Summary

The ADA Standards of Care in Diabetes—2026 is the annually updated, comprehensive clinical practice guideline covering screening, diagnosis, prevention, and management of type 1, type 2, gestational, and other forms of diabetes across the lifespan, along with associated complications and comorbidities. It is a “living document” with interim online updates triggered by new evidence or regulatory changes. New for 2026: the National Kidney Foundation endorsed the CKD section and ISPAD endorsed the Children and Adolescents section, joining prior endorsements from ACC, AGS, ASBMR, and TOS. This introductory section describes scope, methodology, evidence grading, and conflict-of-interest policies rather than specific clinical recommendations.

Key Recommendations

Use the ADA Standards of Care as the reference framework for diabetes screening, diagnosis, treatment goals, and complication management across all ages and diabetes types.
Interpret recommendation grades as reflecting strength of evidence (A, B, C, E) rather than strength of recommendation, with A indicating well-conducted RCT evidence and E indicating expert consensus.
Apply A-level recommendations as the highest-confidence guidance, while recognizing lower-grade recommendations may still be clinically important.
Individualize all recommendations to patient comorbidities, age, disability, values, and preferences rather than applying them rigidly to populations.
Consult the ADA living standards online (professional.diabetes.org/standards-of-care) for interim updates reflecting new drug approvals, label changes, or evidence.
Use section-specific endorsements as quality signals: ACC for CV disease (Sec 10), NKF for CKD (Sec 11, new), AGS for older adults (Sec 13), ISPAD for pediatrics (Sec 14, new), TOS for obesity (Sec 8), ASBMR for bone health (Sec 4).
Recognize that ADA consensus reports, scientific reviews, and ADA statements are distinct from the Standards of Care and do not constitute official ADA clinical practice recommendations.

Thresholds & Doses

80% PPC consensus required to approve any Standards of Care recommendation
Literature search window for 2026 edition: 1 June 2024 to 18 July 2025 (PubMed, Medline, EMBASE, English-language only)
Age strata used throughout the guideline: children birth–11 years, adolescents 12–17 years, adults 18–64 years, older adults ≥65 years
Conflict-of-interest disclosure window: 1 year prior to PPC appointment through publication; PPC chairs must remain unconflicted for 1 year post-publication

Citations

Scope of the Guidelines — age strata and diabetes types covered
Methodology and Procedure — systematic review process and search dates
Table 1, ADA evidence-grading system — definitions of A, B, C, E levels
Evidence to Recommendations — 80% PPC consensus voting threshold
Intended Audience and Endorsements — new NKF and ISPAD endorsements for 2026
Revision Process — public comment, peer review, and live updates
Grading of Evidence and Recommendation Development — grades reflect evidence strength, not recommendation strength