Diabetes Guidelines 2026

 

Diabetes Guidelines 2026: What's New in Evidence-Based Care

The American Diabetes Association (ADA) has released its highly anticipated "Standards of Care in Diabetes—2026," marking another year of comprehensive updates to the gold standard in diabetes management. Published in January 2026, these guidelines reflect the latest scientific research and clinical evidence designed to improve outcomes for the millions of people living with diabetes and prediabetes worldwide.

Overview of the 2026 Standards of Care

The ADA's Standards of Care represents significant advancement in the delivery of evidence-based, person-centered care, synthesizing the latest scientific research with practical clinical strategies to equip healthcare professionals with tools necessary to provide optimal care for individuals living with diabetes. The guidelines include strategies for diagnosing and treating diabetes in children, adolescents, and adults, methods to prevent or delay diabetes and its associated comorbidities like obesity, and care recommendations to enhance health outcomes.

Key Resources Available

The 2026 Standards of Care are accessible through multiple channels to ensure clinicians and patients can access current information:

• Full guidelines published online and in Diabetes Care journal
• Convenient mobile apps for iOS and Android with interactive tables and algorithms
• Abridged version for primary care professionals (coming spring 2026)
• Comprehensive slide decks and webinars with continuing education credits
• Quick-reference pocket charts

Major Changes in 2026: A Technology-Forward Approach

Expanded Diabetes Technology Recommendations

One of the most significant changes in the 2026 guidelines is the emphasis on earlier access to advanced diabetes technologies.

Continuous Glucose Monitoring (CGM)

The 2026 updates include expanded recommendations for technology use, such as continuous glucose monitoring (CGM) and automated insulin delivery (AID). The updated guidelines now recommend CGM use at the onset of diabetes for those using insulin and for anyone at risk of hypoglycemia or who would benefit from CGM in supporting blood sugar management.

CGM is encouraged at diagnosis with earlier access, and over-the-counter CGMs are acknowledged as useful for people with prediabetes or type 2 diabetes wanting lifestyle feedback. Additionally, in people with diabetes on insulin therapy, CGM devices should be used as close to daily as possible for maximal benefit, with uninterrupted access to supplies to minimize gaps in CGM.

Automated Insulin Delivery (AID)

A major change in 2026 is the recommendation of AID systems as the preferred insulin delivery system for all people with type 1 diabetes and children and adults with type 2 diabetes who use insulin. Notably, the updated advice specifies that there should be no requirement of C-peptide level, presence of islet autoantibodies or duration of insulin treatment before initiation of insulin pumps or automated systems. This removes previous barriers to accessing these life-changing technologies.

The ADA Standards recognize open-source AID systems—such as AndroidAPS, Loop, iAPS, and Trio—as part of mainstream diabetes care, with an encouragement for clinicians to engage rather than avoid patient-driven technology.

Revolutionary GLP-1 Guidance for Type 1 Diabetes

For the first time, the 2026 Standards support GLP-1s and similar drugs for people with type 1 diabetes. This represents a paradigm shift in type 1 diabetes management. A major change in the 2026 edition is the new support of GLP-1 and similar drugs for use in adults with type 1 diabetes with a body mass index (BMI) greater than 30 (27.5 for Asian Americans).

For type 2 diabetes patients with comorbidities, the guidelines also suggest broader access for GLP-1-based medicines because of their benefits beyond glucose management and weight. Additionally, GLP-1 medications are now recommended as the initial therapy for adults with type 2 diabetes and liver fibrosis and MASLD (metabolic dysfunction-associated steatotic liver disease).

Updated Management Strategies for Comorbidities

Liver Disease (MASLD and MASH)

The 2026 guidelines place increased emphasis on managing metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). The guidelines now address liver disease, including MASH (metabolic dysfunction-associated steatohepatitis), an advanced form of liver disease marked by excess fat in the liver, which is common in type 2 diabetes and has implications for heart and kidney health.

Kidney Disease Management

The guidelines recommend that individuals with kidney disease may need testing more often, in consultation with their healthcare provider. The guidelines reaffirm blood pressure goals, recommending levels below 130/80 mmHg for most people with diabetes, and aiming for even lower systolic blood pressure when it can be done safely.

Weight Loss and Obesity Management

A more aggressive approach to weight management is now recommended. Lifestyle plans involving diet, physical activity, and other health behaviors should aim for a weight loss target of 5–7% of baseline body weight, demonstrating increased emphasis on obesity as a primary target for intervention.

Nutrition Guidelines: Moving Beyond High-Carbohydrate Diets

The 2026 Standards represent a significant shift in nutritional guidance. Rather than recommending small, frequent high-carbohydrate meals, the new guidelines propose a range of potential eating patterns that fall under the broader umbrella of low-carbohydrate/lower starch diets, including the Mediterranean, plant-based, and the Dietary Approaches to Stop Hypertension (DASH) diet as options that can support patients' overall health.

Mediterranean and low-carbohydrate diets are specified as having the best evidence for preventing or delaying onset of type 2 diabetes in high-risk individuals.

Physical Activity Recommendations

The guidelines maintain emphasis on regular physical activity for blood glucose management and overall health. For adults with diabetes, the recommendation is to engage in 150 minutes or more of moderate- to vigorous-intensity aerobic activity per week, spread over at least 3 days/week, with no more than 2 consecutive days without activity. Additionally, prolonged sitting should be interrupted at least every 30 minutes for blood glucose and other benefits.

