const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Clinical Update";
pres.title = "Latest Updates: Hypertension & Diabetes Mellitus 2025–2026";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
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// ─── TABLE SLIDE ──────────────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE 1 — TITLE SLIDE
// ═══════════════════════════════════════════════════════════════════════════════
{
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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE 2 — TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════════════════════════
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    { num: "01", label: "Hypertension — Classification & Diagnosis", color: C.navy },
    { num: "02", label: "Hypertension — 2025 Guideline Key Updates", color: C.teal },
    { num: "03", label: "Hypertension — Pharmacotherapy & Special Populations", color: C.navy },
    { num: "04", label: "Hypertension — Lifestyle & Risk Assessment (PREVENT)", color: C.teal },
    { num: "05", label: "Diabetes Mellitus — Overview & Classification", color: C.navy },
    { num: "06", label: "DM — ADA 2025/2026 Glycemic Targets & Monitoring", color: C.teal },
    { num: "07", label: "DM — Pharmacotherapy: GLP-1 RAs, SGLT2i, New Agents", color: C.navy },
    { num: "08", label: "DM — Cardiovascular & Renal Risk Reduction", color: C.teal },
    { num: "09", label: "DM — Special Populations (Obesity, CKD, HF, Pregnancy)", color: C.navy },
    { num: "10", label: "HTN + DM — Overlap, Dual Management Strategies", color: C.teal },
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// ═══════════════════════════════════════════════════════════════════════════════
//  ──── SECTION 1: HYPERTENSION ────────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionDivider(pres, "SECTION I", "Hypertension — Updates 2025");

// SLIDE: Classification
addTableSlide(pres, "BP Classification (2025 AHA/ACC — Unchanged from 2017)", [
  [
    { text: "Category", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
    { text: "Systolic (mmHg)", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
    { text: "", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
    { text: "Diastolic (mmHg)", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
    { text: "Action", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
  ],
  [
    { text: "Normal", options: { color: C.green, bold: true } },
    { text: "< 120", options: {} },
    { text: "AND", options: { align: "center" } },
    { text: "< 80", options: {} },
    { text: "No intervention; encourage lifestyle", options: {} }
  ],
  [
    { text: "Elevated", options: { color: C.amber, bold: true } },
    { text: "120–129", options: {} },
    { text: "AND", options: { align: "center" } },
    { text: "< 80", options: {} },
    { text: "Lifestyle modification", options: {} }
  ],
  [
    { text: "Stage 1 HTN", options: { color: "E06020", bold: true } },
    { text: "130–139", options: {} },
    { text: "OR", options: { align: "center" } },
    { text: "80–89", options: {} },
    { text: "Lifestyle ± medication (risk-guided)", options: {} }
  ],
  [
    { text: "Stage 2 HTN", options: { color: C.red, bold: true } },
    { text: "≥ 140", options: {} },
    { text: "OR", options: { align: "center" } },
    { text: "≥ 90", options: {} },
    { text: "Lifestyle + medication (2 agents)", options: {} }
  ],
  [
    { text: "Hypertensive Crisis", options: { color: C.red, bold: true } },
    { text: "> 180", options: {} },
    { text: "AND/OR", options: { align: "center" } },
    { text: "> 120", options: {} },
    { text: "Urgent/emergent evaluation", options: {} }
  ],
]);

// SLIDE: 2025 key updates
addContentSlide(pres, "2025 AHA/ACC Hypertension Guideline — Major Updates", [
  { text: "New Risk Calculator: PREVENT Tool", bold: true, color: C.navy },
  { text: "Replaces Pooled Cohort Equations (PCE); estimates 10- and 30-year ASCVD + HF risk", sub: true },
  { text: "Threshold for initiation: SBP ≥130 OR DBP ≥80 mmHg (even lower-risk Stage 1 patients)", sub: true },
  { text: "Pharmacotherapy Target: < 130/80 mmHg for most adults (UNCHANGED)", bold: true, color: C.navy },
  { text: "Now explicitly recommended (Class I) vs. previous 'reasonable' language", sub: true },
  { text: "Cognitive Protection — UPGRADED to Class I", bold: true, color: C.navy },
  { text: "Intensive SBP < 120 mmHg reduces dementia/MCI (SPRINT 7-year data); Rec: SBP < 130 mmHg", sub: true },
  { text: "ACEI and ARB — Both now Class I for CKD/albuminuria (can use either, NOT both)", bold: true, color: C.navy },
  { text: "Bayesian NMA of 119 RCTs supports benefit on kidney failure, MACE, mortality", sub: true },
  { text: "Secondary HTN Screening — Broader indications", bold: true, color: C.navy },
  { text: "Renovascular, primary aldosteronism, OSA, pheochromocytoma — earlier consideration", sub: true },
  { text: "Ambulatory/Home BP Monitoring — Highlighted for masked & nocturnal HTN", bold: true, color: C.navy },
], { headerColor: C.navy });

