Summary of New Recommendations: ADA's Standards of Care in Diabetes - 2025

<h2 id="improving-care">Improving Care and Promoting Health in Populations</h2><ul><li>It is essential to identify and address various social determinants of health that influence diabetes management, health outcomes, and overall quality of life.</li><li>In individuals with a familial predisposition to type 1 diabetes (T1D) or those identified as having an increased genetic susceptibility to the condition for other reasons, it is essential to conduct antibody-based screening for presymptomatic T1D.</li></ul><h2 id="comprehensive">Comprehensive Medical Evaluation and Assessment of Comorbidities recommendations</h2><ul><li>Referral fora dental examination is recommended at least once a year for individuals with diabetes.</li><li>It is essential for medical and dental teams to collaborate effectively to ensure that glucose-lowering medications and treatment plans are appropriately modified prior to and following the dental procedure.</li><li>Assessment for disability should be performed at the initial visit and an assessment for decline in function should be performed at each subsequent visit.</li><li>Inquire about sexual health in men and screen with a morning serum total testosterone if symptoms and/or signs of hypogonadism are present.</li><li>Men with diabetes or prediabetes should be screened for erectile dysfunction.</li><li>Inquire about sexual health in women who experience depression and/or anxiety and those with recurrent urinary tract infections and should screen for symptoms and/or signs of genitourinary syndrome of menopause.</li><li>The terminology for nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) was updated to metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction–associated steatohepatitis (MASH), respectively.</li><li>Screening for the risk of having or developing cirrhosis related to MASH should be performed by using the fibrosis-4 index (FIB-4).</li><li>Adults with type 2 diabetes or prediabetes and a FIB-4 &gt;1.3 should have additional risk stratification performed.</li></ul><h2 id="diabetes">Diabetes and comorbidities Management Recommendations</h2><ul><li>Use as an adjunct to weight-loss lifestyle interventions in adults with type 2 diabetes, and overweight or obesity—of a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon like peptide 1 (GLP-1) &nbsp;receptor agonist (RA).</li><li>Potential benefits against MASH, warrant glycemic management with pioglitazone, a GLP-1 RA, or a dual GIP. GLP-1 RA is preferred for glycemic management in adults with type 2 diabetes and biopsy-proven MASH or in those with a high risk for liver fibrosis.</li><li>In adults with type 2 diabetes or prediabetes, who have MASLD with moderate or advanced liver fibrosis, consideration can be given to treatment with a thyroid hormone receptor-13 agonist, with referral made “to a gastroenterologist or hepatologist with expertise in MASLD management for the initiation and monitoring of this therapy”.</li><li>Patients with diabetes and obesity who have undergone significant weight loss be screened for malnutrition.<br>Weight management pharmacotherapy should be continued even after weight loss goals in patients have been reached, to keep the weight from returning and to avoid the “worsening of cardiometabolic risk factors”.</li></ul><h2>Pharmacologic Approaches to Glycemic Treatment</h2><ul><li>Guideline emphasizes the importance of selecting glucose-lowering medications that provide sufficient effectiveness and achieve and maintain multiple treatment goals simultaneously, including improving &nbsp;cardiovascular, kidney, weight, and other relevant outcomes, reducing hypoglycemia risk, and considering cost, access, risk for adverse reactions, and individual preferences.</li><li>GLP-1 RA with demonstrated benefits regarding glycemic management and the decrease of heart failure—related symptoms be used in adults with type 2 diabetes who have symptomatic heart failure with preserved ejection &nbsp;fraction (HFpEF) and obesity.<br>Recommendation for use of either selective sodium-glucose transporter-2 (SGLT-2) inhibitor or GLP-1 RA with &nbsp;demonstrated benefits in individuals with type 2 diabetes and chronic kidney disease (CKD).</li><li>Reassessing the need for and/or dose of medications with higher hypoglycemia risk (i.e., sulfonylureas, meglitinides, and insulin) when initiating a new glucose-lowering medication to minimize the risk of hypoglycemia and treatment burden.</li><li>Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should be titrated to the maximally tolerated dose to prevent the progression of CKD and reduce cardiovascular events in nonpregnant individuals with diabetes and hypertension.</li></ul><h2 id="technology-recommendations">Diabetes technology recommendations</h2><ul><li>The initiation of diabetes technology, including continuous glucose monitors (CGMs), automated insulin dosing (AID) systems, and continuous subcutaneous insulin injection (CSII), should be considered promptly at the time of diagnosis, tailored to the specific needs and preferences of both the patient and the caregiver.</li><li>Adults diagnosed with type 2 diabetes who are utilizing non-insulin glucose-lowering medications should be evaluated for the potential use of real-time or intermittently scanned continuous glucose monitors (CGMs) to achieve and sustain their personalized glycemic targets.</li></ul>

<ul><li><a href="#improving-care">Improving Care and Promoting Health in Populations</a></li><li><a href="#comprehensive">Comprehensive Medical Evaluation and Assessment of Comorbidities recommendations</a></li><li><a href="#diabetes">Diabetes and comorbidities Management Recommendations</a></li><li><a href="#technology-recommendations">Diabetes technology recommendations</a></li></ul>

Summary of New Recommendations: ADA's Standards of Care in Diabetes - 2025

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