Objective To investigate the current status of evidence grading and/or recommendation classification in clinical practice guidelines for type 2 diabetes mellitus (T2DM) in China, and to provide references for improving the methodological quality of domestic diabetes guidelines.

Methods The publicly released clinical practice guidelines/consensus(hereofter referred to as the guidelines) for adult T2DM in China published in domestic and international journals from January 1, 2010 to July 1, 2025 were systematically searched to screen the literature and extract data. Descriptive analysis was performed using Excel 2024, and visualized charts were generated with Origin 2024.

Results A total of 118 Chinese T2DM guidelines were included, of which only 49 (41.5%) reported evidence grading and/or classes of recommendation, and 7 classification methods were summarized. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was the most widely applied tool. Evidence grading was mostly presented by letters and four-level classification, while recommendation classification was mainly described in text with two-level classification. Ten guidelines (8.5%) adopted the GRADE system for both evidence and recommendation grading, covering 382 recommendations, of which 337 (88.2%) reported both evidence grading and recommendation grading.

Conclusion The number of Chinese T2DM guidelines shows an increasing trend, and the application frequency of the GRADE system has gradually increased. Nevertheless, it is necessary to consolidate the evidence base and standardize classification criteria of guidelines, and to facilitate clinical decision-making and promote the standardized and scientific development of domestic guidelines.

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