ADA 2026: Triple Hormonal Therapy, Cardiovascular Breakthroughs, and the Push for Equitable Care

If the arc of diabetes medicine has a defining theme in 2026, it is transformation—in the drugs available, in the populations being served, and in the questions researchers are brave enough to ask. From the convention floor to breakout sessions, the American Diabetes Association (ADA) 2026 Scientific Sessions made clear that the field is moving faster than any single clinician can absorb and that the stakes for patients have never been higher.

Experts highlighted how glucagon-like peptide-1 (GLP-1) receptor agonists are evolving far beyond weight loss and glucose control.¹ Presentations focused on strategies to preserve muscle mass during treatment, including exercise, higher protein intake, and emerging combination therapies; new oral and long-acting GLP-1 formulations that may improve access and efficacy; growing evidence that GLP-1 drugs could help reduce osteoarthritis pain and delay joint surgery; and the critical role of personalized nutrition counseling in maximizing outcomes and minimizing treatment discontinuation.

Incretin Therapy's New Frontier

The buzz that dominated hallway conversations and plenary sessions alike centered on what experts are calling the next evolution of incretin therapy.² For years, the GLP-1 receptor agonist class redefined obesity and diabetes management. Now, a triple-hormonal approach, combining GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptor agonism, is poised to shift the paradigm again.

Alyson K. Myers, MD, professor at Albert Einstein College of Medicine and associate chair of faculty mentoring and community engagement at Montefiore Einstein, department of medicine, captured the conference's energy when she reflected on the meeting's headline story.

"The way that we currently know the GLP-1 receptor agonist therapy—the once-a-week shots—it's completely changed. We have to now look at it in a different way," she said. "This triple hormone, where it's GLP-1, GIP, as well as glucagon, is going to change things dramatically: more weight loss, better outcomes in terms of obesity, as well as diabetes. And the fact that there's a move towards doing even less frequent injections—once a month—is really going to be a game changer."

That assessment was echoed by Lee Kaplan, MD, PhD, director of The Obesity and Metabolism Institute, Massachusetts General Hospital, who spoke specifically to the emerging data on survodutide (Boehringer Ingelheim), a dual GLP-1 and glucagon receptor agonist.³ At the meeting, he presented data from the phase 3 SYNCHRONIZE-1 (NCT06066515) and SYNCHRONIZE-MASLD (NCT06309992) trials. The addition of glucagon activity, he explained, is doing something distinct from simple weight reduction.

"What we know is that glucagon receptors are present in the liver, and activation of those receptors is associated with oxidation, mobilization, and reduction of fat in the liver itself," Kaplan said.⁴ "It appears that the reduction in fat in the liver occurs much more quickly before all of the reduction in fat depots, suggesting that what we're seeing is something specific to the treatment and specific to the liver more than just an association with the amount of weight loss."

The implications for metabolic-associated steatohepatitis (MASH) are significant. Kaplan noted that patients with diabetes are at substantially elevated risk for MASH, yet the vast majority go undiagnosed.

"Liver disease tends to be a symptomless disease, and so until you go looking for the diagnosis, you won't find it," he said. "It's similar to diabetes itself." He added that survodutide's combination of GLP-1 and glucagon agonism "in the right balance" appears to confer benefits not only on obesity but also on the nature of fat loss itself—less lean muscle loss and greater reductions in visceral fat, one of the most metabolically dangerous fat depots.

Cardiovascular Risk Reduction: Going Further on LDL

While incretin innovation commanded much of the spotlight, equally important data came from the cardiovascular space. Lawrence Leiter, MD, director of the Lipid Clinic; associate director of the Clinical Nutrition and Risk Factor Modification Centre; associate scientist, Li Ka Shing Knowledge Institute at St. Michael’s Hospital; and professor in the departments of medicine and nutritional sciences at the University of Toronto, presented findings from a prespecified subgroup analysis of the VESALIUS-CV (NCT03872401) trial focused on approximately 6000 patients with high-risk diabetes—those with microvascular complications, chronic insulin therapy, or a diabetes duration of at least 10 years.

The results were striking; treatment with evolocumab (Repatha; Amgen), a proprotein convertase subtilisin/kexin type 9 inhibitor, achieved a median LDL of approximately 45 mg/dL and was associated with a 29% reduction in 3-point major adverse cardiovascular events and a nominal 21% reduction in all-cause mortality in patients who had not yet experienced a myocardial infarction or stroke.

"Our patients with diabetes remain at increased cardiovascular risk," Leiter said. "What we showed is that treating patients with other risk reduction strategies—including GLP-1 RAs or SGLT-2 [sodium-glucose cotransporter 2] inhibitors—is important, but if you really want to minimize cardiovascular risk in these patients, we really have to add intensive LDL lowering to the mix."

Critically, the benefits were consistent regardless of whether patients were already on GLP-1 receptor agonists or SGLT-2 inhibitors. The finding reinforces a comprehensive risk-reduction framework rather than a sequential one.

