Diabetes Care Volume 48, Supplement 1, January 2025 S1

Introduction and Methodology: American Diabetes Association

Professional Practice Committee*
Standards of Care in Diabetes—2025
Diabetes Care 2025;48(Suppl. 1):S1–S5 | https://doi.org/10.2337/dc25-SINT

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Diabetes is a complex, chronic condition DiabetesPro at professional.diabetes.org/ The Standards of Care does not pro-
requiring continuous medical care with standards-of-care/living-standards-update. vide comprehensive treatment plans for
comprehensive risk-reduction strategies The Standards of Care supersedes all previ- complications associated with diabetes,
beyond glycemic management. Ongoing ously published ADA statements—and the such as diabetic retinopathy or diabetic
diabetes self-management education and recommendations therein—on clinical foot ulcers, but offers guidance on how
support are critical to empowering peo- topics within the purview of the Stand- and when to screen for diabetes complica-

INTRODUCTION AND METHODOLOGY

ple, preventing acute complications, and ards of Care; while still containing valu- tions, management of complications in the
reducing the risk of long-term complica- able analysis, ADA statements should primary care and diabetes care settings,
tions. Significant evidence exists that sup- not be considered the current position and referral to specialists as appropriate.
ports a range of interventions to improve of the ADA. The Standards of Care re- Similarly, regarding the psychosocial and
diabetes outcomes. ceives annual review and approval by behavioral health factors often associated
The American Diabetes Association the ADA Board of Directors and is re- with diabetes and that can affect diabetes
(ADA) “Standards of Care in Diabetes,” viewed by the ADA scientific team and care, the Standards of Care provides guid-
referred to here as the Standards of clinical leadership. The Standards of ance on how and when to screen, man-
Care, serves as a comprehensive re- Care also undergoes external peer re- agement in the primary care and diabetes
source to clinicians, researchers, policy view annually. care settings, and referral but does not
makers, and other stakeholders. It out- provide comprehensive management plans
lines key elements of diabetes care, SCOPE OF THE GUIDELINES for conditions that require specialized care,
sets treatment goals, and provides tools The recommendations in the Standards such as mental illness.
to assess care quality, all aimed at im- of Care include screening, diagnostic, and
proving diabetes care and outcomes therapeutic actions that are scientifically INTENDED AUDIENCE
across diverse populations. proved or known based on expert clinical The intended audience for the Standards
The ADA Professional Practice Com- practice or believed to favorably affect of Care includes primary care physicians,
mittee (PPC) updates the Standards of health outcomes of people with diabetes. endocrinologists, nurse practitioners, phy-
Care annually and includes discussion They also cover the prevention, screening, sician associates/assistants, pharmacists,
of emerging clinical considerations in the diagnosis, and management of diabetes- registered dietitian nutritionists, diabetes
text, and as evidence evolves, clinical associated complications and comorbid- care and education specialists, and all
guidance is added to the recommenda- ities. The recommendations encompass members of the diabetes care team. The
tions in the Standards of Care. The Stand- care throughout the life span for youth Standards of Care also provides guidance
ards of Care is a “living” document where (children aged birth to 11 years and to specialists caring for people with diabe-
important updates are published online adolescents aged 12–17 years), adults tes and its multitude of complications, such
should the PPC determine that new evi- (aged 18–64 years), and older adults as cardiologists, nephrologists, emergency
dence or regulatory changes (e.g., drug (aged $65 years). The recommendations physicians, internists, pediatricians, psychol-
or technology approvals, label changes) cover the management of type 1 diabe- ogists, neurologists, ophthalmologists, and
merit immediate inclusion. More informa- tes, type 2 diabetes, gestational diabetes podiatrists. Additionally, these recommen-
tion on the “Living Standards” can be mellitus, and other types of diabetes dations help payors, policy makers, re-
found on the ADA professional website and/or hyperglycemic conditions. searchers, research funding organizations,

