2026 ADA and EASD Guidelines for Adult Type 1 Diabetes Management

Updating Adult Type 1 Diabetes Standards

The updated guidance appears in both the American Diabetes Association journal Diabetes Care and the European Association for the Study of Diabetes publication Diabetologia. Writing panel co-chair Anne L. Peters explained the primary focus of the new document. The biggest change is on how to diagnose new-onset type 1 diabetes in adults. It isn’t always straightforward, so we attempted to provide clearer guidance, Peters told Medscape Medical News. Nicholas B. Argento, director of diabetes technology at Maryland Endocrine and Diabetes in Columbia, told Medscape Medical News, I applaud this effort to update the adult T1D guidelines. It is thorough, well balanced, and will be a great read for anyone who sees those with T1D, Argento said.

Refining Diagnostic Criteria and C-Peptide Testing

Adult-onset type 1 diabetes is frequently misdiagnosed as type 2 diabetes during initial presentation. We talk more about C-peptide testing in the new guidelines than we did before, Peters noted. I look at it clinically — is this person making insulin or not? All people with type 1 diabetes and insulin-deficient people with type 2 diabetes could benefit from automated insulin delivery systems and also from SGLT2 inhibitors or GLP-1-based therapies. Argento noted that the graphic flow sheet was well put together, though he cautioned that measuring islet autoantibodies requires careful interpretation because low-grade positive results can still occur in patients with type 2 diabetes. C-peptide levels can yield misleading readings if checked too early in the disease course when they may still register as normal or low-normal, or when elevated by severe renal disease.

Retiring the Term Latent Autoimmune Diabetes in Adults

The updated document officially discourages use of the term latent autoimmune diabetes in adults, which clinicians often invoke to describe slower-onset type 1 diabetes occurring later in life. The report authors wrote that the term represents a controversial concept lacking universally accepted diagnostic criteria alongside considerable clinical heterogeneity. It is not a specific subtype. It is type 1 by definition because it’s autoimmune, Peters stated. Argento supported that position, noting that relying on the designation contributes to confusion rather than clarity in clinical settings.

Expanding Complications Screening and Cardiovascular Care

Beyond diagnostics, the 2026 report incorporates three new sections requested by clinicians covering microvascular complications screening, cardiovascular risk management, and obesity management. While insulin dosing specifics remain unchanged from the 2021 framework, the panel revised sections addressing psychosocial care, diabetes self-management education, exercise, and nutrition. Argento endorsed the addition of vascular screening and cardiovascular risk strategies, emphasizing that cardiovascular disease remains the leading cause of death in individuals with type 1 diabetes despite frequently going underappreciated. He also welcomed structured guidance for managing obesity within this patient population.