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Comment & Response
May 2014

AACE Response to Viewpoint of December 9, 2013—Reply

Author Affiliations
  • 1Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
  • 2Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
  • 3Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2014;174(5):827-828. doi:10.1001/jamainternmed.2014.166

In Reply Our chief concerns with any expert guidance—whether an algorithm or a guideline—is that the guidance should be produced and reported with transparency and offer evidence-based and patient-centered advice.

Garber et al state that in our article1 we conflate algorithms with guidelines and thus argue against a straw man. Because the algorithm of the American Association of Clinical Endocrinologists (AACE) was “developed to provide clinicians with a practical guide”2(p3) to the management of type 2 diabetes mellitus, the Institute of Medicine standards3 are relevant and apply. We agree that many diabetes management decisions cannot be guided by high-confidence evidence when only low-confidence evidence exists. A clear indication of the level of confidence warranted by the available evidence helps improve the credibility of algorithms and therefore their usefulness.

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