ADA Standards of Care in Diabetes - 2025

Key Sections & Highlights

1. Diagnosis & Classification (Section 2) - PMID: 39651986

• Type 1, Type 2, GDM, and other specific types remain the main categories
• Diagnostic criteria unchanged: FPG ≥126 mg/dL, 2-hr PG ≥200 mg/dL, HbA1c ≥6.5%, or random PG ≥200 with symptoms
• Prediabetes thresholds: FPG 100-125 mg/dL, or HbA1c 5.7-6.4%

2. Glycemic Goals & Hypoglycemia (Section 6) - PMID: 39651981

• HbA1c target: <7.0% for most non-pregnant adults
• Less stringent goal (<8.0%) for those with limited life expectancy, hypoglycemia unawareness, or extensive comorbidities
• CGM targets (Time-in-Range):
  • TIR >70% (70-180 mg/dL) for most adults with T1DM/T2DM
  • Time Below Range (<70 mg/dL) <4%, (<54 mg/dL) <1%
  • Time Above Range (>250 mg/dL) <5%
• Hypoglycemia classification: Level 1 (<70 mg/dL), Level 2 (<54 mg/dL), Level 3 (severe, requiring assistance)

3. Pharmacologic Treatment (Section 9) - PMID: 39651989

• GLP-1 RAs and GLP-1/GIP dual agonists (e.g., semaglutide, tirzepatide) are now preferred agents for T2DM with obesity, ASCVD, heart failure, or CKD - independent of HbA1c
• SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) preferred in T2DM with heart failure with reduced ejection fraction (HFrEF) or CKD
• Metformin remains a first-line option for T2DM without compelling indications for other agents, but is no longer the default "start here" drug - individualized therapy is emphasized
• Tirzepatide (GLP-1/GIP) has expanded indications with strong HbA1c lowering and weight loss data
• Insulin therapy: basal insulin preferred as initial injectable; degludec and glargine U-300 preferred for less hypoglycemia

4. Cardiovascular Risk Reduction (Section 10)

• Statin therapy recommended for all T2DM patients 40-75 years (moderate-high intensity)
• ACE inhibitors / ARBs for patients with hypertension + diabetes + CKD or albuminuria
• Finerenone (a non-steroidal MRA) added as a recommendation for T2DM + CKD to reduce cardiovascular and renal progression
• BP target: <130/80 mmHg for most patients with diabetes

5. Obesity Management (Section 8)

• BMI threshold for intervention lowered - obesity-focused treatment is integral to diabetes management
• GLP-1 RAs and tirzepatide explicitly recommended for weight management in T2DM
• Bariatric/metabolic surgery recommended for T2DM with BMI ≥35 (or ≥30 in Asian Americans)

6. CKD & Diabetes (Section 11)

• UACR screening annually for all T2DM patients
• eGFR targets refined
• SGLT2i + finerenone combination supported for diabetic kidney disease
• RAAS blockade (ACE-I or ARB) remains standard for albuminuric CKD

7. Diabetes in Pregnancy (Section 15) - PMID: 39651985

• GDM screening: 24-28 weeks using 1-step (75g OGTT) or 2-step approach
• Insulin remains the preferred pharmacologic agent in pregnancy; metformin may be used as second-line
• Postpartum T2DM screening at 4-12 weeks and every 1-3 years thereafter

8. Technology & CGM (Section 7)

• CGM recommended for all insulin-using patients
• Automated Insulin Delivery (AID) systems (closed-loop) strongly recommended for T1DM
• Intermittently scanned CGM acceptable where real-time CGM is not feasible

Evidence Grading System

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Note: My data through mid-2026 does not show a separate "2026 ADA Standards" publication on PubMed yet, though one may have been released - the PubMed search above found the 2025 edition as the most recent indexed version. Check diabetesjournals.org for the most current supplement.