiometry (DXA) 2024

CSEM Quality Improvement Committee

The CSEM Quality Improvement Committee was struck and charged by the CSEM Executive in late 2013 to work with Choosing Wisely Canada, a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures. They co-developed the first Five Things Physicians and Patients Should Question, which were released in October 2014:

• Don’t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.
• Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests unless there is a palpable abnormality of the thyroid gland.
• Don’t use Free T4 or T3 to screen for hypothyroidism or to monitor and adjust levothyroxine (T4) dose in patients with known primary hypothyroidism, unless the patient has suspected or known pituitary or hypothalamic disease.
• Don’t prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency.
• Don’t routinely test for Anti-Thyroid Peroxidase Antibodies (anti–TPO).

The Committee will continue to work with Choosing Wisely Canada to develop further evidence-based recommendations for clinical practice, with the goal of helping to achieve appropriate and sustainable improvements in health care.