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American Association of Clinical Endocrinology consensus statement: comprehensive type 2 diabetes management algorithm—2023 update
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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“While recent guidelines call for continuous glucose monitoring (CGM) use for all who require insulin, regardless of diabetes type (7), there is also evidence that patients may not know how to interpret what to do with the CGM data (6, 8, 9).”
From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [7]
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“The American Diabetes Association (ADA) and Korean Diabetes Association (KDA) recommend assessing comorbidities before prescribing DM drugs [9,10].”
BackgroundManagement of type 2 diabetes after metabolic bariatric surgery
Tham, K. W., & Lee, P. C. (2023) · Mini-invasive Surgery · doi:10.20517/2574-1225.2023.80
Nutrition counsellors’ recommended eating patterns for individuals with type 2 diabetes in the USA
KHOSROVANEH, K. L., Hisamatsu, R., Reiss, J., RAU, J., Oshman, L. D., Diez, H. L., Lee, J. M., Aikens, J. E., Richardson, C. R., & Hafez, D. (2024) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2023-000845 · Cited by 1
“Respondents who recommended low-carbohydrate and/or very low-carbohydrate eating pattern(s) to their patients were also asked to report their perceived benefits and concerns about those eating pattern(s) (figure 1).”
BackgroundMetabolic background as the basis for comorbidity in patients with type 2 diabetes mellitus
Demidova, T. Y., & Омариевна, У. Ф. (2024) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2024-137
Cardiovascular Disease Risk and Risk Reduction Strategies in Diabetes Mellitus
Wilson, D. P., Hamilton, L., & Maki, K. C. (2024) · Contemporary cardiology · doi:10.1007/978-3-031-54960-1_14
Ghosh, S. K., WANGNOO, S. K., Chittawar, S., Damodharan, S., Kadam, Y., Kalra, P., Kumar, K. P. S., Periyandavar, I., Sharma, S. K., & Zargar, A. H. (2024) · Journal of Endocrinology and Metabolism · doi:10.14740/jem946
Çimen, İ. (2024) · Science China Life Sciences · doi:10.1007/s11427-024-2667-2
“Diabetes significantly increases the occurrence and adverse prognosis of coronary heart disease, with consensus pointing towards its treatment focusing on the prevention and management of diabetes complications (Samson et al., 2023).”
Kalra, P., Dharmalingam, M., Kubba, S. V., Bhojwani, H. R., & Jain, S. (2024) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20241968
Арутюнов, Г. П., Галстян, Г. Р., Т., Ю. Д., Dzgoeva, F. K., Владиславович, Е. М., В., Ю. К., Г., А. К., Д., В. Л., И., В. С., Ф., Е. Ш., et al. (2024) · Атеросклероз и дислипидемии · doi:10.34687/2219-8202.jad.2024.02.0001 · Cited by 1
Paradigm shift in diabetes care: Glucose-centric to cardio-metabolicrenal approach
Rameshkumar, T., & Katulanda, P. (2022) · Ceylon Journal of Medical Science · doi:10.4038/cjms.v59i1.5065
Ji, C. X., Blecker, S., Oberst, M., Shih, M., Horwitz, L. I., & Sontag, D. A. (2024) · medRxiv · doi:10.1101/2024.09.19.24313155
Hau, N. V. V., Bang, N. V., Xuan, N. T., Linh, P. N. T., Thoi, N. T. N., Trang, V. T., Trung, P. M., Chi, L. V., & Thuy, N. H. (2024) · Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế · doi:10.38103/jcmhch.16.8.12
Cai, X., Ji, L., Yuan, M., Ma, J., Bian, F., Li, S., Pang, W., Yan, S., Zhou, H., Hou, M., et al. (2024) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2024.101197
Use of Automated Machine Learning to Detect Undiagnosed Diabetes in U.S. Adults (Preprint)Preprint
