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Agreeing Language in Veterinary Endocrinology (ALIVE): Hypothyroidism, Hyperthyroidism, (Euglycaemic) Diabetic Ketosis/Ketoacidosis, and Diabetic Remission—A Modified Delphi-Method-Based System to Create Consensus Definitions
Journal article   Open access   Peer reviewed

Agreeing Language in Veterinary Endocrinology (ALIVE): Hypothyroidism, Hyperthyroidism, (Euglycaemic) Diabetic Ketosis/Ketoacidosis, and Diabetic Remission—A Modified Delphi-Method-Based System to Create Consensus Definitions

Stijn J. M. Niessen, Robert Shiel, Astrid Wehner, Miguel Campos, Sylvie Daminet, Federico Fracassi, Peter Graham, Jérémie Korchia, Patty Lathan, Rodolfo Leal, …
Veterinary sciences, Vol.13(1), 35
2026
DOI: https://doi.org/10.3390/vetsci13010035
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Published (Version of Record)CC BY V4.0,  Open Access

Abstract

consensus terminology thyroid hyperthyroidism hypothyroidism diabetes mellitus endocrinology Delphi
Simple Summary After having achieved international consensus over disease, diagnosis, classification, and monitoring concepts in the area of companion animal diabetes mellitus, Cushing’s syndrome, and hypoadrenocorticism, a group of 14 experts and one chair embarked on the third cycle of project “Agreeing Language in Veterinary Endocrinology” (ALIVE), this time focusing on thyroid disease terminology. This cycle’s methods followed, like previous ones, a modified Delphi-approach with small changes to improve efficiency and flexibility, including an off-site chair. For the first time, additionally, feedback on definitions of a previous cycle was incorporated, leading to an update of diabetes mellitus related definitions of ALIVE Cycle 1. This third cycle was completed successfully, accomplishing a majority-based consensus among panellists and international veterinary endocrinology society memberships over 78 thyroid related terminology and five updated diabetes mellitus definitions. As has been the case with the definitions created for other hormonal diseases, it is hoped this work will improve education, research, diagnosis, and treatment in cats and dogs with endocrine disease. Abstract Companion animal endocrinology has benefited from international standardisation of disease terminology for diabetes mellitus, Cushing’s syndrome, and hypoadrenocorticism through Project Agreeing Language in Veterinary Endocrinology (ALIVE). A group of 14 experts and one chair convened for the third cycle of Project ALIVE, focusing on thyroid disease terminology. The cycle employed the modified Delphi approach from previous cycles, augmented by procedural refinements—such as inclusion of an off-site chair and stricter adherence to timelines —to improve efficiency and flexibility. Novel in this round was the integration of feedback from a previous cycle, which resulted in updated definitions for diabetes mellitus originally developed in ALIVE Cycle 1. Outcomes: A 100% consensus was achieved among panellists and 91.4–100% among 105 members of international veterinary endocrinology societies (32% of total memberships) over 78 thyroid-related terminology items and five revised definitions pertaining to diabetes mellitus. These standardised definitions are expected to facilitate clearer communication and education, enhance diagnostic consistency, support research comparability, and improve clinical care in feline and canine endocrine diseases.

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UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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