From its inception in 1989, the American Diabetes Association’s (ADA’s) Standards of Care in Diabetes clinical practice guidelines have evolved from a 4-page document (1) to an impressive 352 pages in 2025, with 17 sections covering everything from population health to diabetes advocacy (2). The expansion of these guidelines throughout the past 36 years has documented our ever-increasing knowledge and understanding of diabetes pathophysiology and pharmacology, as well as the impacts of a changing health care environment. Rapid developments in diabetes care have necessitated that the Standards of Care be published as a Diabetes Care supplement annually and also exist online as a “living document,” with updates as needed throughout each year to reflect emerging data that may affect the current recommendations.
One of the most recognized and useful components of this world-renowned document is its evidence-based algorithm and related recommendations for the pharmacological management of type 2 diabetes, which have evolved over many years (3). This algorithm no longer reflects a single stepwise approach that starts with metformin as the universal first-line therapy. Instead, it has expanded beyond a purely gluco-centric approach to focus on the selection of appropriate treatments with proven benefit to address individuals’ existing comorbidities (e.g., cardiovascular disease, heart failure, and chronic kidney disease). Importantly, the 2025 version of this algorithm for the first time recognizes the importance of mitigating the risk of metabolic dysfunction–associated steatotic liver disease and metabolic dysfunction–associated steatohepatitis, with a related recommendations for agents that may have potential benefits for these conditions.
The 2025 Standards of Care offers a wealth of information of critical importance to primary care clinicians; however, its 352-page length can be daunting and perhaps overwhelming. Recognizing the need in primary care for a more easily accessible resource, the ADA’s Primary Care Advisory Group and key ADA staff have developed an abridged version of the Standards of Care, in a user-friendly graphical format, to summarize the highlights of this impressive document (4). The 2025 abridged Standards of Care is published in this issue starting on p. 182 and is also available on the journal’s website at https://diabetesjournals.org/collection/2720/2025-Abridged-Standards-of-Care.
Based on the principle that a picture is worth a thousand words (or more, in this case), it is our hope that both the complete and abridged versions of the 2025 Standards of Care will further your efforts to provide state-of-the-art, evidence-based care to your people with diabetes.
