The ADA Just Changed the Rules: Your Doctor Must Now Address Heart and Kidney Risk

What Changed in the ADA Standards of Care

At the 86th ADA Scientific Sessions in New Orleans, the organization announced a formal revision to its Standards of Medical Care in Diabetes. The change is conceptually simple but clinically profound: managing type 2 diabetes is no longer primarily about blood sugar control. Cardiovascular risk reduction and kidney protection are now co-equal treatment goals alongside glycemic management.

This shift was supported by an exceptional volume of clinical evidence presented at the meeting. Phase 3 results for five separate drug programs — orforglipron, retatrutide, CagriSema, survodutide, and evolocumab — were presented simultaneously, many published concurrently in peer-reviewed journals including The Lancet and JAMA.

Why This Matters for You as a Patient

If you have type 2 diabetes — or even prediabetes with cardiovascular risk factors — this change directly affects what your doctor should be doing at every visit. Under the previous framework, achieving an A1C target (typically under 7%) was the primary measure of treatment success. Under the new standards:

• Your doctor must assess cardiovascular risk at every diabetes-related visit, not just when symptoms arise.
• Medications that reduce cardiovascular events — specifically GLP-1 receptor agonists and SGLT2 inhibitors — should be prioritized for patients with established cardiovascular disease or high risk, regardless of A1C level.
• Kidney function monitoring (eGFR and urine albumin-to-creatinine ratio) should be a routine part of diabetes care, with early intervention when decline is detected.
• Multi-target therapy is now the standard. A patient whose A1C is well-controlled but who has unaddressed cardiovascular or kidney risk is no longer receiving adequate care.

How GLP-1 Medications Fit the New Framework

GLP-1 receptor agonists are uniquely positioned in the new standards because they address multiple treatment targets simultaneously. The SELECT trial demonstrated that semaglutide reduces major adverse cardiovascular events by 20% in patients with obesity and cardiovascular disease — independent of diabetes status. The FLOW trial showed kidney-protective effects. Additional trials have demonstrated benefits for heart failure with preserved ejection fraction.

This is why the ADA now positions GLP-1s not just as diabetes or weight-loss drugs, but as cardiovascular and renal protective agents that happen to also improve blood sugar and body weight.

The Five Drug Programs Presented at ADA 2026

The data supporting the standards revision came from multiple drug programs, all presented with Phase 3 results:

• Orforglipron (Eli Lilly): FDA-approved April 2026. Oral, non-peptide GLP-1 agonist. ACHIEVE trials showed strong A1C reduction and weight loss across diverse type 2 diabetes populations.
• Retatrutide (Eli Lilly): Triple agonist (GLP-1 + GIP + glucagon). Phase 3 results showing 22-26% weight loss in some populations. Not yet FDA-approved.
• CagriSema (Novo Nordisk): First combination of semaglutide with an amylin analog (cagrilintide). REIMAGINE trials met primary endpoints for A1C reduction with strong weight loss. FDA filing for weight-loss indication submitted; U.S. launch targeted for early 2027.
• Survodutide: Dual GLP-1/glucagon agonist showing promise in metabolic liver disease (MASH) in addition to weight loss.
• Evolocumab: PCSK9 inhibitor for cardiovascular risk reduction, presented alongside the GLP-1 data to reinforce the multi-target treatment approach.

Questions to Bring to Your Next Appointment

Whether you are currently on a GLP-1 or considering starting one, the ADA standards revision creates specific, actionable conversation starters for your next visit:

• "What is my current cardiovascular risk score?" — Your doctor should be able to estimate your 10-year ASCVD risk.
• "When was my kidney function last checked?" — Request eGFR and UACR if they are not in your recent labs.
• "Are there medications I should be on for heart or kidney protection, separate from blood sugar control?" — Under the new standards, the answer may be yes even if your A1C is at target.
• "Should I be on a GLP-1 for cardiovascular benefit, even if my weight or A1C is already reasonable?" — The SELECT trial data supports GLP-1 use for cardiovascular protection independent of weight loss.