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News
The American Diabetes Association and the European Association for the Study of Diabetes have released a major updated joint consensus on type 2 diabetes (T2D) management, calling for earlier use of SGLT2 inhibitors and GLP-1-based therapies — potentially from the time of diagnosis. The guidance shifts focus from simply controlling blood sugar to holistically managing long-term complications. Access and affordability, however, remain significant real-world barriers.
The ADA and EASD have jointly released a sweeping update to their T2D management consensus — the first since 2022 — presented at the EASD 2026 Annual Meeting in Milan. The new guidance moves well beyond blood sugar control, advocating for a holistic approach that addresses cardiovascular disease, chronic kidney disease (CKD), heart failure, liver disease, and sleep apnea as part of integrated diabetes care. Crucially, it recommends starting SGLT2 inhibitors and/or GLP-1-based therapies early — potentially at diagnosis — to protect organs and improve long-term outcomes.
For patients with established CVD, CKD, or heart failure, the guidance now recommends combination therapy with both drug classes. New additions include semaglutide or tirzepatide for obesity-related heart failure with preserved ejection fraction, nonsteroidal mineralocorticoid receptor antagonists for specific kidney and heart failure profiles, and a brand-new section on metabolic liver disease (MASLD/MASH). Meanwhile, the SMARTEST trial — presented alongside the consensus — found that dapagliflozin was not superior to metformin in uncomplicated T2D, raising questions about how broadly the new recommendations should apply.
Key Takeaways:
Why it matters: This consensus reframes T2D care as a multi-organ disease requiring proactive, combination therapy — not just glucose management. But with SGLT2 inhibitors and GLP-1s carrying steep price tags, equitable access remains a critical unresolved challenge, especially in the US.