Screening and Behavioral Health Support

The 2026 Standards place greater emphasis on mental health support and screening, recognizing the psychological burden of diabetes management. The guidelines include guidance on behavioral health screening and referral for concerns such as diabetes distress and anxiety, with recommendations for annual screening for anxiety and fear of hypoglycemia in those at risk.

Person-Centered Care and Team-Based Approach

A foundational principle throughout the 2026 Standards is person-centered care. The Standards of Care stress the importance of coordinated interprofessional teams, which include physicians, diabetes educators, dietitians, pharmacists, and mental health counselors, in guiding diabetes patient care.

The guidelines emphasize that care systems should facilitate in-person and virtual team-based care, include those knowledgeable and experienced in diabetes management as part of the team, and utilize patient registries, decision support tools, proactive care planning, and community involvement to meet needs of individuals with diabetes.

Implementation and Accessibility

Digital Tools and AI Support

To support clinicians in implementing these guidelines, the ADA partnered with the artificial intelligence initiative OpenEvidence to create a tool that will allow physicians to ask the Standards of Care specific questions and receive clinically backed answers, available free of charge for healthcare professionals registered with the ADA.

Living Guidelines Model

The 2026 Standards operate as "living guidelines," meaning they are continuously updated throughout the year as new evidence emerges. The online version, abridged guidelines, and all related materials will be updated in real time throughout the year to reflect the latest evidence and regulatory changes.

Global Endorsements and Professional Recognition

The 2026 Standards have received endorsements from numerous professional organizations, reflecting their comprehensive and evidence-based nature. For the eighth consecutive year, section 10 on "Cardiovascular Disease and Risk Management," received endorsement from the American College of Cardiology. For the second consecutive year, section 13 on "Older Adults" received endorsement from the American Geriatrics Society. For the first time, section 11 on "Chronic Kidney Disease and Risk Management" and section 14 on "Children and Adolescents" received endorsement from the National Kidney Foundation and the International Society for Pediatric and Adolescent Diabetes, respectively.

Implications for Healthcare Practice

The 2026 Standards represent a shift toward:

Earlier intervention: Technologies and therapies are now recommended at diagnosis rather than as last resorts.

Broader access: Removed prerequisites for advanced therapies ensure more patients can benefit from newer treatments.

Personalization: Guidelines emphasize individualized approaches based on patient values, preferences, and comorbidities.

Technology integration: Recognition that patient-driven innovations are part of mainstream care.

Holistic health: Greater attention to mental health, lifestyle, and comorbidity management alongside glucose control.

Conclusion

The 2026 "Standards of Care in Diabetes" represents significant advancement in the delivery of evidence-based, person-centered care, equipping healthcare professionals with the tools necessary to provide optimal care for individuals living with diabetes. With emphasis on technology adoption, broader GLP-1 use, personalized nutrition, and team-based care, these guidelines mark a significant evolution in diabetes management.

Healthcare providers and patients should familiarize themselves with these updated recommendations through the various resources available, from the full text to mobile apps and quick-reference guides. The goal remains consistent across all changes: to improve health outcomes and quality of life for the millions of people affected by diabetes.

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References

1. American Diabetes Association. "Standards of Care in Diabetes—2026." Diabetes Care, January 2026. https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2026

2. American Diabetes Association Professional Practice Committee for Diabetes. "Summary of Revisions: Standards of Care in Diabetes—2026." Diabetes Care, Vol. 49, Supplement 1, January 2026. https://diabetesjournals.org/care/article/49/Supplement_1/S6/163930/

3. Professional Diabetes Association. "Standards of Care in Diabetes - ADA Clinical Guidelines." https://professional.diabetes.org/standards-of-care

4. DiaTribe. "Your Guide to the 2026 ADA Standards of Care." December 2025. https://diatribe.org/diabetes-management/your-guide-2026-ada-standards-care

5. DiabetesOnTheNet. "Factsheet - 2026 ADA Standards." https://diabetesonthenet.com/diabetes-primary-care/factsheet-2026-ada-standards/

6. MedCentral. "The 2026 ADA Standards of Care in Diabetes Embrace Technology to Support Holistic Care." December 2025. https://www.medcentral.com/endocrinology/diabetes/the-2026-ada-standards-of-care-in-diabetes-embrace-technology-to-support-holistic-care

7. Guideline Central. "2026 ADA Diabetes Standards of Care Guideline — New Recommendations." December 2025. https://www.guidelinecentral.com/insights/dec-2025-ada-diabetesstandardsofcare-guideline-spotlight/

8. Diabetotech. "Key Updates: ADA 2026 Diabetes Technology Guidelines." https://www.diabetotech.com/blog/key-updates-ada-2026-diabetes-technology-guidelines

9. ACP Diabetes Monthly. "ADA's Standards of Care for 2026 released." December 2025. https://www.acpjournals.org/doi/10.7326/acpd-20251212_1

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Disclaimer: This blog post is for informational purposes only and should not be considered medical advice. Individuals should consult with their healthcare provider for personalized diabetes management recommendations.

Last Updated: January 2026