Cardiac to Kidney Care, Standards of Care 2025 Offer New Take

This transcript has been edited for clarity. 

Welcome back to the third video on the American Diabetes Association (ADA) 2025 Standards of Care in Diabetes. 

These last sections include a number of really nice figures that make it easy to understand concepts that I think were historically embedded into text and not as clearly detailed as they are now. 

I also want to point out that many of these guidelines were done in conjunction with other societies, such as the American College of Cardiology, the American Society of Nephrology, and others, to align what our guidelines are with what others are saying, which makes sense. I’m going to go fast, but I want to encourage you to look at these sections and understand what the figures are trying to say. 

Section 10 is titled “Cardiovascular Disease and Risk Management.” The first figure to look at details how to treat hypertension in nonpregnant people with diabetes. The next one is a figure I’ve never actually seen before, but really love, which is called “Screening for Undiagnosed Cardiovascular Disease.” It’s clear and simple, and I think it’s very helpful.

The next section looks at lipid management for primary prevention of atherosclerotic cardiovascular disease, and then there’s a section and a figure on lipid management for secondary prevention. Again, these are clear, they’re well thought through, and I think they’re very useful to providers trying to understand how to best treat their patients.

Section 11 goes through “Chronic Kidney Disease and Risk Management.” I think the nicest thing about this, again, is a figure, Figure 11.2, which has these wonderful little pictures in terms of the guidelines now, including healthy eating, physical activity, use of sodium-glucose cotransporter 2 (SGLT2) inhibitors, and when to use metformin, renin-angiotensin-aldosterone system (RAAS) inhibitors, and statins. It’s a very nice way to look at the treatment algorithm for patients who have chronic kidney disease (CKD), and how to advance as more advanced treatment is needed. I find it really nice they framed it this way.

I’m not going to discuss the management of “Retinopathy, Neuropathy, and Foot Care,” but these are all very important aspects in caring for our patients. 

I’m going to discuss the section on “Older Adults,” because again, this has more content in terms of figures and tables. They talk about the concept of trying to really understand patients as they get older. There’s this 4Ms framework of age-friendly health systems, which looks at mentation, mobility, medications, and what matters most. I spend a large amount of time as my patients get older trying to figure out what really is best for them, given the context of what they’re capable of.

There is a figure — and this is actually in an earlier section, but I think of it here — which looks at the health of patients, the age of patients, and what their A1c goals should be. It’s not just a simple figure of where patients should be, but walks them through what they should do based on who they are rather than any given age or any given comorbidity. 

They then have a figure called “Simplification of Complex Insulin Therapy,” which I like because I spend time trying really hard to figure out how to take my patients who need insulin therapy throughout their lives, particularly if they have type 1 diabetes, but to how to make it simpler so I don’t end up with patients confusing insulin doses or developing the hypoglycemia that we’re trying so hard to avoid.

Section 14 is “Children and Adolescents,” not my particular area of specialty has some interesting concepts in it, but not that much that appears to me to be new. 

Section 15 talks about “Management of Diabetes in Pregnancy.” I think what is most different to me is they basically suggest that it’s okay to use continuous glucose monitoring (CGM) values for monitoring patients in terms of their glucose levels throughout pregnancy in conjunction with fingerstick monitoring as necessary. 

Then they discuss “Diabetes Care in the Hospital.” The biggest issue I think we’ve come up with lately is whether or not to stop incretin therapies in the perioperative setting. They give some guidelines in terms of how to help patients prepare for procedures or a surgery, which I think is something we all deal with as we’re trying to get our patients safely through any medical procedure. 

That’s the end of my take on what’s new for 2025. This is a living standard of care, so if interesting new updates are available, they will be published throughout the year. I thank you all for listening, and I hope you all have a happy, healthy new year.

Thank you.