The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force that examined the evidence on blood glucose–lowering therapy in adults with type 2 diabetes and published a position statement (1). Recently, these recommendations were updated and published in the January 2015 issue of the journal (2).

The ADA/EASD recommendations are postulated as being a position statement and not a treatment guideline. However, many physicians give advice to their patients based on this position statement; therefore, the position statement is regarded as a treatment guideline, at least by a part of the diabetes care providers. Since 2012, consensus on how evidence should be graded in the process of developing practice guidelines has changed (3). The updated position statement does not state how the balance of evidence and expertise was incorporated in the recommendations and does not state whether systematic reviews of literature or even systematic processes of consensus were followed or whether the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used (1,2,4). This is particularly important given the abundance of data in which different glucose-lowering agents are compared.

Since 2012, the handling of conflicts of interest (COI) of individual guideline members in the process of the development of practice guidelines has also changed (3), and the process of the development of the ADA/EASD clinical practice recommendations was already criticized in 2012, also for the handling of COI (5). Furthermore, Diabetes Care supports the International Committee of Medical Journal Editors recommendations (http://www.icmje.org/recommendations/browse/roles-and-responsibilities/author-responsibilities–conflicts-of-interest.html), which mandate that authors disclose COI for at least 36 months (3). As disclosures of COI for only 12 months were required for members of the position statement, it would be informative to know why Diabetes Care has made an exception for the ADA/EASD position statement.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

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