The American Diabetes Association (ADA) Standards of Care in Diabetes—2026, published as a supplement to Diabetes Care (Volume 49, January 2026), offers a comprehensive, evidence-graded framework (A–E) for healthcare professionals managing diabetes across diverse populations, including type 1, type 2, gestational, monogenic, and special cases like cystic fibrosis- or immunotherapy-related diabetes. Developed by the Professional Practice Committee through systematic reviews (June 2024–July 2025), the document adopts person-first, empowering language; updates evidence levels; and incorporates endorsements from global societies. Targeting primary care providers, specialists, educators, policymakers, and patients, it stresses shared decision-making, social determinants of health (SDOH), and telehealth to mitigate access barriers, such as insulin cost caps under the Inflation Reduction Act ($35/month) and 15–19% nonadherence due to affordability.
Structured across 16 sections, revisions highlight multifaceted care delivery (Section 1), refined diagnosis/classification with tools like AABBCC for type differentiation and genetic risk scores (Section 2), and prevention strategies including 5–7% weight loss, metformin for high-risk prediabetes, and teplizumab delaying type 1 onset by ~24 months (HR 0.41; Section 3). Comprehensive evaluations prioritize comorbidities like MASLD (FIB-4 screening, GLP-1 RAs reducing fibrosis by 37%) and cognitive/sexual health (Section 4), while health behaviors emphasize DSMES (A1C reduction 0.30%), Mediterranean/low-carb diets, 150 min/week activity, and psychosocial screening (Section 5).
Glycemic targets remain individualized (A1C <7% nonpregnant adults), with hypoglycemia prevention via education and glucagon access; crises like DKA/HHS note SGLT2i risks in type 1 (Section 6). Technology advances promote continuous glucose monitoring (CGM) and automated insulin delivery (AID) as first-line for insulin users, enhancing time-in-range >70% (Section 7). Obesity management favors GLP-1 RAs (semaglutide 6.2% loss) and dual agonists (tirzepatide 9.6–11.6%), alongside bariatric surgery for BMI ≥30 (83–86% type 2 remission at 5 years; Section 8). Pharmacologic approaches prioritize metformin escalation to GLP-1/GIP or SGLT2i for cardiorenal benefits (Section 9).
Cardiovascular disease (CVD) and chronic kidney disease (CKD) sections underscore BP <130/80 mmHg, high-intensity statins (LDL <70 mg/dL primary), and combinations like SGLT2i + finerenone (52% UACR reduction; Sections 10–11). Retinopathy/neuropathy/foot care integrates AI screening and GLP-1 amputation risk reduction (Section 12), with tailored older adult considerations (Section 13) and pediatric updates on CGM/teplizumab (Section 14). Pharmacologic approaches for special populations, including pregnancy (Section 15) and inpatient management (Section 16), ensure holistic, equity-driven care. Overall, the 2026 standards advocate interprofessional, technology-enabled strategies to delay complications, reduce disparities, and improve long-term outcomes, pending further real-world validation.