// SLIDE: Pharmacotherapy
addContentSlide(pres, "First-Line Antihypertensive Therapy — 2025 Update", [
  { text: "First-line agents (UNCHANGED — still recommended as a class)", bold: true, color: C.navy },
  { text: "Thiazide/thiazide-like diuretics (chlorthalidone preferred over HCTZ)", sub: true },
  { text: "Dihydropyridine calcium channel blockers (amlodipine)", sub: true },
  { text: "ACE inhibitors (lisinopril, ramipril)", sub: true },
  { text: "Angiotensin receptor blockers (losartan, olmesartan)", sub: true },
  { text: "ACEi vs ARB — Now BOTH Class I (not just ACEi)", bold: true, color: C.teal },
  { text: "Either may be used; combination of both is NOT recommended (risk of AKI, hyperkalemia)", sub: true },
  { text: "Combination therapy", bold: true, color: C.navy },
  { text: "For BP ≥ 20/10 mmHg above goal: initiate 2 agents simultaneously", sub: true },
  { text: "Preferred: RAS blocker + CCB; or RAS blocker + thiazide diuretic", sub: true },
  { text: "Triple therapy: RAS + CCB + diuretic if still uncontrolled", sub: true },
  { text: "Resistant HTN: consider mineralocorticoid receptor antagonist (spironolactone)", sub: true },
  { text: "β-blockers: reserved for compelling indications (HF, post-MI, AF, angina)", bold: true, color: C.sub },
], { headerColor: C.teal });

// SLIDE: Special Populations
addTwoColSlide(pres, "Special Populations — 2025 AHA/ACC Guidelines",
  "Diabetes + HTN", [
    "BP target: < 130/80 mmHg (130/80 if safely attainable)",
    "ACEI or ARB: preferred when eGFR < 60 or albuminuria ≥ 30 mg/g (Class I-A)",
    "Even mild albuminuria (< 30 mg/g): consider ACEI/ARB to slow DKD",
    "SBP < 120 mmHg may be considered for high CV/kidney risk (ADA 2026)",
    "Home/ambulatory monitoring: detect nocturnal dipping",
    "Lifestyle: DASH diet, weight loss, Na restriction",
  ],
  "Chronic Kidney Disease", [
    "BP target: < 130/80 mmHg",
    "ACEI or ARB: first-line (Class I) for proteinuric CKD",
    "Monitor eGFR and K+ closely after initiation",
    "Diuretics: loop diuretics preferred when eGFR < 30",
    "Elderly/frail: individualize; target < 140/90 may be appropriate",
    "Pregnancy: labetalol, nifedipine, methyldopa safe; avoid ACEi/ARB",
  ],
  { headerColor: C.teal }
);

