Here you can find the critical updates introduced in the 2020 ADA guidelines. These revisions reflect a growing shift toward outcome driven care and tighter cardiovascular and renal protection. The ADA places stronger emphasis on pharmacological therapy with GLP 1 agonists or SGLT 2 inhibitors for patients with established cardiovascular disease, heart failure, or chronic kidney disease. These medication classes now sit at the center of evidence based management because they improve outcomes far beyond glucose control.
The guidelines highlight that patients with existing cardiovascular or renal disease face the highest risk of complications. Because of that, the ADA urges clinicians to prioritize therapies with proven benefit in these groups. GLP 1 agonists offer meaningful reductions in major cardiovascular events. SGLT 2 inhibitors provide powerful protection against heart failure and progressive kidney decline. When used well, they reshape long term health trajectories for many people living with type 2 diabetes.
The ADA also reminds clinicians that guidelines evolve with new evidence. Each January, the organization reviews recent trials and updates the recommendations accordingly. This yearly cycle helps clinicians stay aligned with best practices and ensures that patients receive the most current, outcome oriented care. Stay tuned for the next update.
About Dr. Gerti Tashko, MD
Dr. Gerti Tashko, MD, is an endocrinologist in Montgomery County, Maryland. He is uniquely quadruple board-certified in endocrinology, lipidology, hypertension, and obesity medicine. His practice delivers root-cause-focused metabolic and endocrine care, available virtually and in person. He uses advanced diagnostics, personalized nutrition, and preventive medicine to improve long-term health.
DIABETES CARE, ADA GUIDELINES, JANUARY 2020
GENERAL CHANGES
The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the American Diabetes Association (ADA) has long been a leader in producing guidelines that capture the most current state of the field.
Section 1. Improving Care and Promoting Health in Populations
Additional information was included on the rising cost of medications, particularly insulin.
A new section “Migrant and Seasonal Agricultural Workers” was added to discuss the challenges of managing type 2 diabetes-specific to this group.
Section 2. Classification and Diagnosis of Diabetes
The debate as to whether slowly progressive autoimmune diabetes with an adult-onset should be termed latent autoimmune diabetes in adults is now acknowledged.
- A new recommendation was added about avoiding discontinuation of RAS blockade in response to minor increases in serum creatinine in the absence of volume depletion.
- A new recommendation (2.8) was added regarding testing for prediabetes and/or type 2 diabetes for women with overweight or obesity and/or who have one or more additional risk factors for diabetes who are planning a pregnancy.
- Additional considerations were added to the section “Cystic Fibrosis–Related Diabetes” (CFRD) regarding the use of A1c tests to detect CFRD.
- The 2020 Standards of Care includes a new section on “Pancreatic Diabetes or Diabetes in the Context of Disease of the Exocrine Pancreas” to describe this form of diabetes and its diverse set of etiologies.
- The “Gestational Diabetes Mellitus” (GDM) section was revised, and the two-step approach for screening and diagnosing GDM no longer includes the National Diabetes Data Group criteria.