The American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes-2022 provides a comprehensive update of recommendations for the diagnosis and treatment of diabetes mellitus. Summarized below are some of the key updates including screening recommendations, therapeutic guideline changes, and hypoglycemia management.

Screening for type 2 diabetes (T2D) should be considered in adults of any age with overweight or obesity who have at least one additional risk factor (Table 2.3). Adults without identified risk factors should be screened starting at age 35 (recommendations for screening previously started at age 45), repeated every three years at minimum or sooner if risk factors change. ¹ 

While metformin remains a first-line therapeutic option, the 2022 Standards recommend therapeutic choices based on comorbidities as well as patient-centered factors, such as cost and access (Figure 9.3). Patients may be considered for other initial medications, independent of metformin use or baseline glycemic control, based on comorbid atherosclerotic coronary artery disease, heart failure, or chronic kidney disease.² 

Lifestyle modification and diabetes education are foundational components of treatment in T2D. The 2022 Standards added emphasis on multiple risk factor management, such as glycemic control, management of lipids and blood pressure, and optimization of therapies based on end-organ benefit to reduce the risk of diabetes-related complications (Figure 10.1).³ 

Regimen changes such as deintensification can be used to reduce the risks of hypoglycemia and polypharmacy, particularly in older adults, as long as individualized glycemic targets are maintained.⁴