Generated Narrative: ArtifactAssessment

Artifact URL: https://fevir.net/resources/ArtifactAssessment/179469

Artifact Description: An example using the ArtifactAssessment Resource for representation of the many judgments and concepts used to justify a recommendation.

identifier: FEvIR Object Identifier/179469

title: Justification for Recommendation: ADA Obesity Management Recommendation 8.16

citeAs: Justification for Recommendation: ADA Obesity Management Recommendation 8.16 [Database Entry: FHIR ArtifactAssessment Resource]. Contributors: In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179469. Revised 2023-12-06. Available at: https://fevir.net/resources/ArtifactAssessment/179469. Computable resource at: https://fevir.net/resources/ArtifactAssessment/179469.

artifact: Composition/179466: Recommendation: ADA Obesity Management Recommendation 8.16

content

informationType: container

summary: 8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans) and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. A

type: Recommendation Specification (Recommendation Justification Code System#RJCS-content0; Evidence Based Medicine on FHIR Implementation Guide Code System#recommendation-specification)

RelatedArtifacts

-	Type	Classifier	Citation	ResourceReference
*	derived-from	Guideline (), Citation Resource ()	8. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2021 [Journal Article]. Contributors: American Diabetes Association. In: Diabetes care, PMID 33298419. Published January 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/33298419/.	Citation/32137: JournalArticleCitation: ADA 2021 Standards of Medical Care 8. Obesity Management for the Treatment of Type 2 Diabetes

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component

informationType: comment

summary: 8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans) and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. A

type: Recommendation Statement (Evidence Based Medicine on FHIR Implementation Guide Code System#recommendation-statement)

freeToShare: true

component

informationType: classifier

type: Rating System (Evidence Based Medicine on FHIR Implementation Guide Code System#rating-system)

classifier: ADA Level of Evidence ()

freeToShare: true

component

type: Strength of Recommendation (Recommendation Justification Code System#RJCS-1000; Evidence Based Medicine on FHIR Implementation Guide Code System#strength-of-recommendation)

freeToShare: true

component

type: Direction of Recommendation (Recommendation Justification Code System#RJCS-1014; Evidence Based Medicine on FHIR Implementation Guide Code System#direction-of-recommendation)

classifier: Favors intervention (Recommendation Justification Code System#RJCS-2021)

freeToShare: true

component

type: Ratings (Evidence Based Medicine on FHIR Implementation Guide Code System#ratings)

classifier: A ()

freeToShare: true

component

type: Discussion (Evidence Based Medicine on FHIR Implementation Guide Code System#discussion)

freeToShare: true

component

summary: Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates.

type: Population (Recommendation Justification Code System#RJCS-1015; Evidence Based Medicine on FHIR Implementation Guide Code System#population)

relatedArtifact

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component

type: Action (Recommendation Justification Code System#RJCS-1016; Evidence Based Medicine on FHIR Implementation Guide Code System#action)

freeToShare: true

component

type: Opposite Action (Recommendation Justification Code System#RJCS-1017; Evidence Based Medicine on FHIR Implementation Guide Code System#opposite-action)

freeToShare: true

content

informationType: container

summary: ADA Level of Evidence A. A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions.

type: Evidence (Recommendation Justification Code System#RJCS-content1; Evidence Based Medicine on FHIR Implementation Guide Code System#evidence)

RelatedArtifacts

-	Type	Classifier	Citation	ResourceReference
*	justification	Guideline (), Citation Resource ()	Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877	Citation/33089: JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations
*	justification	Evidence Resource ()	derived from Figure 2C of: Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877	Evidence/33244: ComparativeEvidence: Mean difference in HbA1c effect of bariatric surgery in 2016 meta-analysis "MeanDiffA1c2016metaAnalysis"

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summary: ADA Level of Evidence A. A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions.

