✨ 2026 Diabetes Criteria: What Actually Changed from 2025?

🎯 I. Medical Goals & HbA1c Regulation

• Target unchanged: HbA1c <7% remains the benchmark.
• New emphasis: Strong focus on Time-in-Range (TIR) as a core indicator.
• Holistic approach: Treatment choices now integrate cardiac, renal, and liver status from the start.
• Shift in philosophy: From “digital glucose control” (2025) ➝ to “guided organ-function control” (2026).

💊 II. Metformin & PI3K Inhibitors

• Metformin stays first-line, but with an expanded preventive role.
• 2026 adds clarity: Hyperglycemia caused by PI3K inhibitors officially integrated into care pathways.
• Identified drugs: Idelalisib, Copanlisib, Duvelisib, Umbralisib, and Alpelisib (highest risk)—not highlighted in 2025.

❤️ III. Cardiovascular & Obesity Prioritization

• 2025: SGLT2, GLP-1, or GIP-GLP-1 only for high-risk patients.
• 2026: Any presence of cardiovascular disease, kidney disease, or high obesity triggers immediate use, even with normal HbA1c.
• Evidence remains strong:
  • 30–35% ↓ heart-failure hospitalization
  • 40% ↓ kidney-function decline
  • 14–20% ↓ major cardiac events

🧬 IV. GLP-1 & GIP-GLP-1: Expanded Therapeutic Role

• 2025: Focus on HbA1c and weight reduction.
• 2026: Official link to MASLD/MASH (fatty liver diseases) added.
• Consistent outcomes:
  • 1–2% HbA1c reduction
  • 12–20% weight loss
  • Significant liver-fat improvement

🛡️ V. SGLT2 Inhibitors: Stronger Foundation

• Upgraded from “preferred” (2025) to “essential” (2026) for kidney disease & heart failure.
• Integration of National Kidney Association guidelines.
• Supported by unchanged but strong data:
  • 30–35% ↓ heart failure
  • 40% ↓ kidney decline

💉 VI. Insulin: Repositioned

• No insulin until GLP-1, GIP-GLP-1, and SGLT2 options are exhausted — unless severe symptoms appear.
• Type 1 diabetes: AID systems + continuous monitoring now recommended from diagnosis, clearer than 2025.

📱 VII. Technology & Continuous Monitoring

• 2026: CGM becomes standard, not optional.
• Time-in-Range becomes a primary decision factor.
• Smart Automated Insulin Delivery (AID) receives broader recognition.

🔮 VIII. Future Treatments: From Research to Roadmap

• 2026 organizes innovations as “Upcoming Therapeutic Trends.”
• Added pipeline includes:
  • Retatrutide (triple agonist)
  • Cagrilintide + Semaglutide
  • Danuglipron
  • FGF-21 analogs
  • Resmetirom
  • Teplizumab (immunotherapy)
• Not just research—clear pathways for future integration.

🌟 IX. Core Differences: 2026 vs 2025

The four pillars of change:

1. From glucose-focused → organ-protective care (heart, kidney, weight).
2. Official integration of MASLD/MASH into diabetes management.
3. Technology (CGM & AID) becomes essential at nearly all stages.
4. Clear listing of PI3K-drug–induced hyperglycemia and its management