ADA 2026: Diabetes Technology Innovations Expand Beyond Traditional CGM Use

The technology presentations at the 86th American Diabetes Association (ADA) Scientific Sessions highlighted a major shift in diabetes care. Continuous glucose monitoring (CGM) is moving beyond intensive insulin management and becoming a broader therapeutic tool for people with type 2 diabetes (T2D), while automated insulin delivery systems continue to expand and emerging ketone monitoring technologies promise to improve safety and reduce the risk of diabetic ketoacidosis (DKA).

For pharmacists, the message from ADA 2026 was clear: diabetes technology is no longer reserved for a small subset of highly engaged patients. Technology is increasingly being integrated throughout the continuum of diabetes care and is becoming an essential component of cardiometabolic management.

CGM Expansion Beyond Insulin Therapy

One of the most important technology presentations at ADA 2026 was the randomized controlled trial, CONNECT, which evaluated the Dexcom G7 CGM system in adults with T2D not treated with insulin.¹

CONNECT enrolled 283 adults across 22 primary care practices and provided the first Level A evidence supporting CGM use in people with T2D not using insulin. Participants randomized to CGM achieved a mean A1C reduction of 1.6% compared with 0.7% in the routine care group, representing a between-group difference of 0.9%. Additionally, 68% of CGM users achieved an A_1C below 7.5%, while 46% achieved an A_1C below 7.0%. Improvements were particularly impressive among participants with baseline A_1C values greater than 10%, where mean A1C reduction reached 3.1%.¹

Beyond A_1C, CGM users experienced substantial improvements in time in range (70-180 mg/dL), averaging approximately 62% versus 41% in the routine care group, equivalent to approximately 5 additional hours per day spent within target glucose range. Improvements emerged within the first month and were sustained throughout the 26-week study period.¹

Importantly, glycemic benefits were observed regardless of concomitant use of GLP-1 receptor agonists or sodium-glucose cotransporter 2 (SGLT2) inhibitors, suggesting CGM provides additive benefit even when patients are receiving contemporary cardiometabolic therapies.¹

The CONNECT qualitative substudy further demonstrated the impact of CGM on patient experience. Investigators identified 3 consistent themes among CGM users: real-time actionable feedback, improved lifestyle and behavioral changes, and reduced cognitive burden with greater confidence in self-management. Participants frequently reported that CGM helped them understand the relationship between food choices, physical activity, medications, and glucose outcomes in ways that traditional monitoring could not.²

Bottom line for pharmacists: CONNECT provides some of the strongest evidence to date supporting earlier CGM adoption in T2D, including patients not treated with insulin.

GluCoCare Demonstrates CGM Benefits in Primary Care

Another highly practical study was the GluCoCare trial, which evaluated CGM versus traditional blood glucose monitoring among adults with insulin-treated T2D managed in primary care settings.³

The cluster-randomized study included 360 adults across 50 primary care clinics. After 12 months, patients using CGM achieved significantly greater A_1C reductions than those using blood glucose monitoring alone (0.80% vs 0.47%; P = .012). Importantly, hypoglycemia remained uncommon in both groups.³

Unlike many technology studies conducted in specialty endocrinology settings, the GluCoCare trial evaluated CGM implementation in real-world primary care environments where many pharmacists practice.

Bottom line for pharmacists: CGM can be successfully implemented in routine primary care and should be viewed as a practical therapeutic tool rather than a specialty intervention.

Libre Data Highlight Faster Achievement of Glycemic Goals

Additional evidence supporting earlier CGM adoption came from an analysis evaluating FreeStyle Libre use in adults with T2D not treated with insulin.⁴

Using propensity-matched electronic health record data from the Truveta database, investigators found that FreeStyle Libre users achieved A_1C targets more rapidly than non-CGM users. Among adults younger than 65 years of age, Libre use was associated with significantly faster achievement of A_1C targets below 6.5%, 7%, and 8%. Among adults aged 65 years and older, Libre use was associated with faster achievement of an A1C below 8%, which is consistent with individualized glycemic goals often recommended in older adults.⁴

These findings reinforce the broader theme emerging from ADA 2026: CGM use is expanding beyond traditional insulin-treated populations and may help reduce therapeutic inertia while accelerating achievement of glycemic goals.

Bottom line for pharmacists: Earlier CGM adoption may improve engagement, facilitate treatment intensification, and help patients achieve glycemic targets more quickly.

Automated Insulin Delivery Continues to Expand

ADA 2026 also highlighted continued innovation in automated insulin delivery systems.

Two notable presentations were featured in the oral session, "What's New with Insulin Delivery Systems."^5,6 One evaluated the Twiist Automated Insulin Delivery System, which integrates the Twiist pump with the Tidepool Loop algorithm in adults with insulin-treated T2D. Interim analysis demonstrated improvement in time in range from 60% to 77% while reducing time below range and maintaining a favorable safety profile.⁵

Another presentation featured the STRIVE trial (NCT06865989), a multicenter, randomized trial evaluating a next-generation Omnipod algorithm in individuals with T1D or T2D. Results demonstrated continued progress toward increasingly sophisticated insulin automation systems capable of improving glycemic management across diverse populations.⁶

These presentations reflect the continued movement toward increasingly interoperable diabetes ecosystems integrating CGMs, insulin pumps, connected devices, and advanced dosing algorithms.

Bottom line for pharmacists: Familiarity with automated insulin delivery systems is becoming increasingly important as these technologies continue to move into routine clinical practice.

