ADA Publishes 2026 Standards of Care With Updates to Sections on Technology, Obesity, Cardiometabolic Disease Management

The American Diabetes Association (ADA) released the Standards of Care in Diabetes—2026 this week, an annual publication of the association's updated evidence-based recommendations for diagnosing, treating, and preventing diabetes and related comorbidities in children, adolescents, and adults.

“The 2026 Standards of Care in Diabetes represents significant advancement in the delivery of evidence-based, person-centered care," Rita Kalyani, MD, MHS, ADA’s chief scientific and medical officer, said in the ADA’s December 8 announcement. "These guidelines synthesize the latest scientific research with practical clinical strategies, thereby equipping health care professionals with the tools necessary to provide optimal care for individuals living with diabetes,”

Expanded Recommendations for Diabetes Technology

Continuous glucose monitoring (CGM). One of the most notable updates in 2026 is the expanded guidance on diabetes technology. CGM is now recommended at the time of diabetes onset and at any point thereafter for individuals who may benefit, not limited to insulin users or those at high risk for hypoglycemia. This broader recommendation reflects growing evidence that CGM improves glycemic management and clinical outcomes across diverse patient populations.

Automated insulin delivery (AID): AID systems and continuous subcutaneous insulin infusion (CSII) recieved the same emphasis, with new guidance eliminating prior requirements for initiation in individuals with type 1 diabetes (T1D), such as minimum C-peptide levels, the presence of islet autoantibodies, or duration of insulin therapy, all changes meant to expand access to technology and support individualized diabetes care.

School and workplace. Also added is guidance on facilitating use of CGM and insulin delivery systems in educational and workplace settings, allowing children, adolescents, and adults sufficient time to monitor and manage their glucose levels safely.

Updates in Pharmacologic Management and Obesity Treatment

Updates to guidance on glucose lowering therapy cross clinical contexts. The 2026 guidelines place signficant emphasis on selecting glucose-lowering therapies with cardiometabolic benefits, ie for cardiovascular, heart failure, and kidney health, irrespective of HbA1c. For individuals with chronic kidney disease, a recommendation was added that provides guidance on initiation or continuation of GLP-1-based therapy in individuals on dialysis to reduce cardiovascular risk. Symptomatic heart failure and metabolic dysfunction–associated steatohepatitis (MASH) are also specifically addressed, with recommendations supporting GLP-1 or dual GIP/GLP-1 receptor agonists when evidence shows benefit.

For obesity pharmacotherapy, recommendations emphasize individualized dosing and titration to optimize efficacy, minimize adverse effects, and enhance medication adherence. For people with T1D and obesity, GLP-1 receptor agonists and metabolic surgery are now recommended adjunctive therapies alongside insulin.

Nutrition, Lifestyle, and Obesity Prevention

The updated Standards reinforce the role of nutrition and lifestyle interventions in diabetes prevention and management. Evidence-based eating patterns, including Mediterranean-style and low-carbohydrate diets, are recommended for preventing type 2 diabetes (T2D). Guidance also emphasizes monitoring for adequate nutritional intake and integrating physical activity as part of obesity treatment and weight management strategies. Clinically significant weight loss of 5–7% of initial body weight is encouraged for individuals at high risk for T2D.

Specialized Contexts: Cancer, Transplantation, and Hospital Care

The 2026 guidelines introduce comprehensive recommendations for glycemic management during cancer treatment, including hyperglycemia induced by mTOR inhibitors, PI3K inhibitors, immune checkpoint inhibitors, and glucocorticoids. Metformin is recommended as first-line therapy for drug-induced hyperglycemia, with insulin reserved for severe or crisis-level hyperglycemia. Dose adjustments for existing glucose-lowering therapy are advised for individuals with preexisting diabetes.

Similarly, guidance for organ transplantation emphasizes insulin for postoperative management and individualized noninsulin therapy for long-term care, including consideration of GLP-1 receptor agonists for cardiometabolic benefit. Hospital and perioperative care recommendations now include target glucose ranges (100–180 mg/dL) and HbA1c or time-in-range goals (<8% or >50%) prior to elective surgery.

Updates for Older Adults, Children, and Pregnancy

Older adults. For older adults, CGM is recommended to reduce hypoglycemia and treatment burden, with individualized blood pressure goals (less than 130/80 mm Hg for most, less than 140/90 mmHg for frail patients), protein intake guidance (0.8 g/kg/day or more), and assessment for geriatric syndromes and functional impairment.

Children. The guidance on management of both T1D and T2D in children and adolescents now recommends nutrition education, psychosocial screening (distress, anxiety, fear of hypoglycemia, disordered eating), and pediatric pharmacotherapy updates for GLP-1 receptor agonists, SGLT2 inhibitors, and dual GIP/GLP-1 therapy.

Pregnancy. Pregnancy and preconception counseling guidance highlights the discontinuation of noninsulin glucose-lowering therapies, such as GLP-1 receptor agonists and dual GIP/GLP-1 therapy, before attempting conception, as well as updated antihypertensive thresholds.

Behavioral Health and Comorbidity Management

The 2026 Standards emphasize the importance of behavioral health screening, including annual assessments for anxiety and fear of hypoglycemia, and referral pathways for identified concerns. Emerging technologies in foot care, such as smart mats and insoles for early ulcer detection, and adjunctive therapies for diabetic foot ulcers, are now highlighted.

Algorithms and Evidence-Based Guidance

Included in the 2026 Standards of Care are updated clinical algorithms covering insulin therapy in T1D, management of symptomatic heart failure, CKD treatment, and atherosclerotic cardiovascular disease prevention in T2D. These updates reflect a focus on pragmatic, evidence-based approaches designed for real-world clinical implementation.

The full Standards of Care supplement is available in the January 2026 issue of Diabetes Care and online at ADA’s DiabetesPro professional portal. Additional resources, including an interactive app, slide decks, webcasts for CE credit, and a quick-reference pocket chart, provide healthcare professionals with tools for practical application in clinical settings.