Guideline Video

Guideline Resources

  • Title: Diabetes Standards of Care 2026
  • Society: American Diabetes Association
  • Publish Date: December 8, 2025
  • Summary
  • Full-text

Video Transcription

Today we’ll be going over the American Diabetes Association’s newest guideline on Diabetes Standards of Care 2026.

The American Diabetes Association, also known as the ADA “Standards of Care in Diabetes,” referred to here as the Standards of Care, serves as a comprehensive resource to clinicians, researchers, policymakers, and other stakeholders. It outlines key elements of diabetes care, sets treatment goals, and provides tools to assess care quality, all directed at improving diabetes care and outcomes across diverse populations.

In today’s rapid update video, we’ll just be going over the key changes and recommendations that were added to this 2026 update. For the full summary of revisions or for the full guideline, make sure to check it out on guidelinecentral.com

 Let’s get started. 

For the section on Diagnosis and Classification of Diabetes

  • Recommendation 2.9 was added to highlight that people with a confirmed single IA-2 autoantibody should be monitored similarly to people with stage 2 type 1 diabetes but negative for IA-2 autoantibodies, as they have a comparable risk of progression to stage 3. 
  • Recommendation 2.18 was added to reinforce monitoring of postprandial or random plasma glucose in the setting of recurrent or long-term treatment with glucocorticoids. Recommendation 2.19 was added to underscore the role of counseling and education regarding the risk of hyperglycemia in people initiating treatment with immune checkpoint inhibitors, PI3Kα inhibitors, and other anticancer therapy medications. 
  • Recommendation 2.20 was added to provide guidance regarding plasma glucose monitoring at each visit in people treated with immune checkpoint inhibitors. Recommendation 2.21 was added to emphasize close monitoring of plasma glucose in people initiating treatment with PI3Kα inhibitors, which are associated with a particularly high risk of hyperglycemia during the first weeks of treatment. 
  • Recommendation 2.22 was added to prompt fasting or random plasma glucose monitoring at each visit in people treated with mammalian target of rapamycin inhibitors

Moving on to the section on  Prevention or Delay of Diabetes and Associated Comorbidities

  • Recommendation 3.8 was added to recommend considering using metformin to prevent hyperglycemia in high-risk individuals treated with a PI3Kα inhibitor.
  • Recommendation 3.9 was added to recommend considering using metformin to prevent hyperglycemia in high-risk individuals treated with high-dose glucocorticoids.

For Comprehensive Medical Evaluation and Assessment of Comorbidities

Recommendation 4.13b was added to state that treatment may be considered in adults with diabetes with a T-score between −2.0 and −2.5 in the presence of additional fracture risk. 

Then on the section on Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises

  • Recommendation 6.17 was added to promote inclusion of oral glucose in first aid kits for use in treating hypoglycemia in workplaces, schools, and other institutions and public settings.

For Diabetes Technology

  • Recommendation 7.7 was added and discusses older students 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.

For Obesity and Weight Management for the Prevention and Treatment of Diabetes

  • Recommendation 8.20 was added to state that the individualized dose and dose titration for obesity pharmacotherapy should balance efficacy, benefits, and tolerability.
  • Recommendation 8.29 was added to include GLP-1 RA–based therapy and/or metabolic surgery as treatment options for obesity in people with type 1 diabetes.

On to the section Pharmacologic Approaches to Glycemic Treatment

  • Recommendation 9.9a was added to recommend use of a dual glucose-dependent insulinotropic polypeptide and GLP-1 RA with demonstrated benefits for heart failure–related symptoms and reduction in heart failure events
  • Recommendation 9.33 was added to recommend the assessment of these individuals for the need of insulin therapy to prevent potential diabetic ketoacidosis and to use additional testing to determine if hyperglycemia is related to immunotherapy-associated diabetes.
  • Recommendations 9.34 and 9.35a state that metformin should be considered as first-line treatment, and Recommendation 9.35b states that insulin should be reserved for severe hyperglycemia and hyperglycemic crises due to its potential impact on PI3K inhibitor efficacy
  • Recommendation 9.36 was added to recommend adjustment or initiation of additional glucose-lowering therapies to maintain individualized glycemic goals based on the glucocorticoid treatment plan and ongoing assessment of glucose levels.
  • Recommendation 9.37 was added to recommend that insulin is preferred and that a dipeptidyl peptidase 4 inhibitor can be considered for mild hyperglycemia. 
  • Recommendation 9.38a states that noninsulin pharmacotherapy can be used and that the selection of medication may be contingent upon the transplanted organ(s), Recommendation 9.38b states that a GLP-1 RA can be considered due to additional cardiometabolic benefits. Recommendation 9.38c was added to recommend the addition of insulin to noninsulin pharmacotherapy if individualized long-term glycemic goals cannot be achieved or maintained.

For Cardiovascular Disease and Risk Management

  • Recommendation 10.44h was added to recommend a nonsteroidal MRA with proven benefit in reducing worsening heart failure events for people with diabetes and symptomatic stage C heart failure with ejection fraction >40%.

For 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 individuals 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 to address SGLT2 inhibitor use in individuals who are not on dialysis to reduce the risk of CKD progression and for cardiovascular benefits. Recommendation 11.11b was added to provide guidance on initiation or continuation of GLP-1–based therapy in individuals on dialysis to reduce cardiovascular risk. 

And last the section on Diabetes Care in the Hospital

  • Recommendation 16.14 suggests an A1C goal <8% within 3 months of elective surgery. Alternatively, a 14-day glucose management indicator goal <8% or time in range >50% can also be used. 
  • Recommendation 16.15 was added to advise a blood glucose range 100–180 mg/dL during the perioperative period.

And there you have it. Make sure to check out the full guideline and other clinical tools from the  American Diabetes Association at guidelinecentral.com.

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