Endocrine Society GUIDELINES Bundle (free trial)

Metabolic Risk

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106 Commerce Street, Suite 105 Lake Mary, FL 32746 TEL: 407.878.7606 • FAX: 407.878.7611 Order additional copies at GuidelineCentral.com Copyright © 2019 All rights reserved ESMET1973 Disclaimer is pocket guide attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. is pocket guide should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. e ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aer consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. Source James L. Rosenzweig, George L. Bakris, Lars F. Berglund, Marie-France Hivert, Edward S. Horton, Rita R. Kalyani, M. Hassan Murad, Bruno L. Vergès, Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab. September 2019, 104(9):1–47. Abbreviations AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; DM, diabetes mellitus; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; HDL, high density lipoprotein; HDL-C, high density lipoprotein-cholesterol; IDF, International Diabetes Federation, IFG, impaired fasting glucose; IGT, impaired glucose tolerance; LDL, low density lipoprotein; LDL-C, low density lipoprotein-cholesterol; NCEP-ATPIII, National Cholesterol Education Program – Adult Treatment Panel III Criteria for Metabolic Syndrome; NHLBI, National Heart Lung and Blood Institute; OGTT, oral glucose tolerance test; RCT, randomized control trial; SBP, systolic blood pressure; STOP-NIDDM, Study to Prevent Non-Insulin-Dependent Diabetes Mellitus; T2DM, type 2 diabetes mellitus; TGL, triglycerides; WC, waist circumference Grading System Quality of Evidence High Quality Moderate Quality Low Quality Very Low Quality Description of Evidence • Well-performed RCTs • Very strong evidence from unbiased observational studies • RCTs with some limitations • Strong evidence from unbiased observational studies • RCTs with serious flaws • Some evidence from observational studies • Unsystematic clinical observations • Very indirect evidence from observational studies Strength of Recommendation Strong (1): "ES recommends…" Benefits clearly outweigh harms and burdens or vice versa 1|⊕⊕⊕⊕ 1|⊕⊕⊕ 1|⊕⊕ 1|⊕ Conditional (2): "ES suggests…" Benefits closely balanced with harms and burdens 2|⊕⊕⊕⊕ 2|⊕⊕⊕ 2|⊕⊕ 2|⊕ Ungraded Good Practice Statement UGPS

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