const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
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pres.author = 'American Diabetes Association';
pres.title = 'ADA Standards of Care in Diabetes 2026';

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
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// ─── HELPERS ─────────────────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – MASTER TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
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// SLIDE 2 – TABLE OF CONTENTS
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    ["1", "Improving Care & Promoting Health in Populations", "S13"],
    ["2", "Diagnosis and Classification of Diabetes", "S27"],
    ["3", "Prevention or Delay of Diabetes & Associated Comorbidities", "S50"],
    ["4", "Comprehensive Medical Evaluation & Assessment of Comorbidities", "S61"],
    ["5", "Facilitating Positive Health Behaviors & Well-being", "S89"],
    ["6", "Glycemic Goals, Hypoglycemia & Hyperglycemic Crises", "S132"],
    ["7", "Diabetes Technology", "S150"],
    ["8", "Obesity and Weight Management", "S166"],
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    ["10", "Cardiovascular Disease and Risk Management", "S216"],
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// ═══════════════════════════════════════════════════════════════════════════
// SECTION 1 – IMPROVING CARE & PROMOTING HEALTH
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("1", "Improving Care and\nPromoting Health in Populations", "Diabetes Care 2026;49(Suppl. 1):S13–S26");

contentSlide("State of Diabetes in the U.S. — 2026", [
  "38.4 million people living with diabetes (11.6% of U.S. population) as of 2021",
  "97.6 million adults with prediabetes (38.0% of U.S. adults) — many unaware",
  "Over 100 million adults 20+ years living with obesity — high risk for type 2 diabetes",
  "Diabetes prevalence higher in non-Hispanic Black (17.4%), Asian (16.7%), and Hispanic (15.5%) adults vs. White (13.6%)",
  "Rising complications since early 2010s: kidney failure, amputations, stroke, heart failure, hyperglycemic crises",
  "Only 50.5% of adults with diabetes achieved A1C <7%; just 22.2% met all three risk factor goals (A1C, BP, cholesterol)",
  "Annual cost of diagnosed diabetes in the U.S. (2022): ≥$413 billion ($307B direct + $106B lost productivity)"
]);

twoColSlide("Evidence-Based Care Models", [
  "Chronic Care Model (CCM): 6 elements — delivery system design, self-management support, decision support, clinical info systems, community resources, health system culture",
  "CCM interventions reduce A1C (mean −0.21%), blood pressure, and process-of-care metrics",
  "Patient-Centered Medical Home (PCMH) improves comprehensive primary care",
  "Accountable Care Organizations (ACOs) support CCM implementation"
], [
  "Telehealth reduces A1C by 0.37% (meta-analysis of 681 trials, 2025)",
  "Telemedicine especially effective for rural populations, pediatrics, and underserved communities",
  "DSMES (self-management education) reduces A1C; delivered via mHealth, video, peer support",
  "Value-based payment models and Alternative Payment Models drive quality improvement"
], "Care Delivery Models", "Telehealth & Digital Health");

contentSlide("Tailoring Treatment: Social Determinants of Health (SDOH)", [
  "SDOH — economic, environmental, political, social conditions — drive major health inequities in diabetes",
  "Health systems must stratify quality data by insurance status, race, ethnicity, language, disability, SDOH (Rec. 1.6)",
  "Assess food insecurity, housing insecurity, financial barriers, health access at every clinical encounter (Rec. 1.7)",
  "~13% of Americans food insecure (2022); food insecurity linked to higher glycemia, depression, lower self-care",
  "Two-item food insecurity screener: assess worry about food running out and food not lasting until next paycheck",
  "Housing insecurity (~8% diabetes prevalence in this group) complicates medication storage, self-management",
  "Language barriers: professional interpreters required; trained family members should be avoided when possible",
  "Community health workers (CHWs) and community paramedics support underserved populations (Rec. 1.9)"
]);

