This transcript has been edited for clarity.
Welcome to the second video on the American Diabetes Association’s Standards of Care in Diabetes—2025.
We’re starting with Section 5, “ Facilitating Positive Health Behaviors and Well-Being to Improve Health Outcomes.”
The section emphasizes the notion that people really need to be referred for diabetes self-management education and support. I couldn’t agree more. My patients always learn something when they go for these individual or group sessions. Please send your patients for diabetes education, because it’s exceedingly useful.
Then, they go into these other recommendations, which I think are important. I’ve been seeing many people on glucagon-like peptide 1 (GLP-1) receptor agonists or dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP) receptor agonist therapy who are getting too skinny. They really need to learn about what’s a normal healthy weight.
They now recommend to screen for malnutrition, especially in those who have undergone metabolic surgery and for those being treated with weight management pharmacologic therapies. I think we do our patients a real disservice if they start losing too much lean body mass. Remember, you can be too thin.
They do recommend a lifestyle that I recommend, which is to have plant-based proteins and fiber — at least to encourage that in the diet — and to limit foods high in saturated fats to reduce cardiovascular risk.
They also recommend drinking water as a primary source of fluid intake, not obviously sugary sodas or even diet sodas. I try to encourage my patients to drink water. Many of them are better at it than I am, but it’s important that we discuss that.
Something I really love is that they now discuss the difference between religious fasting and intermittent fasting. They worked together with the Diabetes and Ramadan International Alliance, and they have a new figure that basically looks at the similarities and differences between religious and intermittent fasting.
Then they discuss how to approach patients who are doing both kinds of fasting. I really like that, and I think it’s very helpful because many of us have patients who do both kinds of fasting, and it’s important to know how to manage those patients.
They talk about smoking cessation, which includes tobacco, e-cigarettes, and cannabis. They say, slightly amusingly to me since I live in California, not to use recreational cannabis in any form owing to the risk for cannabis hyperemesis syndrome.
I have many patients who do use legal recreational cannabis, and I warn them about cannabis hyperemesis syndrome. Most of them are not about to give up the use of cannabis, so I just want to make sure they’re safe when they use it.
In terms of psychosocial care, they talk about screening for diabetes distress, depression, anxiety, fear of hypoglycemia, and disordered eating behaviors. These are very important. They have two new tables that are very useful in terms of illustrating all the psychosocial concerns and their relationships with diabetes-related outcomes in people with type 1 and type 2 diabetes.
Section 6 is titled “ Glycemic Goals and Hypoglycemia.” A big part of this section is a new subsection about hyperglycemic crises. This was published a couple of months ago, but I’d encourage you to review it and make sure it’s something that you’re well aware of because it discusses how to diagnose and treat diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
This section also includes Figure 6.2, which I really like. It’s a figure that’s meant to help us determine A1c targets for our patients, and I think it’s a better figure than the prior ones we’ve had. It is pictorial, and it shows us as people change in terms of their individual health status and their functional status, how we should choose their A1c targets. I would encourage you to look at this, because I think it is more visual and perhaps more understandable than prior approaches to do this.
Section 7 is titled “ Diabetes Technology,” which is arguably my favorite section. I happen to love diabetes technology because I think it really helps me help my patients. They recommend starting diabetes technology early, even at diagnosis. I try to start it as early as possible because I think it helps patients understand their diabetes better from the get-go.
They talk about all the new research in the field, and there’s been a large amount. Much of the data look at the use of automated insulin delivery systems, and most of the studies confirm their utility and safety. They do have a new table that includes a description of the over-the-counter continuous glucose monitoring (CGM) devices that are now available. They recommend using CGM, when possible, in patients with type 2 diabetes who aren’t on insulin or on drugs that can cause hypoglycemia to help in their management.
Section 8 is titled “ Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes.” They don’t really change much in terms of what we know how to do, but they do suggest using additional measurements of body fat distribution if the body mass index is indeterminate.
Then they talk about looking carefully at patients as they lose weight, and monitoring obesity-related anthropometric measurements at least every 3 months during active weight management therapy.
