A.D.A. Standards of Care 2026 – Οι νέες συστάσεις για το διαβήτη από την Αμερικανική Διαβητολογική Εταιρεία

(Link to 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S001)

(Link to 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S002)

Recommendation 2.8 was divided into two components to emphasize the importance of prompt evaluation for stage 3, overt type 1 diabetes in people with one or more islet autoantibodies (Recommendation 2.8a); Recommendation 2.8b maintains the original guidance that people with multiple islet autoantibodies should be referred to a specialized center for education and possibly preventative interventions.

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, phosphoinositidylinositol 3-kinase α (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 (mTOR) inhibitors.

Recommendation 2.24a was updated to reiterate that, when feasible, an annual oral glucose tolerance test (OGTT) starting at the age of 10 years is the preferred screening test for cystic fibrosis–related diabetes.

Recommendation 2.24b was modified to highlight that A1C can be used as a part of an alternative two-step screening strategy for cystic fibrosis–related diabetes when OGTT is not feasible.

Previous Recommendations 2.26b and 2.26c on gestational diabetes mellitus screening were consolidated and updated and are now Recommendation 2.31b; the associated narrative text was moved to section 15, “Link to 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026Diabetes Management in Pregnancy,” and updated to reflect recent evidence and controversies in the management of early abnormal glucose metabolism in pregnancy. The text in the “Gestational Diabetes Mellitus” subsection was updated and more closely integrated with the information in section 15, “Link to 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026Diabetes Management in Pregnancy.”

(Link to 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S003)

(Link to 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S004)

(Link to 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S005)

(Link to 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S006)

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.

The section “Intercurrent Illness” was expanded to include criteria for holding specific diabetes medication classes during acute illness.

The section “Hyperglycemic Crises: Diagnosis, Management, and Prevention” was revised to include more content on the outpatient prevention and management of diabetic ketoacidosis. Reflecting this expanded content, “Hyperglycemic Crises” was added to the section title.

Figure 6.1, which shows an individualized approach to setting glycemic goals, was expanded to include individualized goals for CGM metrics based on health status and other person- and treatment-specific factors.

(Link to 7. Diabetes Technology: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S007)

Recommendations were added regarding education and training of people with diabetes and health care professionals based on the type of device. In the narrative text, more details were added about education and training based on the type of device. Major updates include content about the support health care professionals may need and information about device initiation for different types of diabetes.

Recommendation 7.3 was divided into two recommendations and includes guidance regarding prescribing and initiating device use. Recommendation 7.3a discusses prescribing, initiating, and following a CGM device, and Recommendation 7.3b describes the same aspects for automated insulin delivery (AID) systems.

Recommendation 7.6 was changed to specify children and adolescents in a school setting and states that children and adolescents should be supported at school in the use of diabetes technology, such as CGM systems, continuous subcutaneous insulin infusion (CSII), connected insulin pens, and AID systems. Older students (aged ≥18 years) are discussed in the new Recommendation 7.7, which also discusses workplace accommodation. Recommendation 7.7, for those aged ≥18 years, states that for adults with diabetes using diabetes technology, reasonable accommodations in educational and work settings should include having sufficient time to manage their devices and respond to high and low glucose levels.

Recommendation 7.8 discusses early initiation of all devices, as indicated based on a person’s circumstances. New Recommendation 7.8a states that there should be no requirement of C-peptide level, the presence of islet autoantibodies, or duration of insulin treatment before initiation of CSII or AID.

The “Blood Glucose Monitoring” section includes updated literature highlighting the benefits of glucose monitoring for people with type 2 diabetes. Additionally, it reinforces the importance of ensuring that individuals using CGM also have access to blood glucose monitoring.

Recommendation 7.15 states that use of CGM is now recommended at diabetes onset and anytime thereafter for children, adolescents, and adults with diabetes who are on insulin therapy, on noninsulin therapies that can cause hypoglycemia, and on any diabetes treatment where CGM helps in management.

Recommendation 7.17 briefly discusses use of diabetes devices in pregnancy, which is discussed in detail in section 15, “Link to 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026 Diabetes Management in Pregnancy.”

Recommendation 7.25a states that AID systems are the preferred insulin delivery system for people with type 1 diabetes and adults and children with type 2 diabetes on multiple daily injections, CSII, or sensor-augmented pump therapy and for other forms of insulin-deficient diabetes.

Recommendation 7.25b states that AID systems can be considered in people with type 2 diabetes on basal insulin who are not meeting their individualized glycemic goals.

The narrative text further discusses that the benefits of CGM have been shown regardless of age, sex, education or income levels, or baseline diabetes characteristics.

Link to 7. Diabetes Technology: Standards of Care in Diabetes—2026Table 7.3 provides updated definitions of types of CGM devices. Intermittently scanned CGM (isCGM) is no longer discussed, although it is referenced as an older option. The three types of devices are now real-time CGM (rtCGM), over-the-counter CGM (OTC-CGM), and professional CGM.

(Link to 8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes–2026https://doi.org/10.2337/dc26-S008)

(Link to 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc25-S009)

(Link to 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S010)

(Link to 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S011)

(Link to 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S012)

(Link to 13. Older Adults: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S013)

(Link to 14. Children and Adolescents: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S014)

(Link to 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S015)

(Link to 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S016)

Two new recommendations were added for glycemic goals in the perioperative period. To improve postoperative outcomes, Recommendation 16.14 suggests an A1C goal <8% (<64 mmol/mol) 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 (5.6–10.0 mmol/L) during the perioperative period.

For individuals with diabetes not being discharged to their home, Recommendation 16.18 was updated to suggest considering the capabilities of the facility for diabetes management.

Link to 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026Tables 16.1 and Link to 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—202616.2 were included to provide information on diagnostic criteria and clinical presentation for diabetic ketoacidosis and hyperglycemic hyperosmolar state.

The narrative text was updated to expand upon technology use in the hospital setting and noninsulin therapies in the perioperative period.

(Link to 17. Diabetes Advocacy: Standards of Care in Diabetes—2026https://doi.org/10.2337/dc26-S017)

No revisions have been made for the 2026 Standards of Care.