What changes can be expected in patient care due to updates in the American Diabetes Association (ADA) 2026 guidelines?

ADA 2025 Standards: Key Changes in Diabetes Care

The 2025 ADA Standards of Care introduce a fundamental shift toward addressing social determinants of health (SDOH) as a core component of diabetes management, alongside strengthened emphasis on person-centered team-based care and quality improvement infrastructure. 1

Major Structural Changes

Social Determinants of Health Integration

• Treatment decisions must now explicitly capture key elements within SDOH, moving beyond traditional clinical parameters to address factors often beyond an individual's direct control that significantly impact both clinical and psychosocial outcomes 1
• This represents a critical evolution from prior guidelines that mentioned patient preferences but did not mandate systematic SDOH assessment as part of treatment planning 1
• The 2025 guidelines specifically emphasize addressing these determinants for individuals from racial and ethnic minority communities, underserved geographic areas (rural or urban), and those facing socioeconomic barriers 1

Enhanced Team-Based Care Requirements

• Care systems must now facilitate both in-person AND virtual team-based care, a direct response to lessons learned during the COVID-19 pandemic 1
• Teams must include members "knowledgeable and experienced in diabetes management" as a formal requirement, not merely a suggestion 1
• The guidelines mandate utilization of patient registries, decision support tools, proactive care planning, and community involvement—representing a more prescriptive approach than the 2020 standards which simply suggested these tools 1

Quality Improvement Mandate

System-Level Requirements

• Health systems must adopt a culture of quality improvement with implementation of benchmarking programs and engagement of interprofessional teams 1
• This moves beyond the 2020 recommendation to simply "assess diabetes health care maintenance" toward requiring sustainable and scalable process changes 1
• The emphasis on "reliable and relevant data metrics" now explicitly includes attention to care costs, individual preferences and goals, and treatment burden—a more comprehensive framework than previous iterations 1

Psychosocial Care Evolution

While the 2025 guidelines maintain the psychosocial screening protocols established in 2021-2023, they now integrate these within the broader SDOH framework 1:

• Routine monitoring for diabetes distress, depression, anxiety, disordered eating, and cognitive dysfunction remains standard 1
• Referral to mental health specialists should occur when self-care remains impaired after tailored diabetes education 1
• The 2025 standards emphasize that psychosocial care must be "person-centered" and "culturally informed," aligning with the SDOH focus 1

Clinical Practice Implications

Decision-Making Framework

Treatment decisions must be:

1. Timely and evidence-based 1
2. Collaborative with patients based on individual preferences, prognoses, and comorbidities 1
3. Informed by financial considerations—a new explicit requirement 1
4. Guided by SDOH assessment 1

Implementation Priorities

• Establish virtual care capabilities if not already in place, as this is now a standard requirement rather than an option 1
• Implement systematic SDOH screening as part of routine diabetes assessment 1
• Develop or join benchmarking programs to support quality improvement initiatives 1
• Ensure access to interprofessional team members with diabetes expertise, including mental health providers when indicated 1

Critical Distinctions from Prior Guidelines

The 2025 standards differ from 2020 guidelines 1 by:

• Mandating SDOH integration rather than simply acknowledging patient preferences 1
• Requiring virtual care infrastructure, not just suggesting it 1
• Demanding quality improvement culture adoption at the system level 1
• Explicitly including financial considerations in treatment decision-making 1

Common pitfall: Treating these as aspirational goals rather than practice standards. The 2025 guidelines use stronger language ("ensure," "must") compared to previous versions, indicating these are expected components of diabetes care, not optional enhancements 1.