Your Guide to the 2026 ADA Standards of Care
The American Diabetes Association recently released major diabetes care updates, which include new recommendations on diabetes technology, therapy, and preventative health.
The ADA's annual Standards of Care provides guidance for healthcare professionals, but also helps people with diabetes understand treatment recommendations and prepare for discussions with their healthcare team.
The 2026 updates include expanded recommendations for technology use, such as continuous glucose monitoring (CGM) and automated insulin delivery (AID), and for the first time, support GLP-1s and similar drugs for people with type 1 diabetes. The document also clarifies recommendations for protection against long-term complications.
Here is a highlight of some of the most impactful changes in this year's guidelines.
Broad support for AID systems
The new 2026 guidelines recommend AID systems as the preferred insulin delivery system for all people with type 1 diabetes and children and adults with type 2 diabetes who use insulin.
More than DIY
Last year, the Standards of Care voiced support for the use of open-source AID systems in type 1 diabetes for the first time. This year, the guide pointed to large studies that support the effectiveness and safety of open-source AID systems and reinforced the idea of moving away from calling them DIY systems, reflecting the large number of people involved in building, maintaining, and sharing algorithms publicly for safety and transparency.
Use in pregnancy
The guidelines also highlighted the benefits of AID use with systems that have been designed and tested for use during pregnancy. The document notes that most FDA-approved AID systems in the U.S. rely on glucose targets above those recommended for pregnancy, and do not use pregnancy-specific algorithms.
The Standards recommend counseling on the use of AID systems in pregnancy, including guidance on switching between automated and manual modes, to reduce hypoglycemia and improve blood sugar management.
CGM use
The 2026 guidelines support CGM use at the onset of diabetes for those who use insulin, and for anyone at risk of hypoglycemia or who would benefit from CGM in supporting blood sugar management.
The ADA also emphasizes that CGM systems are most effective when paired with education and ongoing support. The guidelines recommend that those using CGM receive training in the following areas:
- How to interpret CGM data
- Managing skin reactions
- Understanding factors that can affect accuracy
Daily use is encouraged when possible, along with the use of a glucometer when CGM readings don’t match symptoms, for example, during warmup periods or if CGM supplies are delayed.
Type 1 and incretin therapy
A major change in the 2026 edition is the new support of GLP-1 and similar drugs for use in adults with type 1 diabetes with a body mass index (BMI) greater than 30 (27.5 for Asian Americans).
The guidelines also suggest broader access for GLP-1-based medicines because of their benefits beyond glucose management and weight, such as protecting against kidney, heart, and liver disease.
The guidelines recommend that people with type 1 starting these medicines receive counseling that covers:
- The need to reduce insulin doses and the potential risk of hypoglycemia
- Maintaining adequate carbohydrate intake
- Regular ketone testing to reduce the risk of diabetic ketoacidosis
- Adjusting insulin dosing over time
Obesity and weight management
New in 2026 is a recommendation for yearly screening for overweight or obesity using BMI, combined with waist-to-hip measurements or body composition tests when available.
For people with overweight or obesity, the recommendations suggest that losing 5-7% of their starting body weight can improve blood sugar management and reduce cardiovascular health risks.
Lifestyle interventions such as counseling on nutrition and physical exercise are recommended. Telehealth, remote programs, and mobile apps are encouraged when in-person counseling isn't available.
The new Standards also emphasize the importance of personalizing dosing when using weight loss medications – for some, the optimal dose may be lower than the FDA-approved maximum.
Hospitalization and surgery
A new section focuses on preparing for surgery and maintaining safe glucose levels during hospital stays, surgery, and after care. For the first time, the ADA provides specific targets, recommending an A1C of 8% or lower before surgery and blood glucose levels between 100-180 mg/dL before, during, and after procedures. These targets are intended to safely allow flexibility based on surgical risk, hypoglycemia concerns, and personalized treatment plans.
New guidance also addresses care after hospital stays, including careful consideration of post-surgery care facilities for people who are not recovering at home. The updated guidelines aim to help caregivers more clearly recognize and treat DKA and hyperglycemic hyperosmolar state, which involves extremely high blood sugar, severe dehydration, and altered mental status, without the ketone buildup seen in DKA.
Protecting long-term health
The new guidelines take a broader approach to long-term health, recognizing that heart disease, kidney disease, and diabetes as interconnected conditions that require coordinated approaches for prevention and treatment.
Preventing eye, nerve, and kidney damage
The updated guidelines point to long-term studies that show early and ongoing improvement of glucose management can provide lasting protection for complications related to vision, nerves, and the kidneys.
Heart health
In addition to managing blood sugar, blood pressure, and cholesterol levels, recommendations include using GLP-1 and similar medicines (such as Ozempic and Mounjaro) and SGLT-2 inhibitors (like Jardiance and Farxiga) in type 2 diabetes, which provide benefits beyond glucose control, including protection for the heart and kidneys.
Kidney health
The updated guidelines recommend that most people with diabetes get kidney tests at least once a year, including a urine test for protein and a blood test to estimate kidney function.
People with existing kidney disease may need testing more often, in consultation with their healthcare provider. The guidelines also reaffirm blood pressure goals, recommending levels below 130/80 mmHg for most people with diabetes, and aiming for even lower systolic blood pressure (the top number, representing peak pressure in your arteries) when it can be done safely.
Liver health
The updated guidance places new emphasis on liver disease, including MASH (metabolic dysfunction-associated steatohepatitis), an advanced form of liver disease marked by excess fat in the liver, which is common in type 2 diabetes and has implications for heart and kidney health. GLP-1 medications are now recommended as the initial therapy for adults with type 2 diabetes and liver fibrosis and MASLD (metabolic dysfunction-associated steatotic liver disease), a condition closely linked to obesity and diabetes.
The bottom line
The 2026 ADA Standards of Care emphasize earlier, broader, and more comprehensive diabetes care. Technology, including CGM and AID, is now recommended soon after diagnosis in both type 1 and type 2 diabetes, with fewer restrictions. The guidelines also reaffirm support for open-source AID and clarify how AID and CGM may be used in pregnancy.
The updated guidelines also recommend, for the first time, the use of GLP-1 and similar drugs for people with type 1 diabetes and obesity, along with vital education on reducing hypoglycemia and DKA risk. The recommendations also emphasize the benefits of personalized dosing for weight loss medicines, noting the most effective dose may not be the highest approved one.
New recommendations move beyond glucose management and recommend a connected approach to protecting the heart, kidneys, liver, eyes, nerves, and feet through earlier screening, lowering blood pressure targets for those at higher risk, and expanded use of newer diabetes medications.
Read more recommendations for diabetes and related care here: