ADA Standards of Care 2025: Complete Guide to Diabetes Management

Every January, the American Diabetes Association releases its updated Standards of Care—a comprehensive guide that shapes how diabetes is treated across the United States and influences practice worldwide. The 2025 edition brings significant changes reflecting the latest research, new medications, and evolving technology.

Whether you're living with diabetes, caring for someone who is, or simply want to understand the current state of diabetes care, this guide breaks down the most important updates from the 400+ page document.

The ADA Standards of Care is an annually updated clinical practice guideline that provides evidence-based recommendations for diabetes diagnosis, treatment, and prevention. It's developed by the Professional Practice Committee—a panel of physicians, researchers, and diabetes experts who review thousands of studies to determine what works best.

These standards aren't just suggestions—they're the foundation upon which:

• Insurance coverage decisions are made
• Quality metrics for healthcare providers are established
• Clinical guidelines worldwide are based
• Your doctor likely makes treatment decisions

1. Expanded Emphasis on Social Determinants of Health

The 2025 standards place unprecedented focus on social determinants of health (SDOH)—the conditions in which you live, work, and play that affect health outcomes. The ADA now recommends that healthcare providers routinely screen for:

• Food insecurity
• Housing instability
• Financial barriers to care
• Health literacy limitations
• Social isolation

Why this matters: Diabetes doesn't exist in a vacuum. The guidelines acknowledge that telling someone to "eat healthy" is ineffective if they lack access to nutritious food or can't afford medications.

2. Refined Diabetes Staging System

The 2025 standards continue to emphasize viewing diabetes as a continuum rather than a binary condition. The staging system now includes:

This staging helps intervene earlier—when reversal is still possible.

3. First-Line GLP-1 Agonists for High-Risk Patients

Perhaps the most significant change: GLP-1 receptor agonists are now recommended as first-line treatment (alongside metformin) for patients with:

• BMI ≥ 27 kg/m² AND one or more weight-related comorbidity, OR
• BMI ≥ 30 kg/m²

This acknowledges that for many patients, addressing weight is as important as addressing blood sugar.

4. Updated Blood Pressure and Lipid Targets

The 2025 standards refine cardiovascular risk management:

• Blood Pressure: Individualized targets, generally < 130/80 mmHg
• LDL Cholesterol: More aggressive targets for high-risk patients
• Statin Therapy: Recommended for most patients 40-75 years old

5. Enhanced Screening Recommendations

New screening intervals emphasize earlier detection of complications:

• Retinopathy: Annual eye exams for type 2 diabetes at diagnosis; for type 1, begin 5 years after diagnosis (changed from 3-5 years)
• Neuropathy: Annual screening using simple tests
• Kidney disease: Annual eGFR and albumin-to-creatinine ratio

Based on the new standards, here's how treatment typically progresses:

For Type 2 Diabetes at Diagnosis:

First Line (Start Immediately):

1. Lifestyle modification (nutrition therapy, physical activity)
2. Metformin (unless contraindicated)
3. AND GLP-1 agonist OR SGLT2 inhibitor if high cardiovascular or kidney risk

If A1C Remains Above Target:

• Add a second agent from a different class
• Consider dual therapy if A1C is 1.5% above target at diagnosis

If A1C Remains Above Target on Two Agents:

• Add a third agent OR
• Consider basal insulin

Individualized Targets Matter

The standards emphasize that no single target fits all. Factors to consider include:

Continuous Glucose Monitoring (CGM)

The 2025 standards strongly recommend CGM for all patients with type 1 diabetes and suggest it for patients with type 2 diabetes on basal-bolus insulin.

Key CGM Metrics to Track:

• Time in Range (TIR): Percentage of time with glucose 70-180 mg/dL (goal: >70%)
• Time Below Range (TBR): Percentage of time with glucose <70 mg/dL (goal: <4%)
• Time Above Range (TAR): Percentage of time with glucose >180 mg/dL (goal: <25%)

CGM is now considered as effective as A1C for assessing glycemic control, and for many patients, superior.

Automated Insulin Delivery (AID) Systems

These "hybrid closed-loop" systems automatically adjust insulin based on CGM readings. The 2025 standards endorse AID systems as the most effective method currently available for managing type 1 diabetes.

