An Evaluation of the Current Type 2 Diabetes Guidelines: Where They Converge and Diverge

In providing the best care for patients, health care providers (HCPs) rely on clinical experience and judgment, published literature, and evidence-based clinical guidelines to direct decisions and serve as benchmarks for achieving optimal patient outcomes. Several published guidelines are available to support HCPs in caring for patients with type 2 diabetes. These include recommendations from the American Diabetes Association (ADA),1 the World Health Organization (WHO),2 the American Association of Clinical Endocrinologists (AACE),3 the Indian Health Service (IHS),4 and the Center for Medicaid and Medicare Services (CMS).5 These guidelines are kept current through periodic review of available literature and research to ensure that they are up to date and based on the latest available evidence.Practicing clinicians and the various guideline development committees have diverse perspectives regarding how best to incorporate published research findings into clinical practice when managing patients with a disease as complex as type 2 diabetes. We conducted an evaluation to identify consistencies and discrepancies among the guidelines for nonpregnant adults with type 2 diabetes in the areas of screening, diagnosis, management, and prevention.The ADA, WHO, and IHS guidelines recommend that adults be evaluated for type 2 diabetes if they are overweight (BMI ≥ 25 kg/m2) and have one or more of the following risk factors: first-degree relative with diabetes, women who delivered a baby weighing > 9 lb, diagnosis of hypertension > 140/90 mmHg, diagnosis of polycystic ovarian syndrome, history of gestational diabetes mellitus (GDM), or acanthosis nigricans (Table 1).1,2,4 However, several minor differences do exist among the guidelines. The ADA1 recommends that adults with prediabetes be screened annually and that adults who are ≥ 45 years of age without preexisting conditions be screened every 3 years. The WHO2 recommends that adults …