Re: ADA 2006 Standards of Care

<wmmckee@xxxxxxx> wrote in message
news:1155585222_34517@xxxxxxxxxxxxxxxxxxxxxxx
Hello Friends,

So that everyone will be on the same level playing field, here is a link
to
the 2006 Position Paper of the ADA relating to standards of care for
diabetics.

http://care.diabetesjournals.org/cgi/reprint/29/suppl_1/s4.pdf


Hi Will,
thank you for this usefull link
Here is the comment on this in the same issuue of Diabetes Care :

http://care.diabetesjournals.org/cgi/reprint/29/2/476

I would like to take issue with the use
of the phrase "standards of medical care in
diabetes," which is used to title all the individual
components of these recently
updated ADA guidelines. I think this
phrase is unhelpful for both the health
care community and the public at large, in
that it strongly suggests that these guidelines
are the definitive source to inform a
"standard of care" for diabetes. Any deviation
from the guideline may then be interpreted
as "substandard care."
A number of these guideline recommendations
cite a level of evidence "E"
(i.e., based on "[e]xpert consensus or clinical
experience"). In most taxonomies,
this is considered the weakest level of evidence
available. The U.S. Preventive Services
Task Force (USPSTF), in their most
recently circulated guidelines, assigns an
"I" ("inconclusive") rating to whether
asymptomatic individuals should be routinely
screened for type 2 diabetes and a "B" rating ("fair evidence that the
services
improve important health outcomes and
concludes that benefits outweigh harms")
to screening adults with hypertension or
hyperlipidemia.
Given the importance of defining a
standard of care for any disease management,
I teach medical students that wellconstructed
guidelines developed by a
nonpartisan group and based on a good
level of evidence (such as the "B" rating
by USPSTF) are the best informants of
standard of care. Given the "I" rating by
USPSTF, there clearly is room for clinical
judgment when it comes to screening the
general population. I respectfully suggest
that it would be more helpful if the ADA
guidelines, instead of being titled "Standard
of Medical Care in Diabetes," were
titled something like "ADA Consensus
Panel Guidelines."
DAVID POWER, MD, MPH

hth
Gys






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