ADA 2026 Guidelines Recommend Earlier Use of Diabetes Technology and Personalized Care
USA: The American Diabetes Association (ADA) Standards of Care in Diabetes—2026 provide updated recommendations for the prevention, diagnosis, and management of diabetes across different patient populations. The comprehensive guidance addresses type 1 and type 2 diabetes, children, pregnancy, older adults, and people living with diabetes-related or other comorbid conditions. A major focus of the latest update is the earlier and broader adoption of diabetes technology, particularly continuous glucose monitoring (CGM) and automated insulin delivery.
Published in Diabetes Care in January 2026, the updated Standards of Care place greater emphasis on using technology and individual clinical characteristics to guide diabetes management rather than relying solely on conventional measures such as glycated hemoglobin (HbA1c).
Key Recommendations:
- Introduce diabetes technology earlier: The ADA recommends early consideration of diabetes devices for people with both type 1 and type 2 diabetes rather than reserving technology for patients with longstanding or difficult-to-control disease.
- Use CGM at or near diagnosis: CGM should be initiated at diagnosis for most people receiving insulin and may also be appropriate for other individuals when the technology is expected to assist diabetes management.
- Consider automated insulin delivery in type 2 diabetes: Automated insulin delivery systems, historically associated primarily with type 1 diabetes, can be considered for people with type 2 diabetes who remain above glycemic targets despite basal insulin therapy.
- Expand assessment of glycemic control: Treatment goals should incorporate CGM-derived measures alongside HbA1c. For most adults, the recommended targets include an HbA1c below 7% and time in range above 70%. Less stringent goals may be appropriate for older adults with complex health conditions.
- Use individualized CGM targets: The guidance provides targets for time in range, time below range, and time above range according to individual clinical circumstances, allowing clinicians to assess glucose control beyond a single HbA1c value.
- Base medication selection on comorbidities: Pharmacological treatment should increasingly be determined by a patient's associated cardiovascular, renal, hepatic, and other health conditions rather than being guided solely by HbA1c levels.
- Consider GLP-1 receptor agonists in specific comorbidities: Greater emphasis is placed on the use of glucagon-like peptide-1 (GLP-1) receptor agonists in people with conditions such as heart failure with preserved ejection fraction and metabolic dysfunction–associated steatohepatitis.
- Adopt individualized blood pressure targets: For people with diabetes at high risk for cardiovascular or kidney disease, a systolic blood pressure target below 120 mm Hg is recommended when appropriate. For most other adults, a target below 130/80 mm Hg is advised when it can be achieved safely.
The updated recommendations reflect a broader shift toward technology-enabled, comorbidity-focused, and individualized diabetes care. By incorporating CGM data into treatment targets and encouraging earlier use of advanced insulin-delivery systems, the ADA aims to provide clinicians with additional tools for improving glycemic management.
The guidance also highlights that treatment decisions should account for the patient's overall health and associated conditions rather than relying on HbA1c alone. This approach may help clinicians tailor both pharmacological and technological interventions to the individual needs and risks of people living with diabetes.
Reference:
American Diabetes Association Professional Practice Committee for Diabetes. Standards of care in diabetes — 2026. Diabetes Care 2026 Jan; 49:Suppl 1:S1. DOI: 10.2337/dc26-S001.
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