Insulin is more than 100 years old. The American Diabetes Association® (ADA) itself is 85. There are more classes of diabetes drugs, and more individual agents, than ever before. There is serious discussion of diabetes remission with dietary, pharmacologic, and surgical therapies. However, the diabetes community has yet to reach the ultimate goal of improving health outcomes for every person living with diabetes.

“There have been many hurdles that we have overcome as a field, but there are some especially daunting challenges that lie ahead,” said Rita Rastogi Kalyani, MD, MHS, the ADA’s President, Medicine & Science, during the Sunday, June 22, session, President, Medicine & Science Address and Banting Medal for Scientific Achievement. “Closing the circle from progress to promise is our unfinished journey.”

The ADA began its diabetes journey with six physicians at an American College of Physicians meeting in New Orleans in 1939 wondering why there was no group discussing diabetes. The first ADA meeting, in 1940, attracted just 26 attendees.

The organization has built itself into a global leader in diabetes research and care, witnessing the development of novel agents that can prevent atherosclerotic cardiovascular disease (ASCVD), heart failure, and chronic kidney disease (CKD) and lead to substantial weight loss. Meanwhile, novel insulins and new technologies have eased the daily management burden of diabetes, immunotherapy can now delay type 1 diabetes, and islet transplantation is a clinical reality.

“So why haven’t we yet attained the holy grail in the field of diabetes, which is to improve health outcomes for each and every individual living with diabetes, irrespective of whether it is type 1, type 2, or another type of diabetes?” Dr. Kalyani said.

One reason is clinical inertia. A large health system study of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in diabetes and ASCVD found low prescribing of these treatments by endocrinologists (22%), primary care providers (13%), and cardiologists (1.8%) through 2021.

Additionally, diabetes prevalence is growing. The International Diabetes Federation 2025 Atlas put the global diabetes burden at 11% of adults, or 589 million individuals, and rising.

Complication rates in youth onset diabetes are also increasing. The TODAY study of people aged 10–17 at baseline reported an 80.1% incidence of microvascular complications including nerve, retinal, or kidney disease, over 15 years of follow-up.

Similarly concerning is the worsening of A1C rates among adults aged 20–44.

“Our youngest adults who have the greatest chance of accruing complications over their lifetime are the ones with the most suboptimal A1C levels,” Dr. Kalyani said.

Race and ethnicity also matter for attainment of A1C targets, she noted. Research has shown that Hispanic individuals have the highest prevalence of not meeting A1C goals, followed by non-Hispanic Blacks and non-Hispanic whites, among an insured population.

Additionally, the availablity of specialized care varies by location.

“There is a gap between the knowledge we have now and the action we need in the future to meet the needs of all people with diabetes.”

—Rita Rastogi Kalyani, MD, MHS, ADA President, Medicine & Science

More than 80% of people living with diagnosed diabetes in the United States are managed by primary care because most of the country lacks local access to endocrinology care.

“We have come so far, but we still have so much more to do,” Dr. Kalyani said. “There is a gap between the knowledge we have now and the action we need in the future to meet the needs of all people with diabetes.”

It is difficult to predict how and when that gap might close in an environment where the continued existence of the National Institutes of Health (NIH) and other public scientific research is uncertain, she continued. The best way to predict the future is to create it, she added, recalling author Peter Drucker.

“We are the promise, and the time to act is now,” she declared. “The work we do together today has never been more critical. Get involved with ADA. Actively participate in professional education and scientific meetings, and encourage others to join the community. Stay updated on the latest clinical guidelines to deliver the highest standards of care. Invest in mentoring the next generation to drive innovative research. Educate the professional and lay communities.

“And most importantly, use your voice, speak out!” she said, emphasizing the key role of advocacy.

On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85th Scientific Sessions, from June 25–August 25.