The American Diabetes Association (ADA) has released its updated 2025 Standards of Care, with significant new recommendations focused on addressing emerging challenges in diabetes management. These updates cover a broad range of topics, from the use of continuous glucose monitoring (CGM) in type 2 diabetes to strategies for tackling medication shortages and enhancing heart and kidney health with GLP-1 receptor agonists.
Addressing Drug Shortages in Diabetes Care
A primary focus of the new Standards is the ongoing issue of drug shortages. The ADA has issued clear guidance urging healthcare providers to avoid prescribing compounded medications that lack FDA approval. In cases where a glucose-lowering medication is unavailable, the Standards recommend transitioning patients to an alternative FDA-approved drug. Once the shortage resolves, physicians should reassess the treatment plan and consider returning to the original medication.
Dr. Raveendhara Bannuru, Vice President of Medical Affairs and Quality Improvement Outcomes at the ADA, explained that this strong stance on drug shortages is a response to the evolving challenges in diabetes care, emphasizing the importance of using FDA-approved treatments.
Expanding Use of Continuous Glucose Monitoring for Type 2 Diabetes
Another notable update involves the use of CGM for adults with type 2 diabetes who are treated with non-insulin glucose-lowering medications. Data supporting the effectiveness of CGM in this group led the ADA to recommend its broader use, underscoring the role of technology in improving diabetes management outcomes.
“We have seen the evolving landscape of effective non-insulin therapies for type 2 diabetes management,” Dr. Bannuru noted. “It’s important to incorporate technology appropriately and effectively to improve outcomes.”
Screening for Presymptomatic Type 1 Diabetes
For individuals with a family history or high genetic risk of type 1 diabetes, the new Standards emphasize the importance of antibody-based screening before symptoms arise. The approval of teplizumab-mzwv (Tzield) for delaying the onset of type 1 diabetes, along with other potential therapies, makes early screening critical. Early identification can prevent diabetic ketoacidosis and reduce emergency hospitalizations typically seen at diagnosis.
“This kind of preemptive screening would prevent those issues,” Dr. Bannuru remarked, referring to the hospitalizations often triggered by severe complications at diagnosis.
Lifestyle Recommendations and Nutritional Guidance
The updated Standards also place significant focus on lifestyle factors, particularly nutrition and sleep. The new guidelines encourage people with diabetes to adopt evidence-based eating patterns and stress the importance of sleep, recommending 6-9 hours per night to help prevent type 2 diabetes. The ADA emphasizes that nutrition plans should be tailored to the individual, with shared decision-making between patients and healthcare providers.
“One of the highlights this year is emphasizing the intake of lean and plant-based protein sources while limiting saturated fats,” said Dr. Bannuru.
Additional Key Recommendations
The 2025 Standards introduce other critical recommendations, including:
Expanded use of GLP-1 receptor agonists to promote heart and kidney health.
Continued use of obesity medications even after weight-loss goals are achieved.
New treatments for metabolic dysfunction-associated steatotic liver disease (MASLD) in individuals with moderate or advanced liver fibrosis.
A recommendation against the use of recreational cannabis for individuals with type 1 diabetes or those at risk of diabetic ketoacidosis (DKA).
Updated guidance on the use of GLP-1 receptor agonists and similar drugs in the perioperative period, acknowledging the need for further research to provide clearer recommendations.
Accessing the Standards of Care
The ADA’s 2025 Standards of Care are available as a supplement in the January 2025 issue of Diabetes Care, and healthcare professionals can access them through the ADA’s interactive app, which includes guidance, tables, and algorithms. The Standards will be continuously updated throughout 2025 to reflect new research and regulatory changes.
These updates underscore the ADA’s commitment to providing healthcare professionals with the latest evidence-based tools to improve the care and outcomes for people with diabetes.
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