Ji, M., & An, R. (2024) · doi:10.2196/preprints.68260
Evaluating the Impact of Integrating Ayurveda with Allopathy in Diabetes Management: A Meta-Analysis
Murugaiyan, V., Samuel, K. S. K. J., Kalaiselvan, S., & Marokey, A. S. (2024) · Biosciences Biotechnology Research Asia · doi:10.13005/bbra/3310
Karara, M. W., Okalebo, F., Karimi, P. N., & Opanga, S. A. (2025) · Journal of Advances in Medical and Pharmaceutical Sciences · doi:10.9734/jamps/2025/v27i1742
Cai, J., Li, P., Li, W., Hao, X., Li, S., & Zhu, T. (2024) · doi:10.2196/preprints.70475
Mbaye, M. N., Anzouan-Kacou, J.-B., Tia, W. M., Bamba, D., Dione, J.-M. A., Kâ, E. H. F., Kane, A. D., Ngaïdé, A. A., Niang, A., Moke-Bédji, L. O., et al. (2025) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2025.01.001
Zhang, J., Li, A., Quan, J., Wu, J. J., Cai, H., Ding, Y., Tang, J., Ma, X., & Zhang, J. (2025) · Diabetes Therapy · doi:10.1007/s13300-024-01690-8
“…for instance, to achieve HbA1c levels ≤ 6.5% or as close to normal as possible, was advocated by the American Association of Clinical Endocrinologists Consensus for most patients and it was also recommended in the CDS guideline for some patients in better overall health conditions [11, 13].”
InfluentialAbordaje racional de la prediabetes
Cuenca, A. M. C., Flores, A. E., Moore, J. R., Coman, A. C., & Hernández, M. L. (2025) · FMC - Formación Médica Continuada en Atención Primaria · doi:10.1016/j.fmc.2024.05.010
Inhibidores del cotransportador de sodio-glucosa tipo 2
Martínez, E., & Fernández, I. V. (2025) · Actualización en Medicina de Familia · doi:10.55783/amf.210205
3. Blood glucose-lowering therapies – Non-insulin options for type 2 diabetes
Colagiuri, S., & Ceriello, A. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112147
Digital Decision Support for Perioperative Care of Patients With Type 2 Diabetes: A Call to Action
Cai, J., Li, P., Li, W., Hao, X., Li, S., & Zhu, T. (2025) · JMIR Diabetes · doi:10.2196/70475
“As the American Association of Clinical Endocrinology stated in their 2023 Type 2 Diabetes Management Algorithm [16], personalized care is emphasized through evidence-based tools such as continuous glucose monitoring and automated insulin dosing systems.”
Sobczak, C., Oser, S. M., Warman, M., Daffron, A., Buss, D., Wettergreen, S. A., Oser, T. K., Parascando, J. A., & Jortberg, B. T. (2025) · ADCES in Practice · doi:10.1177/2633559x251328956
Pulipati, V. P., Zilbermint, M. F., & Patel, S. B. (2025) · Endocrine Practice · doi:10.1016/j.eprac.2025.04.009
Prevalence of Heart Failure With Type 1 Diabetes and Type 2 Diabetes Among US Adults
Chetty, A. K., & Chen, A. S. (2025) · Endocrine Practice · doi:10.1016/j.eprac.2025.04.019
Clinical pharmacist roles in a virtual continuous glucose monitor initiation service
Wettergreen, S. A., Sobczak, C., Jortberg, B. T., Oser, S. M., Buss, D., Parascando, J. A., Daffron, A., & Oser, T. K. (2025) · JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY · doi:10.1002/jac5.70046
“21 – 25 Despite the clinical, behavioral, and psychosocial benefits of CGM in people with type 1 and type 2 diabetes, access is relatively limited outside of endocrinology practices.”
Metadata
- 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
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2023-05
- Volume
- 29
- Issue
- 5
- Pages
- 305-340
- ISSN
- 1530-891X (ISSN-L)
- 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
- Open access
- closed
- 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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