American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update

Susan L Samson; Priyathama Vellanki; Lawrence Blonde; Elena A Christofides; Rodolfo J Galindo; Irl B Hirsch; Scott D Isaacs; Kenneth E Izuora; Cecilia C Low Wang; Christine L Twining; Guillermo E Umpierrez; Willy Marcos Valencia

doi:10.1016/j.eprac.2023.02.001

American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update

Endocr Pract. 2023 May;29(5):305-340. doi: 10.1016/j.eprac.2023.02.001.

Affiliations

¹ Chair of Task Force; Chair of the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
² Vice Chair of Task Force; Associate Professor of Medicine, Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Emory University; Section Chief, Endocrinology, Grady Memorial Hospital, Atlanta, Georgia.
³ Director, Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Health, New Orleans, Louisiana.
⁴ Endocrinology Associates, Inc., Columbus, Ohio.
⁵ Associate Professor of Medicine, University of Miami Miller School of Medicine; Director, Comprehensive Diabetes Center, Lennar Medical Center, UMiami Health System; Director, Diabetes Management, Jackson Memorial Health System, Miami, Florida.
⁶ Professor of Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
⁷ Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
⁸ Associate Professor, Department of Internal Medicine, Endocrinology, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada.
⁹ Professor of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
¹⁰ Endocrinology, Diabetes and Metabolism, Maine Medical Center, Maine Health, Scarborough, Maine.
¹¹ Professor of Medicine, Emory University School of Medicine, Division of Endocrinology, Metabolism; Chief of Diabetes and Endocrinology, Grady Health Systems, Atlanta, Georgia.
¹² Endocrinology and Metabolism Institute, Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio.

PMID: 37150579
DOI: 10.1016/j.eprac.2023.02.001

Abstract

Objective: This consensus statement provides (1) visual guidance in concise graphic algorithms to assist with clinical decision-making of health care professionals in the management of persons with type 2 diabetes mellitus to improve patient care and (2) a summary of details to support the visual guidance found in each algorithm.

Methods: The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts who updated the 2020 AACE Comprehensive Type 2 Diabetes Management Algorithm based on the 2022 AACE Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan and consensus of task force authors.

Results: This algorithm for management of persons with type 2 diabetes includes 11 distinct sections: (1) Principles for the Management of Type 2 Diabetes; (2) Complications-Centric Model for the Care of Persons with Overweight/Obesity; (3) Prediabetes Algorithm; (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Complications-Centric Algorithm for Glycemic Control; (7) Glucose-Centric Algorithm for Glycemic Control; (8) Algorithm for Adding/Intensifying Insulin; (9) Profiles of Antihyperglycemic Medications; (10) Profiles of Weight-Loss Medications (new); and (11) Vaccine Recommendations for Persons with Diabetes Mellitus (new), which summarizes recommendations from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention.

Conclusions: Aligning with the 2022 AACE diabetes guideline update, this 2023 diabetes algorithm update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and diabetes mellitus and highlights the importance of appropriate management of atherosclerotic risk factors of dyslipidemia and hypertension. One notable new theme is an emphasis on a complication-centric approach, beyond glucose levels, to frame decisions regarding first-line pharmacologic choices for the treatment of persons with diabetes. The algorithm also includes access/cost of medications as factors related to health equity to consider in clinical decision-making.

Keywords: diabetes algorithm; diabetes management; diabetes mellitus; diabetes treatment; type 2 diabetes.

Publication types

Practice Guideline

MeSH terms

Cardiovascular Diseases*
Diabetes Mellitus, Type 2* / drug therapy
Dyslipidemias* / therapy
Endocrinologists
Endocrinology*
Glucose / therapeutic use
Humans
Hypertension*
Obesity / therapy
Overweight
Prediabetic State* / therapy
United States

Substances

Glucose

Grants and funding

K23 DK123384/DK/NIDDK NIH HHS/United States