Improving Care and Promoting Health in Populations

Diagnosis and Classification of Diabetes

Prevention or Delay of Diabetes and Associated Comorbidities

Comprehensive Medical Evaluation and Assessment of Comorbidities

Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes

Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises

Diabetes Technology

Obesity and Weight Management for the Prevention and Treatment of Diabetes

Pharmacologic Approaches to Glycemic Treatment

Cardiovascular Disease and Risk Management

Chronic Kidney Disease and Risk Management

Retinopathy, Neuropathy, and Foot Care

Older Adults

Children and Adolescents

Management of Diabetes in Pregnancy

Diabetes Care in the Hospital

Diabetes Advocacy

Document Overview

Design and created by Guideline Central in participation with the American Diabetes Association.

Diabetes Standards of Care 2026

American Diabetes Association

Publication Date: Dec 8, 2025

Page Last Updated: Apr 6, 2026

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Table 4.1 Components of the Comprehensive Diabetes Medical Evaluation at Initial, Follow-up, and Annual visits

	Visit
	Initial	Every follow-up	Annual
Past medical and family history
Diabetes history
• Characteristics at onset (e.g., age and symptoms and/or signs)	✓
• Review of previous treatment plans and response	✓
• Assess frequency, cause, and severity of past hospitalizations	✓
Family history
• Family history of diabetes in a first-degree relative	✓
• Family history of autoimmune disorders	✓
Personal history of complications and common comorbidities
• Common comorbidities (e.g., obesity, OSA, and MASLD)	✓		✓
• High blood pressure or abnormal lipids	✓		✓
• Macrovascular and microvascular complications	✓		✓
• Hypoglycemia: awareness, frequency, causes, and timing of episodes	✓	✓	✓
• Presence of hemoglobinopathies or anemias	✓		✓
• Last dental visit	✓		✓
• Last foot exam	✓		✓
• Last dilated eye exam	✓		✓
• Visits to specialists	✓
• Disability assessment and use of assistive devices (e.g., physical, cognitive, vision and auditory, history of fractures, and podiatry)	✓	✓	✓
• Personal history of autoimmune disease	✓
Surgical and procedure history
• Surgeries (e.g., metabolic surgery and transplantation)	✓	✓	✓
Interval history
• Changes in medical or family history since last visit		✓	✓
Behavioral factors
• Physical activity, sleep behaviors, eating patterns and weight history	✓	✓	✓
• Assess familiarity with carbohydrate counting (e.g., type 1 diabetes or type 2 diabetes treated with MDI)	✓		✓
• Screen for OSA	✓	✓	✓
• Tobacco, alcohol, and substance use	✓		✓
Medications and vaccinations
• Current medication plan	✓	✓	✓
• Medication-taking behavior, including rationing of medications and/or medical equipment	✓	✓	✓
• Medication intolerance or side effects	✓	✓	✓
• Complementary and alternative medicine use	✓	✓	✓
• Vaccination history and needs	✓		✓
Technology use
• Assess use of health apps, online education, patient portals, etc.	✓	✓	✓
• Glucose monitoring (meter/CGM): results and data use	✓	✓	✓
• Review insulin pump settings and use and connected pen and glucose data	✓	✓	✓
Social life assessment
Social network
• Identify existing social supports	✓		✓
• Identify surrogate decision maker and advanced care plan	✓		✓
• Identify social determinants of health (e.g., food security, housing stability, transportation access, financial security, and community safety)	✓		✓
• Assess daily routine and environment, including school or work schedules and ability to engage in diabetes self-management	✓	✓	✓
Physical examination
• Height, weight, and BMI; growth and pubertal development in children and adolescents	✓	✓	✓
• Blood pressure determination	✓	✓	✓
• Orthostatic blood pressure measures (when indicated)	✓		✓
• Fundoscopic examination (refer to eye specialist)	✓		✓
• Thyroid palpation	✓		✓
• Skin examination (e.g., acanthosis nigricans, insulin injection or insertion sites, and lipodystrophy)	✓	✓	✓
• Comprehensive foot examination, determination of temperature, vibration or pinprick sensation, and 10-g monofilament exam	✓		✓
• Visual inspection (e.g., skin integrity, callous formation, foot deformity or ulcer, and toenails)*	✓	✓	✓
• Check pedal pulses and screen for PAD with ABI testing if a PAD diagnosis would change management	✓		✓
• Screen for depression, anxiety, diabetes distress, fear of hypoglycemia, and disordered eating	✓		✓
• Assessment for cognitive performance if indicated	✓		✓
• Assessment for functional performance if indicated	✓		✓
• Assessment for bone health (e.g., loss of height and kyphosis)	✓		✓
Laboratory evaluation
• A1C, if the results are not available within the past 3 months or if earlier assessment is necessary	✓	✓	✓
• Lipid profile, including total, LDL, and HDL cholesterol and triglycerides^‡	✓
• Liver function tests (i.e., FIB-4)^‡	✓		✓
• Spot urinary albumin-to-creatinine ratio	✓		✓
• Serum creatinine and estimated glomerular filtration rate^§	✓		✓
• Thyroid-stimulating hormone in people with type 1 diabetes^‡	✓		✓
• Celiac disease screening in people with type 1 diabetes^ǁ	✓
• Vitamin B12 if taking metformin for >5 years	✓		✓
• CBC with platelets	✓		✓
• Serum potassium levels in people treated with ACE inhibitors, ARBs, or diuretics^§	✓		✓
• Calcium, vitamin D, and phosphorous as appropriate	✓		✓

