From the Guidelines
The 2025 American Diabetes Association (ADA) Standards of Care prioritize a patient-centered approach to diabetes management, emphasizing comprehensive cardiovascular risk reduction and individualized treatment plans to improve morbidity, mortality, and quality of life outcomes. The guidelines recommend early screening for diabetes, particularly in overweight or obese adults beginning at age 35, with more frequent screening for high-risk populations 1. For type 2 diabetes management, metformin remains the preferred first-line medication, but the guidelines now more strongly recommend early consideration of GLP-1 receptor agonists (like semaglutide, tirzepatide) or SGLT2 inhibitors (like empagliflozin, dapagliflozin) for patients with established cardiovascular disease, heart failure, or chronic kidney disease 1.
Key updates in the 2025 ADA Standards of Care include:
- Target HbA1c for most adults is less than 7%, though this can be personalized to less than 6.5% for selected patients or relaxed to less than 8% for those with limited life expectancy or high hypoglycemia risk
- Comprehensive cardiovascular risk reduction, including blood pressure targets below 130/80 mmHg for most patients and statin therapy based on risk stratification
- Individualized eating patterns rather than a one-size-fits-all approach, while encouraging regular physical activity of at least 150 minutes of moderate-intensity exercise weekly
- Importance of diabetes technology, including continuous glucose monitoring for all insulin-treated patients, and addressing social determinants of health as critical factors in diabetes care 1.
The guidelines also highlight the importance of screening for geriatric syndromes, hypoglycemia, and polypharmacy in older adults with diabetes, as these may affect diabetes management and diminish quality of life 1. Overall, the 2025 ADA Standards of Care aim to provide a comprehensive and patient-centered approach to diabetes management, prioritizing individualized treatment plans and comprehensive cardiovascular risk reduction to improve outcomes for people with diabetes.
From the Research
Overview of 2025 ADA Standards of Care
There are no research papers provided that directly discuss the 2025 ADA standards of care. However, the available studies provide information on the comparative effectiveness of different diabetes medications.
Comparative Effectiveness of Diabetes Medications
- The study 2 compared the efficacy of GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors as an add-on to insulin and oral hypoglycemic drugs in patients with type 2 diabetes.
- The study 3 evaluated the comparative effectiveness and safety of monotherapy and metformin-based combination therapy for type 2 diabetes.
- The study 4 compared the risk of major adverse cardiovascular events among patients with type 2 diabetes treated with SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas.
- The study 5 found that metformin initiation was associated with exceptional longevity compared to sulfonylurea initiation in women with type 2 diabetes.
- The study 6 evaluated the comparative effectiveness of SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors in preventing hyperkalemia in people with type 2 diabetes.
Key Findings
- GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors can effectively lower HbA1c and FPG levels in patients with type 2 diabetes 2.
- Metformin is associated with a lower risk of cardiovascular mortality and all-cause mortality compared to sulfonylureas 3.
- SGLT2 inhibitors and GLP-1 receptor agonists are associated with a lower risk of major adverse cardiovascular events compared to DPP-4 inhibitors and sulfonylureas 4.
- Metformin initiation is associated with exceptional longevity compared to sulfonylurea initiation in women with type 2 diabetes 5.
- SGLT-2 inhibitors and GLP-1 receptor agonists are associated with a lower risk of hyperkalemia compared to DPP-4 inhibitors in people with type 2 diabetes 6.