Endocr Pract
AACE refreshes its type 2 diabetes algorithm for 2026
Clinical Takeaway: Think beyond glucose. The 2026 AACE update pushes clinicians to prioritize weight management, screen carefully for diabetes subtype, and select therapies based on comorbidities—especially cardiovascular, renal, and liver disease—early in care.
The American Association of Clinical Endocrinology (AACE) has released its 2026 update to its Algorithm for Management of Adults With Type 2 Diabetes, reflecting rapid advances in cardiometabolic science and persistent gaps in real‑world diabetes care. Published in Endocrine Practice on March 17, 2026, the update is the first since 2023 and continues AACE’s shift from glucose‑centric treatment toward individualized, outcomes‑driven care.
What’s new? Most notably, the algorithm now includes a dedicated diabetes classification pathway, designed to reduce misdiagnosis. After confirming diabetes, clinicians are guided to assess whether the patient truly fits a type 2 phenotype—or whether alternate etiologies such as type 1 diabetes, monogenic diabetes, pancreatic disease, or medication‑induced hyperglycemia should be considered. Misclassification remains common and can delay appropriate therapy.
The 2026 update also elevates weight management as a foundational pillar across prediabetes and type 2 diabetes care, aligning with newer AACE obesity guidance. Lifestyle modification and anti‑obesity pharmacotherapy are positioned not as adjuncts, but as central drivers of cardiometabolic risk reduction.
In addition, AACE expands its comorbidity‑ and complication‑centric approach to glycemic control. Updated pathways highlight the preferential use of GLP‑1 receptor agonists and SGLT2 inhibitors in patients with atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, and—new to the algorithm—metabolic dysfunction–associated steatotic liver disease (MASLD).
“The algorithm has a way of simplifying and showing the pathways that could be best for a patient,” said task force chair Susan L. Samson, MD, PhD, emphasizing that it is meant to guide—not replace—clinical judgment.
Overall, the 2026 AACE algorithm reinforces a clear message: effective diabetes management now means treating the whole patient, not just the A1C.
Source: Samson SL, et al. (2026, March 17). Endocr Pract. American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes - 2026 Update