Type 2 Diabetes (T2D) is the most common form of diabetes. It is associated with defects in insulin resistance and secretion. Comorbid conditions often accompany T2D and should be taken into consideration when formulating a management strategy.
In today's side-by-side comparison, we compare the latest clinical practice guideline on T2D from the American Diabetes Association (ADA) and the Comorbidites- and Complications-Centric Glycemic Control Algorithm from the American Association of Clinical Endocrinology (AACE). We encourage you to use the links below for more information.
Guidelines for Comparison
| Item | Diagnosis and Classification of Diabetes: Standards of Care in Diabetes - 2026 | American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes – 2026 Update |
|---|---|---|
| Authoring Organization | American Diabetes Association | American Association of Clinical Endocrinology |
| Publication Date | December 2025 | March 2026 |
| Graded Recommendations | Yes, uses ADA evidence-grading system | No, based on clinical consensus |
| Links | Summary / Full Text | Summary / Full Text |
Key Takeaways
Guidance from both the ADA and AACE on the treatment of T2D puts emphasis on tailoring therapy choices based on individual patient factors including comorbid conditions. Treatment burden and outcomes are improved when therapy has a synergistic effect.
Both guidance documents make recommendations for the use of GLP-1RAs, SGLT2 inhibitors, GIP/GLP-1RAs, and Pioglitazone for patients with T2D based on high-risk comorbidities: ASCVD, heart failure, CKD, and liver disease. Some of the key similarities and differences in their recommendations are reviewed below.
ASCVD:
GLP-1RA or SGLT2 inhibitor:
- No preference from ADA
- GLP1-RAs preferred according to the AACE.
Heart Failure:
SGLT2 inhibitor:
- Recommended by both ADA and AACE for HFrEF
- ADA also recommends this for HFpEF
GLP-1RA and GIP/GLP-1RA:
- Both consider these options for patients with obesity-related HFpEF
Chronic Kidney Disease (CKD):
SGLT2 inhibitor:
- Recommended by both societies for patients with CKD.
GLP-1RA:
- ADA recommends GLP-1RA for CKD and prefers GLP-1RAs for patients with advanced CKD.
- The AACE did not address GLP-1RA use for patients with CKD.
SGLT2 inhibitor + finerenone:
- The AACE notes this combination as an emerging therapy that may benefit patients with CKD.
- This was not addressed by the ADA.
Liver Disease:
GLP-1RA:
- Both prefer GLP-1RAs for patients with comorbid MASLD, MASH, or at high risk for liver fibrosis.
GIP/GLP-1RA:
- Both consider GIP/GLP-1RAs an option.
Pioglitazone:
- Both consider prioglitazone an option.
Pioglitazone + GLP-1RA or SGLT2 inhibitor:
- AACE also considers prioglitazone + SGLT2 inhibitor an option. This combination was not addressed by the ADA.
- Both consider prioglitazone + GLP-1RAs an option.
Treatment Based on High-Risk Comorbidities
| Comorbidity: Atherosclerotic Cardiovascular Disease (ASCVD) or high risk for ASCVD | ADA | AACE |
|---|---|---|
| GLP-1RA | Glucagon-like peptide 1 receptor agonist (GLP-1RA) recommended (level A evidence) | GLP-1RA first-line |
| SGLT2 | Sodium-glucose cotransporter 2 (SGLT2) inhibitor recommended (level A evidence) | SGLT2 inhibitor is an alternative option |
| Comorbidity: Heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF) | ADA | AACE |
|---|---|---|
| SGLT2 | SGLT2 inhibitor (HFpEF or HFrEF) recommended (level A evidence) | SGLT2 inhibitor first-line for HFrEF |
| GIP/GLP-1RA | Include a glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RA for patient with HFpEF + obesity ( level A evidence) | GIP/GLP-1RA may benefit obesity-related HFpEF |
| GLP-1RA | Include a GLP-1RA for patients with symptomatic HFpEF + obesity (level A and B evidence) | GLP-1RA may benefit obesity-related HFpEF |
| Comorbidity: Chronic Kidney Disease (CKD) | ADA | AACE |
|---|---|---|
| SGLT2 | SGLT2 inhibitor or GLP-1RA recommended (level A evidence) | SGLT2 inhibitor recommended |
| SGLT2 + finerenone | Not Addressed | SGLT2 inhibitor + finerenone (nonsteroidal minerocorticoid receptor antagonist) considered (emerging evidence) |
| GLP-1RA | GLP-1RA preferred for advanced CKD (level B evidence) | Not Addressed |
| Comorbidity: Metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic-dysfunction-associated steatohepatitis (MASH), or high risk for liver fibrosis | ADA | AACE |
|---|---|---|
| GLP-1RA | GLP-1RA preferred (level A evidence) | GLP-1RA first-line (MALSLD) |
| GIP/GLP-1RA | GIP/GLP-1RA may be considered (level B evidence) | GIP/GLP-1RA may be an option |
| Pioglitazone | Pioglitazone may be considered (level B evidence) | Pioglitazone may be considered |
| Pioglitazone + GLP-1RA | Pioglitazone + a GLP-1RA considered (level B evidence) | Pioglitazone + GLP-1RA or SGLT2 inhibitor may be considered |
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