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31 Recommendation Grading Category/ Grade Definition A Clear evidence from well-conducted, generalizable, randomized controlled trials that are adequately powered, including : • Evidence from a well-conducted multicenter trial • Evidence from a meta-analysis that incorporated quality ratings in the analysis Compelling nonexperimental evidence, ie, "all or none" rule developed by Center for Evidence Based Medicine at Oxford Supportive evidence from well-conducted randomized controlled trials that are adequately powered, including : • Evidence from a well-conducted trial at one or more institutions • Evidence from a meta-analysis that incorporated quality ratings in the analysis B Supportive evidence from well-conducted cohort studies • Evidence from a well-conducted prospective cohort study or registry • Evidence from a well-conducted meta-analysis of cohort studies Supportive evidence from a well-conducted case-control study C Supportive evidence from poorly controlled or uncontrolled studies • Evidence from randomized clinical trials with one or more major or three or more minor methodological flaws that could invalidate the results • Evidence from observational studies with high potential for bias (eg, case series with comparison to historical controls) • Evidence from case series or case reports Conflicting evidence with the weight of evidence supporting the recom- mendation E Expert consensus or clinical experience Abbreviations A1c, glycohemoglobin; ABI, ankle-brachial index; ACE, angiotensin-converting enzyme; AMP, adenosine monophosphate; ARB, angiotensin receptor blockers; BG, blood glucose; BMI, body mass index; CGM, continuous glucose monitoring ; CHD, coronary heart disease; CHF, congestive heart failure; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; DCCT, Diabetes Control and Complications Trial; DKA, diabetic ketoacidosis; DPN, distal symmetric polyneuropathy; DPP-4, dipeptidyl peptidase-4; DSME, diabetes self-management education; eGFR, estimated glomerular filtration rate; FDA, US Food and Drug Administration; FPG, fasting plasma glucose; GDM, gestational diabetes mellitus; GFR, glomerular filtration rate; GI, gastrointestinal; GIP, glucose-dependent insulinotropic polypeptide; GLP, glucagon-like peptide; HDL-C, high-density lipoprotein cholesterol; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome; HNF, hepatocyte nuclear factor; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; IPF, insulin promoter factor; LDL-C, low-density lipoprotein cholesterol; MNT, medical nutrition therapy; MODY, maturity-onset diabetes of the young ; MUFA, monounsaturated fat; NGSP, National Glycohemoglobin Standardization Program; NPDR, nonproliferative diabetic retinopathy; OGTT, oral glucose tolerance test; PAD, peripheral artery disease; PDR, proliferative diabetic retinopathy; PPAR, peroxisome proliferator-activated receptor; PPG, postprandial glucose; SMBG, self-monitoring blood glucose; SU, sulfonylurea; TZD, thiazolidinedione; UKPDS, United Kingdom Prospective Diabetes Study