Patient guide · Diabetes
Diabetes: what good care looks like
Modern diabetes care protects the heart and kidneys, not just blood sugar. Here is what the guidelines recommend and what a good visit includes.
What diabetes is, in plain language
Diabetes means your blood sugar (glucose) stays too high because your body does not make enough insulin, does not use it well, or both. Type 1 diabetes is caused by the immune system destroying insulin-producing cells, usually starting in childhood or young adulthood, and always requires insulin. Type 2 diabetes, far more common, develops when the body becomes resistant to insulin and the pancreas cannot keep up, often over years, and is strongly linked to weight, activity level, and genetics.
High blood sugar is measured by a fasting glucose test, an oral glucose tolerance test, or hemoglobin A1C, which reflects average blood sugar over about three months. Uncontrolled diabetes damages blood vessels and nerves over time, raising the risk of heart attack, stroke, kidney failure, vision loss, and nerve damage.
What the current guidelines recommend
The main guideline is the ADA Standards of Care in Diabetes, updated every year. A central recommendation is that medicine choice should go beyond blood sugar control alone: for people with type 2 diabetes who also have heart disease, heart failure, or chronic kidney disease, a GLP-1 receptor agonist or SGLT2 inhibitor is recommended specifically for the protection these classes give those organs, independent of their effect on blood sugar.
The treatments, and why each one is recommended
Metformin remains the usual first medicine for type 2 diabetes: it is inexpensive, well studied, and lowers blood sugar without causing weight gain or low blood sugar on its own.
GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide) and SGLT2 inhibitors (empagliflozin, dapagliflozin) are recommended, often regardless of A1C level, for people who also have cardiovascular disease, heart failure, or chronic kidney disease, because trials show they reduce heart attacks, heart failure hospitalizations, and kidney failure beyond what blood sugar control alone explains.
Insulin is added when other medicines are not enough to reach your target, or is needed from diagnosis in type 1 diabetes and some cases of type 2.
Blood sugar targets are individualized: an A1C under 7 percent is typical for many adults, but the right target depends on your age, other health conditions, and risk of low blood sugar, which your clinician should set with you rather than apply the same number to everyone.
What guideline-based care looks like at a visit
A good clinician checks A1C roughly every 3 to 6 months, reviews your home blood sugar readings or continuous glucose monitor data, and checks blood pressure, cholesterol, kidney function (including a urine albumin-to-creatinine ratio), and your feet at regular intervals. An annual dilated eye exam and periodic screening for nerve damage are also standard. Medicine choices should be reassessed as your health changes, particularly if a heart, kidney, or blood vessel condition develops.
Red flags that a clinician is not following the guidelines
- Selling supplements, peptides, or compounded drugs as treatment
- Stopping proven medicines without a medical reason
- Ordering unproven tests or “detox” programs
- Telling you the guidelines are wrong without evidence
- Not offering a GLP-1 receptor agonist or SGLT2 inhibitor when you have heart, kidney, or blood vessel disease alongside diabetes, since these classes protect those organs beyond blood sugar control
Why choosing a guideline-based clinician matters
Landmark trials of SGLT2 inhibitors and GLP-1 receptor agonists have shown reductions of roughly a quarter to a third in cardiovascular death, heart failure hospitalization, or kidney failure in people with type 2 diabetes and existing heart or kidney disease, benefits separate from blood sugar lowering. Long-term follow-up of intensive blood sugar control also shows fewer complications affecting the eyes, kidneys, and nerves. Choosing a clinician who prescribes according to your full risk profile, not blood sugar alone, measurably changes these outcomes.
Questions to ask your doctor
- Which guideline do you follow for diabetes, and what year is it from?
- Which of the recommended treatments am I on, and if not, why not?
- What targets are we aiming for, and how will we track them?
- What should make me call you before my next visit?
- Do you sell any supplements or compounded medicines? (A guideline-based clinic does not.)
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The guidelines behind this guide
Summaries in plain language, with links to the official documents and PDFs.
American Diabetes Association · 2026
Standards of Care in Diabetes, 2026
- The ADA updates this guideline every year; it is the reference most US diabetes care follows.
- A1C goals are individualized (under 7 percent for many adults), with continuous glucose monitors recommended for anyone on insulin.
- For people with heart disease, heart failure, or kidney disease, SGLT2 inhibitors and GLP-1 receptor agonists are recommended regardless of A1C.
- Weight management, blood pressure, statins, kidney checks, eye and foot exams, and vaccines are part of routine care.
KDIGO · 2022
KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease
- For people with both diabetes and kidney disease: an ACE inhibitor or ARB, an SGLT2 inhibitor, metformin if kidney function allows, and a statin.
- Finerenone is added for those with albumin in the urine despite those medicines.
- GLP-1 receptor agonists are preferred when more glucose lowering is needed.
NICE (United Kingdom) · 2022
NICE NG28: Type 2 diabetes in adults: management
- The UK national guideline, written by the National Institute for Health and Care Excellence and updated in 2022.
- Individual A1C targets (usually 48 mmol/mol, about 6.5 percent, on lifestyle or one medicine; 53, about 7 percent, on medicines that can cause lows).
- Metformin first; an SGLT2 inhibitor is added, or used first, for people with heart failure, heart disease, or high heart risk.
- Covers blood pressure, foot and eye checks, kidney protection, and when to refer.
NICE (United Kingdom) · 2022
NICE NG17: Type 1 diabetes in adults: diagnosis and management
- Offers continuous glucose monitoring to all adults with type 1 diabetes and supports insulin pumps and hybrid closed-loop systems for those who qualify.
- Recommends structured education (such as DAFNE) within a year of diagnosis and an A1C target of 48 mmol/mol, about 6.5 percent, where it can be reached safely.
- Sets out ketone testing, sick-day rules, and how to spot and manage hypoglycemia.
Find a vetted endocrinologist near you
Every endocrinologist listed has a verified license, board certifications on record, and a dated attestation to these guidelines. No reviews, no ratings.
Dr. Karl Nadolsky, DO
VerifiedEndocrinologist, Weight loss doctor · Holland, MI
Endocrinologist and obesity medicine specialist who trained at Naval Medical Center Portsmouth and Walter Reed, chairs the AACE Comprehensive Obesity Management Algorithm, and practices at the Endocrine Clinic at the Gym in Holland, Michigan.
Call (616) 312-2859