Background Guideline adaptation has always been the methodological basis of the German National Disease Management Guideline (NDMG) Programme. Although it allows highly efficient and resource-saving workflows, the NDMG development process becomes an increasingly time-consuming and resource-intensive challenge.

Objective The objective of the present project was to analyse the performance of the adaptation methods used for the NDMG guidelines development to identify the critical issues causing an extensive effort and to find possible coping solutions.

Methods We reviewed each NDMG method report from the beginning of the programme in 2002 to 2012. We extracted and evaluated the duration of the process, the number of source guidelines used and number and themes of additional literature searches over the course of years also in comparison of the first and second editions.

Results One of the 14 NDMGs was excluded because of missing adaptation method during the updating process. The comparison of first half of the programme between 2002 to 2007 and second half from 2007 to 2012 revealed an average duration of the development process of 22,7 versus 49,9 months. Until 2007 4,5 and after 2007 3,7 source guidelines were used on average. The number of topics of systematic literature searches has been rising over the years. On average 5 additional searches were conducted in the last 5 years. 42% of all topics covered pharmacotherapy.

Discussion The adaptation methodology is still very useful and efficient. However, prioritisation and consensus processes and strict orientation on the selected source guidelines need to be optimised to reduce the increasing effort.