contentSlide("Access to Care & Cost Considerations", [
  "Affordable Care Act expansion increased access; yet only 33% of older adults with T1D saw endocrinologist in 2019",
  "18.6% of T1D adults and 15.8% insulin-treated T2D adults rationed insulin due to cost (national survey, 2021)",
  "Inflation Reduction Act (2022): capped Medicare insulin out-of-pocket at $35/month per insulin",
  "25 states + D.C. capped out-of-pocket insulin costs in commercial plans",
  "High-deductible health plans increase financial hardship, delay screening, reduce monitoring, raise complication risk",
  "Health care teams must screen for financial hardship and cost-related medication non-adherence (Rec. 1.7)",
  "ADA recommendations: cost-sharing reform, net-price insulin transparency, no excessive administrative burden"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 2 – DIAGNOSIS & CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("2", "Diagnosis and Classification of Diabetes", "Diabetes Care 2026;49(Suppl. 1):S27–S49");

contentSlide("Diagnostic Criteria for Diabetes (Non-Pregnant Individuals)", [
  "A1C ≥6.5% (≥48 mmol/mol) — NGSP-certified, DCCT-standardized laboratory method",
  "Fasting Plasma Glucose (FPG) ≥126 mg/dL (≥7.0 mmol/L) — fasting = no caloric intake for ≥8 hours",
  "2-h Plasma Glucose ≥200 mg/dL (≥11.1 mmol/L) during 75-g OGTT",
  "Random Plasma Glucose ≥200 mg/dL (≥11.1 mmol/L) with classic hyperglycemia symptoms",
  "In absence of unequivocal hyperglycemia: two abnormal results from different tests required",
  "A1C advantages: no fasting, convenient, greater preanalytical stability, less day-to-day variation",
  "A1C limitations: lower sensitivity vs. 2-h PG; affected by hemoglobin variants, anemia, kidney failure, pregnancy"
]);

twoColSlide("Prediabetes Criteria & Type 2 Diabetes Screening", [
  "FPG 100–125 mg/dL (IFG)",
  "2-h PG 140–199 mg/dL during OGTT (IGT)",
  "A1C 5.7–6.4% (39–47 mmol/mol)",
  "A1C 5.7–6.4% with absolute diabetes risk of 25–50%; A1C 6.0–6.4% = highest risk",
  "Prediabetes associated with obesity, dyslipidemia, hypertension — prompt CVD screening"
], [
  "Screen asymptomatic adults of any age with overweight/obesity + ≥1 risk factor (Rec. 2.12a)",
  "For all others: start at age 35 years (Rec. 2.12b)",
  "Children/adolescents: after puberty or age 10 if overweight/obese + risk factors (Rec. 2.15)",
  "Repeat every 3 years if normal; sooner with symptoms or risk changes",
  "Consider screening people on statins, thiazides, atypical antipsychotics, HIV antiretrovirals (Rec. 2.16)"
], "Prediabetes Thresholds", "Screening Recommendations");

contentSlide("Type 1 Diabetes: Stages & Classification", [
  "Stage 1: ≥2 islet autoantibodies (GAD, IA-2, ZnT8, IA) + normoglycemia — 5-yr progression risk ~44%",
  "Stage 2: ≥2 autoantibodies + dysglycemia (not yet diagnostic of diabetes)",
  "Stage 3: overt clinical diabetes (classic symptoms, hyperglycemia, ~50% present with DKA)",
  "Autoantibody screening offered to family members of T1D patients and those with elevated genetic risk (Rec. 2.7)",
  "Teplizumab (anti-CD3): FDA-approved to delay progression from Stage 2 to Stage 3 T1D",
  "'ABCDE' differential (T1 vs T2): Age, Autoimmunity, Body habitus, Background, Control, Comorbidities",
  "LADA = autoimmune β-cell destruction with adult onset — consider in adults failing non-insulin therapies",
  "ICI-induced diabetes: occurs in 0.6–1.4% on immune checkpoint inhibitors; often presents as DKA"
]);

