New 2025 ADA/EASD Hyperglycaemia Management Guidelines: What Clinicians Need to Know!

In January 2025 the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) released their latest joint guidance on managing hyperglycaemia in type 2 diabetes.

Consolidated into the ADA’s Standards of Care 2025 and an updated EASD implementation note, the document refines the 2022 consensus algorithm while adding important clinical, technological and lifestyle dimensions.

Below is a practitioner-oriented overview of the most salient changes.


1. From “Glucocentric” to Cardio-Renal-Metabolic (CKM) Care

The guideline’s organising theme is now “cardiovascular-kidney-metabolic health (CKM).” Each pharmacologic decision must weigh glycaemic potency, cardiorenal benefit and weight effect simultaneously rather than sequentially. The term replaces the older “cardiorenal” wording and is used throughout Section 9 of the Standards as well as in the EASD quick-reference tables.

Clinical pearl: Patients with established ASCVD, heart failure with preserved ejection fraction, or CKD should start with an SGLT2 inhibitor or GLP-1 receptor agonist—irrespective of baseline A1C—unless contraindicated.

2. Weight-Forward Algorithm & Anti-Obesity Pharmacotherapy

Weight status now determines the early choice of glucose-lowering agents:

  • BMI ≥ 27 kg m² → consider GLP-1 RA, dual GIP/GLP-1 RA (e.g., tirzepatide) or high-dose semaglutide
  • BMI ≥ 35 kg m² or “priority weight concern” → combine lifestyle, anti-obesity medication and, if needed, metabolic surgery referral

The pharmacologic flowchart visually flags weight-positive agents (e.g., sulfonylureas, insulin) so prescribers can minimise them when comparable glycaemic control is achievable with weight-neutral/negative drugs

3. Earlier Combination Therapy & “Deprescribe to Simplify”

Data showing faster β-cell decline when A1C remains >7 % prompted the panel to recommend dual therapy at diagnosis if A1C ≥9 % or if cardiorenal indicators warrant. Conversely, clinicians are urged to de-intensify sulfonylureas or basal insulin once target glycaemia is maintained on newer agents to reduce hypoglycaemia risk and regimen complexity.

4. Tech Expansion: CGM for (Almost) Everyone

Continuous glucose monitoring (CGM) use is “strongly recommended” for all people with type 1 diabetes and for those with type 2 who:

  • take basal-bolus insulin, or
  • use any drug carrying hypoglycaemia risk, or
  • need help correlating lifestyle factors with glucose trends.

Insurers are encouraged to broaden coverage, citing evidence that CGM reduces A1C and acute-care utilisation in type 2 diabetes.

5. Lifestyle Section Adds Sleep as a “Third Pillar”

For the first time, sleep duration and quality joins nutrition and physical activity as a core behaviour to address in pre-diabetes and diabetes visits. Adults should aim for 7–9 hours nightly; clinicians are advised to screen for obstructive sleep apnoea and shift-work disorder.

6. Liver & Renal Updates

  • NAFLD terminology is replaced with MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH for its inflammatory form.
  • GLP-1 RA, dual agonists and pioglitazone are highlighted as agents with emerging histological benefit in MASH.
  • SGLT2 inhibitors are now recommended down to eGFR 20 mL min⁻¹ 1.73 m⁻² for CKD, and may be initiated in dialysis patients with residual function for cardiovascular benefit.

7. Broader Screening and Person-First Language

New tables outline disability assessments, peripheral arterial-disease screening after 10 years of diabetes, and routine discussion of sexual health in men and women. The document continues the shift to person-first language—e.g., “people with diabetes” instead of “diabetics”—to reduce stigma.

8. So What Should You Do Now?

Here’s what I’d suggest: 

  1. Ask your doctor if you’re on the best medications for your heart, kidneys, and weight.
  2. If you’re gaining weight or having lows, see if your meds need adjusting.
  3. Talk about CGM — it could make a big difference.
  4. Sleep better, move more, eat smarter — the basics still matter.
  5. Don’t hesitate to ask questions. You deserve clear, kind answers.


These new guidelines are not about making things harder — they’re about making diabetes care smarter and safer for you. I’m here to help explain what’s new and how to use it in real life.

If you have questions about your medication, blood sugar levels, weight, or how to use a CGM — feel free to send your question through our Q&A page. I’ll make sure your answer is safe, clear, and backed by real science.

Stay strong — and remember: you’re in control, and you’re not alone.
– Dr. Albana Greca

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