ADA Standards of Care 2023-2024
The American Diabetes Association (ADA) Standards of Medical Care in Diabetes are updated annually and represent the most widely referenced clinical guidelines for T2D management in English-speaking countries. Tirzepatide was added to the ADA standards in the 2023 update, following FDA approval in May 2022. It was classified as a “dual GLP-1/GIP receptor agonist” and positioned as a “glucose-lowering option with the potential for weight loss.”
The ADA uses a patient-centred, comorbidity-driven framework. For patients with T2D and established atherosclerotic cardiovascular disease (ASCVD), heart failure, or CKD, SGLT2 inhibitors and GLP-1 receptor agonists with demonstrated cardiovascular benefit are prioritised. Tirzepatide’s position in this pathway is evolving — it does not yet have a completed dedicated CVOT, so it is not formally prioritised for cardiovascular risk reduction over agents with established CV outcomes trials (semaglutide SUSTAIN-6, liraglutide LEADER, dulaglutide REWIND, empagliflozin EMPA-REG). However, the ADA 2025 update explicitly named tirzepatide as a preferred agent for patients with T2D and overweight/obesity because of its “weight-independent benefits.”
The ADA 2023/2024 positions tirzepatide in the very high efficacy tier for glycaemic control (alongside insulin and combination regimens), above DPP-4 inhibitors, lower-dose GLP-1 RAs, and SGLT2i for glucose lowering specifically.
Ontology ADA Standards of Care 2023-2024 [recommended_by] Tirzepatide ADA Standards of Care 2023-2024 [guideline_for] Type 2 Diabetes ADA Standards of Care 2023-2024 [relates] HbA1c Reduction ADA Standards of Care 2023-2024 [relates] Insulin-Use Reduction ADA Standards of Care 2023-2024 [relates] Semaglutide
Recommendations
- Recommended for: T2D patients with overweight/obesity requiring glucose lowering and weight loss; patients in whom insulin initiation can be delayed; patients with high baseline HbA1c
- Caution or not recommended for: Patients with personal/family history of MTC or MEN2; patients with severe gastroparesis; pending CV safety for those with established ASCVD without completed CVOT
- Position relative to insulin: Preferred over insulin initiation if glycaemic target achievable without insulin; insulin remains required for advanced beta-cell failure
- Position relative to GLP-1 therapies: Higher glycaemic efficacy than GLP-1 RAs (SURPASS-2 data); similar or slightly higher GI side effect burden; no dedicated CVOT yet
- Position relative to SGLT2 therapies: SGLT2i preferred when CKD or heart failure is primary concern due to more robust renoprotective and HF evidence; tirzepatide increasingly positioned alongside SGLT2i for cardiorenal benefit as evidence matures
Connections
- Tirzepatide — recommended_by, [2023–2024], source: ADA Standards
- Type 2 Diabetes — guideline_for, [2023–2024]
- Semaglutide — relates (co-mentioned as preferred agent)
- Dedicated CKD Outcome Trial — evidence_gap_for (gap that limits stronger CKD positioning)