The newly released 2026 ADA/EASD Consensus Report on Management of Type 2 Diabetes, published on October 2, represents an important evolution in the management of type 2 diabetes, expanding the focus beyond hyperglycemia to a more holistic approach that addresses the multiple long-term conditions associated with diabetes.
This forward thinking document reinforces healthy lifestyle behaviors as the foundation of care, including nutritious eating, physical activity, movement, adequate sleep, and avoidance of tobacco and harmful substance use.
Author: Beverly Thomassian, RN, MPH, CDCES, BC-ADM
CEO: DiabetesEd Services
Just as importantly, the report emphasizes psychological well-being, weight management, and individualized medication management as essential components of comprehensive diabetes care. Referral for DSMES and MNT are recognized as a critical component of effective diabetes treatment.
One of the most significant updates is the recommendation to consider earlier use—potentially beginning at diagnosis—of SGLT2 inhibitors and/or GLP-1–based therapies when appropriate. Rather than viewing these medications solely as glucose-lowering agents, the consensus highlights their role in organ protection and improving long-term outcomes for people with type 2 diabetes.
Perhaps the most encouraging message is that many of the tools needed to dramatically improve outcomes for people with type 2 diabetes are already available to us. The challenge and opportunity for diabetes healthcare professionals is to advocate and implement these evidence-based strategies consistently, systematically, and equitably so that everyone living with diabetes has the opportunity to benefit.
7 Takeaways Diabetes Healthcare Professionals Need to Know
As you read the full 2026 ADA/EASD Consensus Report yourself, do you think these are the major takeaways, or would you choose different areas to emphasize from the report?
1. Think beyond A1C: treat the whole person and protect organs early.
Perhaps the biggest philosophical shift is that type 2 diabetes management is no longer primarily about getting glucose to target. The goals are preventing complications and optimizing quality of life across the lifespan. The new framework integrates glucose and weight management with cardiovascular, kidney, liver, psychological, behavioral, and social health.
For diabetes healthcare professionals, this reinforces the importance of asking not simply, “What is the A1C?” but “What are this person’s greatest health risks, needs, and priorities?”
2. Lifestyle counseling gets a memorable upgrade: the “5 S's.”
I love this emphasis on supporting behavior change. The report introduces a 24-hour behavioral framework built around Standing, Stepping, Sweating, Strengthening, and Sleep. Instead of focusing only on structured exercise, clinicians are encouraged to address prolonged sitting, everyday movement, aerobic activity, resistance training, and sleep quality, quantity, and timing.
The report recommends at least 150 minutes per week of moderate-to-vigorous aerobic activity—or 75 minutes vigorous—plus resistance exercise 2–3 times weekly. It also emphasizes breaking up prolonged sitting and recognizes sleep as an integral part of metabolic health.
3. Choice of glucose-lowering medication – Keep it Individualized
The 2026 Consensus Report emphasizes a more individualized and proactive approach to medication management. Medication selection needs to consider the whole person, including weight goals, sarcopenia, other chronic conditions, potential adverse effects, personal circumstances, and individual preferences.
Along with DSMES, meeting with a RDN and healthy lifestyle recommendations, most people with type 2 diabetes may benefit from the early introduction of an SGLT2 inhibitor and/or GLP-1–based therapy, potentially starting at diagnosis.
When insulin is clinically indicated, the report recommends generally starting with basal insulin, usually after GLP-1–based therapy, while continuing other beneficial glucose-lowering medications, particularly cardio-kidney protective agents such as SGLT2 inhibitors. At the same time, more treatment isn’t always better. For people experiencing frailty, medications associated with hypoglycemia—especially sulfonylureas—should be reassessed and potentially de-intensified.
Finally, when hyperglycemia remains difficult to manage despite multiple guideline-directed therapies, the report reminds us to step back and consider whether something else may be contributing. Targeted screening for secondary causes of hyperglycemia, such as hypercortisolism, may be appropriate in people with treatment-resistant type 2 diabetes.
The overarching message is clear: choose therapies earlier and thoughtfully, protect the heart and kidneys, minimize hypoglycemia, and continually individualize treatment as a person’s needs and circumstances change.
4. Recognition of Treatment Behaviours and Persistence – A look at the Why
Nearly half of people with type 2 diabetes experience challenges taking medications consistently or continuing their treatment plan over time.
But rather than labeling someone as “nonadherent,” the 2026 Consensus Report encourages us to look deeper and ask, “What is getting in the way?” There are many reasons a person may decide not to take a medication as prescribed, including side effects, fear of hypoglycemia, medication costs or lack of access, concerns that the medication isn’t working, or simply finding that the treatment plan doesn’t fit into their daily life.
As diabetes healthcare professionals, we can consider asking, “What makes it difficult for you to take this medication?” or “How is this treatment plan working for you?” These questions create space for honest conversations without blame or judgment.
The report also reminds us to identify what helps people succeed. Family and social support, a trusting relationship with the healthcare team, diabetes education, motivation, affordable access to medications and healthy foods, and honoring individual preferences can all support consistent medication use.
This section reminds us that before adding another medication or intensifying therapy, explore whether the person believes in and feels safe with the current treatment plan. Sometimes the most effective intervention isn’t another prescription—it’s listening, identifying the barrier, and working together to find a solution that fits the person’s life.