The “Standards of Care in Diabetes,” formerly called “Standards of Medical Care in Diabetes,” was originally published in 1988. The most recent full
review and revision was in December 2024.
*A complete list of members of the American Diabetes Association Professional Practice Committee is provided in this section.
Duality of interest information for each author is available at https://doi.org/10.2337/dc25-SDIS.
Suggested citation: American Diabetes Association Professional Practice Committee. Introduction and methodology: Standards of Care in Diabetes—2025.
Diabetes Care 2025;48(Suppl. 1):S1–S5
© 2024 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the
work is not altered. More information is available at https://www.diabetesjournals.org/journals/pages/license.
S2 Introduction and Methodology Diabetes Care Volume 48, Supplement 1, January 2025

and advocacy groups to align their policies race and ethnicity, ability level). A PPC chair Full disclosure statements from all com-
and resources and deliver optimal care for or co-chairs are appointed by the ADA mittee members are solicited and re-
people living with diabetes. (N.A.E. and R.G.M. are co-chairs for the viewed during the appointment process.
The ADA strives to improve and up- 2025 Standards of Care) and oversee the Disclosures are then updated through-
date the Standards of Care to ensure committee. In addition to the PPC mem- out the guideline development process
that clinicians, health plans, and policy bers, several professionals serve as desig- (specifically before the start of every
makers can continue to rely on it as the nated subject matter experts to support meeting), and disclosure statements are
most authoritative source for current the PPC in the development of specific submitted by every Standards of Care
guidelines for diabetes care. The Stand- content areas of the Standards of Care. contributor upon submission of the up-
ards of Care recommendations are not While designated subject matter experts dated Standards of Care section. Mem-
assist with content development, only PPC

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intended to preclude clinical judgment. bers are required to disclose conflicts
They must be applied in the context of members formally vote on Standards of for a time frame that includes 1 year
excellent clinical care, with adjustments Care recommendations for final approval. prior to initiation of the committee ap-
for individual preferences, comorbidities, Additionally, several organizations have pointment process until publication of
and other patient factors. For more de- endorsed specific sections of the 2025 that year’s Standards of Care. Potential
tailed information about the management Standards of Care. The American College of dualities of interest are evaluated by a
of diabetes, please refer to Medical Man- Cardiology (ACC) reviewed and approved designated review panel and, if neces-
agement of Type 1 Diabetes (1) and Med- Section 10, “Cardiovascular Disease and sary, the Legal Affairs Division of the
ical Management of Type 2 Diabetes (2). Risk Management.” The American Society ADA. The duality of interest assessment
for Bone and Mineral Research reviewed is based on the relative weight of the fi-
METHODOLOGY AND PROCEDURE and approved the “Bone Health” sub- nancial relationship (i.e., the monetary
section in Section 4, “Comprehensive amount) and the relevance of the rela-
The Standards of Care includes discussion
Medical Evaluation and Assessment of tionship (i.e., the degree to which an in-
of evidence and clinical practice recom-
Comorbidities.” The Obesity Society re- dependent observer might reasonably
mendations intended to optimize care for
viewed and approved Section 8, “Obesity interpret an association as related to the
people with diabetes by assisting health
and Weight Management for the Prevention
care professionals and individuals in mak- topic or recommendation of consider-
and Treatment of Type 2 Diabetes.” New to
ing shared decisions about diabetes care. ation). In addition, the ADA adheres to
the 2025 Standards of Care, the American
The recommendations are informed by section 7 of the Council of Medical Spe-
Geriatrics Society reviewed and approved
a systematic review of evidence and an cialty Societies “Code for Interactions with
Section 13, “Older Adults.”
assessment of the benefits and risks of Companies” (3). The duality of interest re-
Each section of the Standards of Care is
alternative care options. view panel also ensures the majority of
reviewed annually and updated with the
the PPC and the PPC chair or co-chairs
latest evidence-based recommendations by
Professional Practice Committee are without potential conflict relevant to
a subcommittee. The subcommittees per-
The PPC of the ADA is responsible for the subject area. Furthermore, the PPC
form systematic literature reviews and iden-
the Standards of Care content. The PPC chair or co-chairs are required to remain
tify and summarize the scientific evidence.
is an interprofessional expert committee unconflicted for 1 year after the publica-
An information specialist with knowledge
comprising physicians, nurse practitioners, and experience in literature searching (a li- tion of the Standards of Care. Members
pharmacists, diabetes care and education brarian) is consulted as necessary. A guide- of the committee who disclose a poten-
specialists, registered dietitian nutritionists, line methodologist (R.R.B. for the 2025 tial duality of interest pertinent to any
behavioral health scientists, and others Standards of Care) with expertise and train- specific recommendation are prohib-
who have expertise in a range of areas ing in evidence-based medicine and guide- ited from participating in discussions
including but not limited to adult and pedi- line development methodology oversees all related to those recommendations and
atric endocrinology, epidemiology, public methodological aspects of the development their votes are excluded. No expert panel
health, behavioral health, cardiovascular of the Standards of Care and serves as a sta- members were employees of any phar-
risk management, microvascular complica- tistical analyst. maceutical or medical device company
tions, nephrology, neurology, ophthalmol- during the development of the 2025
ogy, podiatry, clinical pharmacology, pre- Disclosure and Duality of Interest Standards of Care. Members of the PPC,
conception and pregnancy care, weight Management their employers, and their disclosed po-
management and diabetes prevention, and All members of the expert panel (the tential dualities of interest are listed in
use of technology in diabetes manage- PPC members and subject matter ex- the section “Disclosures: Standards of
ment. Each year, ADA conducts a national perts) and ADA scientific team are re- Care in Diabetes—2025.”
call for applications to recruit members of quired to comply with the ADA policy on
the PPC. Appointment to the PPC is based duality of interest, which requires disclo- Funding Source
on excellence in clinical practice and re- sure of any financial, intellectual, or other The Standards of Care guideline is funded
search, with attention to appropriate interests that might be construed as con- by ADA general revenue. No other entity,
representation of members based on stituting an actual, potential, or apparent including industry, provides financial sup-
considerations including but not limited conflict, regardless of relevancy to the port for the guideline. Committee members
to demographic, geographic, work setting, guideline topic. For transparency, ADA re- received no remuneration for their partici-
or identity characteristics (e.g., gender, quires full disclosure of all relationships. pation in development of this guideline.
diabetesjournals.org/care Introduction and Methodology S3

