Guidance on Type 1 Diabetes Management in Adults Updated
https://diabetesjournals.org/care/article/doi/10.2337/dci26-0122/172498/The-Management-of-Type-1-Diabetes-in-Adults-The
Consensus Report
The Management of Type 1 Diabetes in Adults. The Updated 2026 Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Free
https://doi.org/10.2337/dci26-0122
This 2026 consensus report from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) builds on the 2021 consensus report to provide guidance for managing type 1 diabetes in adults.
Reflecting
• the rapid advances in the field, this update places particular emphasis
• on the integration of new technologies, while all sections have been revised to incorporate n
• ew evidence, advances in clinical practice, and novel therapies, including interventions to delay the onset of stage 3 type 1 diabetes.
• It also broadens its scope to screening for long-term diabetes complications, and
• the management of obesity and cardiovascular risk factors.
• Psychosocial care and
• diabetes self-management education and support (DSMES) remain key elements.
A new 2026 updated consensus report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) addresses diagnosis and management of type 1 diabetes (T1D) in adults, with a major focus on differentiating T1D from other types of diabetes, including type 2 diabetes (T2D), in adults with new-onset diabetes.
“The biggest change is on how to diagnose new-onset type 1 diabetes in adults. It isn’t always straightforward, so we attempted to provide clearer guidance,” writing panel Co-Chair Anne L. Peters, MD, professor of clinical medicine in the Department of Endocrinology/Internal Medicine, University of Southern California, Los Angeles, told Medscape Medical News.
The report was published both in the ADA’s journal Diabetes Care and in the EASD’s Diabetologia. It updates the first such guidance, which was published online in 2021.
Asked to comment on the new statement, Nicholas B. Argento, MD, director of diabetes technology at Maryland Endocrine and Diabetes in Columbia, told Medscape Medical News, “I applaud this effort to update the adult T1D guidelines. It is thorough, well balanced, and will be a great read for anyone who sees those with T1D.”
Article Key Points
• Adult-onset T1D often misdiagnosed as T2D; consider <35 y, BMI <25, wt loss, DKA, glucose >360.
• No single clinical feature confirms T1D; ~40% misdiagnosed after age 30.
• Suspected T1D: test islet autoantibodies; ≥2 or strongly + = T1D diagnosis.
• If IAbs negative/low-titer single +, use C-peptide; <0.6 ng/mL supports T1D.
• New sections add microvascular screening, CV risk mgmt, obesity, psychosocial care, exercise, nutrition.
Dive Deeper
• Which biomarkers best distinguish adult T1D from T2D?
• How accurate is C-peptide for adult diabetes classification?
• What predicts adult-onset T1D misdiagnosis as T2D?
• New-Onset T1D in Adults Often Misdiagnosed
The document advises considering adult-onset T1D among individuals with new-onset diabetes who are younger than 35 years, who have a BMI < 25 or unintentional weight loss, who have ketoacidosis or glucose > 360 mg/dL on presentation, who have rapid (within 3 years) progression to insulin therapy, or who have any uncertainty about diabetes type.
However, the document also points out that misdiagnosis of T1D as T2D in adults occurs in about 40% of those diagnosed after age 30 and that this error is more likely in those with overweight or obesity. “No single clinical feature confirms type 1 diabetes in isolation,” the authors cautioned.
Argento commented, “It is critical for providers to realize that 30%-40% of those with T1D present after age 30…presentation is often not classic, and many presenting with T1D as adults have obesity, so we should not restrict consideration only to those who have lower BMI. Seventy percent of adults are overweight or obese, so an adult T1D is more likely to be overweight than underweight.”
An algorithm in the report advises that adults suspected to have T1D be tested for islet autoantibodies (IAbs). If there are two or more, or if one is strongly positive, T1D is the diagnosis. If negative for IAbs or if just a single low-titer IAb is present, C-peptide testing should be considered. If < 0.6 ng/mL, T1D is the diagnosis. If the C-peptide level is > 0.6 ng/mL, further guidance is provided for distinguishing monogenic diabetes from T2D or other types.
