ADA's Standards of Care for 2026 released
New recommendations from the American Diabetes Association (ADA) do away with treatment prerequisites for automated insulin delivery and provide guidance on using obesity medications in people with diabetes, among other topics.
The American Diabetes Association has released its updated Standards of Care in Diabetes for 2026.
The standards, published Dec. 8, no longer recommend treatment prerequisites before starting continuous subcutaneous insulin infusion or automated insulin delivery and include new guidance on individualizing doses of obesity medications in people with diabetes, among other topics.
Use of continuous glucose monitoring (CGM) is now recommended at diabetes onset and any time thereafter for patients with diabetes who are on insulin therapy, on noninsulin therapies that can cause hypoglycemia, and on any diabetes treatment where CGM helps in management. They also now recommend glucagon-like peptide-1 receptor agonists and/or metabolic surgery as treatment options for obesity in people with type 1 diabetes.
Regarding nutrition, the standards offer guidance on eating patterns that have been shown to help prevent type 2 diabetes, including Mediterranean-style and low-carbohydrate diets, and emphasize that patients intentionally trying to lose weight should be monitored for adequate nutritional intake. The standards also include expanded discussion about the importance of physical activity during obesity treatment and encourage increased physical activity generally with the goal of all patients meeting activity guidelines.
In addition, the standards provide new guidance for managing glucose levels in patients undergoing treatment for cancer or those receiving organ transplants. They note that those at high risk for cardiovascular or renal disease should aim for a systolic blood pressure below 120 mm Hg. For older adults, an on-treatment blood pressure goal below 130/80 mm Hg is recommended when it can be achieved safely and a more relaxed goal (e.g., <140/90 mm Hg) is recommended for those with poor health, limited life expectancy, or high risk for adverse effects of antihypertensive therapy.
The standards also include changes to guidance on behavioral health screening and referral for diabetes distress and anxiety treatment; new and updated algorithms on insulin therapy in type 1 diabetes, prevention and treatment of symptomatic heart failure, treatment of chronic kidney disease, and prevention of atherosclerotic cardiovascular disease in type 2 diabetes; and new recommendations on inpatient care, including glycemic goals in the perioperative period.
The full Standards of Care were published as a supplement to Diabetes Care and include a summary of revisions. They are also available in a Standards of Care app. An abridged version for primary care professionals will be released in spring 2026, according to an ADA press release.