contentSlide("Other Specific Diabetes Types", [
  "Monogenic diabetes (MODY): autosomal dominant; most common subtypes HNF1A-MODY, GCK-MODY, HNF4A-MODY — consider in young adults with atypical features and multi-generational family history",
  "Neonatal diabetes: onset <6 months of age; 80–85% have identifiable monogenic cause; genetic testing mandatory",
  "CFRD (cystic fibrosis–related diabetes): ~50% of CF adults; screen annually by OGTT from age 10 years",
  "Post-transplant diabetes mellitus (PTDM): ~90% of kidney recipients show early hyperglycemia; significant risk for CVD and CKD",
  "Glucocorticoid-induced diabetes: up to 18–32% incidence with supraphysiologic doses; screen with postprandial glucose",
  "GDM diagnosis: one-step 75-g OGTT (IADPSG criteria, ADA preferred) or two-step approach (100-g OGTT, Carpenter-Coustan/NDDG thresholds)"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 3 – PREVENTION
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("3", "Prevention or Delay of Diabetes\nand Associated Comorbidities", "Diabetes Care 2026;49(Suppl. 1):S50–S60");

contentSlide("Lifestyle Interventions to Prevent Type 2 Diabetes", [
  "DPP (Diabetes Prevention Program): ≥7% weight loss + 150 min/wk moderate activity → 58% reduction in T2D incidence over 3 years vs. placebo",
  "At 21 years follow-up: lifestyle group median diabetes-free survival extended by 3.5 years; metformin by 2.5 years",
  "ADA Recommendation (3.3): target ≥5–7% weight loss via reduced-calorie diet + ≥150 min/week moderate activity",
  "Evidence-based eating patterns (Mediterranean, low-carbohydrate) reduce T2D risk (Rec. 3.4)",
  "Resistance training and breaking up prolonged sedentary time lower postprandial glucose",
  "Physical activity also reduces risk of gestational diabetes mellitus (GDM)",
  "National DPP: CDC-recognized program; Medicare and expanding Medicaid coverage available"
]);

twoColSlide("Pharmacologic Prevention & Technology-Assisted Programs", [
  "Metformin: recommended for prediabetes especially if BMI ≥35, age <60, prior gestational diabetes",
  "Long-term metformin use: modest A1C reduction, weight benefit, low cost",
  "Teplizumab: delays Stage 2→Stage 3 T1D progression by ~2 years (Rec. 2.8c)",
  "Screen for prediabetes at least annually in at-risk populations (Rec. 3.1)",
  "Monitor Stage 2 T1D with A1C every 6 months + annual 75-g OGTT (Rec. 3.2)"
], [
  "Smartphone/web/telehealth DPP delivery as effective as in-person for glycemic outcomes (Rec. 3.6)",
  "Digital tools expand reach and reduce geographic/transportation barriers",
  "Programs should address digital divide and health literacy needs",
  "DPP coverage: Medicare (requires BMI >25, prediabetes evidence), expanding state Medicaid",
  "Evidence confirms diabetes complications reduced with earlier prediabetes prevention interventions"
], "Pharmacologic Prevention", "Technology-Assisted Prevention");

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 4 – COMPREHENSIVE EVALUATION
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("4", "Comprehensive Medical Evaluation\nand Assessment of Comorbidities", "Diabetes Care 2026;49(Suppl. 1):S61–S88");

contentSlide("Initial and Follow-up Medical Evaluation", [
  "Initial visit: confirm diagnosis, classify diabetes, assess glycemic status and treatments, evaluate complications and comorbidities",
  "Identify care partners, support systems, available resources, SDOH and structural barriers",
  "Follow-up: at least every 3–6 months, individualized; at minimum annually",
  "Assess self-management behaviors, nutrition, psychosocial health at each visit",
  "Routine immunizations, sleep, bone health, sexual health are part of comprehensive evaluation",
  "Use person-centered language: 'person with diabetes' (not 'diabetic person') — avoids stigma and blame",
  "Goals: prevent/delay complications, optimize quality of life through collaborative treatment planning"
]);

