2025 ADA Standards of Care: 4 Key Changes You Shouldn’t Miss
The start of a new year means one thing in diabetes care and education—new Standards of Care! While the guidelines continue to grow in size and detail, much like a thick phone book, their annual updates are incredibly important for shaping high-quality care for people living with diabetes. Here are four key updates I’m particularly excited to see this year.
What are the Standards of Care?
The ADA Standards of Care are widely recognized as the gold standard for evidence-based guidelines in diagnosing and managing diabetes and prediabetes. Grounded in the latest scientific research and clinical trials, these guidelines provide strategies for diagnosing and treating diabetes in both youth and adults. They also outline methods to prevent or delay type 2 diabetes and its related comorbidities, such as obesity, while offering care recommendations aimed at improving health outcomes.
The first ADA Standards of Care, published in 1989, offered evidence-based recommendations in just four pages. In contrast, the 2025 Standards span over 350 pages, far from a quick lunchtime read.
Why Do the Standards Change Each Year?
Diabetes management is a rapidly evolving field, with new clinical trials, technologies, and medications continuously shaping treatment approaches. The ADA Standards are updated annually to incorporate the latest evidence, research advancements, and emerging best practices in diabetes care. These updates ensure healthcare providers have access to the most current guidelines to optimize patient outcomes and maintain alignment with evidence-based practices.
Additionally, the revisions address changes in healthcare policy, population health trends, and insights from the Professional Practice Committee, ensuring the standards remain relevant and applicable across diverse care settings.
Four Key Changes to Consider
While there are numerous changes to the 2025 Standards of Care, which you can review in the Summary of Revisions, I recommend paying special attention to these four updates that are likely to influence your practice in diabetes care and education.
#1. Expanding the Role of CGM in Non-Insulin Users
The benefits of continuous glucose monitoring are well known, including reduced episodes of hypoglycemia, improved time in range, better A1c levels, and less glycemic variability. It’s no surprise that even individuals not using insulin to manage their glucose can benefit from CGM.
Although not as “intensive” as insulin, oral medications and non-insulin injectables can still pose risks associated with their use. Declining renal function, cognitive impairment, and polypharmacy can further elevate these risks, particularly in older adults.
Clinicians and educators are encouraged to explore the potential of CGM for adults not using insulin. While insurance coverage may be limited, two new over-the-counter, cash-pay options have made CGM more accessible than ever before.
7.16 Consider using rtCGM and isCGM in adults with type 2 diabetes treated with glucose-lowering medications other than insulin to achieve and maintain individualized glycemic goals. The choice of device should be made based on the individual’s circumstances, preferences, and needs. Grade B.
#2. Maximizing GLP-1 Therapy Beyond Weight Loss
The benefits of GLP-1 therapy are extensive, which include improved glucose, reduced cardiovascular disease risk, and enhancements in inflammation, sleep apnea, and even addiction or impulse control. In recent years however, the focus on weight loss has taken center stage, often overshadowing its role in diabetes management. Clinicians and patients alike sometimes overlook the therapy’s immense potential for supporting heart and kidney health.
It’s important to resist discontinuing weight management therapy after achieving the target weight. Even with diabetes remission (euglycemia for over three months without medications), prior exposure to hyperglycemia can cause lasting macrovascular and microvascular damage, posing risks even for individuals with “perfectly controlled diabetes.”
8.19 Weight management pharmacotherapy indicated for chronic therapy should be continued beyond reaching weight loss goals to maintain the health benefits. Sudden discontinuation of weight management pharmacotherapy often results in weight gain and worsening of cardiometabolic risk factors. Grade A.
#3. The Critical Role of Sleep
As if the effects of poor sleep in your own life weren’t evidence enough, both the quality and duration of sleep have a profound impact on diabetes management and disease prevention. This year’s updates to the Standards emphasize sleep as a central component in managing prediabetes and type 2 diabetes, elevating it to the same importance as other lifestyle factors like physical activity and eating patterns. Poor sleep quality has been linked to a 40–84% higher risk of developing type 2 diabetes.
Chronotype preference has been associated with various chronic diseases, including type 2 diabetes. Individuals with an evening preference (ie. going to bed late and waking up late) have a 2.5-fold greater chance of developing type 2 diabetes compared to those with a morning preference (ie. going to bed early and waking up early), regardless of sleep duration or sufficiency.
#4 SCREEN FOR DIABETES
I greatly appreciate that the Standards emphasize the importance of antibody-based screening for presymptomatic type 1 diabetes in those with a family history or an otherwise elevated genetic risk. Early screening and detection can help mitigate many of the risks associated with a “surprise” type 1 diabetes diagnosis. Hospitalization for new-onset type 1 diabetes with diabetic ketoacidosis can be a highly traumatic experience with lasting health consequences.
There is immense potential for diabetes care and education specialists to provide resources on screening for early diagnosis at the community level.
2.7 Autoantibody-based screening for presymptomatic type 1 diabetes should be offered to those with a family history of type 1 diabetes or otherwise known elevated genetic risk. Grade B.
Key Takeaways
The ADA Standards of Care are the gold standard for evidence-based guidelines in diagnosing and managing diabetes and prediabetes. The 2025 updates offer practical, actionable guidance for integrating advancements in diabetes care into clinical practice, emphasizing prevention, early detection, and comprehensive management strategies. While the 350+ pages may seem overwhelming, the 2025 Standards are an invaluable resource for guidance and reference.
The full 2025 Standards of Care are available on the American Diabetes Association website.
