03/10/2026
ADA/EASD 2026: What has changed-and what matters in your clinic?
we highlight the most practical updates compared with the 2022 report:
1. Organ protection starts earlier
The report now supports early use of an SGLT2 inhibitor and/ or GLP-1-based therapy in most people with type 2 diabetes-potentially from diagnosis. Treatment should reflect the person's clinical needs, risks, preferences, and access.
Clinical message: Consider long-term organ protection when choosing the first treatment.
2. A stronger role for early combination therapy
Consider combining SGLT2 inhibitors and GLP-1-based therapies earlier in people with overlapping cardiovascular disease, chronic kidney disease, and heart failure. In high-risk patients, this decision can be independent of HbA1c.
Clinical message: An HbA1c at target does not mean organ protection is complete.
3. Kidney protection now has more options
SGLT2 inhibitors remain foundational. New outcome evidence strengthens the role of semaglutide in slowing CKD progression. Finerenone adds protection in appropriate patients with albuminuric CKD.
4. More treatment options for obesity-related HFpEF For people with obesity and heart failure with preserved ejection fraction, semaglutide or tirzepatide is recommended to improve heart failure symptoms. SGLT2 inhibitors retain their central role in heart failure care.
5. Liver disease has greater influence on drug choice
For type 2 diabetes with obesity and MASLD, GLP-1-based therapy with proven benefit is recommended. In biopsy-proven MASH, a therapy with proven liver benefit is preferred; pioglitazone or tirzepatide may also be considered.
6. Sleep apnea becomes a treatment consideration
In people with type 2 diabetes, obesity, and obstructive sleep apnea, tirzepatide or a GLP-1 receptor agonist with proven benefit may be prioritized.
Clinical message: Ask about snoring, daytime sleepiness, and diagnosed sleep apnea.
7. A broader place for CGM
CGM should be considered in type 2 diabetes, especially in people using insulin. The report also recognizes benefits from periodic use beyond insulin-treated patients.
8. Resistant diabetes deserves a diagnostic rethink
The report advises considering targeted screening for secondary causes, including hypercortisolism, when diabetes remains resistant despite appropriate treatment with multiple agents.
Clinical message: Persistent poor control may need further investigation.
Weight management, person-centered care, and organ protection were already central in 2022. The 2026 advance is earlier action, stronger outcome evidence, and more treatment choices for specific complications.