type: Summary of Findings (Evidence Based Medicine on FHIR Implementation Guide Code System#summary-of-findings)

freeToShare: true

component

type: Desirable Effects (Recommendation Justification Code System#RJCS-1004; Evidence Based Medicine on FHIR Implementation Guide Code System#desirable-effects)

freeToShare: true

component

type: Undesirable Effects (Recommendation Justification Code System#RJCS-1005; Evidence Based Medicine on FHIR Implementation Guide Code System#undesirable-effects)

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summary: A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions.<br/>In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement.

type: Discussion (Evidence Based Medicine on FHIR Implementation Guide Code System#discussion)

relatedArtifact

relatedArtifact

relatedArtifact

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content

informationType: container

type: Net Effect (Recommendation Justification Code System#RJCS-1007; Evidence Based Medicine on FHIR Implementation Guide Code System#net-effect)

freeToShare: true

Components

-	Type	FreeToShare
*	Values/Preferences (Recommendation Justification Code System#RJCS-1006; Evidence Based Medicine on FHIR Implementation Guide Code System#preferences "Preferences")	true
*	Discussion (Evidence Based Medicine on FHIR Implementation Guide Code System#discussion)	true

content

informationType: container

type: Judgments (Recommendation Justification Code System#RJCS-content2; Evidence Based Medicine on FHIR Implementation Guide Code System#judgments)

freeToShare: true

Components

-	Type	FreeToShare
*	Justification (Evidence Based Medicine on FHIR Implementation Guide Code System#justification)	true
*	Problem Importance (Recommendation Justification Code System#RJCS-1003; Evidence Based Medicine on FHIR Implementation Guide Code System#problem-importance)	true
*	Resources/Costs (Recommendation Justification Code System#RJCS-1008; Evidence Based Medicine on FHIR Implementation Guide Code System#costs "Costs")	true
*	Cost-effectiveness (Recommendation Justification Code System#RJCS-1009; Evidence Based Medicine on FHIR Implementation Guide Code System#cost-effectiveness)	true
*	Equity (Recommendation Justification Code System#RJCS-1010; Evidence Based Medicine on FHIR Implementation Guide Code System#equity)	true
*	Acceptability (Recommendation Justification Code System#RJCS-1011; Evidence Based Medicine on FHIR Implementation Guide Code System#acceptability)	true
*	Feasibility (Recommendation Justification Code System#RJCS-1012; Evidence Based Medicine on FHIR Implementation Guide Code System#feasibility)	true

content

informationType: container

type: Considerations (Recommendation Justification Code System#RJCS-content3; Evidence Based Medicine on FHIR Implementation Guide Code System#considerations)

freeToShare: true

Components

-	Summary	Type	FreeToShare
*		Subgroup Considerations (Recommendation Justification Code System#RJCS-1019; Evidence Based Medicine on FHIR Implementation Guide Code System#subgroup-considerations)	true
*		Implementation Considerations (Recommendation Justification Code System#RJCS-1020; Evidence Based Medicine on FHIR Implementation Guide Code System#implementation-considerations)	true
*		Monitoring Considerations (Recommendation Justification Code System#RJCS-1021; Evidence Based Medicine on FHIR Implementation Guide Code System#monitoring-considerations)	true
*	All members of the PPC are required to disclose potential conflicts of interest with industry and other relevant organizations. These disclosures are discussed at the outset of each Standards of Care revision meeting. Members of the committee, their employers, and their disclosed conflicts of interest are listed in 'Disclosures: Standards of Medical Care in Diabetes—2021' (https://doi.org/10.2337/dc21-SPPC). The ADA funds development of the Standards of Care out of its general revenues and does not use industry support for this purpose. NOTE: The disclosed conflicts of interest was not found at the suggested URL	Competing Interests (Recommendation Justification Code System#RJCS-1002; Evidence Based Medicine on FHIR Implementation Guide Code System#competing-interests)	true
*		Research Priorities (Recommendation Justification Code System#RJCS-1022; Evidence Based Medicine on FHIR Implementation Guide Code System#research-considerations "Research Considerations")	true