Cited by 375Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

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American Association of Clinical Endocrinology consensus statement: comprehensive type 2 diabetes management algorithm—2023 update

Samson, Susan L., Vellanki, Priyathama, Blonde, Lawrence, Christofides, Elena A., Galindo, Rodolfo J., Hirsch, Irl B., Isaacs, Scott D., Izuora, Kenneth E., Low Wang, Cecilia C., Twining, Christine L., Umpierrez, Guillermo E., Valencia, Willy Marcos·2023·Endocrine Practice

DOI 10.1016/j.eprac.2023.02.001

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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.

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In-hospital initiation of sodium-glucose co-transporter-2 inhibitors in patients with acute heart failure
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Improvements in Glycemic Control With a Digital Diabetes Logbook: Secondary Analysis of a Randomized Controlled Trial Enriched by Observational, Real-World Data
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“…our analysis had 2 aims: (1) to assess whether the proportion of people with type 1 and type 2 diabetes who achieved an HbA 1c value below 6.5% [12] at follow-up was greater in the intervention arm of the RCT compared with the control group and (2) to evaluate the long-term effects on glycemic…”
Influential
Heterogeneity of Cardiovascular Effects of Second‐Line Glucose‐Lowering Therapies in Adults With Type 2 Diabetes Across the Range of Moderate Baseline Cardiovascular Risk
Deng, Y., Polley, E. C., Herrin, J. S., SWARNA, K. S., Kent, D. M., Ross, J. S., Maron, B. A., Mickelson, M. M., & McCoy, R. G. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.040217 · Cited by 3
Lobeglitazone improves glycaemic control as add‐on therapy to empagliflozin plus metformin in patients with type 2 diabetes mellitus: A double‐blind, randomised, placebo‐controlled trial
Seo, D. H., Min, K. W., Sohn, H. S., Kim, S. Y., Jeong, I., Park, C., Yoon, K., Kim, S. H., & Cha, B. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70257 · Cited by 3
Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes
Larson, R., Philbrick, A. M., Carlin, C., & Harris, I. M. (2023) · Journal of Pharmacy Technology · doi:10.1177/87551225231194027 · Cited by 3
Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study
Yeh, J., & Newsome, P. N. (2024) · Hepatology · doi:10.1097/hep.0000000000000768 · Cited by 3
Metformin for Type 2 diabetes mellitus
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“Similar recommendations are made by the American Association of Clinical Endocrinology, 11 which recommends SGLT2 or GLP-1 drugs ahead of or without metformin.”
Safety and Efficacy of Switching Patients With Type 2 Diabetes From Glucagon-Like Peptide-1 Receptor Agonists to Tirzepatide: A Case Series
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Multidisciplinary stakeholder engagement in a type 2 diabetes comparative effectiveness study utilizing real-world data
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“…therapy decisions remain complicated due to emerging drug classes and unclear comparative effectiveness of common second-line options, like GLP-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sulfonylureas [3,15].”
Real-world safety of dapagliflozin plus metformin in patients of type 2 diabetes mellitus in China: Post-hoc analysis of the DONATE study
Guo, L., Wang, J., Li, L., Yuan, L., Chen, S., Wang, H., Li, T., Qi, L., & Hong, Y. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111959 · Cited by 3
“…of SGLT2i and metformin is recommended by Chinese and international guidelines and consensus as first line treatment and is increasingly used;[4,9 – 12] a recent real-world observational study in Japan showed that SGLT2i plus metformin ranked third among dual-therapies, with 11.1% – 16.6% of…”
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Comparative Safety of Glucagon‐Like Peptide 1 Receptor Agonists ( GLP ‐1‐ RAs ) in Type 2 Diabetes and Chronic Weight Management: A Real‐World Data Study
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Compounded incretins in clinical practice: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy
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Comparative Study on Physical Activity in Diabetic and Non-Diabetic Individuals and Influential Factors — China, 2020–2021
