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In this episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, explore the updated American Diabetes (ADA) 2025 Standards of Care, focusing on therapeutic advancements in diabetes management.

Hosts discussed the significant changes to treatment algorithms and new guidance designed to enhance outcomes for people with diabetes and related conditions. One of the major updates discussed is the expanded flexibility in the treatment algorithm for type 2 diabetes (T2D) and chronic kidney disease (CKD), including glucagon-like peptide-1 receptor agonists (GLP-1 RA), such as semaglutide, as an alternative to patients who may not tolerate sodium-glucose co-transporter 2 (SGLT2) inhibitors.

Isaacs and Bellini emphasized the complementary benefits of combining these therapies, particularly for kidney protection and glucose management. The episode also highlighted updates on the use of GLP-1 RAs for patients with obesity-related heart failure with preserved ejection fraction (HFpEF), underscoring the evolving role of these medications beyond glucose lowering.

The discussion then shifted to the introduction of recommendations for metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). GLP-1 RAs, dual GLP-1/GIP agonists, and combinations with pioglitazone are now recognized as promising treatment options to mitigate these risks. Hosts delved into the importance of identifying disease severity using FIB-4 scores and how these guidelines aim to address the rising prevalence of fatty liver disease among people with diabetes.

Another noteworthy update focused on screening for type 1 diabetes (T1D), particularly in first-degree relatives of individuals with the disease. Isaacs and Bellini review the new staging framework, which classifies T1D progression into three distinct stages, and the inclusion of ICD-10 codes for accurate diagnosis. They also discussed the role of teplizumab (TZIELD) in delaying disease progression in individuals aged ≥8 years and what this could represent for early intervention.

With practical insights and real-world applications, this episode provided a comprehensive look at how these updates from the ADA’s 2025 Standards of Care will shape therapeutic decision-making and improve care for people with diabetes.

Key Episode Timestamps

00:00 Updates to 2025 ADA Standards of Care

03:06 GLP-1 Agonists and SGLT2 Inhibitors Combination Therapy

04:34 Heart Failure Stratification and Obesity-Associated Heart Failure

07:04 Introduction of Liver Disease into Algorithms

10:28 Screening for Type 1 Diabetes and New Guidelines

13:57 Guidelines for Pre-Symptomatic Type 1 Diabetes

17:35 Nutrition and Medication Adjustments

20:45 Vitamin D Monitoring and Supplementation

22:12 ADA Standards of Care App