ADA/EASD 2026 consensus on type 2 diabetes
SGLT2 inhibitor and/or GLP-1-based therapy potentially from diagnosis, metformin no longer the mandatory first step, weight as essential as glucose, finerenone as the third layer in albuminuric CKD
The final ADA/EASD consensus report on the management of type 2 diabetes, 2026, presented at EASD 2026 in Milan by Melanie Davies and John Buse and published open access in Diabetologia and Diabetes Care. The focus has broadened from hyperglycaemia to holistic management with weight, blood pressure, lipids and direct heart, kidney and liver protection. Key statements: earlier use, potentially from diagnosis, of an SGLT2 inhibitor and/or GLP-1-based therapy (including tirzepatide) in most people, independent of metformin and HbA1c; early combination in people with CVD, CKD or heart failure; weight targets as essential as glycaemic targets, with weight-lowering agents preferred and metabolic surgery considered; SGLT2 inhibitors as the foundation for heart failure and CKD protection, GLP-1-based therapy added for MACE, kidney and weight, and finerenone added in albuminuric CKD (UACR above 3 mg/mmol); semaglutide or tirzepatide in obesity-related HFpEF; MASLD screening and GLP-1-based therapy; basal insulin usually after GLP-1-based therapy; CGM considered, especially on insulin; deprescribing sulfonylureas in frailty; and a chapter on equitable access. Lower certainty in people with risk factors only. A wide gap with the current Dutch GP standard.