contentSlide("Comorbidities & Interprofessional Team Care", [
  "People with diabetes benefit from coordinated interprofessional team: CDCEs, primary care, subspecialists, nurses, RDNs, exercise specialists, pharmacists, podiatrists, behavioral health professionals",
  "Management plan considers: age, cognitive ability, work/school schedule, health beliefs, literacy/numeracy, eating patterns, cultural factors, comorbidities, financial concerns",
  "Assess and screen for: hypertension, dyslipidemia, ASCVD risk, obesity, CKD, retinopathy, neuropathy, foot complications, sleep disorders, dental disease, cancer screening",
  "Bone health: risk of osteoporosis/fractures elevated in T1D (and T2D with specific medications); assess appropriately",
  "Behavioral health: screen for depression, diabetes distress, anxiety, disordered eating at each visit",
  "Hepatitis B vaccination recommended; other vaccines per standard adult immunization schedule",
  "Sexual health, sleep apnea, periodontal disease assessments incorporated into care"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 5 – POSITIVE HEALTH BEHAVIORS
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("5", "Facilitating Positive Health Behaviors\nand Well-being to Improve Health Outcomes", "Diabetes Care 2026;49(Suppl. 1):S89–S131");

twoColSlide("DSMES: Diabetes Self-Management Education & Support", [
  "All people with diabetes should participate in DSMES — developmentally appropriate and culturally sensitive (Rec. 5.1)",
  "4 critical times: at diagnosis, annually, when complications arise, transitions in life/care",
  "Improves: diabetes knowledge, self-care behaviors, A1C (−0.5 to −1%), quality of life, reduced mortality risk",
  "DSMES team: nurses, RDNs, pharmacists, social workers, behavioral health professionals, CHWs",
  "Telehealth/mHealth DSMES effective; comparable to or better than in-person care"
], [
  "Fewer than 10% of individuals referred for DSMES through insurance actually receive it",
  "Barriers: awareness, time, cost, transportation, access — must be systematically addressed",
  "Behavioral strategies: motivational interviewing, goal setting, problem-solving (Rec. 5.4)",
  "Provide culturally and socially appropriate DSMES in group or individual settings (Rec. 5.5)",
  "Report DSMES participation to broader care team for coordinated management (Rec. 5.5)"
], "DSMES Overview", "Barriers & Strategies");

contentSlide("Medical Nutrition Therapy (MNT)", [
  "MNT is effective in improving glycemia, lipids, blood pressure, and quality of life in diabetes",
  "No one-size-fits-all eating pattern: Mediterranean, low-carbohydrate, DASH, plant-based diets all have evidence",
  "Carbohydrate monitoring (counting, exchanges, experience-based estimation) supports glycemic control",
  "Reduced carbohydrate intake has greatest evidence for lowering post-meal glucose",
  "Sodium: <2,300 mg/day; alcohol in moderation; non-nutritive sweeteners may reduce sugar intake if substituted",
  "Registered Dietitian Nutritionist (RDN) referral for individualized MNT should be routine",
  "People using insulin: consistent carbohydrate intake per meal OR adjust insulin to match carbohydrate intake"
]);

