Your Guide to the 2025 ADA Standards of Care
The American Diabetes Association (ADA) recently released their 2025 Standards of Care, which – for the first time – includes recommendations for CGM use in type 2 diabetes, the use of GLP-1 drugs for kidney and heart health, and more.
Each year, the ADA publishes recommendations for diabetes care based on the latest scientific research and clinical trials. The updated 2025 Standards of Care offer comprehensive diabetes care strategies for healthcare providers that go beyond blood sugar management and include screening and prevention.
The ADA guidelines are a "living document" that publishes updates as new scientific evidence and helpful information about diabetes management emerges. Here are some of the highlights for 2025.
CGM for type 2 diabetes
For the first time, continuous glucose monitoring (CGM) is recommended for people with type 2 diabetes, including those who are not on insulin. Research shows CGM use can help reduce the risk of serious complications, including diabetic ketoacidosis (DKA), severe low blood sugar events, diabetes-related coma, and hospitalizations for hypoglycemia and hyperglycemia. Studies have also found that using CGM may improve A1C levels and blood sugar management in people with type 2 diabetes.
Though many insurance plans (including Medicare) may only cover CGM for people who require insulin, there are now over-the-counter (OTC) options, like the Stelo and Libre Rio, available for less than $100 per month. OTC CGM devices are recommended for people with prediabetes or type 2 diabetes who don’t require insulin.
The Standards of Care notes that OTC CGM is meant to provide behavioral insights on factors like diet and exercise, not manage day-to-day blood sugar. For such people, using CGM several times per year for two weeks at a time may be useful and less expensive than continuous CGM.
GLP-1s and SGLT-2 inhibitors for kidney and heart health
There is new guidance on incretin-based medications such as Mounjaro (tirzepatide) and Ozempic (semaglutide) and SGLT-2 inhibitors like Jardiance (empagliflozin) and Farxiga (dapagliflozin) for people with type 2 diabetes, emphasizing benefits for the heart and kidneys. The 2025 guidelines do not, however, recommend using these medicines for type 1 diabetes due to the risk of adverse events. GLP-1 receptor agonists and SGLT-2 inhibitors are prescribed by some healthcare providers “off-label” for people with type 1 diabetes, but the ADA does not currently recommend them due to insufficient efficacy and safety data.
Ozempic has been shown to slow the progression of kidney disease and reduce the risk of heart or kidney-related death in people with chronic kidney disease and type 2 diabetes. Mounjaro may help protect the kidneys and reduce the risk of heart failure in people with type 2 diabetes at risk of cardiovascular disease. There are clinical trials currently recruiting to further evaluate these medications to determine the benefits beyond A1C and weight loss.
Screening for type 1 diabetes
The updated guidelines recommend antibody-based screening for those with a family history or known genetic risk for type 1 diabetes. If caught in the early stages, providers may be able to prescribe newer treatments like Tzield (teplizumab), which may help delay the onset of type 1 diabetes and the need for insulin therapy. An early diagnosis and prompt treatment also reduce the risk of developing DKA with the diagnosis of type 1 diabetes.
Antibody screening involves a simple blood test for antibodies associated with type 1 diabetes. You can get one at a laboratory, doctor’s office, or have one done for free through the TrialNet Pathway to Prevention of T1D Study.
Open-source AID systems
The 2025 Standards of Care emphasized support for open-source closed loop automated insulin delivery (AID) systems, which studies have found to be safe and effective for diabetes management. Also known as do-it-yourself (DIY) systems, the preferred terminology per the new guidelines is now open-source. The ADA advises healthcare providers to learn how these systems work so they can assist their patients with diabetes in optimizing open-source AID settings.
Weight management treatments
For those taking medication for weight management, the ADA recommends staying on it – even if weight loss goals are reached. Research has found that not only does stopping treatment typically result in weight regain, but it can also worsen cardiometabolic risk factors like obesity, high blood pressure, high cholesterol, and insulin resistance.
The ADA also recommends healthcare providers more closely monitor people taking weight loss medications, moving from annual measurements to every three months. Since rapid weight loss can result in malnutrition, there is a new recommendation that those taking weight management treatments also be screened for malnutrition.
Nutritional guidance
Nutrition is a critical aspect of diabetes management. It’s also important for weight management – even if you’re taking weight loss medication. The 2025 Standards of Care has expanded its nutritional recommendations, focusing on eating patterns that include foods rich in nutrients but lower in calories such as fruit, vegetables, legumes, and whole grains.
New this year is a recommendation that suggests drinking water instead of beverages containing non-nutritive sweeteners (artificial sweeteners). Non-nutritive sweeteners are preferred to sugar-sweetened beverages if consumed in moderation or short-term to reduce caloric intake. For people partaking in religious fasting like during Ramadan, there is now a screening tool available to help assess any risks beforehand.
Exercises updates
While any kind of physical activity is good for you, the guidelines emphasize resistance or strength training (like weight lifting) – especially for those focused on weight loss. Fitting in strength training two to three times a week is recommended to avoid muscle loss, improve insulin sensitivity, and maintain a healthy metabolism.
Generally, the ADA recommends getting at least 150 minutes of moderate-intensity exercise per week. Not only does regular physical activity help with weight management, but it can also help blunt blood sugar spikes – for example, if you take a walk after a meal.
Mental health screening
Diabetes is a challenging condition to manage due to the burdens of care for people living with it, along with their families and caregivers. The guidelines now recommend healthcare providers incorporate mental health screenings for anxiety (especially related to fear of hypoglycemia), depression, diabetes distress, and disordered eating into regular care visits. Providers should also recommend appropriate interventions, including counseling and CGM use, and how to access them.
Recreational marijuana use
The 2025 guidelines warn against the use of cannabis for people with type 1 diabetes as studies show an increased risk of DKA. Incidents of DKA in individuals with type 1 diabetes using cannabis are also associated with cannabis hyperemesis syndrome, which is marked by severe nausea, abdominal pain, and vomiting.
The bottom line
There’s so much valuable information packed into the 2025 ADA Standards of Care it’s almost impossible to summarize, but the highlights include updates to screening for type 1 diabetes, new nutritional guidance, recommendations for those taking weight loss medication, and CGM for type 2 diabetes.
Other notable recommendations include using AID systems with pregnancy-specific glucose targets for pregnant women with diabetes and using Rezdiffra (resmetirom), a thyroid hormone receptor-beta agonist, to treat moderate to advanced liver disease.
See our coverage of the ADA’s past recommendations for diabetes care and how they’ve evolved here: