ADA guidelines classification scheme

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

The American Diabetes Association (ADA) developed a grading system to grade the quality of scientific evidence to support the ADA recommendations for all position statements.

Evidence Grading System

ADA has developed a grading system for leveling the standards of medical care in diabetes.

Level of evidence Desciption
A ❑ Clear evidence from well-conducted, generalizable randomized controlled trials
that are adequately powered, including
  • Evidence from a well-conducted multicenter trial
  • Evidence from a meta-analysis that incorporated quality ratings in the analysis

❑ Compelling nonexperimental evidence, i.e., “all or none” rule developed by the

Centre for Evidence-Based Medicine at the University of Oxford

❑ Supportive evidence from well-conducted randomized controlled trials that are

adequately powered, including
  • Evidence from a well-conducted trial at one or more institutions
  • Evidence from a meta-analysis that incorporated quality ratings in the analysis
B ❑ Supportive evidence from well-conducted cohort studies
  • Evidence from a well-conducted prospective cohort study or registry
  • Evidence from a well-conducted meta-analysis of cohort studies

❑ Supportive evidence from a well-conducted case-control study

C ❑ Supportive evidence from poorly controlled or uncontrolled studies
  • Evidence from randomized clinical trials with one or more major or three or more minor methodological flaws that could invalidate the results
  • Evidence from observational studies with high potential for bias (such as case series with comparison with historical controls)
  • Evidence from case series or case reports

❑ Conflicting evidence with the weight of evidence supporting the

recommendation
E ❑ Expert consensus or clinical experience

References



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