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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
