In Reply: In the mid 2000s, several measurement developers endorsed optimal measures for all persons with diabetes aged 18 to 74 years, even though the ACCORD1 and other studies were ongoing and, consequently, the outcomes still unknown. The strength of evidence supporting recommendations varied widely. For example, the American Diabetes Association guideline still recommends a blood pressure goal of less than 130/80 mm Hg based on level C evidence, defined as “supportive evidence from poorly controlled or uncontrolled studies.”2 The andon cord analogy highlights the fact that the developers ignored concerns voiced by the National Diabetes Quality Improvement Alliance and a subsequent Agency for Healthcare Research and Quality–funded conference years before ACCORD and other trials reported their findings—early warnings.
Pogach L, Aron DC. Diabetes Quality Measures—Reply. JAMA. 2011;305(19):1966-1968. doi:10.1001/jama.2011.643