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.
Gionfriddo MR, McCoy RG, Lipska KJ. AACE Response to Viewpoint of December 9, 2013—Reply. JAMA Intern Med. 2014;174(5):827-828. doi:10.1001/jamainternmed.2014.166