// SLIDE: Lifestyle & PREVENT tool
addContentSlide(pres, "Lifestyle Modifications & PREVENT Risk Tool — 2025 Update", [
  { text: "Lifestyle Modification — Updated Terminology & Evidence", bold: true, color: C.navy },
  { text: "DASH diet: ↓ SBP by 8–14 mmHg; low-Na diet: ↓ 2–8 mmHg", sub: true },
  { text: "Regular aerobic exercise (150 min/week): ↓ 4–9 mmHg", sub: true },
  { text: "Weight reduction: ↓ ~1 mmHg per kg lost", sub: true },
  { text: "Limit alcohol: ≤ 1 drink/day (women), ≤ 2 drinks/day (men)", sub: true },
  { text: "Smoking cessation: comprehensive CV risk reduction", sub: true },
  { text: "PREVENT Calculator (Predicting Risk of CVD EVENTs) — NEW", bold: true, color: C.teal },
  { text: "Replaces Pooled Cohort Equations; includes HF risk (not just ASCVD)", sub: true },
  { text: "Estimates both 10-year and 30-year CVD risk", sub: true },
  { text: "Includes patients with diabetes and CKD (previously excluded from PCE)", sub: true },
  { text: "Stage 1 HTN + PREVENT ≥ 7.5%: initiate pharmacotherapy NOW", sub: true },
  { text: "Stage 1 HTN + PREVENT < 7.5%: 3–6 months lifestyle → reassess", sub: true },
], { headerColor: C.midBlue });

// ═══════════════════════════════════════════════════════════════════════════════
//  ──── SECTION 2: DIABETES MELLITUS ───────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionDivider(pres, "SECTION II", "Diabetes Mellitus — Updates 2025–2026");

// SLIDE: DM Classification
addContentSlide(pres, "Diabetes Mellitus — Classification & Diagnosis", [
  { text: "Diagnostic Criteria (Unchanged — ADA 2025/2026)", bold: true, color: C.navy },
  { text: "HbA1c ≥ 6.5%  |  FPG ≥ 126 mg/dL  |  2h OGTT ≥ 200 mg/dL  |  Random ≥ 200 with symptoms", sub: true },
  { text: "Prediabetes: HbA1c 5.7–6.4%  |  FPG 100–125 mg/dL  |  OGTT 140–199 mg/dL", sub: true },
  { text: "Type Classification", bold: true, color: C.navy },
  { text: "Type 1 DM: autoimmune β-cell destruction; absolute insulin deficiency; positive antibodies (GADA, IA-2)", sub: true },
  { text: "Type 2 DM: insulin resistance + progressive β-cell dysfunction; most common (~90–95%)", sub: true },
  { text: "Gestational DM: diagnosed at 24–28 weeks; OGTT screen", sub: true },
  { text: "MODY: monogenic; family history; young onset; consider genetic testing", sub: true },
  { text: "New: Type 1 DM Staging", bold: true, color: C.teal },
  { text: "Stage 1: +antibodies, normoglycemia | Stage 2: dysglycemia | Stage 3: clinical hyperglycemia", sub: true },
  { text: "Teplizumab (anti-CD3): FDA-approved for Stage 2 → delays Stage 3 by ~2–3 years (PES 2024)", sub: true },
], { headerColor: C.navy });

// SLIDE: Glycemic targets
addTableSlide(pres, "Glycemic Targets — ADA Standards 2025/2026", [
  [
    { text: "Parameter", options: { bold: true, color: C.white, fill: { color: C.teal }, fontSize: 13 } },
    { text: "General Target", options: { bold: true, color: C.white, fill: { color: C.teal }, fontSize: 13 } },
    { text: "Less Stringent (Elderly/Comorbid)", options: { bold: true, color: C.white, fill: { color: C.teal }, fontSize: 13 } },
    { text: "Notes", options: { bold: true, color: C.white, fill: { color: C.teal }, fontSize: 13 } },
  ],
  [
    { text: "HbA1c", options: { bold: true } },
    { text: "< 7.0%", options: { color: C.green, bold: true } },
    { text: "< 8.0%", options: {} },
    { text: "Individualize; < 6.5% if low hypoglycemia risk", options: {} }
  ],
  [
    { text: "Fasting / Pre-meal BG", options: {} },
    { text: "80–130 mg/dL", options: {} },
    { text: "Individualize", options: {} },
    { text: "Check before meals", options: {} }
  ],
  [
    { text: "Peak Post-meal BG (2h)", options: {} },
    { text: "< 180 mg/dL", options: {} },
    { text: "Individualize", options: {} },
    { text: "1–2h after meal start", options: {} }
  ],
  [
    { text: "CGM — Time in Range (TIR)", options: { bold: true } },
    { text: "> 70% (70–180 mg/dL)", options: { color: C.green } },
    { text: "> 50% in elderly", options: {} },
    { text: "NEW: CGM recommended at onset of DM (ADA 2026)", options: {} }
  ],
  [
    { text: "Time Below Range (TBR)", options: {} },
    { text: "< 4% (< 70 mg/dL)", options: { color: C.red } },
    { text: "< 1% (< 54 mg/dL)", options: { color: C.red } },
    { text: "Hypoglycemia prevention", options: {} }
  ],
  [
    { text: "BP Target (with DM)", options: { bold: true } },
    { text: "< 130/80 mmHg", options: { color: C.navy, bold: true } },
    { text: "< 140/90 (poor health/frail)", options: {} },
    { text: "< 120 mmHg SBP if high CV/kidney risk (ADA 2026)", options: {} }
  ],
]);