They talk about weight stigma and bias toward people who live in larger bodies. I think that’s very important because patients often feel judged, and we don’t wish for them to feel that way. They discuss, as discussed above, the need to screen for malnutrition and make sure people aren’t losing too much weight or too much lean body mass. Then they talk about continuing weight management pharmacotherapy beyond the initial weight loss so that weight loss is maintained.
In terms of Section 9, “ Pharmacologic Approaches to Glycemic Treatment,” I don’t think there’s much that’s new — although again, they do discuss the treatment of metabolic dysfunction–associated steatohepatitis (MASH) using GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, pioglitazone, or a combination thereof.
Figure 9.3, as always, discusses the use of glucose-lowering medications in managing type 2 diabetes. I don’t think there’s much different in this figure from prior years because we’ve really added in the notion of treating patients differently who have known cardiovascular disease, renal disease, heart failure, or high-risk individuals compared to patients who don’t have those characteristics.
I really like the new figure because I think it’s easier to follow, and at the bottom, they discuss mitigating the risk for metabolic dysfunction–associated steatotic liver disease (MASLD) or MASH. It’s a little bit more comprehensive, but thematically very simple.
Figure 9.4 is the figure that looks at using injectable therapies in individuals with type 2 diabetes. Although the content here is similar to what it’s been in prior years, it’s actually presented in a way that seems much more readable, and it’s probably going to be more helpful in terms of practitioners wanting to know practically how to start people on injectable therapies.
One of the things they did was to remove the concept of a number that is evidence of overbasalization. We used to say that if basal insulin doses exceeded 0.5 unit per kilogram per day, that was evidence of overbasalization. Now, instead, they want us to look at whether there’s significant bedtime-to-morning or postprandial-to-preprandial glucose changes with occurrences of hypoglycemia — that that’s a good sign that a patient is overbasalized.
That’s the end of video 2. We’ll rejoin with video 3 and the final sections of the Standards of Care in Diabetes—2025.
COMMENTARY
ADA Focus on Diabetes Self-Management, ‘Exceedingly Useful’
DISCLOSURES
| February 06, 2025This transcript has been edited for clarity.
Welcome to the second video on the American Diabetes Association’s Standards of Care in Diabetes—2025.
We’re starting with Section 5, “ Facilitating Positive Health Behaviors and Well-Being to Improve Health Outcomes.”
The section emphasizes the notion that people really need to be referred for diabetes self-management education and support. I couldn’t agree more. My patients always learn something when they go for these individual or group sessions. Please send your patients for diabetes education, because it’s exceedingly useful.
Then, they go into these other recommendations, which I think are important. I’ve been seeing many people on glucagon-like peptide 1 (GLP-1) receptor agonists or dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP) receptor agonist therapy who are getting too skinny. They really need to learn about what’s a normal healthy weight.
They now recommend to screen for malnutrition, especially in those who have undergone metabolic surgery and for those being treated with weight management pharmacologic therapies. I think we do our patients a real disservice if they start losing too much lean body mass. Remember, you can be too thin.
They do recommend a lifestyle that I recommend, which is to have plant-based proteins and fiber — at least to encourage that in the diet — and to limit foods high in saturated fats to reduce cardiovascular risk.
They also recommend drinking water as a primary source of fluid intake, not obviously sugary sodas or even diet sodas. I try to encourage my patients to drink water. Many of them are better at it than I am, but it’s important that we discuss that.
Something I really love is that they now discuss the difference between religious fasting and intermittent fasting. They worked together with the Diabetes and Ramadan International Alliance, and they have a new figure that basically looks at the similarities and differences between religious and intermittent fasting.
Then they discuss how to approach patients who are doing both kinds of fasting. I really like that, and I think it’s very helpful because many of us have patients who do both kinds of fasting, and it’s important to know how to manage those patients.
They talk about smoking cessation, which includes tobacco, e-cigarettes, and cannabis. They say, slightly amusingly to me since I live in California, not to use recreational cannabis in any form owing to the risk for cannabis hyperemesis syndrome.