Evidence Review evidence that forms the basis for the rec- Clinicians care for people, not populations;
The Standards of Care subcommittee for ommendations in the Standards of Care. guidelines must always be interpreted with
each section creates an initial list of rele- All recommendations in the Standards of the individual person in mind. Individual cir-
vant clinical questions that is reviewed and Care are critical to comprehensive care re- cumstances, such as comorbid and coexist-
discussed by the expert panel. In consulta- gardless of rating. ADA recommendations ing diseases, age, education, disability, and,
tion with a systematic review expert and li- are assigned ratings of A, B, or C, depend- above all, the values and preferences of the
brarian, each subcommittee devises and ing on the quality of the evidence in person with diabetes, must be considered
executes systematic literature searches. support of the recommendation. Ex- and may lead to different treatment goals
For the 2025 Standards of Care, PubMed, pert opinion E is a separate category for and strategies. Furthermore, conventional
Medline, and EMBASE were searched for recommendations in which there is no evidence hierarchies, such as the one
the time periods of 1 June 2023 to 19 July

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evidence from clinical trials, clinical trials adapted by the ADA, may miss nuances
2024. Searches are limited to studies pub- important in diabetes care. For example,
may be impractical, or there is conflicting
lished in English. Subcommittee members
evidence. Recommendations assigned an E although there is excellent evidence from
also manually search journals, reference clinical trials supporting the importance of
level of evidence are informed by key opin-
lists of conference proceedings, and reg- achieving multiple risk factor control, the
ion leaders in diabetes (members of the
ulatory agency websites. All potentially optimal way to achieve this result is less
PPC and external subject matter experts)
relevant citations are then subjected to a
and cover important elements of clinical clear. It is difficult to assess each compo-
full-text review. In consultation with the
care. All Standards of Care recommenda- nent of such a complex intervention.
methodologist, the subcommittees pre-
pare the evidence summaries and grad- tions receive a rating for the strength of
the evidence and not for the strength of Evidence to Recommendations
ing for each section of the Standards of
the recommendation. Recommendations All accumulated evidence was reviewed
Care. All PPC members discuss and re-
view the evidence summaries and make with A-level evidence are based on large, and discussed by all PPC members and
well-designed randomized controlled trials external subject matter experts during
revisions as appropriate. The final evi-
or well-done meta-analyses of randomized multiple virtual meetings and a 2-day in-
dence summaries are then deliberated
controlled trials. Generally, these recom- person meeting in Arlington, Virginia, in
on by the PPC, and the recommenda-
mendations have the best chance of im- July 2024. Standards of Care recommen-
tions that will appear in the Standards of
Care are drafted. proving outcomes when applied to the dations were updated based on the
population for which they are appropri- newly acquired evidence, and each rec-
ate. Recommendations with lower levels ommendation was voted on by the PPC,
Grading of Evidence and
Recommendation Development of evidence may be equally important with 80% consensus required for any
A grading system (Table 1) developed by but are not as well supported. recommendation to be approved.
the ADA and modeled after existing meth- Of course, published evidence is only
ods is used to clarify and codify the one component of clinical decision-making. Revision Process
Public comment is particularly important in
the development of clinical practice recom-
Table 1—ADA evidence-grading system for “Standards of Care in Diabetes” mendations; it promotes transparency and
Level of provides key stakeholders, including people
evidence Description with diabetes and their caregivers, the op-
A Clear evidence from well-conducted, generalizable randomized controlled trials portunity to identify and address gaps in
that are adequately powered, including: care.The ADA holds a year-long public com-
• Evidence from a well-conducted multicenter trial
ment period requesting feedback on the
• Evidence from a meta-analysis that incorporated quality ratings in the
analysis Standards of Care. The PPC reviews com-
Supportive evidence from well-conducted randomized controlled trials that are piled feedback from the public in prepara-
adequately powered, including: tion for the annual update but considers
• Evidence from a well-conducted trial at one or more institutions more pressing updates throughout the
• Evidence from a meta-analysis that incorporated quality ratings in the year, which may be published as “living”
analysis
Standards updates. Feedback from the
B Supportive evidence from well-conducted cohort studies, including: larger clinical community and general
• Evidence from a well-conducted prospective cohort study or registry
public was invaluable for the revision
• Evidence from a well-conducted meta-analysis of cohort studies
Supportive evidence from a well-conducted case-control study of the 2024 Standards of Care. Readers
who wish to comment on the 2025
C Supportive evidence from poorly controlled or uncontrolled studies, including:
Standards of Care are invited to do so at
• Evidence from randomized clinical trials with one or more major or three or
more minor methodological flaws that could invalidate the results professional.diabetes.org/SOC.
• Evidence from observational studies with high potential for bias (such as Feedback for the Standards of Care is
case series with comparison with historical controls) also obtained from external peer reviewers.
• Evidence from case series or case reports The Standards of Care is reviewed by ADA
Conflicting evidence with the weight of evidence supporting the recommendation clinical leadership and scientific and medi-
E Expert consensus or clinical experience cal team and is approved by the ADA Board
of Directors, which includes health care
S4 Introduction and Methodology Diabetes Care Volume 48, Supplement 1, January 2025

