ADA Standards of Care in Diabetes 2026: Quick Reference
The bottom line of the American Diabetes Association's Standards of Care in Diabetes 2026: continuous glucose monitoring from diagnosis for people on insulin, automated insulin delivery as the preferred option in type 1 diabetes, and organ-protective drug choices for heart failure, fatty liver disease and chronic kidney disease.
A living guideline: the ADA can update sections during the year.
At a glance
- Offer continuous glucose monitoring from diagnosis to people on insulin or on other drugs that can cause hypoglycemia.
- Automated insulin delivery is the preferred insulin delivery option in type 1 diabetes, with no C-peptide or antibody test needed first.
- In type 2 diabetes with symptomatic heart failure with preserved ejection fraction, use a GIP/GLP-1 or GLP-1 receptor agonist with proven heart failure benefit.
- For CKD with type 2 diabetes and albuminuria, an SGLT2 inhibitor and a nonsteroidal MRA can be started together.
- Most adults: A1C under 7% and blood pressure under 130/80, with a systolic pressure under 120 encouraged at high cardiovascular or kidney risk.
Key recommendations
Screening and diagnosis
With one or more islet autoantibodies, check promptly for stage 3 (clinical) type 1 diabetes; refer people with several autoantibodies to a specialized center.
2.8a, 2.8bScreen people taking glucocorticoids, immune checkpoint inhibitors, PI3K-alpha inhibitors or mTOR inhibitors for new hyperglycemia.
2.18-2.22
Glycemic targets
Set individual A1C and CGM goals by age, health and function; for many nonpregnant adults the goal is an A1C under 7% and more than 70% of time in range.
Section 6
Technology
Recommend CGM at diagnosis and afterwards for people on insulin, on non-insulin drugs that can cause hypoglycemia, or whenever it helps management.
7.15Offer automated insulin delivery as the preferred option in type 1 diabetes, and consider it in type 2 diabetes on insulin that is not at goal.
7.25a, 7.25b, 9.27Do not require C-peptide, autoantibody results or a minimum duration of insulin use before starting a pump or automated insulin delivery.
7.8a
Medications
In type 2 diabetes with symptomatic HFpEF, use a dual GIP/GLP-1 receptor agonist or a GLP-1 receptor agonist with demonstrated heart failure benefit.
9.9a, 9.9bIn type 2 diabetes with MASLD or MASH, or a high risk of liver fibrosis, prefer a GLP-1-based therapy with demonstrated benefit in MASH.
9.12, 9.13aDo not add a fibrate, niacin or omega-3 supplements to a statin to lower cardiovascular risk further.
10.32
Kidney
Use an SGLT2 inhibitor in non-dialysis chronic kidney disease, and an ACE inhibitor or ARB for severely increased albuminuria or an eGFR under 60.
11.11a, 10.10In type 2 diabetes with UACR of 100 mg/g or more and eGFR 30 to 90 on a RAS blocker, an SGLT2 inhibitor and a nonsteroidal MRA can be started at the same time.
11.9
Cardiovascular
Aim for blood pressure under 130/80, and encourage a systolic pressure under 120 in people at high cardiovascular or kidney risk.
10.4
Weight
Target at least 5% to 7% weight loss; obesity medicines and metabolic surgery are options, including GLP-1-based therapy in type 1 diabetes.
5.12, 8.5, 8.29
Older adults
Use CGM in older adults on insulin; aim for blood pressure under 130/80 when safe, and at least 0.8 g/kg of protein a day to protect muscle.
13.5, 13.9, 13.11a
Hospital and surgery
Before elective surgery aim for an A1C under 8% (or a 14-day GMI under 8% or time in range over 50%), and keep perioperative glucose between 100 and 180 mg/dL.
16.14, 16.15
Pregnancy
Stop GLP-1 and GIP/GLP-1 receptor agonists before conception, and start or adjust antihypertensives in pregnancy at 140/90.
Section 15
How to read the grades ADA
A: clear evidence from well-conducted, generalizable randomized trials. B: supporting evidence from well-conducted cohort or case-control studies. C: supporting evidence from poorly controlled or uncontrolled studies, or conflicting evidence. E: expert consensus or clinical experience.
What changed
Compared with the Standards of Care in Diabetes 2025.
CGM
- Before
- CGM recommended for many people on insulin.
- Now
- CGM from diagnosis onward for anyone on insulin or other hypoglycemia-causing drugs, or whenever it helps.
Automated insulin delivery
- Before
- Recommended for type 1 diabetes, with access often tied to C-peptide or antibody results.
- Now
- The preferred option in type 1 diabetes, considered in type 2 on insulin, with no lab prerequisites.
Heart failure
- Before
- SGLT2 inhibitors for heart failure.
- Now
- Also a GIP/GLP-1 or GLP-1 receptor agonist with heart failure benefit for symptomatic HFpEF.
Liver
- Before
- GLP-1 receptor agonists and pioglitazone discussed for MASLD.
- Now
- GLP-1-based therapy with demonstrated MASH benefit preferred.
Kidney
- Before
- SGLT2 inhibitor first, nonsteroidal MRA added for residual albuminuria.
- Now
- Both can be started together in type 2 diabetes with UACR of 100 mg/g or more.
Surgery
- Before
- Perioperative targets less specific.
- Now
- A1C under 8% before elective surgery and glucose 100 to 180 mg/dL around it.
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Questions clinicians ask
When does the ADA publish the next Standards of Care?
The ADA publishes a new edition each year as a supplement to Diabetes Care, usually in mid-December, and can update sections during the year.
Who should use a continuous glucose monitor under the 2026 Standards?
Anyone with diabetes on insulin, people on non-insulin drugs that can cause hypoglycemia, and others when it helps management, starting at diagnosis.
Do patients need a C-peptide test before getting a pump or automated insulin delivery?
No. The 2026 Standards say C-peptide, autoantibody results and insulin duration should not be required before starting a pump or automated insulin delivery.
Sources
- American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes - 2026. Diabetes Care. 2026;49(Suppl 1):S6-S12. doi.org/10.2337/dc26-SREV
- American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes - 2026. Diabetes Care. 2026;49(Suppl 1). diabetesjournals.org/care/issue/49/Supplement_1
Summarized in our own words by 2 Minute Medicine's physician editors from the source documents listed here. Strength and evidence grades are the guideline authors' own. This is a quick reference, not a substitute for the full guideline or for clinical judgment.
For health care professionals. 2 Minute Medicine is independent and is not affiliated with or endorsed by the societies that write these guidelines.
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