*Should be performed at every visit in people with diabetes with sensory loss, previous foot ulcers, or amputations.
^‡May also need to be checked after initiation or dose changes of medications that affect these laboratory values (i.e., diabetes medications, blood pressure medications, cholesterol medications, or thyroid medications).
^§May be needed more frequently in people with diabetes with known chronic kidney disease or with changes in medications that affect kidney function and serum potassium (see Link to 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026Table 11.2).
^ǁIn people with presence of gastrointestinal symptoms, signs, laboratory manifestations, or clinical suspicion suggestive of celiac disease.

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Table 8.2 Median Monthly (30-day) AWP and NADAC of Maximum or Maintenance Dose of Obesity Pharmacotherapies

Medication name	Typical adult maintenance dose	AWP (median and range for 30-day supply)	NADAC (median and range for 30-day supply)
Sympathomimetic amine anorectic: approved for short-term use only
Phentermine	8–37.5 mg daily	$43 ($3–$58)*	$2 ($2–$3)*
Lipase inhibitor
Orlistat	60 mg t.i.d. (OTC)	$58 ($41–$90)	NA
Orlistat	120 mg t.i.d. (Rx)	$675 ($520–$781)	$514 ($416–$611)
Sympathomimetic amine anorectic/antiepileptic combination
Phentermine/topiramate ER	7.5 mg/46 mg daily	$238 ($238–$251)	NA
Opioid antagonist/antidepressant combination
Naltrexone/bupropion ER	16 mg/180 mg b.i.d.	$750	NA
GLP-1 receptor agonist
Liraglutide	3 mg daily	$1,619	$1,303
Semaglutide	2.4 mg once weekly	$1,619	$1,302
Dual GIP and GLP-1 receptor agonist
Tirzepatide	5, 10, or 15 mg once weekly	$1,304**	$1,022

*Data are for 37.5 mg q.d. dose.
**Pricing listed for tirzepatide is for the pens only, not the cost of vials available from the manufacturer.

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Advocacy Statements
The following is a partial list of advocacy statements ordered by publication date, with the most recent statement appearing first. A comprehensive list of advocacy statements is available at Link to Key Statements and Reportsprofessional.diabetes.org/content/key-statements-and-reports.

Diabetes Care in the School Setting
A sizable portion of a child’s day is spent in school, so close communication with and training and cooperation of school personnel are essential to optimize diabetes management, safety, and access to all school-sponsored opportunities. Additionally, the statement further details optimal use of technologies, management of diabetes, behavioral health considerations, and guidance for diabetes care in special situations (e.g., emergency situations or clinical trial participation). Refer to the published ADA statement for diabetes management information for students with diabetes in elementary and secondary school settings (1).

