Every year, the American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes to inform health care professionals about the latest research evidence on the diagnosis and management of diabetes.

A group of clinical practice and research experts developed the Standards of Care by reviewing new evidence about all the scientific fields that are involved in effectively managing diabetes.

Important Updates

This year, the ADA revised nearly all the sections in the Standards of Care, including recommendations for

• diabetes screening
• diagnosis, prevention, evaluation, and management of comorbidities
• patient education
• technology and glycemic assessment
• weight management
• care for special populations, such as children and older people

The updated Standards of Care also emphasizes a patient-centered approach to improve medication adherence and management, reviews social and financial barriers of patients, and suggests in-person or online medical and community resources.

Below are some specific updates in this year’s Standards of Care.

Screening for diabetes

All adults without risk factors should be screened with a test for prediabetes and type 2 diabetes starting at age 35, instead of age 45. The new Standards of Care also emphasizes screening with a fasting glucose test for undiagnosed diabetes in all women who are planning to become pregnant, especially if they have risk factors. For unplanned pregnancies, women should be screened at the first prenatal visit. The recommendation to screen for gestational diabetes between 24 and 28 weeks has not changed.

Caring for patients with overweight or obesity

Adult patients who have overweight or obesity, including older patients, should enroll in a lifestyle behavior-change program to prevent diabetes and its complications. They should receive guidance on healthy meal planning based on both food quantity and nutrition levels. The Standards of Care also shares information about new medicines approved by the FDA for managing obesity, such as an oral hydrogel and semaglutide.

Encouraging vaccines

Not surprisingly, the new Standards of Care offers recommendations and guidance about vaccines—including the COVID-19 and flu vaccines—for patients with diabetes, especially since obesity and diabetes are important risk factors for severe COVID-19.

Monitoring patients’ cognitive capacity or impairment

The Standards of Care has a new section about the importance of monitoring patients’ cognitive capacity or impairment. It recommends referring patients for formal assessment if needed, especially children, patients with hypoglycemia, and older patients. Changes in a patient’s cognitive capacity or signs of cognitive impairment can increase the risk of hypoglycemia, and severe hypoglycemia increases the risk of dementia.

Hypoglycemia unawareness—or hypoglycemia-associated autonomic failure—is described as an “urgent medical issue” in patients with type 1 diabetes, as well as in patients with type 2 diabetes with severe insulin deficiency. The new Standards of Care highlights evidence showing that relaxing glucose targets for a few weeks can improve hypoglycemia awareness in many patients.

The new Standards of Care underscores the importance of patients and caregivers helping to select devices, receiving ongoing training and education, and being evaluated on their skills in using the devices and the data from those devices. The new Standards of Care also emphasizes that people using continuous glucose monitoring devices—scanners able to measure glucose levels over time, usually inserted in the abdomen or the upper arm—must always have access to blood glucose monitoring devices, which are often more accurate devices but require a finger prick.

Managing risk of comorbidities and complications

Comorbidities and risk of complications are now key elements for treatment decisions. While metformin has been the first choice for managing diabetes, health care professionals may now use GLP-1 receptor agonists or SGLT2 inhibitors in addition to or instead of metformin. These medicines can be prescribed to patients with diabetes who have or are at risk for atherosclerosis, heart failure, or chronic kidney disease (CKD) to help reduce cardiovascular events and disease progression. Health care professionals may also use a nonsteroidal mineralocorticoid receptor antagonist (finerenone) when they cannot use SGLT2 inhibitors. Additional recommendations for managing hypertension and high cholesterol are also included in the updated Standards of Care.

To learn more about the methodology, evidence, or other resources related to the Standards of Care, visit the ADA’s Practice Guidelines Resources.

Your clinical experience can provide valuable insights about managing diabetes that can help everyone. Use the comments section to share your thoughts about the new Standards of Care.