professionals, scientists, and other stake- Consensus Report Robert G. Frykberg, DPM, MPH (Section 12)
holders. The ACC performs an independent An ADA consensus report is a document Robert A. Gabbay, MD, PhD (until
on a particular topic that is authored by a 6 September 2024)
external peer review, and the ACC provides Jason L. Gaglia, MD, MMSc (Sections 2, 3,
endorsement of Section 10, “Cardiovascular technical expert panel under the auspices and 9)
Disease and Risk Management.” In addition, of ADA. The document does not reflect Rodolfo J. Galindo, MD (Section 16)
the American Society for Bone and Mineral the official ADA position but rather repre- Sunir J. Garg, MD, FACS (Section 12)
sents the panel’s collective analysis, eval- Monica Girotra, MD (Section 9)
Research provides endorsement for the John M. Giurini, DPM (Section 12)
“Bone Health” subsection of Section 4, uation, and expert opinion. The primary
Mohamed Hassanein, FRCP, CCST (U.K.) (Section 5)
“Comprehensive Medical Evaluation and objective of a consensus report is to pro- Mikhail N. Kosiborod, MD (Section 10)
vide clarity and insight on a medical or Robert F. Kushner, MD, MS (Section 8)
Assessment of Comorbidities,” The Obe-
scientific matter related to diabetes for Seymour R. Levin, MD (Section 4)

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sity Society provides endorsement for Sec- Roeland J.W. Middlebeek, MD, MSc
which the evidence is contradictory,
tion 8, “Obesity and Weight Management (Section 5)
emerging, or incomplete. The report also
for the Prevention and Treatment of Type 2 Lisa Murdock (Section 17)
aims to highlight evidence gaps and to Nicola Napoli, MD, PhD (Sections 4 and 13)
Diabetes,” and the American Geriatrics So-
propose avenues for future research. Sharon J. Parish, MD (Section 4)
ciety provides endorsement for Section 13, Consensus reports undergo a formal re- Flavia Q. Pirih, DDS, PhD (Section 4)
“Older Adults.” Feedback received from ev- view process, including external peer re- Elizabeth Selvin, PhD, MPH (Sections 2 and 6)
ery stakeholder is adequately addressed by view and review by the ADA PPC and Shylaja Srinivasan, MD (Section 14)
the committee, and the final version is ap- ADA scientific team, for publication.
Molly L. Tanenbaum, PhD (Section 5)
Monica Verduzco-Gutierrez, MD (Section 4)
proved by all parties prior to publication. Crystal C. Woodward, MPS (Section 17)
The ADA adheres to the Council of Medical Scientific Review Zobair M. Younossi, MD, MPH (Section 4)
Specialty Societies revised “CMSS Principles A scientific review is a balanced review
for the Development of Specialty Society and analysis of the literature on a scien- ADA Scientific Team
Clinical Guidelines” (4). tific or medical topic related to diabetes. Kirthikaa Balapattabi, PhD
A scientific review is not an ADA position Raveendhara R. Bannuru, MD, PhD
ADA STANDARDS, STATEMENTS, (corresponding author, [email protected])
and does not contain clinical practice rec-
Nuha Ali ElSayed, MD, MMSc
REPORTS, AND REVIEWS ommendations but is produced under Robert A. Gabbay, MD, PhD (until
