The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

This review highlights key advances in diabetic neuropathy (DN) presented at the 2025 annual meetings of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). New studies confirmed the systemic impact of both diabetic peripheral neuropathy (DPN) and diabetic autonomic neuropathy (DAN). Cardiovascular autonomic neuropathy (CAN) was strongly linked with poor glycaemic control, impaired exercise tolerance, and increased risk of heart failure, particularly in patients with silent myocardial infarction. DSPN independently predicted stroke in type 1 diabetes. DN in general was associated with a higher risk of severe mental illness in type 2 diabetes. Therapeutically, dapagliflozin promoted corneal nerve regeneration through anti-inflammatory pathways. Novel biomarkers, such as plasma methylglyoxal, and advanced neuroimaging emerged as promising tools for risk stratification and personalised pain management. Machine learning applied to neuroimaging data identified neural connectivity patterns predictive of treatment response in painful DN. Basic science studies elucidated new mechanisms, including Schwann cell ferroptosis, and a gut-brain axis contributing to neuropathic pain and cognitive decline. Taken together, these findings promote our understanding of DN pathophysiology and therapy.

This research aimed to explore the link between diabetic nephropathy and diastolic dysfunction in individuals with type 2 diabetes mellitus (T2DM), as the precise impact of diabetes on left ventricle diastolic function in patients with chronic renal failure is limited. This cross-sectional study was conducted in the department of general medicine at tertiary care center, over 18 months. This study includes both men and women aged more than 35 years (>35-<70 years) with known or newly diagnosed diabetes mellitus. Involved participants with diabetes mellitus diagnosed using the American Diabetes Association criteria. Diabetic nephropathy was assessed using urine albumin and serum creatinine levels. Patients underwent a two-dimensional-directed M-mode transthoracic echocardiogram and mitral valve inflow assessment. Diastolic dysfunction was classified into three grades, and tissue Doppler imaging was used to measure the E/E' ratio. Data were collected using a predesigned pro forma and entered into an Excel spreadsheet. The study aimed to understand the relationship between diabetes and kidney function. The study involved 101 patients with T2DM, with a mean age of 53.46 ± 9.96 years. Diastolic dysfunction was observed in 57.4% of the population, with 34.7% having Grade I dysfunction, 18.8% having Grade II dysfunction, and 4.0% having Grade III dysfunction. The prevalence of diastolic dysfunction was higher among males (64.3%) compared to females (48.9%). Age-wise distribution showed 66.7% of patients with diastolic dysfunction, while no significant association was found between diabetes duration and diastolic dysfunction. Lipid profile analysis revealed significantly higher low-density lipoprotein levels in patients with diastolic dysfunction compared to those without. A direct relationship between worsening diabetic nephropathy and diastolic dysfunction was found. A significant correlation was found between declining estimated glomerular filtration rate and worsening diastolic dysfunction. The study reveals a high prevalence of left ventricular diastolic dysfunction (LVDD) in type 2 diabetes, linked to age, diabetes duration, poor glycemic control, and diabetic nephropathy. The study suggests that glycemic control and diabetes duration may be more dominant determinants of LVDD. Early detection and aggressive management are crucial to mitigate the risk.

GLP-1 Receptor Agonists Associated With Improved Survival After Infrainguinal Bypass in Diabetic Patients.

This study aimed to investigate the association between fat mass and obesity-associated (FTO) gene Single Nucleotide Polymorphisms (SNPs) and the risk of type 2 diabetes (T2DM) in older Iranian adults, addressing the limited data available for older populations in the Middle East. We analyzed 2,192 older adults from the Bushehr Elderly Health program in southern Iran. T2DM was defined using American Diabetes Association ADA criteria. The Illumina Global Screening Array was used to genotype FTO SNPs. In our analysis, 1,146 SNPs were examined for association with type 2 diabetes using generalized linear models under additive, dominant, and recessive models, controlling for age and sex, following quality control and linkage disequilibrium pruning. False discovery rate (FDR) correction was applied, with significance set at PFDR < 0.05. Among 2,192 elderly participants, 34% had type 2 diabetes. Although none of the examined FTO SNPs showed a statistically significant association with T2DM after FDR correction, the lowest P value was observed for rs16952649 under the additive model (P ≈ 0.002). Known risk alleles, such as rs1421085 (C allele: 42% vs. 43% in Europeans) and rs9940128 (A allele: 45% vs. 44%), were present at similar frequencies to European populations. Ethnic-specific genetic patterns were also observed in the Bushehr cohort. T2DM was not significantly associated with FTO variants, indicating context-dependent effects that were probably influenced by adiposity. The necessity of population-specific genetic research is highlighted by these findings. The online version contains supplementary material available at 10.1007/s40200-025-01721-6.

