The 85th Scientific Sessions of the American Diabetes Association (ADA) was held in Chicago, IL, USA, from June 20 to June 23, 2025. Below is a summary of topics covered in some of the most exciting sessions.
A comparison of the benefits of newer drugs for type 2 diabetes
In this session, Dr. Karol Watson (University of California, Los Angeles, CA, USA) discussed the benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). According to Dr. Watson, to date, there is no strong evidence that dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 RAs improve cardiovascular disease. In contrast, there is compelling evidence supporting the benefit of GLP-1 RAs on reducing stroke, mortality, and kidney disease. Dr. Watson emphasized that sodium-glucose cotransporter (SGLT) 2 inhibitors improve heart failure, kidney outcomes, and cardiovascular mortality, but not stroke. Dr. Jonathan Purnell (Oregon Health & Science University, Portland OR, USA) pointed out that dual GIP/GLP-1 RAs may help reduce hemoglobin A1c below 5.5%, in addition to their beneficial effects on weight loss.
Dr. Alice Cheng (University of Toronto, Toronto, Canada) emphasized that SGLT2 inhibitors reduce cardiovascular mortality and improve renal outcomes and hyperglycemia. In addition, these drugs have the advantage of easy adherence, tolerability, affordability, and suitability for combination with other drugs compared to GLP-1 RAs and dual GIP/GLP-1 RAs. Dr. Avivit Cahn (Hadassah Hebrew University Hospital, Jerusalem, Israel) summarized the multiple options of combined therapies, different mechanisms of actions of antidiabetics, and their side effects. According to Dr. Cahn, the combination of newest drugs further reduces hemoglobin A1c, but are not cost-effective.
Peripheral artery disease (PAD) and diabetes
Dr. Zaina Albalawi (Memorial University of Newfoundland, St. John's, NL, Canada) indicated that diabetes mellitus is a high-risk factor for PAD. The concomitant presence of diabetes and PAD further increases the risk of cardiovascular mortality and limb-related mortality and decreases quality of life. PAD prevalence is estimated at 12.5–22%, and diabetes contributes up to 70% of all limb amputations. Of note, the number of PAD cases is increasing.
Dr. Subodh Verma (University of Toronto, Toronto, Canada) and Dr. Neda Rasouli (University of Colorado, Aurora, CO, USA) pointed out that PAD affects 230 million people and is underdiagnosed. An interesting remark was that the ADA currently recommends screening for PAD in asymptomatic adults with diabetes. Pharmacological treatment for PAD is limited. Although cilostazol is recommended for claudication (a common symptom of PAD), it has no other cardiovascular benefits. Dr. Verma and Rasouli also presented the results from STRIDE trial. Semaglutide 1.0 mg once per week for 52 weeks improved walking capacity in people with symptomatic PAD and type 2 diabetes. Semaglutide also improved symptoms (pain-free walking distance) and quality of life.
Liver disease and diabetes
In this session, Dr. Mandeep Bajaj (Baylor College of Medicine, Houston, TX, USA) showed that up to 65% of individuals with type 2 diabetes have metabolic dysfunction–associated steatotic liver disease (MASLD). Patients with metabolic dysfunction–associated steatohepatitis or MASH (a more severe condition than MASLD), are at higher risk of cardiovascular disease and chronic kidney disease. Dr. Kenneth Cusi (University of Florida, Gainesville, FL, USA) mentioned that 30–50% of individuals with type 2 diabetes have MASH. Dr. Cusi emphasized the importance of screening for liver fibrosis by using a FIB-4 (fibrosis 4—an index based on age and blood biochemical parameters) score of ≥1.3. Individuals with a high FIB-4 score are at risk of cirrhosis. A second useful test is transient elastography, to evaluate liver stiffness. Dr. Diana Barb (University of Florida, Gainesville, FL, USA) summarized the current trends in pharmacological treatment of MASH. Trials with resmetirom 80 or 100 mg have shown MASH resolution in 26–30% and hepatic fibrosis reduction in 24–26%. Semaglutide has also been shown to improve MASH and liver fibrosis. A phase 2 trial with tirzepatide suggests that this drug also improves MASH. Also, pioglitazone treatment may improve MASH and liver fibrosis.
Emerging treatments for pediatric diabetes
Dr. Sarah Lyons (Baylor College of Medicine, Houston, TX, USA) reviewed published consensuses on the management of pediatric diabetes. This should be focused on adherence to management and drugs, screening for psychosocial concerns and micro and macrovascular complications, education for self-management, family support, healthcare preparedness for transition to adult diabetes and patient transfer (from pediatrics to adult medicine), and regular checkups. Dr. Yeray Novoa (ISPAD, Berlin, Germany) discussed the advantages of continuous glucose monitoring systems for diabetes management, as they facilitate remote monitoring and telemedicine, and lower the risk of ketoacidosis and hypoglycemia. Insulin delivery is recommended for children with newly diagnosed type 1 diabetes.
More about diabetes treatment trials
Dr. Jennifer Green (Duke University, Durham, NC, USA) gave an overview of several randomized controlled trials showing the latest clinical advances in the treatment of diabetes. Advanced insulin devices have been shown to be superior to standard management in reducing haemoglobin A1c. Among older adults with type 1 diabetes, hybrid closed-loop systems (also called automated insulin delivery systems) are less prone to induce hypoglycemia than sensor-augmented insulin pumps. The SURMOUNT-1 trial showed that, in individuals with obesity and prediabetes, subcutaneous tirzepatide 10 or 15 mg resulted in weight reduction and a lower risk of progression to type 2 diabetes than that with placebo. The SOUL trial showed that oral semaglutide (up to 14 mg) reduced major adverse cardiovascular events in individuals with type 2 diabetes and atherosclerotic cardiovascular disease or chronic kidney disease. The FLOW trial showed that subcutaneous semaglutide 1.0 mg reduced the risk of kidney outcomes and death from cardiovascular causes in individuals with type 2 diabetes and chronic kidney disease. For type 1 diabetes, ustekinumab (a monoclonal antibody) has shown some promising but modest results in increasing C-peptide blood levels in children and adolescents.
Overall, great progress has been made in the development of new drugs for treating diabetes complications (heart, kidney, brain, liver) and associated conditions such as obesity. However, the development of new, effective drugs specifically targeting insulin resistance and beta-cell dysfunction, which play a key role in the pathogenesis of type 2 diabetes (and beta-cell dysfunction being the primary defect in type 1 diabetes), remains a challenge in the field.