The rapid evolution of diabetes technology is continuing to reshape patient care, with advances in automated insulin delivery (AID), continuous glucose monitoring (CGM), and emerging cell-based therapies offering new possibilities for people living with diabetes.
Speaking with HCPLive at the 86th Scientific Sessions of the American Diabetes Association (ADA 2026) in New Orleans, Louisiana, Rachael Sood, NP, The Diabetes Collective, highlighted automated insulin delivery (AID) as the single most transformative advancement in diabetes management — a view now codified in the 2026 ADA Standards of Care, which formally designate AID as the preferred approach to insulin delivery in both type 1 and type 2 diabetes.
Key Points
- The 2026 ADA Standards of Care designate AID as the preferred insulin delivery method for type 1 and type 2 diabetes, removing prior eligibility barriers.
- Insulet's Omnipod 5 update, announced at ADA 2026, introduces a 100 mg/dL target glucose floor and Libre 3 Plus compatibility.
- Continuous ketone monitoring is gaining consensus support as a tool for earlier DKA detection, including euglycemic DKA tied to SGLT2 inhibitor use.
- Structural barriers — insurance gaps, DME confusion, cost — remain the primary obstacles to AID adoption.
- Cell-based and immunomodulatory therapies are advancing a disease-modification pipeline Sood described as approaching clinical prescribability within a decade.
The 2026 guidelines also eliminate prior requirements for AID initiation in type 1 diabetes, such as minimum C-peptide levels and the presence of islet autoantibodies, changes designed to expand access and support individualized care. Announced simultaneously with ADA 2026, Insulet Corporation also unveiled a significant update to Omnipod 5, including expanded CGM compatibility and algorithm enhancements, reinforcing a week defined by accelerating convergence across device platforms.
Sood identified the growing interoperability of AID systems and CGMs as the most clinically meaningful shift for patients. No longer constrained to single-brand pairings, clinicians can now match pumps and sensors to individual patient preferences.
"We're seeing different brands integrate with different brand pumps," Sood said. "Not every pump is for every patient, and it's fine, because everybody has a choice now of what works for them."
Among the technology updates highlighted at ADA 2026, Sood pointed to Omnipod 5 enhancements as particularly noteworthy. Insulet characterized the update as the most significant algorithm advancement since the system's 2022 launch, following FDA 510(k) clearance in December 2025. The update introduces a new 100 mg/dL target glucose option, expanding available settings to six across a range of 100 to 150 mg/dL.
Omnipod 5 is now also compatible with Abbott's Libre 3 Plus sensor in the US, allowing caregivers to follow patients through Abbott's LibreLinkUp app, the first time Insulet's tubeless system has integrated with the Abbott ecosystem.
While the 10 mg/dL reduction from the prior 110 mg/dL floor may appear modest, the clinical implications extend well beyond the numerical shift. Real-world evidence cited by Insulet shows lowering the target glucose increases time in range without a clinically meaningful rise in time below range. The enhanced algorithm is also designed to reduce automated-mode interruptions during prolonged hyperglycemia, keeping more patients in closed-loop control throughout the day.
Looking ahead, Sood identified dual glucose-ketone monitoring as among the most clinically significant near-term developments.
"We want to prevent people from going into DKA, we want to prevent hospitalization," Sood said. "The glucose ketone monitor I would say is number one."
A 2026 international expert consensus published in The Lancet Diabetes & Endocrinology identified continuous ketone monitoring (CKM) as having the potential to reduce DKA risk and noted the increasing occurrence of euglycemic DKA as making CKM an important addition to the diabetes management toolkit. Data from dual glucose-ketone monitoring systems reveal significant variability in how glucose and ketone levels interact, with investigators suggesting continuous ketone data could shift management paradigms by incorporating dynamic factors such as rate of change and duration of ketone elevation, enabling earlier detection and intervention.
Sood also described growing momentum around dual-hormone closed-loop systems combining insulin and glucagon delivery, noting early data have been presented at international meetings and are expected to receive additional attention during ADA 2026. Research published in Diabetes Care found a dual-hormone closed-loop system reduced hypoglycemia compared with a single-hormone system during and after exercise, though some increase in hyperglycemia was observed with glucagon delivery.
Despite this technological momentum, Sood emphasized persistent structural barriers. Insurance coverage gaps, cost concerns, and confusion around device procurement pathways remain the primary impediments to adoption.
Beyond device innovation, Sood described a growing sense of optimism surrounding type 1 diabetes research. The T1D treatment landscape is entering what investigators have described as a transformative era, with teplizumab establishing the first immunotherapy approval to delay disease onset, other immune-based therapies advancing to preserve beta-cell function, and beta-cell replacement shifting from donor islet transplantation toward stem cell-derived approaches.
"We've been talking about a cure for a long time," Sood said. "I feel like I'm living in it, and in the next 5 to 10 years, I could be actually prescribing some of these therapies."
References
Wilson LM, Jacobs PG, Ramsey KL, et al. Dual-hormone closed-loop system using a liquid stable glucagon formulation versus insulin-only closed-loop system compared with a predictive low glucose suspend system. Diabetes Care. 2020;43(11):2721–2729. doi:10.2337/dc19-2267
Battelino T, Danne T, Edelman SV, et al. Continuous ketone monitoring: international expert recommendations on the application of a new technology. Lancet Diabetes Endocrinol. 2026. doi:10.1016/S2213-8587(25)00331-6
American Diabetes Association Professional Practice Committee. Diabetes technology: Standards of Care in Diabetes — 2026. Diabetes Care. 2026;49(Suppl. 1):S150–S165