Association of diabetes with sarcopenia in patients on hemodialysis: A nationwide cross-sectional study in Portugal.

Background. Metformin is a first-line drug for the treatment of type 2 diabetes mellitus (T2DM) due to its high efficacy, safety and availability. Despite being one of the oldest hypoglycaemic drugs, it remains highly relevant in current clinical practice. Materials and methods. A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar using the following keywords: metformin, type 2 diabetes mellitus, prediabetes, polycystic ovary syndrome, gestational diabetes mellitus. Results. Metformin can be used alone in patients with polycystic ovary syndrome and body mass index (BMI) ≥ 25 kg/m2 to improve insulin sensitivity, glycaemic control, and lipid metabolism. Metformin can be added to combined oral contraceptive therapy in patients being treated for hirsutism and dysmenorrhea. This combination may offer better clinical outcomes, especially in women with BMI &gt; 30 kg/m2, risk factors for diabetes, or impaired glucose tolerance. According to the American Diabetes Association (ADA, 2025), metformin is not a first-line treatment for gestational diabetes but may be considered as an alternative to insulin therapy when insulin is contraindicated or unavailable. NICE guidelines (2020) support the use of metformin in pregnant women with fasting plasma glucose &lt; 7.0 mmol/L if lifestyle modifications are ineffective. Metformin is also recommended by the ADA (2025) for the prevention of T2DM, particularly in adults aged 25–59 years with BMI ≥ 35 kg/m2, elevated fasting plasma glucose (≥ 6.0 mmol/L) or glycated haemoglobin ≥ 6.0 %, and in women with a history of gestational diabetes. Conclusions. Metformin is the drug of choice for women with metabolic disorders, particularly polycystic ovary syndrome. It may be used as an alternative to insulin therapy in gestational diabetes when insulin is unavailable or contraindicated. In addition, metformin is recommended for the prevention of T2DM in patients at high risk of its development

BackgroundThe 1-h plasma glucose (1-h PG) during oral glucose tolerance test (OGTT) may enhance early dysglycemia detection compared with conventional markers. Distinct glucose curve morphologies correlate with glycemic profiles, insulin sensitivity, and β-cell function. We aimed to compare 1-h PG diagnostic performance with conventional methods and explored glucose curve morphology prevalence in a Brazilian population.MethodsThis retrospective cross-sectional study analyzed 1,797 OGTT records from a Brazilian laboratory (2021–2024). Glycemic profiles were classified using 1-h PG, fasting plasma glucose (FPG), 2-h PG, and HbA1c according to American Diabetes Association, Brazilian Diabetes Society and International Diabetes Federation criteria. Cohen's κ assessed inter-method agreement, McNemar’s chi-square tests compared high glycemic risk detection and χ2 tests evaluated associations between curve patterns (monophasic, biphasic, continuous rise) and glycemic status.ResultsParticipants were predominantly female (68.9%; mean age 49.6 ± 15.0 years). The 1-h PG identified 27.8% more intermediate hyperglycemia (IH)/type 2 diabetes mellitus (T2DM) cases than FPG, 16.8% more than 2-h PG, and 26.7% more than HbA1c. The 1-h PG identified more individuals at high glycemic risk than FPG (χ2 = 290, p < 0.001), HbA1c (χ2 = 129, p < 0.001), 2-h PG (χ2 = 165, p < 0.001), and their combined criteria. Among 1361 evaluable curves, 59.6% were monophasic, 38.3% biphasic, and 2.1% continuous rise. Monophasic curves predominated in IH/T2DM, whereas biphasic curves were more frequent in normoglycemia (χ2 = 278; P < 0.001).ConclusionsThe 1-h PG thresholds ≥ 8.6 mmol/L (155 mg/dL) for IH and ≥ 11.6 mmol/L (209 mg/dL) for T2DM identified more dysglycemia cases than conventional methods, supporting early detection utility. Monophasic curve morphology was associated with impaired glycemic profiles, highlighting prognostic relevance.

