2026 ADA Standards of Care in Diabetes Guideline Now Available — Key Recommendation Updates

Published: December 12, 2025

The American Diabetes Association (ADA) just released its Standards of Care in Diabetes 2026 guideline. The comprehensive guideline features hundreds of pages of recommendations, evidence-based summaries, figures, and tables on topics ranging from diabetes advocacy to foot care. The ADA publication serves as a key resource for clinicians, researchers, and others by outlining key elements of diabetes care, establishing treatment goals, and improving outcomes for the diverse array of patients affected by diabetes.

The following rundown is a selection of the many updated sections published in the 2026 Standards of Care in Diabetes, with a particular focus on new recommendations introduced in 2026. For a complete look at all the recommendations included in the 2026 update, view the full-text version.

Diagnosis and Classification of Diabetes

Recommendation 2.9 was added which highlights that patients with a confirmed single IA-2 autoantibody should be monitored similar to people with stage 2 type 1 diabetes but negative for IA-2 autoantibodies, due to comparable risk of progression to stage 3.
Recommendation 2.18 was added. It reinforces monitoring of postprandial or random plasma glucose in recurrent or long-term treatment with glucocorticoids.
Recommendation 2.19 was added and highlights the benefits of education and counseling regarding the risk of hyperglycemia in people starting treatment with certain medications.
Recommendation 2.20 was added and it provides guidance for monitoring plasma glucose among patients treated with immune checkpoint inhibitors, during each visit.
Recommendation 2.21 was added. This recommendation emphasizes the close monitoring of plasma glucose in patients beginning treatment with PI3Kα inhibitors.
Recommendation 2.22 was added and prompts fasting or random glucose monitoring at every visit for patients treated with mTOR inhibitors.

Prevention or Delay of Diabetes and Associated Comorbidities

Recommendation 3.8 was added. This recommendation recommends the use of metformin in preventing hyperglycemia in high-risk patients treated with a PI3Kα inhibitor.
Recommendation 3.9 was added. This recommendation recommends the use of metformin in preventing hyperglycemia in high-risk patients treated with high-dose glucocorticoids.

Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises

Recommendation 6.17 was added and promotes the inclusion of oral glucose in first-aid kits for treating hypoglycemia.

Diabetes Technology

Recommendation 7.7 was added and discusses older students (up to 18 years old) regarding receiving support in school and work regarding diabetes technology.
Recommendation 7.8a was added and states that there should be no requirement of C-peptide level, the presence of islet autoantibodies, or duration of insolent treatment before initiation of CSII or AID.

Obesity and Weight Management for the Prevention and Treatment of Diabetes

Recommendation 8.20 was added. This recommendation states that individualized dose and dose titration for obesity should balance tolerability, efficacy, and benefits.
Recommendation 8.29 was added and lists GLP-1 RA-based therapy and/or metabolic surgery as options for obesity treatment in people with type 1 diabetes.

Pharmacologic Approaches to Glycemic Treatment

Recommendation 9.9a was added and supports the use of dual GIP and GLP-1 RA with demonstrated benefits for heart-failure symptoms and reduction in heart failure events.
Recommendation 9.33 was added and recommends the assessment of patients on immunotherapy who develop hyperglycemia to prevent potential diabetic ketoacidosis and to determine if hyperglycemia is related to immunotherapy-associated diabetes.
Recommendations 9.34, 9.35a, and 9.35b were added. These recommendations state that metformin should be used for individuals with hyperglycemia due to mTOR inhibitors or PI3K inhibitors, and insulin should be reserved for severe hyperglycemia in hyperglycemic crises due to its potential impact on PI3K inhibitor efficacy.
Recommendation 9.36 was added and recommends adjusting or initiating additional glucose-lowering therapies to maintain glycemic goals based on regular assessment of levels.
Recommendation 9.37 was added. This recommendation states that insulin is preferred and a dipeptidyl peptidase 4 inhibitor can be considered for mild hyperglycemia in the postoperative setting.
Recommendations 9.38a, 9.38b, and 9.38c were added. These recommendations discuss organ transplant, cardiometabolic benefits, and the addition of insulin to noninsulin pharmacotherapy.

Cardiovascular Disease and Risk Management

Recommendation 10.44h was added and recommends an nsMRA with proven benefit in reducing worsening heart failure events for people with diabetes and symptomatic stage C heart failure with ejection fraction >40%.

Chronic Kidney Disease and Risk Management

Recommendation 11.9 was added. This recommendation states that simultaneous initiation of an SGLT2 inhibitors and nsMRA can be considered for indivioduals with type 2 diabetes and urine albumin-to-creatinine ratio ≥100 mg/g with eGFR 30–90 mL/1.73 m² on an RAS inhibitor.
Recommendation 11.11a was added and provides guidance on continuation or initiation of GLP-1-based therapy for patients on dialysis, to reduce cardiovascular risk.

Diabetes Care in the Hospital

Recommendation 16.4 was added. This recommendation suggests an A1C goal <8% within three months of elective surgery.
Recommendation 16.5 was added and recommends a blood glucose range of 100-180 mg/dL during perioperative period.