The ADA has been actively involved in the auspices of the ADA by invited ex- 6 September 2024)
developing and disseminating diabetes perts. The scientific review may provide a Elizabeth J. Pekas, PhD
care clinical practice recommendations scientific rationale for clinical practice
and related documents for more than recommendations in the Standards of Acknowledgments
35 years. The ADA Standards of Care is Care. The category may also include task The ADA thanks the following external peer
force and expert committee reports. reviewers:
an essential resource for health care pro- Mohammed K. Ali, MD, MSc
fessionals caring for people with diabe- Joseph A. Aloi, MD
tes. ADA Statements, Consensus Reports, Vanita Aroda, MD
Members of the PPC Ian H. de Boer, MD, MS
and Scientific Reviews support the rec- Nuha Ali ElSayed, MD, MMSc (Co-Chair) Wenche S. Borgnakke, DDS, PhD
ommendations included in the Standards Rozalina G. McCoy, MD, MS (Co-Chair) Anders L. Carlson, MD
of Care. Grazia Aleppo, MD James Flory, MD
Elizabeth A. Beverly, PhD Om Ganda, MD
Kathaleen Briggs Early, PhD, CDCES Thomas W. Gardner, MD, MS
Standards of Care
Dennis Bruemmer, MD, PhD Sherita Hill Golden, MD
The annual Standards of Care supplement Justin B. Echouffo-Tcheugui, MD, PhD Amy Hess-Fischl, MS, RDN
to Diabetes Care contains the official ADA Laya Ekhlaspour, MD Ahmet Hoke, MD, PhD
position, is authored by the ADA, and pro- Rajesh Garg, MD Korey K. Hood, PhD
Kamlesh Khunti, MD, FMedSci Eric L. Johnson, MD
vides all of the ADA’s current clinical prac-
Rayhan Lal, MD M. Sue Kirkman, MD
tice recommendations. Ildiko Lingvay, MD, MPH Cecilia C. Low Wang, MD, FACP
Glenn Matfin, MB ChB, MSc (Oxon) Brynn E. Marks, MD, MSHPEd
ADA Statement Naushira Pandya, MD, FACP Leigh Perreault, MD
An ADA statement is an official ADA Scott J. Pilla, MD, MHS Anne L. Peters, MD
Sarit Polsky, MD, MPH Moshe Phillip, MD
point of view or position that does not Alissa R. Segal, PharmD, CDCES Jane E.B. Reusch, MD
contain clinical practice recommenda- Jane Jeffrie Seley, DNP, MPH Connie M. Rhee, MD, MSc
tions and may be issued on advocacy, Robert C. Stanton, MD Jo-Anne Rizzotto, MEd, RDN
Raveendhara R. Bannuru, MD, PhD Laura Shin, DPM, PhD
policy, economic, or medical issues re-
(Chief Methodologist) Alpana Shukla, MD
lated to diabetes. ADA statements un-
Richard Siegel, MD
dergo a formal review process, including Designated Subject Matter Experts Emily D. Szmuilowicz, MD
external peer review and review by the Brian C. Callaghan, MD, MS (Section 12) Tracey H. Taveira, PharmD, CDOE
appropriate ADA national committee, Kenneth Cusi, MD (Section 4) Guillermo E. Umpierrez, MD, CDCES
Sandeep R. Das, MD, MPH (Section 10) Jenise C. Wong, MD, PhD
ADA clinical leadership, ADA scientific
Osagie Ebekozien, MD, MPH (Sections 1, 2, and 3) Chloe Zera, MD
team, and, as warranted, the ADA Board Barbara Eichorst, MS, RD (Section 5) ACC peer reviewers (Section 10):
of Directors. Talya K. Fleming, MD (Section 4) James L. Januzzi, Jr., MD, FACC
diabetesjournals.org/care Introduction and Methodology S5