Gestational diabetes mellitus is commonly observed in pregnant women and is associated with an increased risk of adverse outcomes for both mother and child, not only during pregnancy but also in the long term thereafter. The present study aimed to develop a predictive nomogram for gestational diabetes mellitus in pregnant women. This multicenter prospective cohort study enrolled 1,398 pregnant women from five major obstetric hospitals in Vietnam's Mekong Delta. GDM was diagnosed based on the 2017 American Diabetes Association criteria. Using Bayesian Model Averaging, the optimal prediction model was identified in the primary cohort (n = 978) and used to construct a nomogram for individualized risk estimation. Model performance was validated in an independent cohort (n = 420), with assessment of discrimination (AUC), calibration (Brier score), and clinical utility (decision curve analysis). The prevalence of GDM was 18.0% (95%CI: 16.0-20.1). The final model included maternal age (OR per year: 1.09; 95%CI: 1.06-1.13), history of macrosomia (OR: 6.04; 95%CI: 2.76-13.19), body mass index (OR per kg/m²: 1.62; 95%CI: 1.25-2.10), and weight gain during pregnancy (OR per kg: 1.12; 95%CI: 1.06-1.18). The model demonstrated good discriminative ability and calibration in the primary cohort (AUC = 0.74, 95%CI: 0.69-0.78; Brier score = 0.123), and acceptable performance in the validation cohort (AUC = 0.70; 95%CI: 0.63-0.77; Brier score = 0.139). The nomogram showed good calibration and yielded higher net benefit across a wide range of risk thresholds (0.1-0.4) in decision curve analysis, indicating strong clinical utility. A nomogram incorporating four routinely assessed clinical parameters offers good predictive accuracy for gestational diabetes mellitus. This model may facilitate early identification and targeted intervention for high-risk pregnant women in both resource-limited and clinical settings.

Pediatric congenital heart disease (CHD) patients have increased risk for cardiovascular (CV) disease. Acquired conditions such as elevated Hemoglobin A1c (HbA1c) are known risk factors for adverse CV outcomes in the adult population. With the increasing rates of pediatric prediabetes and diabetes, data are limited on the screening practices for HbA1c in children with CHD. Presence of elevated HbA1c in this population would potentially increase future CV risk. Our study aimed to evaluate screening practices for HbA1c in youth with CHD and the characteristics of those screened. Youth with CHD with primary cardiology encounters from 2012 to 2019 were evaluated. Available anthropometric, demographic, and lab data were analyzed to determine rates of HbA1c screening, screening eligibility, and compare those screened with HbA1c versus those unscreened. Of 2764 total patients, 7.9% (219/2764) had HbA1c labs with 21.9% (48/219) in the prediabetic/diabetic range. Screened patients had a higher proportion of individuals with elevated or hypertensive blood pressure measurements and overweight/obese body mass index versus unscreened patients. Although 213 patients (7.7%) were screen-eligible for HbA1c per American Diabetes Association recommendations, only 27.2% (58/213) were screened with 37.9% (22/58) in the prediabetic/diabetic range. Only a small percentage of screen-eligible patients were screened with HbA1c. Of those screened, a sizable proportion of patients were in the prediabetic/diabetic range. Improved screening practices for HbA1c and metabolic syndrome in children with CHD are needed.

