ADA releases updated Standards of Care for 2025

The American Diabetes Association's Standards of Care in Diabetes have been updated for 2025.

The latest standards, published Dec. 9, 2024, include new recommendations on several topics, including noting that patients who have a family history of type 1 diabetes or who are otherwise at higher genetic risk should receive antibody-based screening for presymptomatic type 1 diabetes.

In addition, the standards address dental care for the first time, with two new recommendations stating that people with diabetes should be referred for a dental exam at least once per year and that efforts between medical and dental teams should be coordinated so that glucose-lowering medications can be appropriately adjusted before and after dental procedures as needed. A new subsection on female sexual dysfunction, meanwhile, includes a recommendation that health care professionals should inquire about sexual health, particularly in women with depression and/or anxiety and those with recurrent urinary tract infections, and should screen for symptoms and/or signs of genitourinary syndrome of menopause. The terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) were revised to metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) and the standards include recommendations on when and how to screen for risk of developing cirrhosis in these patients.

Regarding facilitating positive health behaviors and well-being, the standards now emphasize all people with diabetes should participate in diabetes self-management education and include new recommendations on religious fasting, as well as an emphasis on screening for malnutrition, especially among patients who have had metabolic surgery and those being treated with pharmacological therapies for weight management. Another new recommendation addresses the association of sodium-glucose cotransporter inhibition with ketoacidosis under certain conditions and provides guidance on awareness, prevention, and risk mitigation, as well as dietary suggestions. The physical activity section now includes a recommendation to limit sedentary activities including screen time. This section also notes that people with type 1 diabetes and those with other forms of diabetes at risk for diabetic ketoacidosis should not use recreational cannabis in any form due to the risk of cannabis hyperemesis syndrome.

In the section on pharmacologic approaches to glycemic treatment, use of a glucagon-like peptide-1 (GLP-1) receptor agonist with demonstrated benefits is now recommended in individuals with type 2 diabetes, symptomatic heart failure with preserved ejection fraction, and obesity. Other new recommendations state that individuals with type 2 diabetes and MASLD or MASH should be treated with a GLP-1 receptor agonist, a dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, pioglitazone, or a combination of GLP-1 receptor agonist and pioglitazone based on staging of liver disease risk and need for weight management. Another new recommendation advises against concurrent use of a dipeptidyl peptidase-4 inhibitor with a GLP-1 receptor agonist due to lack of additional glucose lowering beyond that with GLP-1 receptor agonists alone.

Other revisions and new recommendations address risk management for cardiovascular disease and chronic kidney disease; retinopathy, neuropathy, and foot care; older adults; children and adolescents; diabetes in pregnancy; and diabetes care in the hospital, among other topics. The full Standards of Care were published as a supplement to Diabetes Care and include a summary of revisions.