# 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

## TL;DR

Experts created standardized terminology for thyroid diseases and updated diabetes definitions in pets to improve communication and care.

## Contribution

The novel integration of feedback from prior work led to updated diabetes definitions and consensus on 78 thyroid-related terms.

## Key findings

- Achieved 100% panel consensus and 91.4–100% society member consensus on thyroid terminology.
- Five diabetes mellitus definitions were revised based on prior feedback.
- Standardized terms aim to enhance education, diagnosis, and treatment in veterinary endocrinology.

## Abstract

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.

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.