5. Make Sure We Have the Right Diagnosis
Before developing or intensifying a treatment plan, it is essential to confirm that we are treating the right type of diabetes.
The 2026 Consensus Report reminds healthcare professionals that diabetes is heterogeneous and that accurate classification is essential to selecting appropriate therapy. Not every adult presenting with hyperglycemia has type 2 diabetes. When the clinical picture doesn’t quite fit—such as unexpected weight loss, ketosis, rapid progression to insulin dependence, treatment-resistant hyperglycemia, a strong multigenerational family history, pancreatic disease, or other atypical features—consider whether another form or secondary cause of diabetes may be present.
Before simply adding another medication, pause and ask: Are we sure this is type 2 diabetes? Getting the diagnosis right is the first step toward getting the treatment right.
6. Don't forget the liver—and other diabetes-associated conditions.
The report greatly expands the concept of diabetes-associated multiple long-term conditions. MASLD deserves particular attention: the authors report that it affects more than 70% of people with type 2 diabetes, with more than half developing MASH.
Management needs to integrate metabolic, cardiovascular, kidney, and liver health. Pharmacologic therapy is highlighted for people with MASLD and MASH as listed below:
- For people with obesity, type 2 diabetes and MASLD, a GLP-1-based therapy with proven benefit should be used.
- For people with diabetes and biopsy-proven MASH, a GLP-1-based therapy with proven benefit should be preferred. Pioglitazone or tirzepatide could also be used.
- Combination regimens with pioglitazone and GLP-1-based therapy should be considered for enhanced effect, while treatment with other glucose-lowering agents can be continued as indicated.
In addition, lifestyle intervention, physical activity, and appropriate weight management remain foundational. The broader message is important: today’s diabetes visit encourages us to think beyond the traditional microvascular complications to the heart, kidneys, liver, body composition, sleep, mental health, and overall quality of life.
7. DSMES and Nutrition Therapy: Essential, Not Optional
The 2026 ADA/EASD Consensus Report reinforces the essential role of Diabetes Self-Management Education and Support (DSMES), stating that DSMES is as important to the management of type 2 diabetes as the selection of medication. DSMES, offered on an ongoing basis and provided by trained diabetes care and education specialists, helps people develop the knowledge and skills needed to navigate nutrition, medications, glucose monitoring, healthy behaviors, and prevention of diabetes-related complications.
The report also recommends that all people with type 2 diabetes be offered Medical Nutrition Therapy (MNT) with an individualized eating plan that considers food quality, eating patterns, cultural preferences, clinical goals, and what is realistic and sustainable for that person.
The role of the registered dietitian nutritionist (RDN) is especially important as GLP-1–based therapies become more widely used. The consensus specifically highlights the importance of integrated dietitian-led care for people using these therapies to help maintain nutritional quality, ensure adequate protein intake, and reduce the risk of nutritional deficiencies and loss of lean muscle mass during significant weight loss. Rather than viewing DSMES and nutrition counseling as optional additions to pharmacotherapy, the 2026 report places them where they belong: at the foundation of comprehensive, person-centered type 2 diabetes care.
Coach Beverly's Bottom Line
The 2026 ADA/EASD report represents an important evolution from a traditional “glucose-first” mindset toward proactive, person-centered, organ-protective diabetes care. And that puts diabetes healthcare professionals in an especially important position. DSMES, MNT, shared decision-making, addressing diabetes distress, medication education, technology, psychosocial support, and social determinants aren’t extras surrounding pharmacotherapy—they are integral pieces of effective diabetes care.
Image from 2026 ADA/EASD Consensus Report
Image from 2026 ADA/EASD Consensus Report
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Founder: DiabetesEd Services
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Coach Beverly and Diana Isaacs, PharmD, BC-ADM, CDCES co-lead an exciting day that brings the ADA and AACE Standards to life. Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. After attending, you will be empowered to share the latest in diabetes care with your colleagues and the people in your care.
Day 2 – Insulin, Tech, MNT and Case Studies
Take your knowledge to the next level with this intensive deep-dive into insulin therapy, dosing and pattern management with Dr. Diana Isaacs. Next, stay for the diabetes tech show-and-tell as Diana demonstrates the specs of the latest pumps and sensors. After lunch, nutrition whiz Christine Craig, MS, RDN, CDCES expertly details the latest in MNT and provides real strategies on translating this content to your clinical practice. You will have a chance to put it all together as Coach Beverly leads you through a series of case studies that integrates content from Day 1 and Day 2.
Add-On Day 3 – Engaging the Disengaged
On Saturday, join this exceptional day-long program led by William H. Polonsky, PhD, CDCES & Susan Guzman, PhD (Behavioral Diabetes Institute) that reveals psychosocial forces behind diabetes self-management — tools to break through resistance and inspire change.
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Strategies for Promoting Behavior Change in Diabetes
October 24, 2026
Transform how you engage patients with diabetes — master behavior change, reduce distress, and overcome medication hesitancy.
Why do so many patients know what they should do — but still struggle to do it?
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In this transformative full-day course, world-renowned experts William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD, from the Behavioral Diabetes Institute reveal the hidden psychosocial forces that drive — or derail — diabetes self-management.
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