Japanese Clinical Practice Guideline for Diabetes 2016

statements were developed separately as general questions and clinical questions based on published clinical evidence as well as expert consensus.This guideline offers key recommendations for clinical practice that are supported by scientific evidence from published studies.Studies of interest were obtained by a systematic search of the English and Japanese literature.The electronic databases used for literature search included at least MED-LINE and the Japanese ICHUSHI database (http://www.jamas. or.jp/).The search strategies used were developed by each author.The studies of interest were critically appraised by the authors to determine their relevance to the statements of the guideline and whether they were worth citing.Each study was assigned a level of evidence using the approach described in Table 1.Each statement for the CQs was assigned a grade of recommendation based on the total body of evidence as well as the risk-benefit balance, value, patient preferences, cost, and resources.Statements were graded as A (strongly recommended) or B (recommended), followed by the agreement rate among authors.Grade A or B by consensus reflects a recommendation based solely on the consensus of professionals and indicates that the recommendation was adopted with a ≥70% agreement rate among the authors.A summary table, including an identifier, the research design, the level of evidence and population, methods, and results of the cited articles was attached at the end of each chapter in the original Japanese version (The Japan Diabetes Society: Japanese Clinical Practice Guideline for diabetes 2016.Tokyo: Nankodo, 2016.).Scientific reports supporting a statement were cited as 'References' and additional guidelines or review articles were listed as 'Additional reference materials'.The guideline will be reviewed every 3 years, as there will be considerable advances in clinical research and practice that will require a re-evaluation of the scientific evidence as it becomes available.All potential conflicts of interest were disclosed by authors. GUIDELINE FOR THE DIAGNOSIS OF DIABETES MELLITUSQ1-1 How is diabetes diagnosed?(Figure 1)• The diagnosis of diabetes mellitus should be as comprehensive as possible.It is confirmed by the presence of chronic hyperglycemia, and by the presence of other factors, such as associated symptoms, clinical laboratory findings, a family history of diabetes, and the patient's body weight history 1-5 .For the diagnosis of diabetes, either of the following approaches is to be followed: ① Two assessments of the diabetic type in each patient (one blood glucose test is mandatory).② One assessment of the diabetic type (with mandatory blood glucose testing) along with the presence of chronic hyperglycemic symptoms*.(*typical symptoms of chronic hyperglycemia (e.g., dry mouth, polyposia, polyuria, body weight loss, or diabetic retinopathy).③ Evidence of a prior diagnosis of 'diabetes'.Q1-2 How is hyperglycemia assessed?(Figure 2)• Patients are to be classified into the normal type, borderline type, or diabetic type, based on the combination of fasting and 2-h post-75 g oral glucose tolerance test (OGTT) glucose values.• Patients whose fasting glucose values are 100-109 mg/dL (5.6-6.1 mmol/L) are classified into the 'high normal' category as part of the normal type 6 .• The OGTT is to be proactively considered in high-risk individuals (i.e., those who are suspected to have diabetes or the borderline type, those whose fasting glucose values are shown to be 'high-normal', those with HbA1c values of ≥5.6%, those with obesity or dyslipidemia, and those with a strong family history of diabetes 5 ).