Diabetes Care in 2026: What the Updated Standards Mean for People Actively Managing Diabetes
by IDS Director of Patient Care and Education, Alicia Downs RN MSN CDCES BC-ADM
If you are already living with diabetes or closely monitoring your risk, the 2026 Standards of Care in Diabetes represent an important evolution in how diabetes is diagnosed, monitored, and managed.
These updates reflect growing recognition that diabetes is not a one-size-fits-all condition—We see a continued shift in focus toward earlier screening, diagnosis, and individualization of care as being focuses of the clinical role. We also see advocacy for expansion of access to all levels of technology for all patients with diabetes from the time of diagnosis throughout the lifetime of care and removal of previous “gatekeeping” efforts.
Earlier and More Nuanced Diagnosis of Diabetes
A big focus on earlier detection, staging, diagnosis and interventions
Key points include:
• Prompt evaluation for overt type 1 diabetes when symptoms appear in individuals with one or more autoantibodies
• Referral to specialized centers for people with multiple autoantibodies
• Close monitoring of individuals with a confirmed single IA-2 autoantibody due to similar progression risk, including CGM use
Medication-Associated Hyperglycemia
Routine glucose monitoring is emphasized for people receiving long-term or high-dose glucocorticoids and those starting immune checkpoint inhibitors, PI3Kα inhibitors, or mTOR inhibitors.
Metformin may be considered preventively for high-risk individuals treated with glucocorticoids or PI3Kα inhibitors.
Prevention and Delay of Diabetes
Monitoring now includes progression from prediabetes to all forms of diabetes. Lifestyle interventions remain foundational, with referral to diabetes prevention programs targeting 5–7% weight loss. Mediterranean and lower-carbohydrate eating patterns have the strongest evidence.
Diabetes Technology
Continuous glucose monitoring is recommended at diagnosis or anytime thereafter when it supports management. Automated insulin delivery systems are now preferred for people with type 1 diabetes and many with type 2 diabetes using insulin, without requirements for C-peptide or antibody status. This is a big step in reducing the burden of approving Insulin pump therapy for people on Medicare.
Safety and Special Situations
There is special focus on reform of policies regarding perioperative Glucose targets and use of diabetes tech in perioperative hospital care with tighter glucose targets and recommendations to allow for broader patient self-management. This is encouraging as data shows patients have better outcomes when able to maintain their own management.
We see a large section devoted to the management of diabetes in pregnancy and diabetes technology. Though recommendations are still conservative concerning the use of AID and DIY systems are not listed at all, CGM is now the standard of care in all forms of diabetes in pregnancy.
We also see recommendations for oral glucose rescue products to be included in first aid kit products in schools, workplaces, and public places, which is encouraging, though glucagon would be a better step.
The biggest takeaways this year are…
- Accessibility hurdles for technologies have been greatly reduced. Most notably, including recommendations that CGM users still have access to blood glucose self-monitoring (7.10 People with diabetes should be provided with blood glucose monitoring (BGM) devices as indicated by their circumstances, preferences, and treatment. People using CGM devices must also have access to BGM at all times. Feel free to use this the next time your insurance company tries to deny you test strips because you have a CGM.
- Screening and early intervention are key! First-generation family members should be screened for autoantibodies. Anyone with hyperglycemia that is not responding well to standard therapy should be screened. Knowing your autoantibody state can make a big difference in your treatment options as the map of available options continues to develop.
- People with type 3C diabetes continue to be recognized and considered. From steroid and CF-related diabetes monitoring to treatment, there is significantly more attention given to the screening for and treatment of these forms of diabetes than ever before.
- Diabetes continues to be individualized. We are not a population that can be easily lumped into 2 types. We are a vast community of individuals who deserve to be considered and treated with specialized, individualized care. That care requires a high level of knowledge and expertise.
One Response
This is very important information. It will rarely be discussed in any routine endocrinology visit, but it is vital that those of us with any form of diabetes know about these changes. Thank you for sending it to us.