Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement of the American Diabetes Association and the European Association for the Study of Diabetes

Response to Nathan et al.

I read with great interest the consensus statement by Nathan et al. (1) on behalf of the American Diabetes Association and the European Association for the Study of Diabetes, suggesting a consensus algorithm for initiation and adjustment of therapy for the medical management of hyperglycemia in type 2 diabetes. Describing the process used to develop the algorithm, the authors mentioned two sources: clinical trials that address the effectiveness and safety of different modalities of therapy and clinical judgment, that is, the collective knowledge and clinical experience of the authors, which takes into account benefits, risks, and costs in the treatment of diabetes (1). Because 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 judgments, where the benefits of treatment are weighed against risks and costs in a subjective fashion” …