IntroductionPrediabetes presents an opportunity for early intervention. Growing evidence suggests that psychological stress may contribute to glucose dysregulation, but the findings are inconsistent.This study aimed to clarify the association between perceived stress and glycemic measures, by first testing gender as a moderator, and then examining age as a moderator within each gender group.Research design and methodsWe analyzed cross-sectional data from 470 diabetes-free adults in Singapore. Participants completed the 10-item Perceived Stress Scale, comprising two subscales: perceived helplessness and perceived self-efficacy. Glycemic measures included fasting plasma glucose, glycated hemoglobin, and 2-hour plasma glucose (2h-PG) following an oral glucose tolerance test. Prediabetes was classified according to the American Diabetes Association diagnostic criteria.ResultsMultivariable regression analyses revealed significant moderating effects of gender on the relationship between perceived stress factors and both prediabetes status and 2h-PG levels. Specifically, higher perceived helplessness and perceived self-efficacy were significantly associated with a lower prevalence of prediabetes and lower 2h-PG levels among men. However, these associations were non-significant among women. Age significantly moderated the relationship between perceived helplessness (but not perceived self-efficacy) on prediabetes and 2h-PG levels in women; higher perceived helplessness was associated with a greater prevalence of prediabetes and higher 2h-PG levels among younger women.ConclusionsGender moderated the associations between perceived stress and both prediabetes prevalence and 2h-PG levels. Among women, age further moderated the association between perceived helplessness and these outcomes. Future research should consider both moderators. Tailored psychosocial stress management strategies may help reduce the prevalence of prediabetes and diabetes.Trial registration numberNCT02838693.

Introduction: The American Diabetes Association recommends use of glucagon-like-peptide-1 receptor agonists (GLP-1RAs) by patients with peripheral arterial disease (PAD) despite limited information regarding the impact of GLP-1RAs in these patients. Hypothesis: Patients using GLP-1RAs have lower rates of adverse events following revascularization. Methods: Our retrospective cohort (18-hospital, unified health care system; 2016-2024) included diabetic adults undergoing an index PAD revascularization, stratified by GLP-1RAs prescription. The primary outcome was overall mortality. Secondary outcomes included major adverse limb events (MALE), major adverse cardiac events (MACE), major amputation, and acute coronary syndromes (ACS). Outcomes were compared via Kaplan Meier analysis and entropy-balanced Cox regression using demographic, medical, healthy user parameters, intervention, and facility factors generating adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results: We included 5,008 patients (age 69±11 years; 1,858 [37.1%] females; 4,400 [87.8%] White; 1,766 [35.2%] open interventions) of which 468 (9.3%) were prescribed GLP-1RAs. On unadjusted analysis, GLP-1RAs prescriptions were correlated with lower mortality rates (60 [13%] vs 1,649 [36%], p&lt;0.001) (Figure 1) and ACS events (42 [9%] vs 642 [14%], p=0.04). However, MALE (123 [26%] vs 1,306 [29%], p=0.45), MACE (81 [17%] vs1,048 [23%], p=0.18), and major amputation (38 [8%] vs 498 [11%], p=0.12) differences were non-significant. After entropy-balance, covariates were well balanced with all standardized mean differences &lt;0.1. Entropy-balance and multivariable regression noted GLP-1RA prescriptions were associated with a reduced risk of mortality (aHR [95%CI]: 0.65 [0.44-0.96]), ACS (aHR [95%CI]: 0.61 [0.37-0.99]), and major amputation (aHR [95%CI]: 0.45 [0.28-0.73]) (Figure 2) but failed to reach significance for MALE (aHR [95%CI]: 0.76 [0.56-1.03]) and MACE (aHR [95%CI]: 0.89 [0.61-1.30]). Conclusions: GLP-1RAs use in diabetic patients undergoing revascularization for PAD was associated with significantly decreased rates of postoperative mortality, major amputation, and ACS events after lower extremity revascularization. These findings support the benefit of these medications in the diabetic PAD population and warrant further investigation to understand mechanism of protection of these medications and the potential expanded use in nondiabetic patients with PAD.

One-hour plasma glucose defining stages of type 2 diabetes - The ELSA-Brasil study.

Iohexol clearance, but not estimated GFR, reveals a steeper GFR decline in patients with prediabetes.