contentSlide("Physical Activity, Sleep & Tobacco Cessation", [
  "Physical activity: ≥150 min/week moderate-intensity OR ≥75 min/week vigorous aerobic exercise",
  "Resistance training ≥2 days/week; reduce prolonged sedentary time — break up every 30 minutes",
  "Exercise lowers A1C, blood pressure, lipids, weight; improves cardiovascular fitness and quality of life",
  "Special considerations: hypoglycemia monitoring for insulin/secretagogue users; start gradually",
  "Sleep: inadequate sleep (<6h) linked to higher A1C, insulin resistance, obesity — assess sleep quality",
  "Tobacco: all forms (cigarettes, smokeless, e-cigarettes/vaping) associated with worse diabetes outcomes — offer cessation support",
  "Psychosocial care: screen for depression, diabetes distress, anxiety, disordered eating — refer as needed"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 6 – GLYCEMIC GOALS
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("6", "Glycemic Goals, Hypoglycemia\nand Hyperglycemic Crises", "Diabetes Care 2026;49(Suppl. 1):S132–S149");

highlightSlide("Glycemic Goals for Non-Pregnant Adults", [
  { label: "A1C Goal", text: "<7.0% (<53 mmol/mol) for many non-pregnant adults without severe hypoglycemia" },
  { label: "Time in Range (TIR)", text: ">70% of time at 70–180 mg/dL for most adults using CGM" },
  { label: "Time Below Range", text: "<4% time <70 mg/dL (<1% for older adults)" },
  { label: "Time Above Range", text: "<25% time >180 mg/dL" },
  { label: "Stringent Goal", text: "A1C <6.5% if achievable without hypoglycemia (short duration, youth, no CVD)" },
  { label: "Less Stringent", text: "A1C <8% for older adults with complex health, limited life expectancy, or high hypoglycemia risk" },
]);

contentSlide("Glycemic Monitoring: A1C, CGM & BGM", [
  "A1C: primary assessment tool; reflects average glucose over ~2–3 months; check every 3 months if uncontrolled, every 6 months if at goal",
  "CGM (continuous glucose monitoring): key metrics — TIR, TBR, TAR, GMI, coefficient of variation, mean glucose",
  "CGM increasingly standard for T1D and insulin-treated T2D; reduces hypoglycemia and A1C",
  "BGM (finger-stick capillary): integral for insulin dosing; use structured monitoring for optimal self-management",
  "Discordant A1C vs. CGM/BGM results: consider hemoglobin variants, anemia, kidney disease, high glycemic variability",
  "Fructosamine/glycated albumin: reflect 2–4 week glycemia — useful when A1C unreliable (e.g., hemoglobinopathy, pregnancy)",
  "Standardized CGM reporting (ambulatory glucose profile) recommended for clinical use"
]);

contentSlide("Hypoglycemia: Classification, Assessment & Treatment", [
  "Level 1: glucose <70 mg/dL and ≥54 mg/dL — alert value, warrants intervention",
  "Level 2: glucose <54 mg/dL — clinically significant, requires immediate treatment",
  "Level 3: severe event with altered mental/physical function requiring third-party assistance (irrespective of glucose level)",
  "15-15 Rule: 15g fast-acting carbohydrate → recheck in 15 min; repeat until ≥70 mg/dL; then eat a snack/meal",
  "Glucagon: prescribe to all T1D and high-risk T2D patients; intranasal and ready-to-inject forms preferred",
  "Major risk factors: recent level 2/3 hypoglycemia, impaired hypoglycemia awareness, intensive insulin therapy, kidney failure, cognitive impairment",
  "Level 2 or 3 episodes should trigger reevaluation of treatment plan; consider deintensification (Rec. 6.19)"
]);

contentSlide("Hyperglycemic Crises: DKA & HHS", [
  "DKA (diabetic ketoacidosis): primarily T1D; also SGLT2 inhibitor use, ICIs, COVID-19 — may be euglycemic with SGLT2i",
  "HHS (hyperglycemic hyperosmolar state): primarily T2D with severe insulin deficiency",
  "Risk factors: type 1 diabetes, young/adolescent age, prior DKA/HHS history, behavioral health conditions, insulin rationing, high A1C, substance use, SDOH",
  "Pregnant individuals at risk for euglycemic DKA; clinical threshold lower — seek care urgently at first signs",
  "Prevention: education, CGM access, sick-day rules (hold metformin & SGLT2i when oral intake impaired)",
  "Outpatient mild DKA (hemodynamically stable): subcutaneous insulin + frequent glucose/ketone monitoring + noncaloric fluids",
  "Recurrent DKA in adolescents strongly linked to psychosocial challenges — multidisciplinary intervention needed"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 7 – DIABETES TECHNOLOGY
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("7", "Diabetes Technology", "Diabetes Care 2026;49(Suppl. 1):S150–S165");

