Should you try diet and exercise first and start diabetes medication only if that falls short? Current guidance says no. The American Diabetes Association's Standards of Care in Diabetes for 2026 say medication should start when type 2 diabetes is diagnosed, without delay, with healthy habits emphasized alongside it. Here is what that means for your care.
Lifestyle support starts on day one
Healthy eating, physical activity and weight management remain the foundation of diabetes care. Medical nutrition therapy, counseling that helps you create and follow a meal plan, is part of that care, and a registered dietitian or diabetes educator can be part of your team. Most adults should aim for at least 150 minutes of moderate activity a week, such as 30 minutes on most days, plus strength training twice a week. If you have overweight, losing 5 to 7 percent of your current weight may help prevent or improve some health problems.
Medication from diagnosis
The 2026 Standards say medication should be started at diagnosis, and that starting with a combination of medicines can be considered. Medication does not replace your food and activity plan. The two work together from the start.
Medicine chosen for your whole health
Most people with type 2 diabetes start with metformin, which the Standards describe as effective, safe, inexpensive and widely available. For people with heart disease, heart failure or kidney disease, the Standards recommend medicines with proven benefits for those conditions, such as SGLT2 inhibitors and GLP-1 based medicines. GLP-1 and dual GIP and GLP-1 medicines can also lower body weight. The choice is a shared decision: ask how the expected benefits, side effects and cost apply to you.
Review the plan regularly
The Standards recommend reviewing your medication plan, and how taking it is going for you, at regular intervals such as every 3 to 6 months, and not delaying a change when you are not meeting your goals. Over time, you may need more than one diabetes medicine. Very high blood sugar, or symptoms of high blood sugar, can call for insulin whatever other treatment you are on.
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Exercise safely
If you take insulin or certain other diabetes medicines, such as sulfonylureas, you are more likely to have low blood sugar. Ask your care team how to plan activity, meals and blood sugar checks so you can exercise safely.
A question to bring to your next visit
"How does my current plan address my blood sugar, my weight and my overall health?"
Diabetes care at Hope Integrative Medicine
Our primary care and lifestyle medicine teams build diabetes plans that combine nutrition, activity and medication, in person in West Ashley or by telehealth across South Carolina. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
Sources: American Diabetes Association, 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes, 2026; American Diabetes Association, Oral and Other Injectable Diabetes Medications; NIDDK, Healthy Living with Diabetes; NIDDK, Insulin, Medicines, and Other Diabetes Treatments.
Every patient is different. This article is general information, not medical advice, and may not apply to you. The right medication depends on your diagnoses, other health conditions and current medicines, so take medication only as directed by the provider managing your care. They are your best guide to the treatment that fits you.
Frequently Asked Questions
No. The American Diabetes Association's 2026 Standards of Care say medication should start when type 2 diabetes is diagnosed, without delay, with healthy eating and activity emphasized alongside it.
Most people start with metformin, which the Standards describe as effective, safe, inexpensive and widely available. People with heart disease, heart failure or kidney disease may also take medicines with proven benefits for those conditions.
The Standards recommend reviewing your medication plan at regular intervals, such as every 3 to 6 months, and not delaying changes when you are not meeting your goals.