New Guidelines Recommend Preconception Screening in Diabetes: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 16, 2025, we reported new clinical practice guidelines released at the Endocrine Society's ENDO 2025 annual meeting that emphasized the role of proactive screening in preventing adverse health outcomes in 2 high-impact endocrine conditions: preexisting diabetes in pregnancy and primary aldosteronism.

The guidelines

Ask about intent to conceive. In a joint guideline, experts called for systematic preconception screening in all women of reproductive age with diabetes, regardless of care setting. The document recommends clinicians “ask all women with diabetes of reproductive age about intent to conceive at every reproductive, diabetes and primary care visit” to ensure timely access to preconception care.

The guideline includes specific recommendations around delivery timing, medication management, and the use of diabetes technology. Pregnant individuals with diabetes should be considered for delivery before 39 weeks, given that “the risks associated with continued pregnancy may outweigh those of early delivery.” Clinicians are advised to discontinue GLP-1 receptor agonists before pregnancy and avoid metformin in pregnant individuals with preexisting diabetes already on insulin. For patients with type 1 diabetes, the guideline supports the use of hybrid closed-loop insulin delivery systems during pregnancy. In addition, the document suggests that women with diabetes use contraception until they are ready to become pregnant.

Screen for primary aldosteronism. A separate guideline released at the same meeting calls for expanded screening for primary aldosteronism, a frequently underdiagnosed cause of hypertension. Guideline authors recommend that all individuals diagnosed with hypertension undergo laboratory screening for aldosterone, renin, and potassium levels. The writing committee suggested vs strongly recommended universal screening because of the potential for false-positive test results. When the condition is diagnosed, primary aldosteronism should be managed with treatments specific to the condition, including mineralocorticoid receptor antagonists or adrenalectomy in selected cases.

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