Diabetes and Driving
People with diabetes who wish to operate on-road motor vehicles are subject to various licensing requirements applied by both state and federal jurisdictions. For an overview of existing licensing rules for people with diabetes, factors that impact driving for this population, diabetes technology use, and general guidelines for assessing driver fitness and determining appropriate licensing restrictions, refer to the published ADA statement (2).

Diabetes Management in Detention Facilities
People with diabetes who are in detention facilities deserve equitable care that meets national standards. As many facilities differ and have unique challenges, written policies and procedures are essential to create a solid foundation and infrastructure for diabetes management and the training of medical and security staff. Policies should address considerations such as security needs, transfers, access to medical personnel, needed supplies and equipment, and empowering diabetes self-management. For a comprehensive discussion on these considerations, refer to the published ADA statement (3).

Care of Young Children With Diabetes in the Childcare and Community Setting
Very young children (aged <5 years) with diabetes have legal protections and can be safely cared for by childcare professionals with appropriate training, access to resources, and a communication system with parents or guardians and the child’s diabetes health care professional. Refer to the published ADA advocacy statement for information on young children aged <5 years in settings such as childcare centers, preschools, camps, and other programs (4).

Insulin Access and Affordability
The ADA’s Insulin Access and Affordability Working Group compiled public information and convened a series of meetings with stakeholders throughout the insulin supply chain to learn how each entity affects the cost of insulin for the consumer. Their conclusions and recommendations are published in an ADA statement (5).

Diabetes and Employment
Any person with diabetes, whether insulin treated or noninsulin treated, should be eligible for any employment for which they are otherwise qualified. Employment decisions should never be based on generalizations or stereotypes regarding the effects of diabetes. For a general set of guidelines for evaluating individuals with diabetes for employment, including how an assessment should be performed and what changes (accommodations) in the workplace may be needed for an individual with diabetes, refer to the published ADA statement (6).

ADA Evidence Grading System

Category/Grade	Definition
A	Clear evidence from well-conducted, generalizable, randomized controlled trials that are adequately powered, including: Evidence from a well=conducted multicenter trial Evidence from a meta-analysis that incorporated quality ratings in the analysis Compelling nonexperimental evidence—ie, "all or none" rule developed by Center for Evidence Based Medicine at Oxford Supportive evidence from well-conducted randomized controlled trials that are adequately powered, including: Evidence from a well-conducted trial at one or more institutions Evidence from a meta-analysis that incorporated quality ratings in the analysis
B	Supportive evidence from well-conducted cohort studies Evidence from a well-conducted prospective cohort study or registry Evidence from a well-conducted meta-analysis of cohort studies Supportive evidence from a well-conducted case-control study
C	Supportive evidence from poorly controlled or uncontrolled studies Evidence from randomized clinical trials with one or more major or three or more minor methodological flaws that could invalidate the results Evidence from observational studies with high potential for bias (such as case series with comparison to historical controls) Evidence from case series or case reports Conflicting evidence with the weight of evidence supporting the recommendation
E	Expert consensus or clinical experience

From: http://professional.diabetes.org/nutrition

Document Overview

Document Title: Diabetes Standards of Care 2026

Authoring Society: American Diabetes Association

Document Publication Date: Dec 8, 2025

Page Last Reviewed/Updated: Apr 6, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: diabetesjournals.org/care/issue/49/Supplement_1

Source Citation: American Diabetes Association Professional Practice Committee for Diabetes* (2026). Introduction and Methodology: Standards of Care in Diabetes-2026. Diabetes care, 49(Supplement_1), S1–S5. https://doi.org/10.2337/dc26-SINT

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes,” referred to as the Standards of Care, is intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.