twoColSlide("Continuous Glucose Monitoring (CGM)", [
  "CGM recommended for all adults with T1D and recommended/considered for insulin-treated T2D",
  "Real-time CGM: provides alerts, trends, and data for therapy adjustments",
  "Intermittently scanned (flash) CGM: user-initiated scanning; suitable for motivated patients",
  "CGM use associated with reduced A1C and hypoglycemia in clinical trials",
  "Early CGM initiation at T1D diagnosis in children reduces A1C and improves parental satisfaction",
  "CGM access should be maintained by third-party payors regardless of age or A1C (Rec. 7.5)"
], [
  "Automated Insulin Delivery (AID) systems: CGM + algorithm + insulin pump",
  "Hybrid closed-loop (HCL) systems: automatically adjust basal insulin; outperform open-loop CSII",
  "AID systems improve TIR, reduce TBR and TBR-related events, and improve quality of life",
  "AID effective across age groups, duration of diabetes, and baseline A1C levels",
  "AID initiation requires structured education on system use, troubleshooting, and data interpretation (Rec. 7.3b)",
  "Connected insulin pens track dose/timing; useful for multiple daily injection users"
], "CGM Systems", "Automated Insulin Delivery (AID)");

contentSlide("Insulin Delivery Devices & General Device Principles", [
  "Insulin syringes, pens, inhalation, patch devices, CSII (pumps) — all are valid delivery options",
  "Insulin pens preferred over syringes for ease of use and dose accuracy; smart pens add digital tracking",
  "CSII (insulin pumps): allow fine-tuned basal rate adjustments; essential for AID systems",
  "No device works optimally without education, training, and ongoing support (Rec. 7.1)",
  "Health care professionals must stay current with technology; device manufacturers and ADA resources available",
  "Standardized CGM reporting (ambulatory glucose profile, AGP) facilitates review and therapy adjustments",
  "Practical barriers: cost, insurance coverage lags behind availability; address equity in access proactively"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 8 – OBESITY & WEIGHT MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("8", "Obesity and Weight Management for the\nPrevention and Treatment of Diabetes", "Diabetes Care 2026;49(Suppl. 1):S166–S182");

contentSlide("Obesity Assessment & Weight Loss Goals", [
  "Obesity is a chronic, often relapsing disease — increases risk for T2D development and progression",
  "Screen for overweight/obesity using BMI annually; confirm excess adiposity with waist circumference or other anthropometric measures (Rec. 8.2a)",
  "BMI limitations: misclassifies muscular individuals; South Asian individuals may be at risk at lower BMI thresholds (≥23 kg/m²)",
  "Use person-first language: 'person with obesity'; avoid stigmatizing language — weight bias harms care quality",
  "Modest weight loss (5–7% body weight): improves A1C, blood pressure, lipids; reduces medication need",
  "Greater weight loss (>10–15%): may achieve sustained diabetes remission in T2D",
  "Metabolic surgery: average >20% body weight loss, greatly improves glycemia, often achieves diabetes remission"
]);

