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ESDIA1933d
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
LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, Hirsch IB, McDonnell
ME, Molitch ME, Murad MH, Sinclair AJ. Treatment of diabetes in older adults: an endocrine society
clinical practice guideline. J Clin Endocrinol Metab. 2019:104(5)
Abbreviations
ACE, angiotensin-converting enzyme; ACR, albumin/creatinine ratio; ARB, angiotensin receptor
blocker; ADA, American Diabetes Association; ADL, activity of daily living ; BP, blood pressure;
CGM, continuous glucose monitoring ; CHF, congestive heart failure; CKD, chronic kidney disease;
CVD, cardiovascular disease; DPP, Diabetes Prevention Program; DPP-4, dipeptidyl peptidase-4;
FPG, fasting plasma glucose; GLP-1, glucagon-like-peptide 1; GFR, glomerular filtration rate;
IADL, instrumental activity of daily living ; IFG, impaired fasting glucose; IGT, impaired glucose
tolerance; LDL-C, low-density lipoprotein cholesterol; MCI, mild cognitive impairment; OGTT, oral
glucose tolerance test; PG, plasma glucose; RCT, randomized control trial; SGLT2, sodium-glucose
cotransporter 2; SDM, shared decision-making ; SU, sulfonylurea; T1D, type 1 diabetes; T2D, type 2
diabetes; TZD, thiazolidinedione
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
