Welcome to the latest edition of our Guideline Spotlight, where we will explore the valuable insights and key takeaways from the most recent guideline releases. Today, our focus is on the American Diabetes Association’s (ADA) latest edition of their Standards of Care in Diabetes, which was released on December 9, 2024. This edition consolidates all current clinical practice recommendations of the ADA and aims to equip clinicians, researchers, policy makers, and other stakeholders with the essential components of diabetes care, general treatment goals, and tools for assessing the quality of care. The guidelines are updated annually, or more frequently online if necessary, to incorporate new evidence or regulatory changes.

It is important to note that this summary does not encompass all major points. For a complete list of recommendations, please refer to the summary provided here or access the full text located here. Let’s begin!

Key Takeaways and Recommendations

Continuous Glucose Monitoring

  • Continuous glucose monitoring (CGM) is recommended for individuals with type 2 diabetes, even those who are not using insulin. Research has shown that the use of CGM can significantly reduce the risk of serious complications such as diabetic ketoacidosis (DKA), severe hypoglycemic events, diabetes-related coma, and hospitalizations due to hypoglycemia and hyperglycemia.
  • In addition to CGM, there is new guidance regarding the use of GLP-1 receptor agonists, which include medications like tirzepatide (Mounjaro) and semaglutide (Ozempic). These guidelines emphasize the benefits of these incretin-based medications for heart and kidney health in individuals with type 2 diabetes. It is important to note, however, that these medications are not recommended for individuals with type 1 diabetes.

Pharmacologic Approaches to Glycemic Treatment

  • The recommendations have been updated to provide clear guidance on selecting pharmacotherapy for individuals with type 2 diabetes who have either established or high risk of atherosclerotic cardiovascular disease (ASCVD), heart failure, and chronic kidney disease (CKD). These revisions aim to improve health outcomes for individuals with these conditions, regardless of their A1C levels.
  • It is advised to use GLP-1 RA for individuals with type 2 diabetes, symptomatic heart failure with preserved ejection fraction, and obesity, as it has shown significant benefits.
  • The guidelines have been updated to recommend the use of either SGLT2 inhibitor or GLP-1 RA for individuals with type 2 diabetes and CKD, based on proven benefits.
  • New recommendations have been introduced to suggest treatment options for individuals with type 2 diabetes and either MASLD or MASH. These individuals may benefit from GLP-1 RA, dual GIP and GLP-1 RA, pioglitazone, or a combination of GLP-1 RA and pioglitazone, depending on the stage of liver disease risk and the need for weight management.

Sexual Health

  • It is advisable to evaluate the health of men and conduct screening for morning serum total testosterone if symptoms and/or signs of hypogonadism are evident. Moreover, men with diabetes or prediabetes should undergo screening for erectile dysfunction.
  • In addition, a new section on Female Dysfunction has been incorporated, featuring two new recommendations. Healthcare professionals are encouraged to inquire about the general well-being of women, particularly those dealing with depression, anxiety, or recurrent urinary tract infections. It is also essential to highlight the significance of screening for symptoms and signs of genitourinary syndrome of menopause.

Artificial Sweeteners

  • A recommendation was updated to suggest choosing water over beverages sweetened with either nutritive or nonnutritive sweeteners. Additionally, a new recommendation has been added, stating that nonnutritive sweeteners can be utilized as a substitute for sugar-sweetened products in moderation and for a limited period to decrease overall calorie and carbohydrate consumption.

Mental Health

  • New revisions have outlined the specific psychosocial concerns that healthcare professionals should be screening for in individuals with diabetes. These concerns include diabetes distress, depression, anxiety, fear of hypoglycemia, and disordered eating behaviors. Furthermore, it is recommended that individuals with diabetes, caregivers, and family members undergo annual screening for diabetes distress. 

Marijuana

  • The guidelines for 2025 advise against the recreational use of marijuana for individuals with type 1 diabetes. Research has indicated a higher likelihood of diabetic ketoacidosis (DKA) in individuals with type 1 diabetes who consume cannabis, primarily because of cannabis hyperemesis syndrome. This syndrome can result in serious symptoms like nausea, abdominal pain, and vomiting. It is important for individuals with diabetes to understand these potential risks and carefully consider their health and overall wellness when making decisions about marijuana use.

Sleep

  • Information regarding the importance of sleep health in relation to the risk of developing type 2 diabetes has been included. This addition emphasizes the role of sleep in managing prediabetes and type 2 diabetes, positioning it alongside other lifestyle behaviors such as physical activity and dietary patterns.

Vitamins

  • The information regarding the potential use of vitamin D therapy in preventing type 2 diabetes has been thoroughly revised. Additionally, the content discussing the long-term effects of metformin therapy and its correlation with vitamin B12 deficiency has been updated as well.

Immunizations

  • Updates have been made to the “Immunizations” subsection to include changes related to COVID-19, pneumococcal pneumonia, influenza, and respiratory syncytial virus.

The most recent ADA guidelines incorporate cutting-edge scientific research and clinical trials to provide evidence-based recommendations for diabetes care. This enables healthcare professionals to deliver optimal care for individuals living with diabetes.

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