American Diabetes Association Issues Updates to Standards of Care in Diabetes for 2025
The authors emphasize the importance of multifaceted and team-based approaches to the management of diabetes.
The “Standards of Care in Diabetes 2025” highlighted person-first care, including expanding recommendations that focus on other disease states outside of diabetes, including obesity, cardiovascular health, and chronic kidney disease. Further, the authors emphasized the importance of multifaceted approaches and team-based care.1
The authors emphasize the importance of multifaceted and team-based approaches to the management of diabetes. | Image Credit: Chinnapong - stock.adobe.com
The authors stated, “The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the American Diabetes Association has long been a leader in producing guidelines that capture the most current state of the field.”1
In section 4 of the standards of care, the authors emphasized person-centered and strength-based language to be used for patients and that patients can benefit from a team of interprofessionals that includes diabetes care specialists, primary care and specialty clinicians, nurses, dietitians, pharmacists, dentists, and behavioral health professionals. Particularly, a new recommendation includes a team approach to address overweight and obesity for patients with type 2 diabetes who have metabolic dysfunction-associated steatotic liver disease. Ideally, health care professionals should recommend lifestyle changes, including a structured nutrition plan and physical activity program.2
Glucagon-like peptide-1 (GLP-1) receptor agonists were also highlighted as part of this approach for their many benefits independent of diabetes, including weight loss, cardiac benefits, and liver benefits. GLP-1s are recommended to be used as an adjunct to lifestyle interventions and can be used with a glucose-dependent insulinotropic polypeptide or in combination with pioglitazone, according to the authors.2
In section 5, the authors emphasized the importance of education for self-management of diabetes, including advising patients to join self-management education and support (DSMES) instead of just being encouraged. DSMES can help improve decision-making, self-care behaviors, problem-solving, and active collaboration with the health care team, according to the authors. The program can assess clinical outcomes, well-being, and health status and can be adjusted to meet individual preferences, such as being offered digitally or via telehealth.3
Nutrition and weight management are also emphasized in this section, further showcasing the importance of weight loss for diabetes, nutrition, physical activity, and behavioral therapy. In section 2, the authors also added sleep to the prevention or delay of diabetes sections, discussing how sleep can help in the management of prediabetes and type 2 diabetes. They state that “for the first time, [sleep is] on the same level as other lifestyle behaviors,” including physical activity and nutrition. Sleep is categorized as quantity, quality, and timing, according to the authors. They stated less than 6 hours and more than 9 hours of sleep have up to a 50% increase in type 2 diabetes, and poor quality was associated with approximately a 40% to 84% increased risk of diabetes. For chronotype preference, patients that go to bed later and get up later had a 2.5-fold higher odds ratio for type 2 diabetes compared with those who prefer going to bed earlier and getting up earlier.3,4
Furthermore, changes in obesity and overweight were also emphasized, including additional measurements beyond body mass index to support the diagnosis of obesity, including waist circumference, waist-to-hip ratio, and/or waist-to-height ratio. Further, during active weight management, measurements should be taken at least every 3 months, and continued monitoring, support, and interventions should be given to patients who have achieved the weight loss goals to maintain the long-term effects.5
The authors also acknowledged that there were many minor changes that either clarified other recommendations or reflected new evidence. Additionally, the authors added new language that continued to emphasize person-first outcomes and inclusivity. They stated, “Efforts were made to consistently apply terminology that empowers people with diabetes and recognizes the individual at the center of diabetes care.”1
