Today we are outlining the key elements from the American Association of Clinical Endocrinologists (AACE) consensus statement, Algorithm for Management of Adults With Type 2 Diabetes – 2026 Update. This update builds on evidence-based algorithms designed to support clinicians in the diagnosis and management of prediabetes and diabetes mellitus. 

The updated guidance highlights lifestyle interventions and the treatment of overweight/obesity as key elements in the management of prediabetes and type 2 diabetes. A new diabetes classification algorithm has been added, which is intended to encourage clinicians to consider alternative forms of diabetes and further guide individualized management.

The 2026 AACE guidance is divided into sections that outline the principles for: the management of adults with type 2 diabetes, management of prediabetes and prevention of progression to type 2 diabetes, diagnosis and classification of diabetes mellitus, treatment of cardiovascular risk factors, dyslipidemia and hypertension, comorbidities- and complication-centric and glucose-centric approaches for glycemic control with pharmacotherapy, insulin initiation and titration, benefits and risks of medications for type 2 diabetes and obesity, and an updated immunization guidance from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention. 

Today we’re showcasing the algorithms featured in this AACE consensus statement update. For the most thorough look, refer to the full-text version of the 2026 guidance.

Key Elements from the 2026 Consensus Statement

Management of Adults with Type 2 Diabetes

This algorithm states 10 principles for the management of adults with type 2 diabetes: 

  • Lifestyle modification is the foundation for all therapy.
  • Use a comprehensive approach for weight loss to achieve clinical goals. 
  • Choice of pharmacologic therapy is guided by glycemic targets and comorbidities.
  • Choice of therapy considers ease of use and access.
  • Individualize glycemic targets.
  • Optimal A1C is <6.5% or as close to normal as is safe and achievable.
  • Avoid therapeutic inertia and get to goal as soon as possible.
  • Avoid hypoglycemia. 
  • Continuous glucose monitoring (CGM) is highly recommended to reach glycemic goals in adults with diabetes.
  • Comorbidities and complications must be managed for comprehensive care. 

Prediabetes Algorithm

The prediabetes algorithm goes over the management of prediabetes, which focuses on lifestyle interventions, weight management, and prevention of progression to type 2 diabetes. It also addresses both pharmacologic and nonpharmacologic weight loss interventions.

Diabetes Classification Algorithm

This algorithm emphasizes accurate diagnostic classification of diabetes and reviews steps to confirm the etiology of diabetes mellitus. It can be applied at the time of new diagnosis or revisited later to ensure correct classification and guide management.

Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia

The atherosclerotic cardiovascular disease (ASCVD) risk reduction algorithm on dyslipidemia focuses on lipid management as a key component of reducing ASCVD risk in prediabetes and diabetes. 

Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension

The Atherosclerotic Cardiovascular Disease (ASCVD) risk reduction algorithm on hypertension highlights the importance of blood pressure control as the coexistence of hypertension and type 2 diabetes increases the risk of macrovascular and microvascular complications of diabetes, as well as the risk of cardiovascular events.  

Comorbidities- and Complications-Centric Glycemic Control Algorithm

This algorithm emphasizes a comorbidities- and complications-centric approach to glycemic control, addressing conditions such as heart failure, chronic kidney disease, atherosclerotic cardiovascular disease, stroke/transient ischemic attack, metabolic dysfunction-associated steatotic liver disease, and obstructive sleep apnea. 

Glucose-Centric Glycemic Control Algorithm

The glucose-centric glycemic control algorithm focuses on guiding initial and add-on therapy selection for adults with type 2 diabetes in the absence of the major comorbidities mentioned in algorithm six. 

Initiating and Titrating Insulin Algorithm

This algorithm focuses on initiation and titration of insulin to achieve glycemic control, emphasizing individualized targets and the use of continuous glucose monitoring to optimize glycemic control.  

Profiles of Pharmacotherapy for Type 2 Diabetes

The profiles of pharmacotherapy algorithm summarizes key pharmacologic options for the treatment of adults with type 2 diabetes. This includes medication-specific efficacy, benefits, and adverse effects. 

Profiles of Pharmacotherapy for Obesity

This algorithm provides an overview of FDA-approved weight loss medications, including information on percent of weight loss, A1C reduction when applicable, mechanisms of action, dosing, and titration. 

Vaccine recommendations for Adults with Type 2 Diabetes Mellitus

The vaccine recommendation algorithm focuses on reducing vaccine-preventable illnesses by improving vaccination rates in adults through routine assessment, vaccine recommendations, and coordination of care. 

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