If you've wondered why your doctor reached for a GLP-1 medication, or whether you "qualify" for one, much of the answer traces back to one document: the American Diabetes Association's Standards of Care in Diabetes. The ADA updates it every year, and most US clinicians use it when deciding how to treat diabetes and obesity together.
This guide puts what it says about GLP-1 medications into plain language: what it recommends, for whom, and the one change in the 2026 edition that is new.
What the Standards of Care is
The Standards of Care is a set of evidence-based recommendations. Each one carries a grade (A, B, C, or E) that reflects how strong the evidence behind it is. Clinicians use it as a starting point and then tailor decisions to the person in front of them.
Two things follow from that. First, it changes. A recommendation can be refined or reversed next year as new trials publish, so confirm the current version with your care team before relying on an older summary. Second, it guides treatment and has no say over insurance. A medication being "preferred" in the guideline doesn't mean your plan covers it, because coverage runs on a separate track (see Understanding insurance coverage for GLP-1 medications).
Type 2 diabetes with obesity: GLP-1s are the preferred choice
The clearest message in the guideline is about type 2 diabetes with overweight or obesity. Here, weight management counts as a primary goal alongside blood-sugar control.
When a medication is added specifically to help with weight, the guideline names the preferred option: a GLP-1 receptor agonist (such as semaglutide) or a dual GIP/GLP-1 receptor agonist (such as tirzepatide), because they combine strong weight reduction with glucose lowering (ADA, Standards of Care in Diabetes—2026, §8, 10.2337/dc26-S008 (external link)).
Realistic weight-loss targets
The guideline sets weight loss in tiers, which can help you set your own expectations:
- ≥5% of your starting weight improves blood sugar and cardiovascular risk factors.
- ≥10% can manage or improve many obesity-related conditions and complications.
- ≥15% may be the goal for some people, depending on their health.
It also says weight management should aim for any amount of weight loss, so smaller losses still count. If your results are coming in below the trial headlines, that's common; GLP-1 super-responders (and non-responders) explains why response varies so much.
On dosing: the highest dose isn't automatically the goal
The guideline states that the individualized maintenance dose should balance efficacy, health benefits, and tolerability, and therefore may not necessarily be the maximum approved dose.
So the best dose is the one that gives you a meaningful benefit with side effects you can live with. That may or may not be the biggest number on the pen, and it's something to work out with your prescriber.
The 2026 change: a cautious first for type 1 diabetes
GLP-1 medications were studied and approved almost entirely in type 2 diabetes and obesity, so there was little trial evidence in type 1 diabetes. Safety is the other concern: when these drugs are combined with insulin, the risk of low blood sugar (hypoglycemia) rises, and in type 1 diabetes there is also the risk of diabetic ketoacidosis (DKA). Off-label use in type 1 diabetes grew anyway, especially among people who also had obesity, before the formal evidence caught up.
The 2026 edition brings the guideline in line with that practice. For the first time, it includes a recommendation (8.29) that supports GLP-1 receptor agonist–based therapy, and metabolic (weight-loss) surgery, as options for treating obesity in adults who have type 1 diabetes. Eligibility mirrors the usual obesity threshold: a BMI of 30 or higher (27.5 or higher for Asian American adults). That's as of the 2026 Standards; the ADA revises them every December, so check the current edition.
Three points matter here:
- It treats obesity and doesn't replace insulin. People with type 1 diabetes still need insulin. A GLP-1 is an add-on for weight.
- It's newer and more cautious than the type 2 guidance, because the evidence base is thinner, though growing.
- It needs close supervision. Because combining a GLP-1 with insulin can raise the risk of hypoglycemia and DKA, this should happen only under close clinician supervision, with a clear plan for adjusting insulin and monitoring blood sugar and ketones.
If you have type 1 diabetes and are curious, raise it directly with your endocrinologist. Talking to your doctor about GLP-1 medications can help you prepare.
What this means for you
If you have type 2 diabetes with overweight or obesity, GLP-1 (or GIP/GLP-1) medications are the guideline's preferred weight-focused option. That gives you solid footing when you discuss them with your clinician.
If you have type 1 diabetes with obesity, there's now formal guideline support to discuss GLP-1 therapy, framed as a supervised obesity treatment with real safety caveats.
For everyone, "preferred" status reflects clinical evidence. It says nothing about coverage or whether a drug suits you. Your dose, your drug, and whether treatment is right for you are decisions to make with your care team.
This article summarizes clinical guideline recommendations for general education. It is not medical advice, and guidelines are updated at least yearly. GLP-1 use in type 1 diabetes in particular carries hypoglycemia and DKA risks and should only be considered with a clinician. Always confirm current recommendations and any treatment decision with your own healthcare provider.