OBJECTIVE:This consensus statement provides evidence-based visual guidance in graphic algorithms and a summary of evidence and considerations to assist health care professionals with the diagnosis and management of adults with prediabetes and diabetes mellitus in shared decision making to improve care. METHODS:The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts to update the 2023 AACE Comprehensive Type 2 Diabetes Management Algorithm and align this algorithm update with related AACE clinical guidance. RESULTS:This algorithm for management of adults with type 2 diabetes (T2D) includes 11 sections: (1) Principles for the Management of Adults With T2D; (2) Prediabetes Algorithm (3) Diabetes Classification Algorithm (new); (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Comorbidities- and Complications-Centric Glycemic Control Algorithm; (7) Glucose-Centric Glycemic Control Algorithm; (8) Initiating and Titrating Insulin Algorithm; (9) Profiles of Pharmacotherapy for T2D; (10) Profiles of Pharmacotherapy for Obesity; and (11) Vaccine Recommendations for Adults With T2D. CONCLUSIONS:This 2026 update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and T2D. It also provides guidance on the management of atherosclerotic risk factors of dyslipidemia and hypertension. A new algorithm was added to ensure that other causes and classes of diabetes are considered beyond T2D. There continues to be an emphasis on a complications- and comorbidities-centric approach, beyond glucose levels, to frame decisions regarding first-line and subsequent pharmacological choices for treating adults with T2D.
BACKGROUND:In patients with myocardial infarction (MI), quantifying expression of platelet FcɣRIIa (pFCG) stratifies risk of subsequent MI, stroke, and death. AIMS:Assess the prognostic implications of clinical risk alone and in combination with the pFCG test. METHODS:Patients (n = 749) were enrolled in a prospective non-interventional trial during hospitalization with type 1 MI (ST elevation and non-ST elevation). Inclusion criteria included ≥ 2 of the following clinical risk factors: age ≥ 65, multi-vessel coronary artery disease, prior MI, chronic kidney disease, or diabetes mellitus. High and low pFCG (quantified by flow cytometry at a core laboratory) were defined by a prespecified threshold. The primary endpoint was the composite of MI, stroke, and death. RESULTS:Distribution of clinical risk factors was 346 patients (45%) with 2 factors, 272 patients (36%) with 3 factors, and 131 patients (17%) with 4 or 5 factors. A greater number of risk factors was associated with a greater risk of the composite of MI, stroke, and death after 1 year. The event rate with 2 risk factors was 10.2%, with 3 factors it was 14.4%, and with 4/5 factors it was 35.6%. Across all cohorts of clinical risk, the pFCG test identified a higher-risk and a lower-risk cohort. CONCLUSIONS:Both clinical risk and the pFCG test assess prognosis. Results of the pFCG test refine the prognosis defined by clinical risk. The prognostic implications suggest that the pFCG test may be a useful tool to balance ischemic risk with that of bleeding to define treatment strategy. CLINICAL TRIAL REGISTRATION:https://clinicaltrials.gov/study/NCT05175261.
Chemotherapy-induced nausea and vomiting (CINV) remains a significant challenge in pediatric oncology, with limited data guiding optimal antiemetic regimens. This phase 2 study evaluated pharmacokinetics (PK), pharmacodynamics, efficacy, and safety of oral netupitant combined with oral palonosetron (NEPA) in pediatric patients receiving highly or moderately emetogenic chemotherapy. In this multicenter, randomized, double-blind, dose-finding study, pediatric patients (< 18 years) were stratified by age, chemotherapy emetogenicity, and schedule. Patients received one of two netupitant doses (1.33 or 4 mg/kg) with palonosetron (20 µg/kg). Efficacy was assessed via complete response (CR; no emesis and no rescue medication) during acute (0–24h), delayed (> 24–120h), and overall (0–120h) phases. PK parameters were derived from plasma concentrations of netupitant, its metabolites, and palonosetron. Safety was monitored through adverse events and clinical assessments. Among 65 evaluable patients, CR rates were 85.3