twoColSlide("Weight Management Interventions", [
  "High-intensity lifestyle interventions: ≥16 sessions in 6 months, focus on nutrition + activity + behavioral change targeting 500–750 kcal/day deficit (Rec. 8.8a)",
  "If intensive programs unavailable: structured telehealth, mobile app alternatives acceptable (Rec. 8.8b)",
  "Individualize nutrition: create energy deficit regardless of macronutrient composition",
  "Ensure adequate protein intake and micronutrient sufficiency during weight loss (Rec. 8.14)",
  "Shared decision-making guides choice of intervention"
], [
  "GLP-1 receptor agonists (e.g., semaglutide): substantial weight loss (10–15%), major A1C reduction",
  "Dual GIP/GLP-1 RA (tirzepatide): up to 20–22% body weight loss in clinical trials",
  "Anti-obesity medications (AOMs): adjunct to lifestyle; multiple approved options with varying mechanisms",
  "Metabolic surgery: BMI ≥35 with T2D or BMI ≥30 with poorly controlled T2D — consider evaluation",
  "Monitor for nutritional deficiencies, mood changes, medication adjustments after surgery"
], "Behavioral & Lifestyle", "Pharmacologic & Surgical");

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 9 – PHARMACOLOGIC TREATMENT
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("9", "Pharmacologic Approaches\nto Glycemic Treatment", "Diabetes Care 2026;49(Suppl. 1):S183–S215");

contentSlide("Type 1 Diabetes: Insulin Therapy", [
  "MDI (multiple daily injections) or CSII (insulin pump): standard of care for most adults with T1D (Rec. 9.1)",
  "Insulin regimens: basal (NPH, long-acting analogs, pump) + mealtime (RAA or inhaled) + correction doses",
  "Rapid-acting analogs (RAA): lispro, aspart, glulisine — preferred over regular insulin to minimize hypoglycemia (Rec. 9.2)",
  "Ultra-rapid-acting analogs (URAA): faster peak and onset — improves postprandial control and dosing flexibility",
  "DCCT: intensive T1D therapy reduced microvascular complications by 50–76%; EDIC showed persistent benefit >30 years",
  "Carbohydrate counting + insulin-to-carb ratio (ICR) + correction factor (ISF) education mandatory for MDI users (Rec. 9.3)",
  "AID systems (closed-loop): best outcomes for T1D — highest TIR, lowest TBR vs. conventional therapy"
]);

contentSlide("Type 2 Diabetes: Pharmacologic Framework", [
  "Metformin: first-line for T2D if tolerated; low cost, low hypoglycemia risk, weight-neutral or modest loss",
  "GLP-1 RAs (e.g., semaglutide, liraglutide): significant A1C reduction, weight loss, proven CV and kidney benefit — prioritize in T2D with CVD/CKD",
  "Dual GIP/GLP-1 RA (tirzepatide): superior A1C and weight reduction vs. GLP-1 RAs alone",
  "SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin): A1C reduction + heart failure prevention + CKD progression protection + weight loss",
  "Sulfonylureas: low cost but hypoglycemia risk; older agents; consider if cost is primary concern",
  "DPP-4 inhibitors: modest A1C reduction, weight-neutral, low hypoglycemia — CV-safe but no major benefit",
  "Prioritize agents with proven cardiovascular, kidney, or weight benefits over glucose-lowering alone (Fig. 9.1)"
]);

contentSlide("Insulin Therapy in Type 2 Diabetes", [
  "Initiate insulin when: oral/injectable therapies insufficient to achieve glycemic goals",
  "Basal insulin (long-acting analogs): first insulin for most T2D; once daily; titrate to fasting glucose target",
  "U-300 glargine and degludec: longer duration, flatter profile, lower hypoglycemia vs. U-100 glargine",
  "Combination injectable therapy: basal + mealtime insulin OR GLP-1 RA + basal insulin (GLP-1 RA preferred as add-on to delay or minimize insulin initiation)",
  "Inhaled insulin (Afrezza): ultra-rapid onset, suitable as mealtime insulin alternative for selected patients",
  "Concentrated insulins (U-200, U-300, U-500): improve convenience for high-dose insulin users",
  "Insulin self-titration: patients can safely adjust basal insulin based on structured protocols"
]);