Cardiovascular disease remains the leading cause of death in diabetes. The 2025 standards integrate cardiovascular protection into routine diabetes care:

SGLT2 Inhibitors for Heart and Kidney Protection

For patients with:

• Heart failure: SGLT2 inhibitors recommended regardless of A1C
• Chronic kidney disease: Recommended at eGFR ≥ 20 mL/min/1.73 m²
• Established ASCVD: Recommended for secondary prevention

These medications reduce cardiovascular events and slow kidney disease progression—independent of their blood sugar-lowering effects.

GLP-1 Agonists for Cardiovascular Risk Reduction

For patients with established ASCVD, GLP-1 agonists with proven cardiovascular benefit (liraglutide, semaglutide, dulaglutide) are recommended to reduce cardiovascular events.

Older Adults (65+)

The 2025 standards emphasize de-intensification of therapy for older adults to avoid hypoglycemia:

• A1C targets: Individualized, often 7.5-8.0% or higher
• Medication simplification: Reduce pill burden when possible
• Focus: Quality of life over tight control

Pregnancy

Planning pregnancy is crucial for women with diabetes. Recommendations include:

• A1C target: < 6.0% before conception (to reduce birth defects)
• Medications: Discontinue unsafe medications (ACE inhibitors, statins, most oral agents)
• Monitoring: Frequent CGM recommended

Youth and Young Adults

Rising rates of type 2 diabetes in young people necessitate:

• Early screening for at-risk youth (BMI ≥ 85th percentile + one risk factor)
• Family-based lifestyle interventions
• Consideration of metformin when lifestyle alone insufficient

The 2025 standards reinforce the importance of vaccination for people with diabetes, who are at higher risk for complications from vaccine-preventable diseases:

1. Diabetes care is more personalized than ever—targets depend on your age, health status, and personal goals
2. Weight management is now core to diabetes treatment—new first-line options reflect this
3. Technology (CGM, AID) is standard of care—not optional extras
4. Cardiovascular and kidney protection happen alongside—not after—glucose management
5. Your circumstances matter—social determinants of health now receive formal attention

What is the A1C target for most adults with diabetes?

The general A1C target for most nonpregnant adults is <7.0%. However, targets should be individualized. For younger, healthier patients, a target of <6.5% may be appropriate. For older adults or those with limited life expectancy, <8.0% may be more appropriate.

When should someone with type 2 diabetes start insulin?

The 2025 standards recommend considering insulin when:

• A1C remains above target despite two or three oral agents
• There is evidence of significant catabolism (unexplained weight loss)
• Symptoms of hyperglycemia (thirst, frequent urination) are present
• During pregnancy or pregnancy planning

What is the difference between prediabetes and diabetes?

Prediabetes is defined as:

• A1C: 5.7-6.4%
• Fasting plasma glucose: 100-125 mg/dL
• 2-hour OGTT: 140-199 mg/dL

Diabetes is diagnosed when:

• A1C: ≥ 6.5%
• Fasting plasma glucose: ≥ 126 mg/dL
• 2-hour OGTT: ≥ 200 mg/dL
• Random glucose: ≥ 200 mg/dL with symptoms

Are GLP-1 agonists safe for everyone?

GLP-1 agonists are generally safe but should be used with caution or avoided in:

• Personal or family history of medullary thyroid cancer (for some agents)
• Multiple endocrine neoplasia syndrome type 2
• Severe gastrointestinal disease
• Pregnancy (most are not approved)

How often should I see my doctor if I have diabetes?

The 2025 standards recommend:

• Quarterly (every 3 months): For patients not meeting treatment goals or changing therapy
• Semiannually (every 6 months): For patients meeting goals and stable
• Annually: Comprehensive exam including foot exam, neuropathy screening, and laboratory tests

Understanding the standards is just the first step. Managing diabetes effectively requires tracking your progress over time.

Sign up for WellAlly to:

• Track your A1C trends
• Monitor blood sugar patterns
• Store and organize lab results
• Set personalized health goals

Your health journey deserves comprehensive tracking. Start today.

Sources:

• American Diabetes Association. Standards of Care in Diabetes—2025. Diabetes Care 2025; 48(Suppl 1)
• ADA Standards of Care
• CDC Diabetes Resources