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LOGAN-CV: A Prospective Study of a Multifaceted Intervention Targeting United States Clinicians to Improve Guideline-Based Management of Lipid-Lowering Therapy
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Endocrinology for the Hepatologist
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“The presence of MASLD in a patient with T2D calls for the use of diabetes medications with proven efficacy to reduce cardiovascular risk and prevent progression of liver disease [24, 32].”
Self-citation
ARTERIAL HYPERTENSION AND DYSLIPIDEMIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: RISK FACTORS, INTERVENTION STRATEGIES AND IMPACT ON CARDIOVASCULAR HEALTH.
França, G. R., Rosa, V. S., Rezende, ⁠. ⁠. H. M., Filho, M. D. E. C., Jansen, H. E. M., Filho, D. J. D. S., Pereira, B. M., Alves, N. C., Pinotti, J. G. F., de Araújo, M. A. A., et al. (2024) · Brazilian Journal of Implantology and Health Sciences · doi:10.36557/2674-8169.2024v6n4p577-589 · Cited by 5
Expert Consensus on Dipeptidyl Peptidase-4 Inhibitor-Based Therapies in the Modern Era of Type 2 Diabetes Mellitus Management in India
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“Studies showed that even a one-year delay in treatment intensification significantly increases the risk of cardiovascular events [30,33].”
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“Based on treatment targets recommended by the American Diabetes Association 18 and the American Association of Clinical Endocrinologists, 19 clinical development programmes of glucose-lowering agents for T2D generally assess the proportion of participants in whom HbA1c 7.0% and ≤ 6.5% is achieved.”
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Vollmer, J., Christian, W. J., & LACY, M. E. (2024) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01717-y · Cited by 3
“A1C testing has also been found to be superior to measure chronic hyperglycemia as opposed to two assessments of fasting blood sugar or OGTT tests [6].”
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“14 Importantly, it emphasizes the necessity of lifestyle modifications and treating overweight and obesity as essential components of prediabetes and diabetes management.”
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Effect of RYGB Limb Lengths on HbA1c in Patients with Obesity and Type 2 Diabetes
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Authors: Samson, S. L., Vellanki, P., Blonde, L., Christofides, E. A., Galindo, R. J., Hirsch, I. B., Isaacs, S. D., Izuora, K. E., Low Wang, C. C., Twining, C. L., Umpierrez, G. E., & Valencia, W. M.
Affiliations: Mayo Clinic (US)
Grady Memorial Hospital (US)
Ochsner Health System (US)
Indiana University Columbus (US)
University of Miami (US)
University of Washington (US)
Emory University (US)
University of Nevada, Las Vegas (US)
Maine Medical Center (US)
Cleveland Clinic (US)
ORCID: Samson, Susan L.
Vellanki, Priyathama
Blonde, Lawrence
Christofides, Elena A.
Galindo, Rodolfo J.
Hirsch, Irl B.
Isaacs, Scott D.
Izuora, Kenneth E.
Umpierrez, Guillermo E.
Valencia, Willy Marcos
Venue: Endocrine Practice
Publisher: Elsevier BV
Published: 2023-05
Volume: 29
Issue: 5
Pages: 305-340
ISSN: 1530-891X (ISSN-L)
DOI: 10.1016/j.eprac.2023.02.001
OpenAlex: W4372214811
Semantic Scholar: 066a5bccabf1b093084ed77c43509daa1c94c321
Cited by: 375
References: 181
Citations by year: 2026: 62 · 2025: 150 · 2024: 124 · 2023: 38
FWCI: 76.07
Type: journal article
Language: en
Update notices: erratum (2023-12-01)
erratum (2023-09-01)
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Endocrine Practice (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (K23DK123384)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: type 2 diabetes, prediabetes, glycemic control, dyslipidemia, hypertension, insulin intensification, antihyperglycemic medications, anti-obesity drugs, obesity, lifestyle modification, health equity
MeSH terms: Endocrinologists, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Endocrinology, Glucose, Humans, Hypertension, Obesity, Prediabetic State, United States, Dyslipidemias, Overweight

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American Association of Clinical Endocrinology consensus statement: comprehensive type 2 diabetes management algorithm—2023 update

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