TABLE 1

Definitions and Recommendation Implications

StatementDefinitionImplication
Strong recommendationA strong recommendation in favor of a particular action is made when the anticipated benefits of the recommended intervention clearly exceed the harms (as a strong recommendation against an action is made when the anticipated harms clearly exceed the benefits) and the quality of the supporting evidence is excellent. In some clearly identified circumstances, strong recommendations may be made when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
RecommendationA recommendation in favor of a particular action is made when the anticipated benefits exceed the harms but the quality of evidence is not as strong. Again, in some clearly identified circumstances, recommendations may be made when high-quality evidence is impossible to obtain but the anticipated benefits outweigh the harms.Clinicians would be prudent to follow a recommendation but should remain alert to new information and sensitive to patient preferences.
OptionOptions define courses that may be taken when either the quality of evidence is suspect or carefully performed studies have shown little clear advantage to 1 approach over another.Clinicians should consider the option in their decision-making, and patient preference may have a substantial role.
No recommendationNo recommendation indicates that there is a lack of pertinent published evidence and that the anticipated balance of benefits and harms is presently unclear.Clinicians should be alert to new published evidence that clarifies the balance of benefit versus harm.
  • It should be noted that, because childhood T2DM is a relatively recent medical phenomenon, there is a paucity of evidence for many or most of the recommendations provided. In some cases, supporting references for a specific recommendation are provided that do not deal specifically with childhood T2DM, such as T1DM, childhood obesity, or childhood “prediabetes,” or that were not included in the original comprehensive search. Committee members have made every effort to identify those references that did not affect or alter the level of evidence for specific recommendations.