In an interview with Pharmacy Times, Dave Dixon, PharmD, FACC, FAHA, FCCP, FNLA, BCACP, CLS, the Nancy and Ronald McFarlane Professor of Pharmacy and chair of the department of Pharmacotherapy & Outcomes Science at Virginia Commonwealth University School of Pharmacy, discussed the most significant cardiovascular updates in the 2026 American Diabetes Association (ADA) Standards of Care. Dixon highlighted that the most meaningful evolution in the guidance is the repositioning of cardiovascular and kidney risk reduction as coequal priorities alongside glucose lowering—no longer as secondary goals. Glucagon-like peptide-1 (GLP-1s) receptor agonists have taken on a more prominent role, supported by clinical trial evidence demonstrating benefit in patients with chronic kidney disease and those with heart failure with an ejection fraction of 40% or greater.
Finerenone, a non-steroidal mineralocorticoid antagonist, also received recognition for its favorable heart failure outcomes in patients with diabetes. Dixon further noted updated blood pressure targets, with new encouragement to achieve systolic blood pressure below 120 mmHg where feasible. He also addressed how pharmacists should reframe medication therapy management conversations around cardiorenal protection rather than glucose control alone, emphasizing that sodium-glucose cotransporter 2 (SGLT2) inhibitors and GLP-1-based therapies offer benefits that extend well beyond glycemic management—a distinction pharmacists are uniquely positioned to communicate to patients.
Pharmacy Times: Can you please introduce yourself?
Dave Dixon, PharmD, FACC, FAHA, FCCP, FNLA, BCACP, CLS: My name is Dave Dixon, professor and chair of the Department of Pharmacotherapy and Outcomes Science at Virginia Commonwealth University School of Pharmacy.
Pharmacy Times: You served as a subject matter expert on the Cardiovascular Disease and Risk Management section of the 2026 American Diabetes Association (ADA) Standards of Care. What were the most meaningful updates in that section, and what do pharmacists specifically need to understand about how the guidance has evolved?
Dixon: Globally speaking, the most meaningful evolution is that cardiovascular and kidney risk reduction is no longer treated as secondary to glucose lowering, and the role of GLP-1–based therapies, in particular, has become clear now that we have several clinical trials showing their added benefit in patients with chronic kidney disease (CKD), as well as patients that have heart failure and an ejection fraction of 40% or greater. We also have evidence that finerenone, the nonsteroidal mineralocorticoid antagonist, has favorable benefits in patients with diabetes in terms of improving heart failure outcomes in those patients with an ejection fraction of 40% or greater.
Key Takeaways
- The 2026 ADA Standards formally elevate cardiovascular and kidney risk reduction to a co-primary treatment goal, meaning pharmacists should no longer treat A1C as the sole measure of therapeutic success in patients with type 2 diabetes.
- GLP-1 receptor agonists and SGLT2 inhibitors are now positioned as core cardiorenal protective therapies irrespective of A1C, and pharmacists play a critical role in helping patients understand that these agents offer long-term risk modification beyond blood sugar control.
- Updated blood pressure guidance encourages achieving systolic blood pressure below 120 mmHg in appropriate patients with diabetes, adding another actionable target for pharmacists engaged in cardiovascular risk management.
A couple of other minor updates that are important to note: traditional risk factors, such as hypertension and dyslipidemia, remain critically important, and while the blood pressure goal is less than 130/80, there is now encouragement to achieve a systolic blood pressure below 120 in patients where that's feasible, based on a couple of recent trials that have demonstrated improved outcomes in patients with diabetes while having a modest risk of adverse effects. Needless to say, there continue to be a lot of updates and changes in this particular area.
Pharmacy Times: The 2026 ADA Standards now position SGLT2 inhibitors and GLP-1 receptor agonists as core pharmacological strategies for cardiovascular and kidney risk reduction, irrespective of A1C. How should pharmacists approach medication therapy management conversations with patients with type 2 diabetes and established or high-risk cardiovascular disease in light of this shift?
Dixon: I think this is really important, and these conversations should really be reframed and focused on cardiovascular and kidney protection. Certainly A1C control is important, and we want to encourage that. We also want our patients to understand that that's not the end, and ultimately we want to reduce their risk of cardiovascular and kidney disease. We have to think beyond glucose control, and those conversations should really emphasize that increased risk of cardiovascular and kidney disease and that we have to go beyond simple glucose control in order to reduce that risk—thinking about it in a very patient-centered way, in terms of explaining that change.
Patients often think about diabetes medications as glucose- or blood sugar–lowering medications. Pharmacists can help patients understand that certain drug classes, such as the SGLT2 inhibitors and GLP-1–based therapies, are different because not only do they improve glucose control, but they modify that long-term risk of cardiovascular and kidney disease. Needless to say, I think that this is an important area, and pharmacists have a lot to contribute in terms of helping communicate these key aspects to patients with diabetes.
