Choosing Wisely in Endocrinology: Recommendations from an Expert Panel of the Colombian Association of Endocrinology, Diabetes, and Metabolism

Context: In 2022, the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE) joined the Choosing Wisely initiative to prevent low-value medical practices. Objective: To generate five evidence-based recommendations to decrease inappropriate clinical practices. Methodology: A reviewing committee was established to identify "do not do" recommendations from ACE members. The most frequent recommendations were pre-selected, and a systematic literature search was conducted. Subsequently iterative rounds were conducted using the Delphi methodology to select the five recommendations that achieved the highest consensus among the panel of experts. Results: Between October 2022 and April 2023, 117 active ACE members submitted a total of 211 recommendations. Of these, 109 were selected for further analysis. Subsequently, a Delphi panel identified five key recommendations, four of which addressed the excessive use of diagnostic tests, while the remaining one focused on therapeutic intervention. Conclusions: To avoid unnecessary procedures, routine thyroid ultrasounds should not be performed on the general population or on hypothyroid individuals without changes in their physical examination. Requesting markers of bone turnover in patients with osteoporosis is also discouraged. Additionally, measuring basal insulin and/or post-glucose load in individuals who are overweight, obese, or have signs of insulin resistance is discouraged, along with indiscriminate measurements of vitamin D and unnecessary prescription of vitamin D supplements in the general population. The implementation of these recommendations could lead to a reduction in overdiagnosis and overtreatment of patients with endocrine conditions. This would help to improve resource management, quality of care, and clinical outcomes, benefiting both patients and the healthcare system.