Background:The 2025 American Diabetes Association guidelines emphasize the benefits of continuous glucose monitoring (CGM) for patients with diabetes receiving insulin therapy. CGM measures interstitial fluid glucose levels, offering an alternative to capillary (finger-stick) devices. This study aimed to evaluate the real-world impact of CGM devices on patients with uncontrolled type 2 diabetes (T2D) compared to traditional blood glucose monitoring (BGM) in a resource-limited population.Methods:This is a retrospective study of patients 18 years or older, with T2D, with a glycated hemoglobin (HbA1c) > 9% at enrollment during the study period of December 1, 2021, to February 12, 2023, at an inner-city hospital. Patients with T2D using CGM devices were compared to a historical cohort of patients from the same population using BGM devices in the same period. The primary outcome was the HbA1c at 3 months. In total, 64 patients were included in the analysis after screening: 27 in the CGM group and 37 in the non-CGM group.Results:For the primary end point of HbA1c at 3-months, the study found no significant difference between groups. After adjustment for baseline differences (age, HbA1c, creatinine, point-of-care glucose, and number of patients on injectables), average treatment effect (ATE) was −0.48% (SE = 0.27) in favor of the non-CGM group (P = .07). Potential outcome means were 8.8% (SE = 0.17) and 8.3% (SE = 0.2) for CGM and non-CGM groups respectively. Both groups achieved clinically meaningful reduction in HbA1c.Conclusion:Our study did not find that CGM titrated regimens resulted in a statistically significant difference in HbA1c change at 3 months compared to non-CGM based treatment. This may indicate that while diabetes technology can help achieve glucose goals in more controlled settings, optimal results in the real world is influenced by many factors, such as insurance coverage, patient adoption, and provider training. More research can be done on identifying factors that yield optimal results in CGM utilization in outpatient settings.

OBJECTIVE Hypoglycemia is a serious complication in people with diabetes. Risk factors include increased age, certain comorbidities, and certain glucose-lowering medications. Although the American Diabetes Association recommends prescribing glucagon to individuals at high risk for hypoglycemia for use in emergent episodes, glucagon use remains low. This is particularly concerning in federally qualified health centers (FQHCs), where patients face socioeconomic barriers that may exacerbate this gap in care. This study evaluated glucagon prescribing rates among high-risk patients with diabetes in a FQHC. RESEARCH DESIGN AND METHODS A retrospective chart review was conducted of patients with diabetes seen between March 2022 and March 2023 who were prescribed a high-risk medication and/or had a history of hypoglycemia. Demographics and clinical characteristics such as history of hypoglycemia, high-risk medications, and active glucagon prescriptions were analyzed using descriptive statistics and comparative tests to determine characteristics associated with glucagon prescriptions. RESULTS Of the 7,304 patients, 95% had type 2 diabetes, and 61.5% were prescribed insulin, but only 4.4% had an active glucagon prescription. Among 65 individuals with documented hypoglycemia, 80% were prescribed a high-risk medication, yet only 13.8% were prescribed glucagon. Patients with type 1 diabetes were more likely to have glucagon prescribed (P = 0.002). CONCLUSION Glucagon was significantly under-prescribed in this high-risk population, highlighting gaps in applying clinical guidelines to practice as well as gaps in access to preventive care. These findings will inform provider education and interventions to improve glucagon prescribing practices.