Scope: Assessment and Screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus

D003922 - Diabetes Mellitus, Type 1

D048909 - Diabetes Complications

D003924 - Diabetes Mellitus, Type 2

D016640 - Diabetes, Gestational

Keywords: diabetes, diabetes complications, diabetes mellitus, gestational diabetes

Target Patient Population: Patients with diabetes

Target Provider Population: Providers caring for patients with diabetes

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Home Health, Hospital, Outpatient, School

Intended Users: Diabetes Educator, Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Index

Diabetes Standards of Care 2026

Improving Care and Promoting Health in Populations

Systems to Support Diabetes Population Health

Tailoring Treatment for Social Context

Diagnosis and Classification of Diabetes

Diagnostic Tests for Diabetes

Use of A1C for Screening and Diagnosis of Diabetes

Classification

Figure 2.1 Flowchart for Investigation of Suspected Type 1 Diabetes in Newly Diagnosed Adults, Based on Data from White European Populations

Type 1 Diabetes

Prediabetes and Type 2 Diabetes

Figure 2.2 ADA Risk Test

Diabetes Induced by Systemic Anti-Cancer Therapy

Pancreatic Diabetes or Diabetes in the Context of Disease of the Exocrine Pancreas

Cystic Fibrosis–Related Diabetes

Posttransplantation Diabetes Mellitus

Monogenic Diabetes Syndromes

Gestational Diabetes Mellitus

Prevention or Delay of Diabetes and Associated Comorbidities

Lifestyle Behavior Change for Type 2 Diabetes Prevention

Pharmacologic Interventions to Delay Type 2 Diabetes

Prevention of Vascular Disease and Mortality

Person-Centered Care Goals

Prevention or Delay of Symptomatic Type 1 Diabetes

Pharmacologic Interventions to Delay Symptomatic Type 1 Diabetes

Comprehensive Medical Evaluation and Assessment of Comorbidities

Person-Centered Collaborative Care

Figure 4.1 Decision Cycle for Person-Centered Glycemic Management in Type 2 Diabetes

Comprehensive Medical Evaluation

Table 4.1 Components of the Comprehensive Diabetes Medical Evaluation at Initial, Follow-up, and Annual visits

Immunizations

Assessment of Comorbidities

Autoimmune Diseases

Bone Health

Cognitive Impairment/Dementia

Dental Care

Disability

Sexual Health in Men

Sexual Health in Women

Metabolic Dysfunction–Associated Steatotic Liver Disease and Metabolic Dysfunction–Associated Steatohepatitis Screening

Screening

Figure 4.2 Diagnostic Algorithm for Risk Stratification and the Prevention of Cirrhosis in Individuals with Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD)

Management

Figure 4.3 Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) Treatment Algorithm

Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes

Diabetes Self-Management Education and Support

Medical Nutrition Therapy

Nonreligious Fasting

Figure 5.1 Differences and Similarities of Religious and Intermittent Fasting for People with Diabetes

Religious Fasting

Physical Activity

Figure 5.2 Importance of 24-h Physical Behaviors for Type 2 Diabetes

Smoking Cessation: Tobacco, E-Cigarettes, and Cannabis

Psychosocial Care

Diabetes Distress

Anxiety

Depression

Disordered Eating Behavior

Serious Mental Illness

Cognitive Capacity and Impairment

Sleep Health

Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises

Assessment of Glycemic Status

Glycemic Goals

Figure 6.1 Individualized A1C and CGM Goals for Nonpregnant Adults

Hypoglycemia Assessment, Prevention, and Treatment

Hyperglycemic Crises: Diagnosis, Management, and Prevention

Diabetes Technology

General Device Principles

Blood Glucose Monitoring

Continuous Glucose Monitoring Devices

Insulin Delivery

Insulin Pumps and Automated Insulin Delivery Systems

Open-Source Automated Insulin Dosing

Obesity and Weight Management for the Prevention and Treatment of Diabetes

Assessment and Monitoring of the Individual With Overweight or Obesity

Nutrition, Physical Activity, and Behavioral Therapy Interventions

Pharmacotherapy

Table 8.2 Median Monthly (30-day) AWP and NADAC of Maximum or Maintenance Dose of Obesity Pharmacotherapies

Metabolic Surgery