Daily Dose: AACE Updates Algorithm for Type 2 Diabetes Management

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On May 8, 2023, we reported on the American Association of Clinical Endocrinology (AACE) 2023 Comprehensive Type 2 Diabetes Management Algorithm unveiled at the AACE Annual Meeting held May 4-6, 2023, in Seattle, Washington.

The algorithm

The 2023 algorithm supplements AACE’s 2022 Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan and emphasizes the need to assess other health concerns, including cardiovascular disease and chronic kidney disease (CKD), to frame pharmacologic decisions for the treatment of type 2 diabetes (T2D). The complications-centric algorithm focuses on patients with T2D who also have atherosclerotic cardiovascular disease (ASCVD), heart failure, stroke, or chronic kidney disease. For persons with ASCVD, clinicians should start treatment with a GLP-1 receptor agonist or SGLT2 inhibitor. Patients with heart failure should receive an SGLT2, whereas those with stroke should receive a GLP-1 or pioglitazone, and adults with CKD should begin therapy with an SGLT2 or GLP-1.

Like the 2022 AACE diabetes guideline, the updated algorithm also emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and T2D. In addition, the algorithm includes access and cost of medications as factors related to health equity to consider in clinical decision-making.

Another new section in the 2023 algorithm is immunization recommendations for patients with T2D, which recommends patients should receive vaccinations according to the Centers for Disease Control and Prevention’s recommended immunization schedule. The paper also details each recommended vaccination and when it should be received.

Note from author

"Over the last several years, the paradigm of diabetes treatment has changed from a strict focus on glucose control and a one-size-fits-all approach, to a personalized assessment that considers a person's existing risks for cardiac events or kidney failure, so we can choose the right medication to decrease those risks," said first author and president-elect of AACE Susan L. Samson, MD, PhD. "Therefore, the latest algorithm provides a road map to easily navigate care and treatment based on both glycemic control and other conditions to improve a person's health and quality of life."

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