ADA-EASD 2026 Consensus Urges Earlier Use of GLP-1 Therapies and SGLT2 Inhibitors in Type 2 Diabetes
USA: The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have released an updated consensus report on the management of type 2 diabetes, shifting the focus from glucose control alone to comprehensive, long-term management of the disease and its associated complications. Published in Diabetologia, the report was led by Melanie J Davies from the Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, UK, and colleagues.
The 2026 update follows a systematic review of evidence published since the previous consensus report in 2022. Designed for multidisciplinary healthcare teams caring for non-pregnant adults with type 2 diabetes, the recommendations emphasise healthy lifestyle behaviours, weight management, psychological support and earlier use of therapies that provide cardiovascular and kidney protection.
The panel highlighted that type 2 diabetes should be managed as a chronic, progressive multisystem condition rather than a disorder defined primarily by elevated blood glucose. Cardiovascular disease (CVD), chronic kidney disease (CKD), heart failure, obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), sleep apnoea, cognitive impairment and mental health conditions should be incorporated into treatment decisions.
The main recommendations include:
- A sustainable healthy eating pattern that creates an appropriate energy deficit should be encouraged for adults with type 2 diabetes and overweight or obesity, alongside medical treatment or metabolic surgery when appropriate.
- Medical nutrition therapy should focus on practical and sustainable dietary habits and be adapted to cultural and individual circumstances.
- Intensive lifestyle interventions targeting at least 10% weight loss may be considered, with potential benefits for type 2 diabetes remission.
- A Mediterranean-style diet should be considered for people with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), where appropriate.
- The “five S” approach—standing, stepping, sweating through aerobic activity, strengthening through resistance exercise and adequate sleep—should form a core part of diabetes management.
- Adults should aim for at least 150 minutes of moderate-to-vigorous aerobic activity, or 75 minutes of vigorous activity, spread over at least three days each week, with resistance exercise two to three times weekly.
- Metabolic surgery may be considered for people with type 2 diabetes and a BMI of at least 30 kg/m², or at least 27.5 kg/m² in people of Asian ancestry, and should be considered at BMI ≥35 kg/m² or ≥32.5 kg/m², respectively.
- SGLT2 inhibitors and GLP-1-based therapies should be considered early, potentially from diagnosis, because of their cardiovascular, kidney and metabolic benefits independent of metformin.
- Combination SGLT2 inhibitor and GLP-1-based therapy may be considered in people at high cardiovascular risk or with established CVD, CKD or heart failure, irrespective of HbA1c.
- SGLT2 inhibitors should form the foundation of heart failure and CKD protection, while GLP-1-based therapies can provide additional cardiovascular, kidney and weight-management benefits.
- In CKD, proven SGLT2 inhibitors should be initiated to reduce kidney and heart failure outcomes and cardiovascular events, while GLP-1-based therapies should be considered for additional cardiovascular and kidney protection.
- Non-steroidal mineralocorticoid receptor antagonists with proven benefit should be considered in appropriate patients with albuminuric CKD.
- In people with obesity, type 2 diabetes and MASLD, weight reduction and lifestyle modification should remain central, with GLP-1-based therapies recommended where indicated.
- People with obesity, type 2 diabetes and obstructive sleep apnoea may benefit from tirzepatide or a GLP-1 receptor agonist with established benefit.
- Diabetes self-management education and support (DSMES) and medical nutrition therapy should be offered to all people with type 2 diabetes and revisited regularly.
- Treatment should be individualised according to cardiovascular and kidney risk, weight, frailty, other multiple long-term conditions (MLTCs), treatment preferences, safety and social circumstances.
- Evidence-based diabetes technologies, including continuous glucose monitoring, should be considered as adjuncts to comprehensive diabetes care, particularly for people using insulin.
The consensus highlights early-onset type 2 diabetes as a high-risk group because of faster glycaemic deterioration and earlier complications, supporting early use of GLP-1-based therapies and SGLT2 inhibitors, alone or in combination, when appropriate. In older or frail adults and those with multiple long-term conditions, cardiovascular and kidney-protective therapies should generally remain similar, but treatment may need adjustment for safety and tolerability. Medication selection should not routinely vary by race, ethnicity or sex, although differences in social determinants, healthcare access and disease burden should guide individual risk assessment.
The report advocates person-centred, integrated diabetes care, addressing multiple long-term conditions, mental health, nutrition, physical activity, weight and social circumstances alongside individual treatment preferences. Key research gaps include defining and sustaining diabetes remission, optimising the sequencing and combination of newer therapies, improving treatment of early-onset diabetes, managing GLP-1-based therapies around pregnancy, preserving muscle during weight loss, and evaluating artificial intelligence and precision medicine.
The authors emphasise that improving outcomes does not depend solely on future therapies. Timely treatment, lifestyle support, DSMES, structured complication surveillance and equitable access to proven cardiovascular- and kidney-protective therapies could substantially reduce complications and premature mortality. Consistent implementation of these established strategies across healthcare systems, they conclude, offers an immediate opportunity to transform type 2 diabetes care.
Reference:
Davies MJ, Aroda VR, Bajaj M, ElSayed NA, Giorgino F, Green J, Kalyani RR, Maruthur NM, Mathieu C, Rosas SE, Rossing P, Slater T, Tankova T, Topsever P, Tsapas A, Buse JB. Management of type 2 diabetes, 2026. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2026 Oct 2. doi: 10.1007/s00125-026-06855-7. Epub ahead of print. PMID: 42825923.
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