CGM: ADA 2026 Standards of Care

The American Diabetes Association (ADA) released its Standards of Care in Diabetes—2026 with updates to continuous glucose monitoring (CGM) and diabetes management. The standards reflect the most current evidence and best practices in clinical care, informed by science and leading experts, and use the evidence ratings below to keep diabetes care at the cutting edge. 

Evidence ratings:

• A, B, or C – Based on the strength of clinical trial data

• E – Expert consensus when research evidence is limited

A major highlight is the enhanced guidance on CGM, providing information on new technologies and approaches to individualized diabetes care.

Key developments for using CGM in clinical settings include:

Expanded CGM use for all types of diabetes

• Recommendation 9.25 was updated to recommend CGM use at diabetes onset and anytime thereafter for adults with diabetes who are on insulin therapy, (A) on noninsulin therapies that can cause hypoglycemia, (B) and on any diabetes treatment in which CGM aids management.¹ (B)

For the first time, the recommendations go beyond “considering” CGM and now recommend its use for adults with type 2 diabetes—even for those on glucose-lowering therapies other than insulin or in cases where CGM can improve management, regardless of the treatment approach.

CGM in older adults

• Recommendation 13.5 now recommends CGM for older adults with type 1 diabetes (A) and type 2 diabetes on insulin therapy (B) to improve glycemic outcomes, reduce hypoglycemia, and reduce treatment burden.

Change for 2026: Older adults with type 2 diabetes on insulin therapy were added to the recommendation to expand CGM to that population.

Diabetes technology barriers reduced

• NEW Recommendation 7.8a states that there should be no requirement for C-peptide level, (B) the presence of islet autoantibodies, (B) or duration of insulin treatment (C) before initiation of continuous subcutaneous insulin infusion or automated insulin delivery.

This new recommendation helps reduce barriers for people with diabetes using insulin by making it easier to adopt advanced diabetes technology.

CGM narrative

• CGM narrative text now emphasizes that "the benefits of CGM have been shown regardless of age, sex, education or income levels, or baseline diabetes characteristics."

This inclusion demonstrates the value of CGM across diverse populations as a standard of care in diabetes management.

Current technologies

• Table 7.3 has been updated to remove intermittently scanned CGM from the list of current technologies—underscoring real-time CGM (rtCGM) as the recognized standard of care.

This shift reflects growing evidence that rtCGM is a standard of care.

Conclusion

The Standards of Care in Diabetes—2026 contributes to advancing clinical recommendations, facilitating expanded insurance coverage, and enabling earlier use of diabetes technology. These changes allow family medicine clinicians and their patients to more readily implement CGM across all life stages, thereby promoting a personalized and proactive approach to diabetes management. 

As coverage policies evolve alongside these standards, you can quickly check your patients’ eligibility and streamline CGM access by using the Dexcom Coverage Evaluator tool.

References

1. American Diabetes Association. (2026). Standards of Care in Diabetes—2026. Diabetes Care, 49(Suppl 1). https://doi.org/10.2337/dc26-SINT 

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