ADA and EASD 2026 consensus: earlier SGLT2 inhibitor and/or GLP-1-based therapy in type 2 diabetes

The study

This is a consensus report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), published in Diabetologia. It updates the 2022 statement on managing type 2 diabetes in non-pregnant adults. The series has been published since 2006.

The new recommendations were informed by a systematic examination of publications since 2022. The stated audience is the multidisciplinary healthcare team providing diabetes care in the USA and Europe.

What they found

This is a guidance document, so it reports recommendations and not trial results. The abstract gives no numbers on effect sizes.

The main messages are:

• The focus is broader. It moves from managing hyperglycaemia to holistic management of type 2 diabetes and its risk of associated multiple long-term conditions.
• Fundamental care includes healthy lifestyle behaviours: healthy eating, 24 h physical behaviours including sleep, and avoiding tobacco and substance use. It also includes psychological support and weight management interventions.
• Earlier use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or/and glucagon-like peptide-1 (GLP-1)-based therapies is advocated, potentially from diagnosis. The stated purpose is to offer organ protection and improve long-term outcomes.
• Earlier combination of SGLT2 inhibitors and GLP-1-based therapies should be considered in people with concomitant CVD, chronic kidney disease and heart failure.

The authors conclude that transforming outcomes is "within our grasp" through consistent, equitable and systematic implementation of strategies and therapies that are already available.

How much weight to give it

The authors call this a consensus report. It reflects expert agreement, informed by a systematic examination of publications since 2022. It is not a new trial or a new analysis of patient data.

The abstract does not report how the evidence was graded, how the panel reached agreement, or how the recommendations were rated. It also does not report funding or conflicts of interest. Readers should check the full report for these details before judging the strength of each recommendation.

The abstract says the aim of earlier treatment is organ protection and better long-term outcomes. It does not say which organs or which outcomes, and it does not say how strong the supporting evidence is for each patient group. The document is written for care in the USA and Europe. The abstract does not discuss other health systems, local costs or access.

For your clinic

The update frames type 2 diabetes care more broadly than glucose control. It stresses the risk of associated multiple long-term conditions. Lifestyle support, psychological support and weight management are described as fundamental aspects of care.

The advice to consider earlier use of SGLT2 inhibitors or/and GLP-1-based therapies, and earlier combination use in people with CVD, chronic kidney disease and heart failure, is worth noting. Before changing local practice, read the full report. Check which patients the earlier-use advice applies to, how strong the evidence is for each recommendation, and how the advice fits Indian guidelines.