The 2026 American Diabetes Association Standards of Care in Diabetes are here—and they’ve made it clear that CGM (continuous glucose monitor) metrics, like time in range, are vital for daily diabetes management.
The ADA Standards of Care are updated annually and include expert recommendations for treatment and management of all kinds of diabetes based on the latest evidence. The Standards of Care recognizes time in range (TIR) as a valid glycemic assessment in people with diabetes (6.1) associated with the risk of microvascular complications and acknowledges time below range and time above range as useful parameters for evaluating treatment. It also recognizes the limitations of A1C—and highlights that A1C does not provide a measure of glycemic variability or hypoglycemia. You can find summaries on past Standards of Care and their parameters around time in range by clicking here.
The Standards of Care state that people with diabetes should be offered any kind of diabetes device, including continuous glucose monitoring (CGM). This means that whether you are treating someone with type 1, type 2, LADA, gestational, or any kind of diabetes—a CGM can be useful for daily diabetes management. Time in range is most easily found through CGM, and expanding access to CGM will expand access to time in range. Increases in time in range with CGM have demonstrated significantly improved glucose levels—reducing A1C by 0.25–3.0% and lowering the risk of diabetes-related complications. Studies show that a 5% increase in TIR correlates with reduced albuminuria, diabetic retinopathy, and neuropathy, while improving overall patient quality of life!
Who should be using CGM? Everyone with diabetes.
The 2026 Standards of Care have expanded who is included in their recommendations of CGM use. This year’s publication expanded the text to underscore the benefits of CGM, which have been shown regardless of age, sex, education, income levels, or baseline diabetes characteristics, including:
- Evidence of CGM benefits in people with type 2 diabetes not using insulin are increasing and have shown greater benefits compared to a blood glucose meter for A1C, TIR, time below range, and time above range (TAR), as well as greater user-reported satisfaction
- Data shows that CGM use in young children with type 1 diabetes reduces hypoglycemia and fear of hypoglycemia in their parents
- Reductions in acute diabetes complications, such as diabetic ketoacidosis (DKA), episodes of severe hypoglycemia or diabetes-related coma, and hospitalizations for hypoglycemia and hyperglycemia, have been observed in adults with type 1 and type 2 diabetes, with persistent effects observed even after 2 years of CGM initiation
Section 7.15 has been updated to state that use of CGM is now recommended to be started immediately at diabetes onset (diagnosis) for children, adolescents, and adults with diabetes who use insulin, are on drugs that could cause low glucose levels, or are on any kind of therapy where CGM could help. This means that as long as CGM values can help a person with diabetes, then the ADA recommends they use one.
CGM use in pregnancy for people with type 2 diabetes and gestational diabetes (GDM) is also discussed. Section 15 features updated findings from recent trials in GDM, which show that CGM is preferred by and has benefits for people with type 2 diabetes and GDM—if you’re interested in learning more about technology use in pregnancy, check out this article!
CGM use after type 1 screening.
Section 3.2 has been updated to recommend CGM use for people with presymptomatic type 1 diabetes—meaning that the metrics CGMs provide can help people in stage 1 and stage 2 type 1 diabetes monitor the progression of their disease, which can help identify rising glucose and need to begin insulin therapy, reduce need for hospital admission with DKA, and provide feedback as to how certain foods affect glucose
Prescribing CGM
This year’s Standards of Care emphasize the importance of CGM education for people with diabetes and healthcare professionals. Section 7.3 states that healthcare professionals should ensure that people with diabetes and caregivers are offered initial and ongoing training and education about their device, including information on:
- How to interpret CGM data
- Managing skin reactions
- Understanding factors that can affect accuracy
To find resources to help with this, visit our time in range hub for people with diabetes!
