Recommendations from the 2024 American Diabetes Association (ADA) guidelines and their level of evidence
| Section | Recommendation | Level of evidence |
|---|---|---|
| Screening and diagnosis | Diabetes may be diagnosed based on glycated hemoglobin (HbA1c) or plasma glucose levels, FPG, 2-h glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT), or random glucose value accompanied by classic hyperglycemic symptoms. | A |
| The HbA1c test should be performed using a method certified by the National Glycohemoglobin Standardization Program (NGSP) as traceable to the Diabetes Control and Complications Trial (DCCT) reference assay. | B | |
| Point-of-care HbA1c testing for diabetes screening and diagnosis should be restricted to U.S. Food and Drug Administration (FDA)-approved devices at Clinical Laboratory Improvement Amendments (CLIA)—certified laboratories and sites. | B | |
| Plasma glucose criteria should be used to diagnose diabetes in conditions associated with an altered relationship between HbA1c and glycemia, such as some hemoglobin variants. | B | |
| Screening for presymptomatic type 1 diabetes may be done by detection of autoantibodies to insulin, glutamic acid decarboxylase (GAD), islet antigen 2 (IA-2), or zinc transporter 8 (ZnT8). | B | |
| Consider screening for diabetes in people taking certain medications, e.g., glucocorticoids, antiretroviral drugs, and thiazides. | E | |
| Annual screening for cystic fibrosis-related diabetes using OGTT. | B | |
| Genetic testing | All those diagnosed with diabetes in the first 6 months of life should have immediate genetic testing for neonatal diabetes, regardless of their current age. | A |
| Genetic testing for maturity-onset diabetes of the young (MODY) in those with an atypical presentation and a family history of diabetes in successive generations. | A | |
| Cardiovascular disease | Perform B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) testing in adults with diabetes to facilitate the prevention of stage C heart failure. | B |
| Bempedoic acid therapy should be considered in statin-intolerant individuals with diabetes. | A | |
| Diabetic kidney disease | Spot urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) should be assessed annually in people with type 1 diabetes for ≥ 5 years and in all those with type 2 diabetes regardless of treatment. | B |
| In those with established chronic kidney disease (CKD), urinary albumin (e.g., spot UACR) and eGFR should be monitored 1–4 times per year depending on the stage of the kidney disease. | B | |
| Periodically assess serum creatinine and potassium levels when ACE inhibitors, angiotensin II receptor blockers (ARBs), and mineralocorticoid receptor antagonists are used. | B | |
| Diabetes in pregnancy | Screen for gestational diabetes mellitus (GDM) at 24–28 weeks of gestation in pregnant individuals not previously found to have abnormal glucose metabolism in the current pregnancy. | A |
| Individuals with a history of GDM should have lifelong screening for the development of prediabetes or diabetes at least every 3 years. | B | |
| Diabetes technology | Initiation of continuous glucose monitoring (CGM) should be offered to people with type 1 diabetes early in the disease, even at the time of diagnosis. | A |
| When used as an adjunct to preprandial and postprandial glucose levels, CGM can help achieve A1C targets in diabetes and pregnancy. | B | |
| Obesity and weight management | In people with diabetes and overweight or obesity, the preferred pharmacotherapy should be a glucagon-like peptide 1 (GLP1) receptor agonist or dual glucose-dependent insulinotropic polypeptide and GLP1 receptor agonist for greater weight loss efficacy. | A |
| Consider additional parameters of body fat distribution, like waist circumference, waist-to-hip ratio, and/or waist-to-height ratio to assess diabetes risk. | E |
