A clinical guideline update on the prevention or delay of diabetes and associated comorbidities was published in January 2025 by the American Diabetes Association (ADA) Professional Practice Committee. These guidelines were published in Diabetes Care (2025;48(Suppl. 1):S50–S58).
Summary of Key Recommendations
| Category | Key Recommendations |
|---|---|
| Screening & Monitoring | Risk assessments and diagnostic tests should be used to detect prediabetes and type 2 diabetes early. |
| Lifestyle Interventions | Structured programs should target 7% weight loss and 150 minutes of physical activity per week. |
| Pharmacologic Interventions | Metformin should be considered for high-risk adults, especially those aged 25-59 with BMI ≥35 kg/m². |
| Prevention of Type 1 Diabetes | Individualized care plans should prioritise weight management, glucose control, and cardiovascular risk reduction. |
| Cardiovascular Risk Reduction | Routine screening and management of blood pressure, cholesterol, and cardiovascular risk factors is advised. |
| Person-Centered Care | Individualised care plans should prioritise weight management, glucose control, and cardiovascular risk reduction. |
Screening and Monitoring
With regard to screening and monitoring, risk assessments and diagnostic tests should be utilised to detect prediabetes and type 2 diabetes in high-risk adults, enabling timely intervention. For individuals with presymptomatic type 1 diabetes, A1C tests should be conducted every six months, and annual oral glucose tolerance tests (OGTT) should be used to monitor disease progression. Monitoring schedules should be personalised according to individual risk factors.
Lifestyle Interventions
With regard to lifestyle interventions, high-risk individuals should engage in structured lifestyle programs to achieve at least a 7% reduction in body weight and 150 minutes of moderate-intensity physical activity weekly. Eating patterns, such as the mediterranean diet, intermittent fasting, and low-carbohydrate diets, should be recommended for individuals at risk of developing type 2 diabetes. Certified, technology-based diabetes prevention programs, including mobile apps and telehealth services, should be utilised to improve accessibility, particularly in underserved communities.
Pharmacologic Interventions
With regard to pharmacologic interventions, metformin should be considered for adults at high risk of diabetes, particularly those aged 25-59 years, with a BMI ≥35 kg/m², and elevated glucose or A1C levels. Long-term users of metformin should undergo periodic monitoring of vitamin B12 levels, especially individuals with anaemia or peripheral neuropathy.
Prevention of Type 1 Diabetes
With regard to the prevention of type 1 diabetes, individuals aged 8 years or older with stage 2 type 1 diabetes should be informed of the option for teplizumab infusion to delay the onset of symptomatic type 1 diabetes. Administration should be conducted in a clinical setting with appropriately trained healthcare providers.
Cardiovascular Risk Reduction
With regard to cardiovascular risk reduction, routine screening and management of cardiovascular risk factors, including blood pressure and cholesterol, should be undertaken for individuals with prediabetes. While statins are known to reduce cardiovascular events, they may also increase diabetes risk in certain high-risk individuals. Regular glucose monitoring should be maintained for statin users, and discontinuation solely due to diabetes risk is not recommended.
Person-Centered Care
With regard to person-centred care, individualised treatment plans should be developed for individuals at high risk for diabetes, with a focus on weight management, glucose control, and cardiovascular risk reduction.
New Updates or Changes
With regard to updates, the 2025 guidelines introduce a greater focus on the role of technology-assisted diabetes prevention programs, emphasising their cost-effectiveness and potential to reach underserved populations. The use of teplizumab to delay the onset of symptomatic type 1 diabetes in individuals aged ≥8 years with stage 2 type 1 diabetes has been introduced. Additionally, sleep health, including sleep duration, quality, and chronotype, is now recognised as an integral component of lifestyle modification for diabetes prevention.
Clinical Application
With regard to clinical application, healthcare providers should identify at-risk patients by using risk-based screening tools to detect prediabetes and diabetes early. Providers should guide patients toward participation in certified diabetes prevention programs or offer personalised lifestyle counselling on diet, physical activity, and weight management. Personalised treatment plans should be developed to determine the appropriateness of metformin for high-risk individuals. Additionally, vitamin B12 levels should be monitored for long-term metformin users. Providers should also prioritise the identification and management of cardiovascular risk factors in patients with prediabetes. Certified technology-assisted programs should be leveraged to increase access to diabetes prevention support, especially for patients with limited access to in-person care.
Special Considerations
With regard to special considerations, women with a history of gestational diabetes should be offered preventive measures such as lifestyle modification or metformin therapy. Ethnic differences in BMI cut-off points for diabetes risk should be acknowledged, with tailored screening and treatment approaches for specific populations, such as individuals of Asian descent. For older adults (aged 70 and older), progression from prediabetes to diabetes is less likely than reversion to normoglycemia or death. As such, providers should assess the risk-benefit ratio when recommending intensive preventive measures.
References and Citations
This summary highlights key recommendations from the “Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2025” published by the American Diabetes Association Professional Practice Committee in Diabetes Care (2025;48(Suppl. 1):S50–S58). For complete guidance, refer to the official publication here: ADA Guidelines 2025.
Disclosure:
This summary was created by integrating human and AI expertise to ensure clarity and precision. The summary is an interpretation and does not replace the official guidelines.
