03/01/2026
ADA Standards of Care 2026: The New Algorithm for Glucose-Lowering Therapy in Type 2 Diabetes
The ADA 2026 reinforces a priorities-first approach:
1️⃣ Reduce cardiovascular & kidney (CVKD) risk
2️⃣ Manage weight
3️⃣ Achieve glycemic goals
4️⃣ Address MASLD/MASH risk
All built on a foundation of healthy lifestyle + DSMES + addressing SDOH.
🔶 1. FIRST PRIORITY: Cardiovascular & Kidney Risk Reduction
A. ASCVD or Indicators of High CV Risk
Preferred: GLP-1 RA with proven CV benefit
Alternative / Add-on: SGLT2i with proven CV benefit
If HbA1c above target → combine GLP-1 RA + SGLT2i
B. Heart Failure (HFpEF or HFrEF)
Preferred: SGLT2 inhibitor
Add GLP-1 RA (proven benefit) if glycemia not controlled or if comorbid obesity
C. CKD (eGFR