What’s New in T1D Care? The 2026 ADA/EASD Consensus
Richard I.G. Holt,J. Hans DeVries, Amy Hess-Fischl, Irl B. Hirsch, M. Sue Kirkman, Tomasz Klupa, Barbara Ludwig, Kirsten Nørgaard, Jeremy Pettus, Eric Renard, Jay S. Skyler, Frank J. Snoek, Ruth S. Weinstock and Anne L. Peters
The Management of Type 1 Diabetes in Adults. The Updated 2026 Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2026 Sep 16. Online ahead of print.
Managing type 1 diabetes (T1D) is changing rapidly. Advances in glucose monitoring, automated insulin delivery, new therapies and a growing focus on cardiovascular health, psychological well-being and individual preferences are reshaping what optimal diabetes care looks like. In 2021, the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) published their landmark consensus report on the management of T1D in adults. The updated 2026 consensus report incorporates new evidence and developments in clinical practice and provides comprehensive guidance for personalised T1D care. The update places particular emphasis on diabetes technology, while also expanding its scope to early-stage T1D, long-term complications, obesity and cardiovascular risk. Diabetes self-management education and support (DSMES) and psychosocial care remain central components of treatment.
KEY FINDINGS
- CGM and automated insulin delivery have become central to T1D management:
Continuous glucose monitoring (CGM) is the preferred method for glucose monitoring in adults with T1D, while automated insulin delivery (AID) systems are considered the optimal method of insulin delivery when they can be used consistently. At the same time, treatment choices should remain personalised and take individual preferences, capabilities and circumstances into account.
- Accurate diagnosis of T1D in adults remains essential: Adult-onset T1D can be mistaken for type 2 diabetes. The updated report recommends combining clinical characteristics with islet autoantibody testing and, when needed, C-peptide measurement. No single clinical feature or biomarker is sufficient in all cases.
- T1D is increasingly viewed as a disease continuum: The report distinguishes three stages, from islet autoimmunity with normal glucose levels (stage 1), through dysglycaemia (stage 2), to clinical T1D (stage 3). Earlier identification creates opportunities for monitoring and potentially delaying progression. Teplizumab, an anti-CD3 antibody, is highlighted as a therapy that can delay the onset of stage 3 T1D in people with stage 2 disease.
- Good T1D care is about more than glucose: Optimising glucose levels remains fundamental to preventing acute and long-term complications, but the report emphasises that care should also address cardiovascular risk, psychological well-being, treatment satisfaction and quality of life. Person-centred care and shared decision-making are key principles.
- Education and psychosocial support remain essential, even as technology advances:
DSMES is recommended for everyone with T1D and should not be a one-time intervention. It should be revisited throughout life, including at diagnosis, when treatment targets are not met, during major transitions and when complications develop. Education should address both practical diabetes management and the psychosocial aspects of living with T1D.
- The scope of T1D management has broadened: The updated report gives greater attention to screening and management of long-term complications, cardiovascular risk factors and obesity. It also covers specific situations and populations, including physical activity, older adults, pregnancy and inpatient care.
A central message throughout the report is that advances in technology should go hand in hand with personalised, multidisciplinary care. The overview on page 1 illustrates this clearly: CGM, AID and analysis of device data are integrated with diabetes education, complication screening and attention to psychosocial needs, with all treatment depending on the individual’s preferences, capabilities and circumstances.
The update also reflects how the goals of T1D treatment are evolving. The aim is not simply to achieve glycaemic targets, but to support people with T1D in living a long and healthy life while minimising hypoglycaemia, cardiovascular risk and the psychosocial burden of diabetes.
CONCLUDING THE AUTHORS STATE
“The guidance aligns with the current ADA ‘Standards of Care in Diabetes’ (Standards of Care) and relevant EASD and ADA documents and aims to support clinicians globally in delivering high-quality, personalized care for adults with type 1 diabetes, with recommendations that can be adapted across diverse health care systems and resource settings.”
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