ADA 2026 Standards of Care Target Implementation, Policy document
ADA updates its guidelines every year, which “means we are very current with the evidence base,” Raveendhara Bannuru, MD, PhD, ADA vice president of medical affairs and lead author of the guidelines, told Medscape Medical News.
“We are also pragmatic,” he added. “We don’t try to come up with recommendations that cannot be easily implemented in the clinic.”
In addition to trying to improve and streamline care for individuals with diabetes, some of the guidelines are “aimed at working with policy people” to help change policy and increase coverage, said Bannuru.
The summary of revisions for 2026 spans seven pages. These are among the highlights:
1. Wider CGM use. ADA now recommends CGM use at diabetes onset and anytime thereafter to improve outcomes for anyone who could benefit from it and not just those using insulin or who are at a risk for hypoglycemia.
“We’re not saying everybody should be put on CGM, but technology has come a very long way, and now the evidence base is more robust to advocate for greater access. The evidence has shown that CGM can improve glycemic management, not just in individuals on insulin therapy,” said Bannuru.
“We were making a kind of soft recommendation, but we wanted to open the doors for policy makers to please think about covering these for whoever is eligible,” he explained.
2. Glycemic management during cancer treatment. Entirely new guidance has been added for managing people with diabetes who initiate cancer treatment or those who develop hyperglycemia from such treatments, including mTOR inhibitors, PI3K inhibitors, and glucocorticoids. Recommendations address glucose monitoring of people initiating these drugs, along with the use of metformin as first-line treatment for cancer drug-induced hyperglycemia, and consideration of insulin therapy for more severe hyperglycemia. For people with preexisting diabetes, the guidance addresses dose adjustment of all glucose-lowering therapies as needed.
“There’s a lot of emerging evidence about hyperglycemia due to chemotherapy. We’re getting consults from our oncology and primary care colleagues saying things like they have a patient who didn’t have diabetes before, but suddenly now their glucose level is 250 [mg/dL],” Bannuru told Medscape Medical News.
“In some cases, these newer cancer therapies are altering immune pathways and showing up as type 1 diabetes,” he said. “We thought it was important to provide some guidance.”
3.
Obesity management. Several new recommendations fall under this heading, both for diabetes prevention and treatment. These include the addition of an adiposity measure in addition to BMI for screening, the need to individualize dosing and dose titration of obesity medications, and inclusion of GLP-1 agonists or metabolic surgery as options for people with T1D and obesity.
There are “a lot of issues with tolerability and adverse events” with anti-obesity medications, so dosing “has to be a gradual, stepwise titration,” said Bannuru. “Some individuals might benefit from a slower rate than recommended by the manufacturer, and some may not need the full maximum approved dose. We want to optimize medication-taking behavior.”
4. And for T1D, he noted, the hope is that the GLP-1 drug labels will remove the current contraindication for diabetes treatment in this population. Until then, the obesity formulations, that is, Wegovy and Zepbound, can be prescribed as adjuncts to insulin for those with obesity.
5. Removal of pump prerequisites. A new recommendation calls for removal of requirements for C-peptide levels, presence of islet autoantibodies, or duration of insulin treatment before initiation of pump or automated insulin delivery therapy. Medicare and some other plans still impose such requirements.
“These things are not associated with responsiveness to these technologies. We’re trying to advocate for more access,” Bannuru commented.
Other 2026 updates include new 6. recommendations for the use of nutrition — including the Mediterranean and low-carbohydrate eating patterns — to prevent T2D and additional guidance on the use of glucose-lowering drugs for indications beyond obesity and diabetes, such as those affecting the heart, kidney, and liver.
7. For older adults, new recommendations address CGM use, blood pressure targets, physical activity, protein intake, and treatment modification.
8. New perioperative guidance advises an A1c goal of < 8% or time in range > 50% prior to elective surgery and a glucose target of 100-180 mg/dL during surgery.
9. The 2026 Standards have picked up two new endorsements from other professional organizations. The American Society for Bone and Mineral Research approved the section on bone health, and the International Society for Pediatric and Adolescent Diabetes approved ADA’s guidance on children and adolescence. Endorsement of relevant sections from previous years continues from the American College of Cardiology, The Obesity Society, the American Geriatrics Society, and the National Kidney Foundation.
Bannuru reported being employed by the ADA. He reported having no further disclosures.
From www.medscape.com
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