>> The National Care Guideline (NVL) for diabetes mellitus type 2 has finally been approved with 90% consensus! At first glance, this seems to be a success and since a guideline only specifies a treatment corridor for 80% in our patients, we could go back to business as usual; But because, in my opinion, appearances can be deceiving, let's take a look at the 10% of this guideline, which were not adopted by consensus.
These are medications and treatment options for which there is only low-grade evidence due to the fact that they have not been available for very long. And that brings us to the core of the problem: Germany and its healthcare system have an evidence problem. An extremely different understanding of evidence has long been evident in the decisions of the bodies relevant to the medical system. And the separate opinions of the remaining 10% of this NVL are based on the different definition of evidence: On the one hand, there is the group around IQWiG, DEGAM and the AkdÄ, which only understands evidence at the highest level - RCT. On the other hand, there are doctors and practitioners who consistently apply Sackett's concept of evidence in its diversity (“best available evidence”) in everyday life in order to care for the patients entrusted to them using all available options to the best of their knowledge and the latest findings.
The people who are actually affected and who are entrusted to us are sidelined: due to this NVL, interested parties and patient representatives have expressed great concerns and fears, coupled with corresponding uncertainty about adequate treatment in the future. The potentially associated negative consequences for patient care remain to be seen. It remains to be hoped that many years of motivational efforts through countless training courses and events have not been destroyed in this way!

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