AACE Guidance Redefines Approach to Diabetes Treatment Landscape

The 2026 update to the American Association of Clinical Endocrinology (AACE) Consensus Statement officially redefined the landscape of diabetes care, ushering in a new era where comorbidities and complications take center stage over traditional glucose-centric metrics. This paradigm shift, detailed in the recently released algorithm, represents a critical call to action for the pharmacy profession to move beyond the dispensing counter and into a more robust role as clinical navigators of cardiorenal and metabolic health.¹

“Because weight and age can be misleading, and misclassification can delay the right treatment. Adults who appear to have ‘typical’ type 2 diabetes may actually have other types of diabetes such as latent autoimmune diabetes in adults, monogenic diabetes, pancreatogenic diabetes, steroid-related diabetes, or another secondary cause,” Hailey Choi, PharmD, BCACP, CDCES, an associate professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, said in an interview.

About The New Guidance

For years, the primary driver of therapy was the hemoglobin A_1C level, but the 2026 guidance emphasizes that selecting agents like sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists should occur early, often independent of initial A_1C or metformin use, when heart failure, chronic kidney disease (CKD), or atherosclerotic risk is present.¹

Choi stated that the initial regimen should be driven by the comorbid conditions, including cardiovascular disease, stroke, heart failure, CKD, metabolic dysfunction-associated steatotic liver disease, and obesity. The regimen should also be based on evidence regarding the agents or classes of medication for the comorbidities for patients with type 2 diabetes (T2D).

A significant clinical addition to this update is the diabetes classification algorithm, which serves as a vital tool for preventing misdiagnosis. It is increasingly recognized that many adults are mislabeled with T2D based solely on their age or weight, leading to potentially dangerous delays in appropriate treatment. Pharmacists can play a pivotal role here by monitoring for clinical red flags, such as a patient rapidly progressing to insulin dependence in less than 3 years or the unexpected development of ketosis while on an SGLT2 inhibitor.¹

“The 2026 AACE update introduced a diabetes classification algorithm specifically to reduce misdiagnosis and encourage clinicians to think more carefully about etiology. That matters because the wrong label can lead to the wrong therapy, missed insulin deficiency, avoidable adverse outcomes, and less personalized care overall,” Choi said.

In terms of monitoring, the consensus statement now views continuous glucose monitoring as a highly recommended standard for achieving individualized glycemic goals. The move away from a singular focus on A_1C toward metrics like time in range and the glucose management indicator allows for a much more precise and safer titration of therapy.¹

The Pharmacist’s Role

For the majority of adults, the goal remains a safe and achievable A_1C of ≤6.5%, but the guidelines warn against therapeutic inertia, urging physicians to evaluate and adjust regimens every 3 months or less. Pharmacists, through medication therapy management, are the frontline defense against such inertia, ensuring that therapy is escalated promptly to meet these intensive targets.¹

“While pharmacists play a key role in managing diabetes and obesity through pharmacotherapy, we also provide essential support for lifestyle modification. This includes helping patients set realistic goals and offering foundational education on nutrition and physical activity,” Choi said. “In addition, we identify and address barriers such as food insecurity, cost, time constraints, stigma, and low health literacy.”

Furthermore, she emphasized that obesity is a chronic disease, which can be supported by lifestyle modifications as well as pharmacotherapy. When appropriate, the pharmacist can also refer patients to registered dietitians, physical therapists, or weight management programs for more education and guidance.

“The AACE guidelines still continue to provide a glucose-centric glycemic control algorithm for those without high risk or established comorbidities, so pharmacists should still consider this aspect in patients who present with severe hyperglycemia or those without concurrent comorbid conditions,” Choi concluded.

READ MORE: Diabetes Resource Center

Are you ready to elevate your pharmacy practice? Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips straight to your inbox.

REFERENCES

1. Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes - 2026 Update. Endocr Pract. 2026;32(4):473-518. doi:10.1016/j.eprac.2026.01.006