For people with diabetes who want to understand what comprehensive care includes.
The American Diabetes Association updates its Standards of Care every year. The document is designed for healthcare professionals, not as a do-it-yourself treatment manual. Still, it can help patients see whether important areas of care are being reviewed.
The following ten themes are a practical summary, not every recommendation and not a substitute for clinical judgement.
Quick answer
The 2026 Standards continue a person-centred approach: treatment should consider diabetes type, heart and kidney risk, weight, hypoglycaemia, pregnancy, mental health, cost, access and personal preferences. Technology, medicines and targets should be matched to the person rather than applied as a single ladder for everyone.
Ten themes to discuss
1. Diabetes type and diagnosis still matter
The Standards expand attention to presymptomatic type 1 diabetes and testing when adult diabetes does not fit a typical pattern. Correct classification can change insulin, monitoring and family counselling.
2. Heart and kidney protection can guide medicine choice
Some SGLT2 inhibitors, GLP-1 receptor agonists and related treatments have benefits beyond glucose lowering in selected people. Choice depends on kidney function, cardiovascular disease, heart failure, side effects and access.
3. Weight care is a core treatment goal for many people with type 2 diabetes
The Standards recommend non-judgemental language and individual treatment using nutrition, activity, behavioural care, medicine or metabolic surgery as appropriate. Obesity medicines may require long-term use to maintain benefit.
4. Diabetes technology is expanding
Continuous glucose monitoring, pumps and automated insulin delivery can help selected users across more care settings. Training, affordability, data burden, skin tolerance and backup plans remain essential.
5. Hypoglycaemia prevention deserves active review
Clinicians should assess risk, simplify treatment when needed, provide education and prescribe glucagon for everyone using insulin and for others at high risk of hypoglycaemia. Families and carers may need training.
6. Mental and behavioural health belong in diabetes care
The 2026 Standards emphasise screening for diabetes distress, depression, anxiety, fear of hypoglycaemia and disordered eating, along with referral to professionals experienced in diabetes where possible.
7. Nutrition should be individualised
There is no single ideal percentage of carbohydrate, protein and fat for everyone. Medical nutrition therapy should reflect health goals, culture, budget, access and preferences while maintaining adequate nutrition.
8. Physical activity includes reducing sitting
Adults are generally encouraged towards aerobic and resistance activity, with plans adapted for complications and fitness. Breaking up prolonged sitting can also help glucose.
9. Complication screening remains central
Eye, kidney, nerve, foot, cardiovascular, oral and other health checks should follow diabetes type, duration, age and risk. Screening only helps when abnormal results lead to action.
10. Social barriers are clinical information
Food insecurity, housing, medicine cost, language, transport and digital access affect treatment. The Standards recommend assessing and addressing these barriers rather than labelling the person non-adherent.
How to use the Standards at an appointment
Bring a short list of priorities. Ask which recommendations apply to your diabetes type and risk. Review medicines by purpose: glucose, heart, kidney, weight or symptom control. Confirm what screening is due and what result would trigger action.
Do not use a headline about the Standards to start, stop or switch medicine. Some recommendations are graded from strong trial evidence; others are expert consensus. The full context matters.
Turn ten themes into five questions
Ask: Are my diabetes type and treatment goals still correct? Which medicines are for glucose and which protect the heart, kidneys or weight? Am I having hypoglycaemia or treatment burden that the average result hides? Which complication checks are due? What cost, language, food, housing or technology barrier is limiting the plan?
Five focused questions are more usable than printing the entire guideline. Bring your medicine list and a short glucose summary so the discussion can end with named actions, owners and dates.
How to read a guideline headline
Check which population the recommendation covers. A change for adults with type 2 diabetes and chronic kidney disease may not apply to a child with type 1 diabetes. Look for words such as “recommended”, “consider” and “may” because they signal different levels of certainty and individualisation.
Confirm whether the medicine, device or test is approved and funded where you live. Guideline evidence can be strong while access remains limited. Ask what alternative provides the most important benefit if the preferred option is unavailable.
Build an annual care map
Some topics need review at every visit, such as severe hypoglycaemia, side effects and ability to obtain medicines. Others follow annual or risk-based schedules, including kidney, eye, foot and cardiovascular assessment. Pregnancy planning, acute illness or a new complication can change the timetable.
Keep results with the date and follow-up action, not just a tick that the test occurred. A kidney result, retinal photograph or foot-risk category only improves care when someone interprets it and acts when needed.
At the end of the visit, ask for the plan in plain language: what changes now, what stays the same, what should be measured, and when the decision will be reviewed. This is where a long guideline becomes useful care.
Common mistakes to avoid
- Treating annual changes as proof that last year’s care was wrong.
- Applying a recommendation for type 2 diabetes to type 1 diabetes.
- Focusing only on A1C and ignoring hypoglycaemia or quality of life.
- Assuming the most advanced device is the best choice for everyone.
- Turning a guideline into a rigid rule when circumstances differ.
Frequently asked questions
Are the ADA Standards law?
No. They are evidence-based clinical recommendations and require professional judgement, individualisation and local context.
Do they apply outside the United States?
The evidence is internationally relevant, but medicine approval, funding, screening programmes and national guidelines differ.
Where can patients read the updates?
The complete Standards and summary of revisions are available through Diabetes Care. Ask your clinician to explain the sections that affect your care.
The bottom line
The 2026 Standards broaden the definition of good diabetes care. Glucose remains important, but so do heart and kidney protection, weight, technology, mental health, hypoglycaemia, access and the person’s own goals.
Related Living Diabetes guides
Sources and further reading
- ADA: Summary of revisions to the Standards of Care 2026
- ADA Standards of Care 2026: Introduction and methodology
- ADA Standards of Care 2026: Diagnosis and classification
- ADA Standards of Care 2026: Glucose goals and hypoglycaemia
- ADA Standards of Care 2026: Pharmacological treatment
- ADA Standards of Care 2026: Positive health behaviours and well-being
This article is a general overview, not a complete guideline or individual treatment recommendation.