// SLIDE: GLP-1 RA update
addContentSlide(pres, "GLP-1 Receptor Agonists — 2025/2026 Key Role", [
  { text: "Mechanism & Benefits", bold: true, color: C.navy },
  { text: "Incretin effect: ↑ insulin secretion (glucose-dependent), ↓ glucagon, delays gastric emptying, ↑ satiety", sub: true },
  { text: "CV benefit: ↓ MACE (major adverse CV events) — LEADER, SUSTAIN-6, HARMONY, REWIND trials", sub: true },
  { text: "Renal benefit: semaglutide (FLOW trial) — ↓ kidney disease progression + CV death", sub: true },
  { text: "Weight loss: Very high efficacy — semaglutide, tirzepatide (dual GIP/GLP-1)", sub: true },
  { text: "2025/2026 Updates — ADA Recommendations", bold: true, color: C.teal },
  { text: "GLP-1 RA with proven CV benefit: FIRST-LINE irrespective of A1c in established ASCVD/high CVD risk", sub: true },
  { text: "Tirzepatide (dual GIP/GLP-1 RA): superior A1c reduction + weight loss vs semaglutide (SURPASS trials)", sub: true },
  { text: "HFpEF + obesity + T2DM: GLP-1 RA recommended (STEP-HFpEF trial — semaglutide ↓ HF symptoms)", sub: true },
  { text: "MASH/MASLD: GLP-1 RA or dual GIP/GLP-1 RA — beneficial (added to algorithm Fig 9.4, ADA 2026)", sub: true },
  { text: "CKD with T2DM: Semaglutide safe and recommended even in advanced CKD (ADA 2026 Rec 9.11)", sub: true },
  { text: "Inhaled insulin & insulin patch: emerging options noted in 2025 ADA", sub: true },
], { headerColor: C.teal });

// SLIDE: SGLT2 inhibitors
addContentSlide(pres, "SGLT2 Inhibitors — Updated Role in T2DM 2025/2026", [
  { text: "Mechanism", bold: true, color: C.navy },
  { text: "Block SGLT2 in proximal tubule → ↑ glucosuria → ↓ BG, BP, body weight, uric acid", sub: true },
  { text: "Cardioprotective via volume unloading, reduced preload/afterload, anti-inflammatory effects", sub: true },
  { text: "Established CV & Renal Indications (ADA 2025 Class A)", bold: true, color: C.teal },
  { text: "Heart failure (HFrEF and HFpEF): dapagliflozin, empagliflozin (EMPEROR, DAPA-HF, EMPEROR-Preserved)", sub: true },
  { text: "CKD progression: canagliflozin, dapagliflozin, empagliflozin (CREDENCE, DAPA-CKD, EMPA-KIDNEY)", sub: true },
  { text: "Established ASCVD: canagliflozin, empagliflozin — ↓ CV death, MI, stroke", sub: true },
  { text: "2025/2026 ADA Guidance", bold: true, color: C.navy },
  { text: "Use irrespective of background metformin or A1c level — focus on complication prevention", sub: true },
  { text: "Rec 9.11 (ADA 2026): continue SGLT2i even in advanced CKD for cardiorenal protection", sub: true },
  { text: "Dose reduction required at eGFR < 45 mL/min/1.73m²; check individual drug label", sub: true },
  { text: "Key ADRs: genital mycotic infections, DKA (rare, especially T1DM), Fournier's gangrene", sub: true },
  { text: "DKA: hold perioperatively, before procedures, major illness — SICK DAY RULES", sub: true, bold: true, color: C.red },
], { headerColor: C.midBlue });

