New alliance accelerates evidence-based care for diabetes patients in primary care settings.
By Daniel Beaird
Approximately 90% of patients with Type 2 diabetes receive care for the disease from a primary care physician (PCP). That number is around 50% for those with Type 1 diabetes. But despite new treatments and technology, diabetes outcomes have only marginally improved during the past decade.
As the number of patients with diabetes has increased during the past few decades, the exact cause of Type 2 diabetes is still unknown. But the impact of nutrition, physical activity, obesity and lifestyle changes are documented to be associated with the increased risk and incidence of the disease.
The American Diabetes Association (ADA) is dedicated to improving care for those patients through the new Diabetes Primary Care Alliance. It aims for better outcomes by accelerating the adoption of evidence-based standards of care in primary care for diabetes patients and it’s seeking 5,000 early adopters to help drive improvement across almost 300,000 primary care practices in the U.S.
“It’s been estimated that a delay of up to 17 years exists between the discovery of new technologies and medicines and the subsequent widespread adoption into community practice,” said Kevin Peterson, MD, MPH, vice president of primary care for the ADA.
So the ADA has pursued a national strategy for improving delivery of diabetes care in primary care settings and for speeding the dissemination and adoption of innovation through practice-based research networks in the new Alliance. With an average of about 100 practices each, the networks work with the ADA to provide onsite and virtual support to practices and promote the implementation of evidence-based care management processes.
The Alliance engages with more than 3,600 primary care practices and other healthcare partners to drive implementation through education, quality improvement and research that improves evidence-based clinical practice, enhances the primary care team and improves clinical outcomes.
According to Dr. Peterson, most PCPs support between 150 and 200 patients with diabetes, and it’s estimated that every fourth or fifth patient in a primary care office has diabetes.
“There are about 5,000 endocrinologists in the U.S. compared to about 350,000 PCPs, so most diabetes care is handled by primary care with the reliance on preventive care even greater in primary care,” he said.
Diabetes care programs and trusted health data
The seven largest primary care organizations on the ADA’s Primary Care Council are helping identify the care services a patient with diabetes should expect from a primary care practice.
They include the American Association of Physician Associates, American Academy of Family Physicians, American Association of Nurse Practitioners, American College of Physicians, American College of Osteopathic Family Physicians, American Society of Health-System Pharmacists and American Pharmacists Association.
These organizations along with practice-based research networks, accountable care organizations (ACOs) and health systems are helping identify innovative practices and thought leaders who are eager to provide high quality diabetes care in a primary care setting.
“The innovative practices that join the Alliance will provide a model to promote and scale change across primary care practices in order to improve diabetes care delivery,” Dr. Peterson said.
That change must include effective metrics for the programs implemented. DARTNet Institute, a nonprofit organization that represents practices and practice-based research networks, will act as a national data center to help the ADA capture them. DARTNet interacts with 26 separate EHRs and provides support for dashboards and other actionable tools.
“DARTNet is a trusted resource for data collection expertise,” Dr. Peterson explained. “They have experience with many primary care networks and practices and can help engage and support practices in the work of the Alliance.”
A key component will be the creation of the ADA DARTNet Institute Alliance for Diabetes, a consortium of practices that will facilitate the use of aggregate health data to enhance evidence-based diabetes care delivery and improve outcomes in participating practices.
Getting resources to areas disproportionately affected by diabetes
The Alliance includes practices in under resourced communities and racially and ethnically diverse communities – those that are often disproportionately impacted by diabetes.
“Each project in the Alliance includes health equity strategies specific to each topic and geographic area participating,” Dr. Peterson said. “The Alliance primary care practices are over sampled in areas of need and practices that provide services to ethnic minorities.”
These practices join with other Alliance members and health systems from other ADA primary care quality improvement initiatives to improve education, promote evidence-based clinical practice, decrease the clinical burden on staff and introduce strategies to improve diabetes care in primary care settings.
Notable updates to Standards of Care in 2025
The new Alliance’s mission is to improve diabetes care delivery in primary care through the dissemination and implementation of the ADA’s “Standards of Care in Diabetes—2025.” Released in December, the Standards of Care is the gold standard in evidence-based guidelines for diagnosing and managing diabetes and prediabetes. Notable updates to the Standards of Care in 2025 include:
- Consideration of continuous glucose monitor (CGM) use for adults with Type 2 diabetes on glucose-lowering agents other than insulin.
- Guidance on actions to take during circumstances of medication unavailability, such as medication shortages.
- Additional guidance on the use of GLP-1 receptor agonists beyond weight loss for heart and kidney health benefits.
- Guidance on continuation of weight management pharmacotherapy beyond reaching weight loss goals.
- Guidance for treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) with moderate or advanced liver fibrosis using a thyroid hormone receptor-beta agonist.
- Emphasis on the use of antibody-based screening or presymptomatic Type 1 diabetes in those who have a family history or known genetic risk.
- Guidance on the use of recreational cannabis for Type 1 diabetes and those with other forms of diabetes at risk for diabetic ketoacidosis (DKA).
- Key updates highlighting potentially harmful medications in pregnancy and guidance for appropriately modifying the care plan.
- Expanded nutrition guidance to encourage evidence-based eating patterns, including those incorporating plant-based proteins and fiber, that keep nutrient quality, total calories and metabolic goals in mind.
Other noteworthy changes include:
- Emphasis on water intake over nutritive and nonnutritive sweetened beverages; and the use of nonnutritive sweeteners over sugar-sweetened products in moderation and for the short term to reduce overall calorie and carbohydrate intake.
- Importance of meeting resistance training guidelines for those treated with weight management pharmacotherapy or metabolic surgery.
- Guidance for DKA and hyperglycemic hyperosmolar state (HHS) in the outpatient and inpatient settings.
- Screening updates for fear of hypoglycemia, diabetes distress and anxiety.
- Improved approach for diabetes care delivery for older adults.
- Guidance on the use of GLP-1 receptor agonists and dual GIP and GLP-1 receptor agonists in the perioperative care setting.
The ADA updates annually the Standards of Care through the efforts of its Professional Practice Committee (PPC). The PPC includes physicians, nurse practitioners, certified diabetes care and education specialists, registered dietitian nutritionists, pharmacists and methodologists. Its members hold an expertise in a range of related fields.