I have many patients who do use legal recreational cannabis, and I warn them about cannabis hyperemesis syndrome. Most of them are not about to give up the use of cannabis, so I just want to make sure they’re safe when they use it.
In terms of psychosocial care, they talk about screening for diabetes distress, depression, anxiety, fear of hypoglycemia, and disordered eating behaviors. These are very important. They have two new tables that are very useful in terms of illustrating all the psychosocial concerns and their relationships with diabetes-related outcomes in people with type 1 and type 2 diabetes.
Section 6 is titled “ Glycemic Goals and Hypoglycemia.” A big part of this section is a new subsection about hyperglycemic crises. This was published a couple of months ago, but I’d encourage you to review it and make sure it’s something that you’re well aware of because it discusses how to diagnose and treat diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
This section also includes Figure 6.2, which I really like. It’s a figure that’s meant to help us determine A1c targets for our patients, and I think it’s a better figure than the prior ones we’ve had. It is pictorial, and it shows us as people change in terms of their individual health status and their functional status, how we should choose their A1c targets. I would encourage you to look at this, because I think it is more visual and perhaps more understandable than prior approaches to do this.
Section 7 is titled “ Diabetes Technology,” which is arguably my favorite section. I happen to love diabetes technology because I think it really helps me help my patients. They recommend starting diabetes technology early, even at diagnosis. I try to start it as early as possible because I think it helps patients understand their diabetes better from the get-go.
They talk about all the new research in the field, and there’s been a large amount. Much of the data look at the use of automated insulin delivery systems, and most of the studies confirm their utility and safety. They do have a new table that includes a description of the over-the-counter continuous glucose monitoring (CGM) devices that are now available. They recommend using CGM, when possible, in patients with type 2 diabetes who aren’t on insulin or on drugs that can cause hypoglycemia to help in their management.
Section 8 is titled “ Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes.” They don’t really change much in terms of what we know how to do, but they do suggest using additional measurements of body fat distribution if the body mass index is indeterminate.
Then they talk about looking carefully at patients as they lose weight, and monitoring obesity-related anthropometric measurements at least every 3 months during active weight management therapy.
They talk about weight stigma and bias toward people who live in larger bodies. I think that’s very important because patients often feel judged, and we don’t wish for them to feel that way. They discuss, as discussed above, the need to screen for malnutrition and make sure people aren’t losing too much weight or too much lean body mass. Then they talk about continuing weight management pharmacotherapy beyond the initial weight loss so that weight loss is maintained.
In terms of Section 9, “ Pharmacologic Approaches to Glycemic Treatment,” I don’t think there’s much that’s new — although again, they do discuss the treatment of metabolic dysfunction–associated steatohepatitis (MASH) using GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, pioglitazone, or a combination thereof.
Figure 9.3, as always, discusses the use of glucose-lowering medications in managing type 2 diabetes. I don’t think there’s much different in this figure from prior years because we’ve really added in the notion of treating patients differently who have known cardiovascular disease, renal disease, heart failure, or high-risk individuals compared to patients who don’t have those characteristics.
I really like the new figure because I think it’s easier to follow, and at the bottom, they discuss mitigating the risk for metabolic dysfunction–associated steatotic liver disease (MASLD) or MASH. It’s a little bit more comprehensive, but thematically very simple.
Figure 9.4 is the figure that looks at using injectable therapies in individuals with type 2 diabetes. Although the content here is similar to what it’s been in prior years, it’s actually presented in a way that seems much more readable, and it’s probably going to be more helpful in terms of practitioners wanting to know practically how to start people on injectable therapies.
One of the things they did was to remove the concept of a number that is evidence of overbasalization. We used to say that if basal insulin doses exceeded 0.5 unit per kilogram per day, that was evidence of overbasalization. Now, instead, they want us to look at whether there’s significant bedtime-to-morning or postprandial-to-preprandial glucose changes with occurrences of hypoglycemia — that that’s a good sign that a patient is overbasalized.
That’s the end of video 2. We’ll rejoin with video 3 and the final sections of the Standards of Care in Diabetes—2025.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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