// ═══════════════════════════════════════════════════════════════════════════
// SECTION 10 – CARDIOVASCULAR DISEASE
// ═══════════════════════════════════════════════════════════════════════════
sectionBanner("10", "Cardiovascular Disease\nand Risk Management", "Diabetes Care 2026;49(Suppl. 1):S216–S245");

contentSlide("CVD Overview: Risk & Impact in Diabetes", [
  "CVD is the leading cause of morbidity and mortality in people with diabetes",
  "ASCVD: ACS, MI, stable/unstable angina, coronary revascularization, stroke, PAD, aortic aneurysm",
  "Diabetes independently increases ASCVD risk; clusters with hypertension, hyperlipidemia, obesity",
  "Heart failure: ≥2x more prevalent in diabetes vs. non-diabetes — includes HFpEF, HFmrEF, HFrEF",
  "Despite evidence-based guidelines, many people with T2D do not achieve recommended risk factor goals",
  "SGLT2 inhibitors and GLP-1 RAs now considered core pharmacological strategy for CV and kidney risk reduction",
  "Multifactorial approach: glycemia management + BP management + lipid management + CV/kidney-beneficial medications"
]);

contentSlide("Hypertension Management in Diabetes", [
  "Blood pressure goal: <130/80 mmHg for most adults with diabetes (individualized via shared decision-making) (Rec. 10.3)",
  "Hypertension defined as SBP ≥130 mmHg or DBP ≥80 mmHg on 2+ readings on 2+ occasions",
  "BPROAD trial (2024): intensive SBP goal <120 mmHg → 21% reduction in nonfatal stroke, MI, heart failure, or CV death vs. <140 mmHg",
  "ESPRIT trial: confirmed benefit of intensive SBP <120 mmHg in individuals with diabetes or prior stroke",
  "Lifestyle: weight loss, DASH diet, reduced sodium, increased physical activity, limited alcohol",
  "First-line medications: ACE inhibitors or ARBs (especially if albuminuria); thiazides, CCBs",
  "Home blood pressure monitoring improves adherence and cardiovascular risk prediction"
]);

contentSlide("Lipid Management & Antiplatelet Therapy", [
  "Statin therapy: moderate-to-high intensity statin recommended for most people with diabetes and established CVD or high risk",
  "LDL target: <70 mg/dL for high-risk T2D; <55 mg/dL for very-high-risk (established ASCVD)",
  "For those not at LDL goal on maximally tolerated statin: add ezetimibe; then PCSK9 inhibitor if needed",
  "Triglycerides ≥500 mg/dL: fibrate therapy to reduce pancreatitis risk; omega-3 fatty acids for residual hypertriglyceridemia",
  "Antiplatelet therapy: aspirin 75–162 mg/day for secondary prevention (established CVD); consider primary prevention in high-risk adults >50 years",
  "GLP-1 RAs (liraglutide, semaglutide) and SGLT2 inhibitors: reduce major adverse CV events, heart failure hospitalization, and CKD progression",
  "Integrated cardiovascular risk management is foundational to preventing diabetes complications"
]);

// ═══════════════════════════════════════════════════════════════════════════
// CLOSING SLIDE
// ═══════════════════════════════════════════════════════════════════════════
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    "Diabetes care must be person-centered, team-based, and address SDOH to reduce health disparities",
    "Early screening, classification, and presymptomatic T1D detection are critical for timely intervention",
    "Lifestyle modification and structured prevention programs remain the cornerstone for T2D prevention",
    "Glycemic goals individualized: consider A1C, TIR, TBR — balance benefit vs. hypoglycemia risk",
    "Diabetes technology (CGM, AID) dramatically improves outcomes and quality of life",
    "GLP-1 RAs, dual GIP/GLP-1 RAs, and SGLT2 inhibitors are disease-modifying — use for CV/kidney benefit",
    "Obesity treatment (behavioral, pharmacologic, surgical) can achieve diabetes remission",
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