// SLIDE: DM Drug Algorithm Table
addTableSlide(pres, "T2DM Pharmacotherapy — ADA 2025 Algorithm Summary", [
  [
    { text: "Drug Class", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 12 } },
    { text: "Key Agents", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 12 } },
    { text: "Glucose Lowering", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 12 } },
    { text: "Weight Effect", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 12 } },
    { text: "CV/Renal Benefit", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 12 } },
    { text: "Key Indication", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 12 } },
  ],
  [
    { text: "GLP-1 RA", options: { bold: true, color: C.teal } },
    { text: "Semaglutide, dulaglutide, liraglutide", options: {} },
    { text: "Very High", options: { color: C.green } },
    { text: "↓↓ (high–very high)", options: { color: C.green } },
    { text: "ASCVD, CKD, HF", options: { color: C.green, bold: true } },
    { text: "ASCVD, obesity, MASH", options: {} }
  ],
  [
    { text: "Dual GIP/GLP-1 RA", options: { bold: true, color: C.teal } },
    { text: "Tirzepatide", options: {} },
    { text: "Very High", options: { color: C.green } },
    { text: "↓↓↓ (very high)", options: { color: C.green } },
    { text: "HFpEF, MASH", options: { color: C.green } },
    { text: "Obesity + T2DM", options: {} }
  ],
  [
    { text: "SGLT2 Inhibitors", options: { bold: true, color: C.teal } },
    { text: "Empagliflozin, dapagliflozin, canagliflozin", options: {} },
    { text: "High", options: { color: C.green } },
    { text: "↓ (intermediate)", options: { color: C.green } },
    { text: "HF, CKD, ASCVD", options: { color: C.green, bold: true } },
    { text: "HF, CKD", options: {} }
  ],
  [
    { text: "Metformin", options: {} },
    { text: "Metformin", options: {} },
    { text: "High", options: { color: C.green } },
    { text: "Neutral/modest ↓", options: {} },
    { text: "Neutral", options: {} },
    { text: "First-line foundation", options: {} }
  ],
  [
    { text: "DPP-4 Inhibitors", options: {} },
    { text: "Sitagliptin, saxagliptin", options: {} },
    { text: "Intermediate", options: {} },
    { text: "Neutral", options: {} },
    { text: "Neutral (saxagliptin: ↑ HF)", options: { color: C.amber } },
    { text: "eGFR-friendly option", options: {} }
  ],
  [
    { text: "Sulfonylureas", options: {} },
    { text: "Glipizide, glimepiride", options: {} },
    { text: "High", options: { color: C.green } },
    { text: "↑ weight", options: { color: C.red } },
    { text: "Neutral", options: {} },
    { text: "Low cost", options: {} }
  ],
  [
    { text: "Insulin", options: {} },
    { text: "Basal, bolus, degludec, glargine", options: {} },
    { text: "Very High", options: { color: C.green } },
    { text: "↑ weight", options: { color: C.red } },
    { text: "Neutral", options: {} },
    { text: "T1DM; advanced T2DM", options: {} }
  ],
]);

// SLIDE: CV & Renal Risk Reduction
addContentSlide(pres, "Cardiovascular & Renal Risk Reduction in T2DM — 2025/2026", [
  { text: "Core Principle (ADA 2025/2026): Manage hyperglycemia AND prevent complications simultaneously", bold: true, color: C.navy },
  { text: "Established ASCVD or High CVD Risk", bold: true, color: C.teal },
  { text: "Add GLP-1 RA with proven CVD benefit AND/OR SGLT2i irrespective of A1c or metformin use", sub: true },
  { text: "Can combine both GLP-1 RA + SGLT2i for additive cardiorenal benefit", sub: true },
  { text: "Consider pioglitazone if additional CV protection needed (no HF)", sub: true },
  { text: "Heart Failure (HF)", bold: true, color: C.navy },
  { text: "HFrEF: SGLT2i (empagliflozin, dapagliflozin) — Class I recommendation", sub: true },
  { text: "HFpEF: empagliflozin + tirzepatide/semaglutide (EMPEROR-Preserved, STEP-HFpEF)", sub: true },
  { text: "Chronic Kidney Disease (CKD)", bold: true, color: C.teal },
  { text: "SGLT2i: slow progression, ↓ ESKD, ↓ CV events (CREDENCE, DAPA-CKD, EMPA-KIDNEY)", sub: true },
  { text: "GLP-1 RA: semaglutide (FLOW trial) — ↓ kidney disease progression + CV death", sub: true },
  { text: "Finerenone (MRA): added for T2DM + CKD (FIDELIO-DKD, FIGARO-DKD trials)", sub: true },
  { text: "Statin therapy: high-intensity statin for ASCVD; moderate-intensity for risk reduction", sub: true },
], { headerColor: C.teal });

