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Comment & Response |

AACE Response to Viewpoint of December 9, 2013

Alan J. Garber, MD, PhD1; Daniel Einhorn, MD2,3; Jeffrey I. Mechanick, MD, ECNU1
[+] Author Affiliations
1American Association of Clinical Endocrinologists, Jacksonville, Florida
2American College of Endocrinology, Jacksonville, Florida
3Diabetes and Endocrine Associates, La Jolla, California
JAMA Intern Med. 2014;174(5):827. doi:10.1001/jamainternmed.2014.193.
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To the Editor The Viewpoint by Gionfriddo et al1 regarding the American Association of Clinical Endocrinologists (AACE) Comprehensive Diabetes Management Algorithm reflects a failure to differentiate between an algorithm and a guideline. They conflate algorithms with guidelines and argue against this nonexistent straw man. What we published is explicitly an algorithm, entitled an algorithm, and not a guideline, which is explicitly defined and governed by our own published protocols.2 In fact, our algorithm directs readers to previously published guidelines as needed.3 Algorithms are evidence- and nuance-based clinical practice tools, derived from extant guidelines and new information, to optimize care. More specifically, algorithms rely on diverse layers of evidence in order to clarify complicated management decisions, the totality of which cannot be exclusively guided by published randomized clinical trials or other higher levels of evidence. Thus, responsible clinical decision making requires that each patient encounter uses all available evidence; to do otherwise is to abdicate clinical responsibility for patient care.


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May 1, 2014
Michael R. Gionfriddo, PharmD; Rozalina G. McCoy, MD; Kasia J. Lipska, MD, MHS
1Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
2Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
3Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2014;174(5):827-828. doi:10.1001/jamainternmed.2014.166.
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