“We talk more about C-peptide testing in the new guidelines than we did before,” said Peters. “I look at it clinically — is this person making insulin or not? All people with type 1 diabetes and insulin-deficient people with type 2 diabetes could benefit from automated insulin delivery systems and also from SGLT2 inhibitors or GLP-1-based therapies.”
Argento said the graphic flow sheet was “well put together,” adding, “when measuring islet autoantibodies, one has to be cautious if they are low-grade positive because the person may still have T2D. But [the authors] cover this very nicely in the full text. The IAb tests are highly sensitive if definitely positive.”
Regarding C-peptide testing, Argento pointed out that “it can lead to misinterpretation if checked early in the course [of the disease], where it can still be normal or low normal, but not likely after 3 years. It can be elevated in severe renal disease, so needs to be used with caution in that group.”
Avoid Using the Term ‘LADA’
The guidance discourages the use of the term “latent autoimmune diabetes in adults” (LADA), which often refers to slower-onset T1D in adults. “LADA is a controversial concept with no universally accepted diagnostic criteria and considerable heterogeneity in clinical presentation and progression,” the authors wrote in the paper.
Peters told Medscape Medical News, “It is not a specific subtype. It is type 1 by definition because it’s autoimmune.”
Argento agreed, noting that “use of that term contributes to confusion rather than clarity.”
Complications Screening and Management, Psychosocial Issues
Also new in this 2026 guidance are three new sections about screening for microvascular complications, cardiovascular risk management, and management of obesity. This isn’t new guidance, but those topics weren’t included in the 2021 version because the advice didn’t differ from that of other diabetes management guidelines. However, people requested that these topics be included in the adult T1D management update, Peters said.
On the other hand, this document doesn’t cover the specifics of insulin dosing because that was covered in the 2021 version and hasn’t changed, she added.
In the 2026 update, several other sections were modified on the basis of newer information, including psychosocial care, diabetes self-management education, exercise, and nutrition.
Argento said he thought it “was a good idea to add the need for screening for micro- and macrovascular complications.”
In addition, “adding information on cardiovascular risk management was great because this is the leading cause of death in those with T1D, which is often not appreciated,” he said. “I also applaud the addition of managing obesity in T1D.”
Peters reported serving as a director, officer, partner, employee, advisor, consultant, or trustee for Vertex and receiving research grants from Insulet Corporation, Abbott Diabetes Care, and Zucara Therapeutics Inc. Argento declared serving on advisory boards for Convatec and Eli Lilly and Company and on the speakers bureaus for Dexcom, Tandem, Eli Lilly and Company, Novo Nordisk, and Boehringer Ingelheim.
Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social
Type 1 diabetes is an autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels.
Type 1 diabetes may sometimes be referred to as juvenile diabetes, however, this term is generally regarded as outdated as, whilst it is commonly diagnosed in children, the condition can develop at any age.
Insulin dependent diabetes is another term that may sometimes be used to describe type 1 diabetes.
Because type 1 diabetes causes the loss of insulin production, it therefore requires regular insulin administration either by injection or by insulin pump.
Type 1 diabetes symptoms
Type 1 diabetes symptoms should be acted upon immediately, as without treatment this type of diabetes can be deadly.
Symptoms include:
• Above average thirst
• Tiredness during the day
• Needing to pee regularly
• Unexplained weight loss
• Genital itchiness
Type 1 diabetes tends to develop more slowly in adults than it does in children and in some cases type 1 diabetes in adults may be misdiagnosed as type 2 diabetes.
Type 1 diabetes in adults over 35 years old will sometimes be referred to as Latent Autoimmune Diabetes of Adulthood (LADA).
• See more information on recognising the signs of type 1 diabetes
Type 1 causes
Type 1 diabetes is caused by a fault in the body’s immune response in which the immune system mistakenly targets and kills beta cells, the cells in the pancreas responsible for producing insulin.