Richard J. Kovacs, MD, MACC Joshua J. Neumiller, PharmD, CDCES MS, Ed. Arlington, VA, American Diabetes
Dave L. Dixon, PharmD, FACC President-elect, Heath Care & Education Association, 2022
Prakash C. Deedwania, MD, FACC 2. American Diabetes Association. Medical
AGS peer reviewers (Section 13): The ADA thanks the following individuals for Management of Type 2 Diabetes. 8th ed.
Alyce Adams, MD their support: Meneghini L, Ed. Arlington, VA, American Diabetes
Alexandra Lee, MD Celeste Durnwald, MD Association, 2020
Sei Lee, MD Anastassios G. Pittas, MD, MS 3. Council of Medical Specialty Societies. CMSS
Alexandra M. Yacoubian code for interactions with companies. Accessed 2
The ADA thanks the ADA Presidents and The ADA thanks the following individuals for August 2024. Available from https://cmss.org/
Presidents-elect: figure design: code-for-interactions-with-companies/
Mandeep Bajaj, MBBS, President, Medicine & Michael Bonar 4. Council for Medical Specialty Societies. CMSS
Science Charlie Franklin principles for the development of specialty society

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Patti Urbanski, MEd, RD, President, clinical guidelines. Accessed 2 August 2024.
Heath Care & Education References Available from https://cmss.org/wp-content/
Rita Rastogi Kalyani, MD, MHS, President-elect, 1. American Diabetes Association. Medical uploads/2017/11/Revised-CMSS-Principles-for-
Medicine & Science Management of Type 1 Diabetes. 8th ed. Kirkman Clinical-Practice-Guideline-Development.pdf