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AACE/ACE Consensus Statement

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AACE/ACE Consensus Statement AACE/ACE Consensus Statement CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM – 2019 EXECUTIVE SUMMARY Alan J. Garber, MD, PhD, MACE1; Martin J. Abrahamson, MD2; Joshua I. Barzilay, MD, FACE3; Lawrence Blonde, MD, FACP, MACE4; Zachary T. Bloomgarden, MD, MACE5; Michael A. Bush, MD, FACE6; Samuel Dagogo-Jack, MD, FACE7; Ralph A. DeFronzo, MD8; Daniel Einhorn, MD, FACP, FACE9; Vivian A. Fonseca, MD, FACE10; Jeffrey R. Garber, MD, FACP, FACE11; W. Timothy Garvey, MD, FACE12; George Grunberger, MD, FACP, FACE13; Yehuda Handelsman, MD, FACP, FNLA, MACE14; Irl B. Hirsch, MD15; Paul S. Jellinger, MD, MACE16; Janet B. McGill, MD, FACE17; Jeffrey I. Mechanick, MD, FACN, FACP, FACE, ECNU18; Paul D. Rosenblit, MD, PhD, FNLA, FACE19; Guillermo E. Umpierrez, MD, FACP, FACE20 NOTE: This is a corrected version of the article originally published in Volume 25, Issue 1, January 2019 issue of Endocrine Practice. A correction will be published in the February 2019 issue of Endocrine Practice outlining the revisions. This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician. Accepted for publication December 15, 2018 Wayne State University School of Medicine, Professor, Internal Medicine, From the 1Chair, Professor, Departments of Medicine, Biochemistry Oakland University William Beaumont School of Medicine, Visiting and Molecular Biology, and Molecular and Cellular Biology, Baylor Professor, Internal Medicine, First Faculty of Medicine, Charles University, College of Medicine, Houston, Texas, 2Beth Israel Deaconess Medical Prague, Czech Republic, Past President, American Association of Clinical Center, Department of Medicine and Harvard Medical School, Boston, Endocrinologists, 14Medical Director & Principal Investigator, Metabolic Massachusetts, 3Division of Endocrinology Kaiser Permanente of Georgia Institute of America, Chair, AACE Lipid and Cardiovascular Health Disease and the Division of Endocrinology, Emory University School of Medicine, State Network, Tarzana, California, 15Professor of Medicine, University of Atlanta, Georgia, 4Director, Ochsner Diabetes Clinical Research Unit, Washington School of Medicine, Seattle, Washington, 16Professor of Clinical Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medicine, University of Miami, Miller School of Medicine, Miami, Florida, Medical Center, New Orleans, Louisiana, 5Clinical Professor, Department The Center for Diabetes & Endocrine Care, Hollywood, Florida, Past of Medicine, Icahn School of Medicine at Mount Sinai, Editor, the President, American Association of Clinical Endocrinologists, 17Professor Journal of Diabetes, New York, New York, 6Past Clinical Chief, Division of of Medicine, Division of Endocrinology, Metabolism & Lipid Research, Endocrinology, Cedars-Sinai Medical Center, Associate Clinical Professor Washington University School of Medicine, St. Louis, Missouri, 18Professor of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California, of Medicine, Medical Director, The Marie-Josee and Henry R. Kravis Center 7Professor and Director, Division of Endocrinology, Diabetes, & Metabolism, for Clinical Cardiovascular Health at Mount Sinai Heart, Director, Metabolic A.C. Mullins Chair in Translational Research, Director, Clinical Research Support, Divisions of Cardiology and Endocrinology, Diabetes, and Bone Center, University of Tennessee Health Science Center, Memphis, Disease, Icahn School of Medicine at Mount Sinai, New York, New York, Past Tennessee, 8Professor of Medicine, Chief, Diabetes Division, University President, American Association of Clinical Endocrinologists, Past President, of Texas Health Science Center at San Antonio, San Antonio, Texas, American College of Endocrinology, 19Clinical Professor, Medicine, Division 9Medical Director, Scripps Whittier Diabetes Institute, Clinical Professor of of Endocrinology, Diabetes, Metabolism, University California Irvine School Medicine, UCSD, President, Diabetes and Endocrine Associates, La Jolla, of Medicine, Irvine, California, Co-Director, Diabetes Out-Patient Clinic, California, 10Professor of Medicine and Pharmacology, Assistant Dean for UCI Medical Center, Orange, California, Director & Principal Investigator, Clinical Research, Tullis Tulane Alumni Chair in Diabetes, Chief, Section Diabetes/Lipid Management & Research Center, Huntington Beach, of Endocrinology, Tulane University Health Sciences Center, New Orleans, California, and 20Professor of Medicine, Emory University, Section Head,, Louisiana, 11Endocrine Division, Harvard Vanguard Medical Associates, Diabetes & Endocrinology, Grady Health System, Atlanta, Georgia, Editor- Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, in-Chief, BMJ Open Diabetes Research & Care. Massachusetts, 12Butterworth Professor, Department of Nutrition Sciences, Address correspondence to American Association of Clinical University of Alabama at Birmingham, Director, UAB Diabetes Research Endocrinologists, 245 Riverside Avenue, Suite 200, Jacksonville, FL 32202. Center, GRECC Investigator and Staff Physician, Birmingham VAMC, E-mail: [email protected]. DOI: 10.4158/CS-2018-0535 Birmingham, Alabama, 13Chairman, Grunberger Diabetes Institute, To purchase reprints of this article, please visit: www.aace.com/reprints. Clinical Professor, Internal Medicine and Molecular Medicine & Genetics, Copyright © 2019 AACE. ENDOCRINE PRACTICE Vol 25 No. 1 January 2019 69 70 Diabetes Management Algorithm, Endocr Pract. 2019;25(No. 1) apy and all classes of obesity, antihyperglycemic, lipid- Abbreviations: lowering, and antihypertensive medications approved by A1C = hemoglobin A1C; AACE = American the U.S. Food and Drug Administration (FDA) through Association of Clinical Endocrinologists; ACCORD December 2018. = Action to Control Cardiovascular Risk in Diabetes; This algorithm supplements the American Association ACCORD BP = Action to Control Cardiovascular Risk of Clinical Endocrinologists (AACE) and American College in Diabetes Blood Pressure; ACE = American College of Endocrinology (ACE) 2015 Clinical Practice Guidelines of Endocrinology; ACEI = angiotensin-converting for Developing a Diabetes Mellitus Comprehensive Care enzyme inhibitor; AGI = alpha-glucosidase inhibitor; Plan (4) and is organized into discrete sections that address apo B = apolipoprotein B; ARB = angiotensin II recep- the following topics: the founding principles of the algo- tor blocker; ASCVD = atherosclerotic cardiovascular rithm, lifestyle therapy, obesity, prediabetes, management disease; BAS = bile acid sequestrant; BMI = body mass of hypertension and dyslipidemia, and glucose control with index; BP = blood pressure; CCB = calcium chan- noninsulin antihyperglycemic agents and insulin. In the nel blocker; CGM = continuous glucose monitoring; accompanying algorithm, a chart summarizing the attri- CHD = coronary heart disease; CKD = chronic kidney butes of each antihyperglycemic class appears at the end. disease; DKA = diabetic ketoacidosis; DPP4 = dipep- tidyl peptidase 4; eGFR = estimated glomerular filtra- Principles tion rate; EPA = eicosapentaenoic acid; ER = extended The founding principles of the Comprehensive Type release; FDA = Food and Drug Administration; GLP1 2 Diabetes Management Algorithm are as follows (see = glucagon-like peptide 1; HDL-C = high-density- Comprehensive Type 2 Diabetes Management Algorithm— lipoprotein cholesterol; HeFH = heterozygous famil- Principles): ial hypercholesterolemia; LDL-C = low-density-lipo- 1. Lifestyle optimization is essential for all patients protein cholesterol; LDL-P = low-density-lipoprotein with diabetes. Lifestyle optimization is multifaceted, particle; Look AHEAD = Look Action for Health in ongoing, and should engage the entire diabetes team. Diabetes; NPH = neutral protamine Hagedorn; OSA = However, such efforts should not delay needed phar- obstructive sleep apnea; PCSK9 = proprotein conver- macotherapy, which can be initiated simultaneously tase subtilisin-kexin type 9 serine protease; RCT = and adjusted based on patient response to lifestyle randomized controlled trial; SU = sulfonylurea; SGLT2 efforts. The need for medical therapy should not be = sodium-glucose cotransporter 2; SMBG = self-moni- interpreted as a failure of lifestyle management but as toring of blood glucose; T2D = type 2 diabetes; TZD = an adjunct to it. thiazolidinedione 2. Minimizing the risk of both severe and nonsevere hypoglycemia is a priority. It is a matter of safety, adherence, and cost. EXECUTIVE SUMMARY 3. Minimizing risk of weight gain is also a priority. This is important for long-term health, in addition to safety, This algorithm for the comprehensive management adherence, and cost. Weight loss should be consid- of persons with type 2 diabetes (T2D) was developed to ered in all patients with prediabetes and T2D who provide clinicians with a practical guide that considers the also have overweight or obesity.
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