Guidelines for medical management of hyperglycaemia in type 2 diabetes and duality of interest

Excerpt

To the Editor: I read with great interest the Consensus Statement article by Nathan et al. [1] on behalf of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), suggesting a consensus algorithm for initiation and adjustment of therapy for the medical management of hyperglycaemia in type 2 diabetes. In describing the process used to develop the algorithm, the authors mentioned two sources: (1) clinical trials that address the effectiveness and safety of different modalities of therapy; and (2) clinical judgement, i.e., the collective knowledge and clinical experience of the authors, which takes into account benefits, risks and costs in the treatment of diabetes [1]. Since the authors point to the ‘paucity of high-quality evidence in the form of well-controlled clinical trials that directly compare different diabetes treatment regimens’, they propose that the scarce-evidence-based information should be supplemented by ‘value judgements, where the benefits of treatment are weighed against risks and costs in a subjective fashion’ [1]. This need for value judgement, in particular in the context of the preparation of a consensus statement that may influence the therapy of millions of patients, presupposes a high level of independence and balanced judgement from the authors. The carefully written and critical description of the different modalities of treatment suggests that this was probably the case for the present guidelines [1]. …