"In order to achieve maximal cardiovascular risk reduction in our patients with diabetes, we really need to use a comprehensive risk reduction strategy," Leiter emphasized. "We achieved a median LDL of around 45 milligrams per deciliter, which is lower than what many current guidelines are recommending, and based on our results, we believe that one should be aiming for these newer, lower targets."

Metabolic Mechanisms and the Pharmacist's Perspective

Bridging the bench and the bedside, Anne Komé, PharmD, CPP, BCACP, CDCES, a clinical pharmacist practitioner in the endocrinology clinic at UNC Chapel Hill Medical Center, moderated a session examining how approved drugs are revealing unexpected metabolic pathways.⁵ Among the abstracts she highlighted: the role of irisin—a hormone secreted from skeletal muscle during physical activity—in amplifying GLP-1's effects and the potential of oral ketones for patients with concurrent heart failure and type 2 diabetes.

For Komé, the takeaway from this body of work is practical. "I always like to kill 2 birds with 1 stone—or even 3 if I can," she said. "Looking at the patient and their patient-specific factors, identifying and ranking comorbidities in terms of which needed to be prioritized, and then going from there. Recognizing you could always change therapy—that's what I love about diabetes: it's not 1 size fits all."

She also discussed her published work on GLP-1 microdosing, an off-label practice gaining traction among patients facing access or tolerability barriers.⁶ "Our goal is to get these patients on drugs who would benefit, and also to find a dose and regimen that works best for them, which may not always fall into the parameters as specified by the manufacturer or by guidelines," Komé said, while underscoring that the long-term evidence for microdosing remains under investigation.

The Equity Imperative

Threading through all of it was a question that Myers, who chaired a session titled "Adapting Diabetes Care for All," pushed to the forefront: who actually benefits from these advances?⁷

Drawing on her experience in the Bronx, where 80% to 90% of patients identify as Black or Hispanic and speak dozens of languages, Myers laid out a socioecological framework for understanding why the same disease produces such different outcomes across populations.

"We always want to start with the patient—not to make the patient the victim, but of course the patient is the person who has to live with this," she said. "Are we considering their social determinants of health, like food stability, food deserts that they may live in? Can they get to their doctor's appointments? Do they have access to Wi-Fi so that we can do telehealth visits?"

Access to continuous glucose monitors (CGMs), she argued, is inextricably linked to downstream complications like amputation. "A lot of what we need to do in terms of diabetes prevention for complications starts with good glycemic control, and sometimes the best way to get glycemic control is to be able to have access to these continuous glucose monitors."

She also called on clinicians to examine their own assumptions. "Do we have implicit bias? Am I assuming that because somebody's older, because someone has a lower level of literacy, that they can't use diabetes technology?"

The policy dimension matters as well. Recent CMS changes expanding CGM coverage to patients on a single daily insulin dose were a step forward, Myers noted, but more advocacy is needed, including efforts to pass the ARC Act, which would expand reimbursement for peripheral arterial disease screening in high-risk patients.

An Inflection Point

Taken together, ADA 2026 offered a portrait of a field at an inflection point. Triple hormonal therapies and intensive LDL lowering are expanding what's biologically possible. But as Myers reminded attendees, possibility and access are not the same thing.

"Diabetes prevention is optimal," she said. "We shouldn't forget not just that we want to improve diabetes outcomes, we would actually like to prevent people from developing diabetes."

References

1. Shaw M. GLP-1 therapies in 2026: beyond blood sugar and the scale. AJMC^®. June 9, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/glp-1-therapies-in-2026-beyond-blood-sugar-and-the-scale
2. Grossi G, Myers AK. Culturally tailored diabetes care can improve outcomes and reduce costs: Alyson K. Myers, MD. AJMC. June 6, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/culturally-tailored-diabetes-care-can-improve-outcomes-and-reduce-costs-alyson-myers-md
3. Grossi G, Kaplan L. Emerging data suggest survodutide targets liver fat more rapidly than weight loss: Lee Kaplan, MD, PhD. AJMC. June 7, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/emerging-data-suggest-survodutide-targets-liver-fat-more-rapidly-than-weight-loss-lee-kaplan-md-phd
4. Grossi G, Kaplan L. Survodutide normalizes fat in 61% of patients with ASLD in phase 3 trial: Lee Kaplan, MD, PhD. AJMC. June 7, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/survodutide-normalizes-liver-fat-in-61-of-patients-with-masld-in-phase-3-trial-lee-kaplan-md-phd
5. Grossi G, Komé A. How metabolic effects could shape future diabetes care: Anne Komé, PharmD. AJMC. June 7, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/how-metabolic-effects-could-shape-future-diabetes-care-anne-kom-pharmd
6. Grossi G, Komé A. Anne Komé, PharmD, discusses key metabolic drug effects emerging postapproval. AJMC. June 7, 2026. Accessed June 11, 2026. https://www.ajmc.com/view/anne-kom-pharmd-discusses-key-metabolic-drug-effects-emerging-postapproval