As more insulin producing cells in the pancreas are killed off, the body can no longer control its blood glucose levels and the symptoms of diabetes begin to appear.
What causes the initial fault in the immune system is yet to be discovered, however, research suggests that the condition results from a combination of genetic predisposition with an environmental trigger.
What triggers the immune system to behave this way is yet to be conclusively identified. To date, the strongest evidence points towards a virus as being the most likely trigger.
• Read more about the causes of type 1 diabetes
Diagnosis
If you show signs of having diabetes, your doctor may use blood or urine tests to diagnose diabetes. Your doctor should consider which type of diabetes you have as this can affect how your diabetes is treated. If the type of diabetes is unclear, your doctor may decide to carry out one or more of the following tests:
• Ketone test
• GAD autoantibodies test
• C-pepide test
Because type 1 diabetes can develop quickly within children and young adults, a diagnosis of type 1 diabetes should be followed by same day referral to a multidisciplinary paediatric diabetes care team.
Treatment for type 1 diabetes
The impairment of the pancreas’ ability to produce insulin in type 1 diabetes means that insulin treatment is necessary.
Most people will take insulin by injection with insulin pens. Insulin can also be delivered by wearing an insulin pump. Use of an insulin pump will be considered in people that express an interest in having one and that meet certain eligibility criteria.
It is important that you are given education on how to balance insulin doses with dietary intake and physical activity and how to use blood glucose testing to help you control your diabetes.
Staying physically active and exercising regularly and eating a healthy diet are also important towards maintaining good blood glucose control and minimising the risk of long term diabetes complications. Although diet and exercise have a role to play in type 1 diabetes management, they cannot reverse the disease or eliminate the need for insulin.
• How to test your blood glucose
• How to treat a hypo
• How to inject insulin
• If you have recently been diagnosed, see our newly diagnosed with type 1 diabetes guide.
Type 1 diabetes and complications
Type 1 diabetes is a serious condition which can carry a significant risk of both short term and long term complications.
Short term complications
Short term complications can occur if blood glucose levels go too low or if insulin injections are missed. The short term complications that can occur are:
• Hypoglycemia – too low blood sugar levels
• Ketoacidosis – which can occur if insulin doses are missed or blood glucose levels become too high
Long term complications
Type 1 diabetes can lead to the development of the following long term diabetes complications:
• Heart disease
• Stroke
• Retinopathy
• Kidney disease
• Neuropathy
Whilst the list of complications is a scary prospect, the chances of developing these can be significantly reduced by maintaining good control of your blood glucose levels and ensuring you attend all your diabetic complication screening appointments.
Prevention
In the future, research may find a way to halt the development of type 1 diabetes but, to date, no intervention has successfully prevented type 1 diabetes in humans.
Type 1 diabetes research
Researchers from around the globe are looking for ways to improve type 1 diabetes treatment and to investigate possible cures. Important research areas include:
• Artificial pancreas
• Encapsulated islet cells
• Diabetes vaccines
Type 1 diabetes facts
The risk of developing type 1 diabetes can be affected by your genetics ; i.e. if your parents or siblings have type 1 diabetes.
• In terms of inheritance of type 1 diabetes – there is a 2% risk if the mother has type 1 diabetes, 8% risk if the father has type 1 diabetes; and a 30% risk of the child developing type 1 diabetes if both parents are type 1 [5]
• Within 20 years of diagnosis of type 1 diabetes, nearly all of those diagnosed have some degree of retinopathy [1]
There is also a sub-type of type 1 diabetes known as brittle diabetes.
Famous people with type 1 diabetes include:
• Young pop-rock sensation Nick Jonas
• Actress Sharon Stone
• From the UK, extreme snowboarder Chris Southwell
From www.diabetes.co.uk and www.medscape.com
Nyhetsinfo
Läs hela dokumentet open source free pdf
www red DiabetologNytt