Ketone Monitoring Emerges as the Next Frontier

One of the most exciting technology themes at ADA 2026 involved continuous ketone monitoring and the growing emphasis on proactive ketone management.

Historically, ketone testing has been episodic and reactive, typically performed only when patients become ill or suspect DKA. New technologies and emerging clinical frameworks are seeking to change that paradigm by promoting earlier identification of elevated ketones and more structured intervention before progression to DKA.

The growing interest in this area was reflected by both a featured ADA debate session titled “Continuous Ketone Monitoring for the Masses: Risky or Rewarding?” and the panel discussion “Clinical Algorithm for the Identification, Monitoring, and Management of Elevated Ketones in Ambulatory Settings.”^7,8

During the ketone management symposium, Guillermo Umpierrez, MD, reviewed the increasing burden of DKA; Viral N. Shah, MD, presented the ADA evidence synthesis on ketone monitoring and treatment; and Eden M. Miller, DO, D-ABOM, D-ACD, discussed the future role of continuous ketone monitoring and emerging technologies in diabetes care.⁸

According to Shah, the ADA evidence synthesis framework focuses on identifying who should monitor ketones, when ketones should be checked, defining thresholds for intervention, and establishing treatment pathways designed to prevent progression to DKA. The framework is particularly relevant for people with type 1 diabetes and for patients receiving SGLT2 inhibitors, where early recognition of ketosis may be especially important.⁸

The urgency of improving ketone management was underscored by data presented during ADA 2026 showing increasing rates of DKA hospitalizations and persistent gaps in ketone monitoring and symptom recognition.⁸

Interest in this area has increased further with development of dual glucose-ketone sensing technology that combines glucose and ketone monitoring into a single wearable sensor platform. Abbott recently announced CE Mark approval for Libre Duo, the world's first dual glucose-ketone sensing technology. Speakers discussed how integrated ketone sensing could complement CGM by providing additional metabolic context and supporting earlier intervention before clinically significant ketosis develops.^7,8

Such technologies may ultimately improve safety for:

• individuals with T1D;
• automated insulin delivery users;
• patients receiving SGLT2 inhibitors;
• and individuals at elevated risk for ketosis or DKA

Bottom line for pharmacists: Continuous ketone monitoring and structured ketone management algorithms may represent the next major advancement in diabetes technology and DKA prevention.

What Pharmacists Should Take Away from ADA 2026

Several themes emerged consistently throughout the meeting:

• CGM is becoming standard care for a broader range of individuals with T2D, including those not using insulin.^1,2,4
• Technology is increasingly being implemented in primary care settings, expanding opportunities for pharmacist involvement.³
• Automated insulin delivery systems continue to evolve, becoming more sophisticated, interoperable, and accessible.^5,6
• Continuous ketone monitoring and structured ketone management frameworks may become important new tools for improving metabolic safety and preventing DKA.^7,8

Looking Ahead

ADA 2026 reinforced that diabetes technology is no longer simply about collecting data. Technology is increasingly being used to drive therapeutic decisions, improve patient engagement, reduce complications, and support individualized care.

For pharmacists, proficiency with CGM interpretation, automated insulin delivery systems, and emerging ketone monitoring technologies will become increasingly important as these tools continue to move into mainstream diabetes management.

REFERENCES

1. Oser T, Beck RW, Martens T, et al. CGM for adults with type 2 diabetes not on insulin therapy: The CONNECT randomized controlled trial. Diabetes. 2026;75(Suppl 1):1170-OR. doi:10.2337/db26-1170-OR.

2. Gopisetty N, Singh H, Cadet NN, Oser T, Beck RW. Empowerment through visibility: lived experiences with CGM vs routine care in adults with type 2 diabetes not on insulin. Diabetes. 2026;75(Suppl 1):1160-OR. doi:10.2337/db26-1160-OR.

3. Martens T, Asche SE, Johnson ML, et al. Continuous glucose monitoring vs blood glucose monitoring in patients with type 2 diabetes managed on insulin in primary care: The GluCoCare Study. Diabetes. 2026;75(Suppl 1):1343-OR. doi:10.2337/db26-1343-OR

4. Shubrook J, Wright E, Mehta S, Virdi N. Freestyle Libre use associated with faster time to glycemic target in people with diabetes not treated with insulin. Diabetes. 2026;75(Suppl 1):1341-OR. doi:10.2337/db26-1341-OR.

5. Levy C, Mitri J, Snow K, Beck RW. A multicenter trial assessing the efficacy and safety of the novel Twiist Automated Insulin Delivery system in adults with insulin-treated type 2 diabetes. Diabetes. 2026;75(Suppl 1):1067-OR. doi:10.2337/db26-1067-OR.

6. Forlenza G, Kruger D, Castorino K, et al. Multicenter, randomized trial of a next-generation algorithm for Omnipod in individuals with type 1 or type 2 diabetes: The STRIVE Trial. Diabetes. 2026;75(Suppl 1):1068-OR. doi:10.2337/db26-1068-OR

7. American Diabetes Association Scientific Sessions Program. Continuous Ketone Monitoring for the Masses: Risky or Rewarding? Presented at: ADA 2026 Scientific Sessions. June 2026; New Orleans, LA.

8. Shah VN. ADA evidence synthesis on ketone monitoring and treatment. Presented at: Clinical Algorithm for the Identification, Monitoring, and Management of Elevated Ketones in Ambulatory Settings. American Diabetes Association 86th Scientific Sessions. Presented at: ADA 2026 Scientific Sessions. June 2026; New Orleans, LA.