Type 2 diabetes
Also known as: adult-onset diabetes · DM2 · T2D · T2DM
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Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026 (Section 9)
American Diabetes Association (ADA) · 2026
The ADA updates its Standards of Care annually; this section presents the current algorithm for choosing glucose-lowering medication in type 2 diabetes, weighing cardiovascular and kidney protection alongside glycaemic targets.
Management of Hyperglycaemia in Type 2 Diabetes, 2022: A Consensus Report by the ADA and EASD
EASD (joint consensus with ADA) · 2022
This joint ADA/EASD consensus report describes a holistic, person-centred approach to managing high blood glucose in adults with type 2 diabetes, integrating weight management and cardiorenal risk reduction.
- The report gives greater emphasis to weight management and to social determinants of health, sleep and physical activity than earlier versions. source
- It incorporates cardiovascular and kidney outcome trial evidence for SGLT2 inhibitors and GLP-1 receptor agonists in people at high cardiorenal risk. source
US vs EU key differences
- Notable convergence rather than divergence: the European reference document is itself a joint ADA–EASD consensus, so the US and EU positions on comorbidity-driven drug selection were written by a shared panel. source
- Metformin's status was loosened in the 2022 joint consensus: it is described as traditionally first-line while accepting that other approaches may be appropriate, since GLP-1 receptor agonists and SGLT2 inhibitors deliver cardiovascular and kidney benefit independent of metformin use. source
- The 2022 consensus splits the two protective classes by outcome: SGLT2 inhibitors are favoured for heart failure and kidney endpoints, GLP-1 receptor agonists for stroke reduction, with neither class superior for mortality. source
- Currency gap of four years: the 2026 US standards add recommendations the 2022 consensus could not contain, including GIP/GLP-1 receptor agonist use in type 2 diabetes with obesity and symptomatic HFpEF irrespective of HbA1c. source
What changed recently
- US2025 → 20262026-01-01
The 2026 edition added a recommendation to use a dual GIP/GLP-1 receptor agonist in type 2 diabetes with symptomatic heart failure with preserved ejection fraction, and reworked the MASLD/MASH guidance so a GLP-1 RA with proven hepatic benefit is preferred, with pioglitazone or a dual GIP/GLP-1 RA as alternatives. Guidance on continuing GLP-1-based therapy in advanced chronic kidney disease was also expanded.
- EU2018 → 20222022-09-23
The 2022 consensus report replaced the 2018 report and its 2019 update, raising weight management to equal standing with glycaemic control in the treatment algorithm and recommending SGLT2 inhibitors or GLP-1 receptor agonists for cardiorenal protection independent of HbA1c or metformin use. It also added explicit attention to social determinants of health, health system factors, sleep and physical activity.
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