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The current consensus is developed in accordance with the American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines.[20] Recommendations are based on clinical importance (graded as A: strong, B: intermediate, C: weak, and D: no evidence based), which were coupled with four intuitive levels of evidence (1 = “at least one RCT or meta-analysis of RCTs,” 2 = “at least one nonrandomized or noncontrolled, prospective epidemiological study,” 3 = “cross-sectional or observational or surveillance or pilot study,” and 4 = “existing guideline or consensus expert opinion on extensive patient experience or review”) [Table 4.] Table 4