ADA Updates Diabetes Treatment Guidelines to Reelect Benefits of GLP-1
Further, the authors of the “Standards of Care in Diabetes 2025” highlighted the benefits of continuous glucose monitoring systems and recommend initiating these as soon as possible.
The American Diabetes Association updated the pharmacological glycemic treatment of their “Standards of Care in Diabetes 2025” to better reflect the use of glucagon-like peptide-1 (GLP-1) medication and treatment of concurrent conditions, such as weight, cardiovascular, and kidney issues.1
Further, the authors of the “Standards of Care in Diabetes 2025” highlighted the benefits of continuous glucose monitoring systems and recommend initiating these as soon as possible. | Image Credit: tashatuvango - stock.adobe.com
In the 2025 updates, a constant theme seemed to center around shared and team-based decision-making for patients with type 2 diabetes. For pharmacological treatment, the authors emphasized treatment to help achieve and maintain the treatment goals while also considering other effects, such as cardiovascular disease, kidney disease, and weight management. Further, they highlight the individual’s preference, as well as the risk of hypoglycemia, cost, access, and risk of adverse reactions.2
Recommendations for patients with type 2 diabetes and established or high risk of atherosclerotic cardiovascular disease should include medications with cardiovascular benefits, including GLP-1 medications and/or sodium–glucose cotransporter 2 inhibitors (SGLT2). Similarly, patients with type 2 diabetes and heart failure should receive an SGLT2 inhibitor, and patients with concurrent and chronic kidney disease can receive either an SGLT2 inhibitor or GLP-1. Additionally, patients with concurrent metabolic dysfunction-associated steatotic liver disease or metabolic dysfunction-associated steatohepatitis and obesity or overweight should use a GLP-1 or a dual glucose-dependent insulinotropic polypeptide (GIP).2
The authors also added that there is no evidence to support additional glucose lowering with GLP-1 and dipeptidyl peptidase 4 inhibitors beyond what has already been provided with GLP-1s alone; therefore, they do not recommend the concurrent use. Further, GLP-1 medication or dual GIP and GLP-1 receptor agonists are preferred for patients who have an absence of evidence of insulin deficiency. They also added a new subsection that included special circumstances, including during drug shortages. The authors state that the use of compounded products not approved by the FDA is not recommended due to safety, quality, and effectiveness, and if the medication is unavailable, providers should switch to another FDA-approved medication with similar efficacy. Upon availability, the patient should be assessed for appropriateness before resuming the original medication, according to the authors.2
Additionally, the authors highlighted introducing patients with diabetes to technology earlier, including at diagnosis if deemed necessary. They stated that all reports for continuous glucose monitoring (CGM) systems, connected insulin devices, and continuous subcutaneous insulin infusion and automated insulin delivery systems should provide, at minimum, ambulatory glucose profiles and weekly summaries, but there should be an option for raw data or daily and weekly reports available to the patient’s health care providers. The authors also support the use of real-time CGMS and intermittent scanned CGMs for adolescents and adults with diabetes on any insulin-based therapy. Further, intermittent scanned and real-time CGMs should be considered for adults with type 2 diabetes on glucose-lowering agents other than insulin.3
Furthermore, the authors also highlighted combining CGM, insulin pumps, and/or diabetes apps with online or virtual coaching to improve glycemic outcomes. For example, pharmacist-led interventions with CGMs showed a substantial decrease in hemoglobin A1c for patients with type 2 diabetes, according to a study published in JAPhA Practice Innovations.3,4