Persons with Type 2 diabetes mellitus (T2DM, ~ 38.1million Americans) are at risk of poor health, cardiovascular disease (CVD) and chronic kidney disease (CKD) if their disease is poorly controlled. T2DM control requires disease self-management through adequate physical activity and optimum diet. We evaluated the physical activity and diet patterns of the US T2DM population against the American Diabetes Association and clinical practice guideline norms, and their associations with health outcomes. Using a cross-sectional, observational study design, we studied the US T2DM population's physical activity and fruit/vegetable intake (independent variables), and their associations with three health outcomes, self-rated health (from the SF-36 question on experienced health status, categorized as excellent/very good/good vs. fair/poor), CVD-free status, and CKD-free status. We used pooled data from the Behavioral Risk Factor Surveillance Surveys (2015, 2017 and 2019) on adults aged 30-75 years with T2DM (defined as diabetes mellitus diagnosed after age 30). Physical activity categories were inactive, insufficiently active, sufficiently active, highly active, and fruit/vegetable intake categories, ≤ 2, 3-4, and ≥ 5 daily servings. We used hierarchical logistic regression, adjusting for demographic variables (age, sex, race), and potentially confounding factors, diabetes severity (disease duration, insulin use), chronic comorbidity, overweight/obese, smoking, alcohol overuse, having a regular healthcare provider, and having health insurance. Missing data were coded as a separate category. We conducted a subgroup analysis of those with ≥ 10 years of disease duration. Among 119,298 respondents with T2DM (52.1% female, mean age 62.1 years, 94% insured), 36.9% were physically inactive and 16.2% insufficiently active, 52.6% consumed ≤ 2 daily servings of fruit/vegetables, 57% reported excellent-good health, 24.7% had CVD, and 9.7% had CKD. Physical activity showed a dose-dependent association with self-rated health (reference group, physically inactive; adjusted OR for insufficiently active 1.77 (95%CI 1.71-1.83), sufficiently active, 2.33 (2.24-2.43), highly active, 2.63 (2.54-2.72)), as did fruit/vegetable intake [reference group ≤ 2 daily servings; OR for 3-4 servings, 1.12 (1.09-1.16), and ≥ 5 servings, 1.13 (1.08-1.17)]. Physical activity was associated with being CKD-free (ORs, 1.29 (1.22-1.37), 1.50 (1.40-1.60), 1.52 (1.44-1.60, respectively), and being CVD-free (1.31 (1.25-1.37), 1.34 (1.28-1.41, and 1.37(1.31-1.42), respectively). Fruit/vegetable intake was not associated with CVD. CKD outcome was not studied due to dietary restrictions of CKD patients. Subgroup analyses (53,925 respondents) showed similar results. Over a third of the US T2DM population and the subgroup with long-term T2DM were physically inactive, a sixth were insufficiently active, and over half had negligible fruit/vegetable intake. On the positive side, even limited physical activity and fruit-vegetable intake were associated with substantial health benefits including subjective quality of life (self-rated health) compared to physically inactive/negligible fruit-vegetable intake. Our findings call for disease self-management research focused on physician communication for patient empowerment to enable incremental improvements, however modest.

Disclosure: T.E. Rave: None. S. Tariq: None. A. Bonilla: None. T. Prazeres: None. A.A. Franco Akel: None. R. Belokovskaya: None.People with Diabetes mellitus (DM) have an increased risk of pneumococcal infection. Studies have found that a longer duration of DM and poorer glycemic control increases the relative risk of pneumonia-related hospitalizations by 25-75%. Therefore, the Centers for Disease Control's (CDC′s) Advisory Committee on Immunization Practices and the American Diabetes Association (ADA) recommends pneumococcal vaccines in all patients with DM over the age of 19. At our institution, vaccines are typically offered by primary care providers. However, given the significantly poor glycemic control in the patient population in the Diabetes Practice, these patients are particularly susceptible to infections. This Quality Improvement project aimed to enhance pneumococcal vaccination adherence among adults with DM within our endocrinology practice.We performed a retrospective review of 458 adults aged 19 years or older with a diagnosis of type 2 DM, type 1 DM, latent autoimmune diabetes and monogenic diabetes at Metropolitan Hospital Diabetes Practice from 10/2023-9/2024. Of these patients, 176 (38%) were up to date. We aimed to increase this adherence rate to 60% (Outcome measure). Our intervention strategy (Process measure) included: 1) educating the providers and nursing staff regarding the importance of discussing vaccination risks and benefits, 2) implementing a smart phrase to clinic notes in Epic as a guide to providers to address vaccination status, 3) providing vaccination information sheets to patients, and 4) offering an updated vaccine during the visit.During the first month of intervention we evaluated 78 patients. Prior to their visit, 39 (50%) were not up to date with the pneumococcal vaccine. Of those, 19 (48%) were administered an updated vaccine during their visit, 6 refused vaccination, 3 reported they were vaccinated at an outside facility, and 11 were deferred for other reasons. After our intervention, 58 patients (74%) were up to date with their pneumococcal vaccines. Surveys were anonymously collected from the clinical staff to assess their satisfaction (Balancing measure). Responses noted that the impact of the process on overall time efficiency of daily workflow had no significant change in 56%, improved in 33%, and worsened in 11%. In addition, 67% of staff responded that it had no significant effect in their patient interaction and it did not contribute to an increase in burnout.Our process proved to be effective and made a dramatic improvement in pneumococcal vaccination adherence in patients with DM. A majority of our staff felt no significant impact from this process on their daily work, and some even stated it had improved. A pneumococcal vaccine is an easy way to prevent infection that is often overlooked. This project highlights the need and ease of adhering to this important guideline.Presentation: Monday, July 14, 2025