Practical example of System Engineering

Sample Answer

Strength of Cited Evidence

My thoughts on the strength of the evidence cited:

ADA/ISPAD Guidelines (e.g., Diagnostics, Insulin): These represent the highest level of evidence (Level A/Grade 1) as they are based on systematic reviews and consensus among world-leading experts. The strength is in their comprehensive nature, synthesizing multiple primary studies (often RCTs and large cohort studies) to create a standard of care. They are mandatory practice references.

The TODAY Study (2012 & 2009) & DPP Study (2002):

Strength: These are considered high-level, foundational evidence (Level I-II). The TODAY study was a large, multicenter Randomized Controlled Trial (RCT) specifically designed for youth T2DM, making its findings directly applicable to this patient's demographics (age and diagnosis). The DPP was a large RCT for pre-diabetes, and its demonstration of lifestyle efficacy is powerful evidence for the need for intensive intervention in her case.

Rationale for Use: Since pediatric T2DM studies are less numerous than adult T2DM studies, the TODAY study is the most critical and robust evidence for initial therapeutic choices (Metformin vs. others).

TODAY Observational Cohort (Pihoker et al., 2020):

Strength: This is Level III (Observational/Cohort Study). While not an RCT, its strength lies in its longitudinal design (following the TODAY participants for years) and its focus on psychosocial outcomes, which are difficult to study in an intervention trial. For guiding consultation/collaboration, the evidence from this large, specific cohort is highly compelling and robustly supports integrated care.