// SLIDE: Special populations DM
addTwoColSlide(pres, "T2DM — Special Populations (ADA 2025/2026)",
  "Obesity & Weight Management", [
    "Tirzepatide / semaglutide: very high weight loss efficacy",
    "ADA 2026: aim 5–7% weight loss to improve glycemia + cardiometabolic risk",
    "Metabolic/bariatric surgery: T2DM remission data — BMJ meta-analysis 2025 (PMID 40023186)",
    "GLP-1 RA (+ surgery): now recommended for T1DM + obesity (ADA 2026)",
    "Avoid weight-promoting medications when alternatives exist (Rec 8.15, ADA 2026)",
    "Body fat measure in addition to BMI for better adiposity assessment (2026)",
  ],
  "Pediatric T2DM & Pregnancy", [
    "Pediatric T2DM: GLP-1 RAs + SGLT2i now with FDA approval data in adolescents (ADA 2026)",
    "Tirzepatide: emerging evidence in pediatric population",
    "Pregnancy: insulin preferred; GLP-1 RAs NOT recommended during pregnancy",
    "Gestational DM: screen at 24–28 weeks with 75g OGTT",
    "Posttransplant DM: insulin periop; GLP-1 RA for long-term cardiometabolic benefit (ADA 2026 Rec 9.38)",
    "Digital tools & structured transition programs emphasized for youth (ADA 2026)",
  ],
  { headerColor: C.navy }
);

// SLIDE: Technology & CGM
addContentSlide(pres, "Diabetes Technology — CGM & AID Systems (ADA 2025/2026)", [
  { text: "Continuous Glucose Monitoring (CGM) — Expanded Recommendations", bold: true, color: C.navy },
  { text: "ADA 2026: CGM recommended at ONSET of diabetes (any type) to improve outcomes", sub: true, bold: true, color: C.teal },
  { text: "Preferred over self-monitoring of BG (SMBG) in most patients on insulin", sub: true },
  { text: "Key metric: Time in Range (TIR > 70%, 70–180 mg/dL) — aligns with HbA1c outcomes", sub: true },
  { text: "Flash/iCGM (Libre, Dexcom G7): now accessible across care settings", sub: true },
  { text: "AI-based retinal screening: new guidance on use of AI tools for diabetic retinopathy", sub: true },
  { text: "Automated Insulin Delivery (AID / Closed-Loop)", bold: true, color: C.navy },
  { text: "ADA 2026: AID should be AVAILABLE to all adults with T1DM or T2DM requiring multiple daily injections", sub: true, bold: true, color: C.teal },
  { text: "Hybrid closed-loop: e.g., Tandem Control-IQ, Omnipod 5; reduces HbA1c + hypoglycemia", sub: true },
  { text: "New insulin algorithm for T1DM (Fig 9.2, ADA 2026) — updated for AID integration", sub: true },
  { text: "Insulin Innovations", bold: true, color: C.navy },
  { text: "Inhaled insulin (Afrezza): fast-acting option; noted in 2025 ADA", sub: true },
  { text: "Insulin patch: emerging; convenience for adherence", sub: true },
], { headerColor: C.midBlue });

// ═══════════════════════════════════════════════════════════════════════════════
//  ──── SECTION 3: HTN + DM OVERLAP ────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionDivider(pres, "SECTION III", "HTN + Diabetes — Dual Management");

