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Evidence Grading

Literature Search

This guideline is based on a systematic evidence review evaluating literature published on type 2 diabetes mellitus (T2DM).  The literature search was divided into two stages to identify systematic reviews, (stage I) and randomized controlled trials, meta-analysis and other literature (stage II).  Literature search terms used for this revision are below and include literature from January 1, 2004, through May 31, 2014.  Hand searching of identified articles and work group submission was also undertaken.  For additional information on literature searched, see supplemental tables.

The databases searched included PubMed and Cochrane. The search was limited to only studies in the English language. The following searches were performed and utilized in this document in regards to T2DM: screening, diagnosis, diagnostic testing, risk factors, bariatric surgery, blood pressure, lipid management, insulin, nutrition therapy, glycemic control, weight loss, metformin, self-management and education.

GRADE Methodology

Following a review of several evidence rating and recommendation writing systems, ICSI has made a decision to transition to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

GRADE has advantages over other systems including the current system used by ICSI.  Advantages include:

  • Developed by a widely representative group of international guideline developers
  • Explicit and comprehensive criteria for downgrading and upgrading quality of evidence ratings
  • Clear separation between quality of evidence and strength of recommendations that includes a transparent process of moving from evidence evaluation to recommendations
  • Clear, pragmatic interpretations of strong versus weak recommendations for clinicians, patients and policy-makers
  • Explicit acknowledgement of values and preferences and
  • Explicit evaluation of the importance of outcomes of alternative management strategies.