In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, review key therapy-focused updates from the 2026 ADA Standards of Care, emphasizing areas they view as practice-changing. They begin with updates in heart failure management, highlighting the formal inclusion in the treatment algorithm of GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, alongside SGLT2 inhibitors, for patients with symptomatic heart failure with preserved ejection fraction and obesity. Both hosts stress that placement within the algorithm, rather than narrative recommendations alone, is likely to meaningfully shift clinician behavior.
00:00:01 Intro
00:00:29 Adding GLP-1 RAs to heart failure
00:02:45 GLP-1s in glycemic management
00:04:36 Time in range targets in glycemic management
00:08:10 ADA recommends GLP-1s for T1D
00:12:00 GLP-1s in MASH and MASLD
00:12:57 Changes in kidney protection guidelines
00:14:40 New therapeutic guidance for T1D and T2D
00:17:57 Outro
The discussion then turns to advanced chronic kidney disease, where the Standards now recommend GLP-1 receptor agonists as preferred glucose-lowering therapy for adults with type 2 diabetes and eGFR <30 mL/min/1.73 m², including those approaching or receiving dialysis. Isaacs and Bellini underscore the importance of this guidance in moving practice away from reflexive insulin use, citing lower hypoglycemia risk and established cardiovascular benefit as key advantages.
They also highlight updates to glycemic targets, particularly the integration of continuous glucose monitoring–based time-in-range goals alongside A1C targets across varying levels of health status and life expectancy. The hosts emphasize that this addition both normalizes CGM use and encourages more data-driven, patient-centered clinical conversations, especially in older adults and those with complex comorbidities.
A major point of enthusiasm is the first-time recommendation to consider GLP-1 receptor agonists in individuals with type 1 diabetes and obesity. While acknowledging limitations related to BMI thresholds and the absence of cardiovascular outcomes data in type 1 diabetes, the hosts frame this as an important initial step that reflects growing clinical experience and trial evidence for weight, glycemic variability, and insulin-sparing benefits.
The episode also reviews expanded guidance on metabolic dysfunction–associated steatotic liver disease (MASLD/MASH), kidney protection strategies, and cardiovascular risk reduction, including updated monitoring recommendations, blood pressure targets, and the continued emphasis on SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists such as finerenone. The hosts praise the increasingly clear algorithms and visual tools designed to support real-world decision-making across primary and specialty care.
They conclude by encouraging clinicians to engage with the ADA Standards through multiple formats - including the abridged version and mobile app - and to view the guidelines as a living framework to support comprehensive, proactive diabetes care.