// SLIDE: Overlap
addContentSlide(pres, "Hypertension in Diabetes — A High-Risk Intersection", [
  { text: "Epidemiology", bold: true, color: C.navy },
  { text: "~70–75% of adults with T2DM have hypertension", sub: true },
  { text: "HTN + DM multiplies CV risk: 2× stroke, 3× coronary disease, ×15 ESRD risk vs. normotensive non-diabetics", sub: true },
  { text: "Both conditions share pathophysiology: insulin resistance → ↑ sodium retention, RAAS activation, sympathetic overdrive", sub: true },
  { text: "Unified BP & Metabolic Targets (ADA 2026 + ACC/AHA 2025)", bold: true, color: C.teal },
  { text: "SBP < 130 mmHg for most; < 120 mmHg for high CV/kidney risk (ADA 2026 Rec 10.4)", sub: true },
  { text: "DBP < 80 mmHg", sub: true },
  { text: "Frail/elderly: < 140/90 or individualize", sub: true },
  { text: "Preferred Antihypertensives in DM", bold: true, color: C.navy },
  { text: "First-line: ACEI or ARB (especially with CKD/albuminuria) + CCB or thiazide diuretic", sub: true },
  { text: "SGLT2i: ALSO lowers BP ~3–5 mmHg SBP — dual metabolic + antihypertensive role", sub: true, bold: true, color: C.teal },
  { text: "GLP-1 RA: modest BP-lowering (2–3 mmHg), weight loss, CV protection", sub: true },
  { text: "Avoid: β-blockers as first-line (mask hypoglycemia, worsen insulin resistance)", sub: true },
], { headerColor: C.navy });

// SLIDE: Integrated Management
addTwoColSlide(pres, "Integrated HTN + DM Management — Practical Summary for GPs",
  "Pharmacologic Priorities", [
    "1st: ACEI or ARB (COR I) — BP + DKD protection",
    "Add: CCB or chlorthalidone for BP control",
    "Add: SGLT2i — BP + glucose + HF/CKD protection",
    "Consider: GLP-1 RA — glucose + weight + ASCVD",
    "High-intensity statin for LDL-C < 70 mg/dL (ASCVD) or < 100 mg/dL",
    "Low-dose aspirin: only for established ASCVD (not primary prevention)",
    "Finerenone: T2DM + CKD + albuminuria (add-on therapy)",
  ],
  "Non-Pharmacologic Priorities", [
    "DASH diet: ↓ BP + improves glycemia",
    "Mediterranean diet: ↓ CVD risk + T2DM prevention",
    "Weight loss ≥ 5–7%: ↓ BP + improves HbA1c",
    "Aerobic exercise 150 min/week + resistance training",
    "Sodium restriction: < 2300 mg/day",
    "Self-monitoring: home BP monitoring + CGM",
    "Smoking cessation: essential",
    "Annual screening: lipids, eGFR, UACR, retina, feet",
  ],
  { headerColor: C.teal }
);

// SLIDE: Monitoring Checklist
addTableSlide(pres, "Annual Monitoring Checklist — HTN + T2DM Patients", [
  [
    { text: "Test/Assessment", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
    { text: "Frequency", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
    { text: "Target / Goal", options: { bold: true, color: C.white, fill: { color: C.navy }, fontSize: 13 } },
  ],
  [{ text: "HbA1c", options: {} }, { text: "Every 3–6 months", options: {} }, { text: "< 7.0% (individualize)", options: {} }],
  [{ text: "Blood Pressure", options: {} }, { text: "Every visit", options: {} }, { text: "< 130/80 mmHg", options: { color: C.teal, bold: true } }],
  [{ text: "Fasting Lipid Panel", options: {} }, { text: "Annual", options: {} }, { text: "LDL < 70 mg/dL (ASCVD); < 100 mg/dL (moderate risk)", options: {} }],
  [{ text: "eGFR + Serum Creatinine", options: {} }, { text: "Annual (more frequent if CKD)", options: {} }, { text: "Monitor for decline; adjust meds", options: {} }],
  [{ text: "Urine Albumin-to-Creatinine Ratio (UACR)", options: {} }, { text: "Annual", options: {} }, { text: "< 30 mg/g (normal); if ↑ → ACEI/ARB", options: {} }],
  [{ text: "Dilated Eye Exam", options: {} }, { text: "Annual or per risk", options: {} }, { text: "Screen for diabetic retinopathy; AI retinal tools (ADA 2026)", options: {} }],
  [{ text: "Foot Exam (10g monofilament)", options: {} }, { text: "Annual", options: {} }, { text: "Neuropathy + PAD screening", options: {} }],
  [{ text: "Weight/BMI + Waist Circumference", options: {} }, { text: "Every visit", options: {} }, { text: "Weight loss ≥ 5% if overweight", options: {} }],
  [{ text: "Serum Potassium + eGFR", options: {} }, { text: "1–4 weeks after ACEI/ARB start; then annual", options: {} }, { text: "K+ < 5.5 mEq/L; watch if eGFR declining", options: {} }],
]);

// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE — KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════════════════════════
{
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  const takeaways = [
    { icon: "①", text: "HTN 2025: PREVENT tool replaces PCE for risk assessment. Initiate therapy at ≥130/80 even in Stage 1 if PREVENT ≥7.5%. ACEI/ARB both Class I.", color: C.teal },
    { icon: "②", text: "BP target: <130/80 mmHg for most patients with DM or CKD. <120 mmHg SBP for high CV/renal risk (ADA 2026).", color: C.amber },
    { icon: "③", text: "T2DM with ASCVD/high CVD risk: GLP-1 RA + SGLT2i — use irrespective of A1c or metformin. Complication prevention > glycemia alone.", color: C.teal },
    { icon: "④", text: "SGLT2i: first-line for HF (HFrEF + HFpEF) and CKD protection. Continue in advanced CKD for cardiorenal benefit.", color: C.amber },
    { icon: "⑤", text: "Tirzepatide (dual GIP/GLP-1): superior glycemia + weight loss. Emerging evidence for HFpEF + MASH.", color: C.teal },
    { icon: "⑥", text: "CGM recommended from onset of DM (ADA 2026). AID systems should be available to all T1DM and insulin-requiring T2DM.", color: C.amber },
    { icon: "⑦", text: "Annual checks: HbA1c, BP, lipids, eGFR, UACR, eye exam, foot exam, weight. Treat-to-target + lifestyle remain the pillars.", color: C.teal },
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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE — REFERENCES
// ═══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "References & Key Guideline Documents", [
  { text: "Hypertension", bold: true, color: C.navy },
  { text: "Jones DW et al. 2025 AHA/ACC/… Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Circulation. 2025; PMID: 40811497", sub: true },
  { text: "Overview of the 2025 Hypertension Guidelines. UIC Drug Information Group. December 2025.", sub: true },
  { text: "Santulli G. The 2025 AHA/ACC Hypertension Guidelines: Implications for CV and Renal Risk in Patients with Diabetes. Cardiovasc Diabetol Endocrinol Rep. 2025;11:21.", sub: true },
  { text: "Diabetes Mellitus", bold: true, color: C.navy },
  { text: "American Diabetes Association. Standards of Care in Diabetes — 2025. Diabetes Care 2025;48(Suppl.1).", sub: true },
  { text: "ADA Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes — 2026. Diabetes Care 2026;49(Suppl.1):S6-S12.", sub: true },
  { text: "Agarwal A et al. CV, kidney, and weight loss effects of therapeutics for T2DM: living CPG. BMJ 2025. PMID: 40813129", sub: true },
  { text: "Nong K et al. Medications for adults with T2DM: living systematic review and network meta-analysis. BMJ 2025. PMID: 40813122", sub: true },
  { text: "Kanbour S et al. Bodyweight loss and T2DM remission: systematic review and meta-regression. Lancet Diab Endocrinol 2025. PMID: 40023186", sub: true },
  { text: "Wilson LM et al. Management of Diabetes and Hyperglycemia in Hospital: Systematic Review. Diabetes Care 2025. PMID: 40117466", sub: true },
  { text: "Natale P et al. GLP-1 receptor agonists for people with CKD and diabetes. Cochrane Database Syst Rev 2025. PMID: 39963952", sub: true },
], { headerColor: C.sub });

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
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  .then(() => console.log("DONE: file written successfully"))
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