ADA revises diabetes standards as orforglipron and retatrutide data close 2026 sessions

The American Diabetes Association closed its 86th Scientific Sessions in New Orleans on Monday, June 8, 2026, with a formal revision of its Standards of Care that raises cardiovascular and kidney risk reduction to a co-primary treatment goal alongside blood sugar control ^[1]. The change moves diabetes care away from a single benchmark — the A1C — and toward managing several outcomes at once ^[1].

The revision followed four days of Phase 3 results covering five drug programs: the oral GLP-1 orforglipron, the triple-hormone-receptor agonist retatrutide, Novo Nordisk's CagriSema, Boehringer Ingelheim and Zealand Pharma's survodutide, and the PCSK9 inhibitor evolocumab ^[1].

Orforglipron, a small-molecule oral GLP-1, was tested in the ACHIEVE program. In ACHIEVE-5, which enrolled adults who had type 2 diabetes for a mean of 15 years and were already taking titrated insulin glargine, orforglipron cut A1C by 1.54% to 2.05% across three doses tested, compared with 0.77% for placebo ^[1]. Body weight fell 2.7% to 6.1% in the treatment arms, while the placebo group gained a mean 0.6% ^[1]. An earlier dataset, ACHIEVE-3, found orforglipron was superior to oral semaglutide in A1C reduction and produced 73.6% more relative weight loss at 52 weeks ^[1]. Unlike oral semaglutide, which showed cardiovascular benefit in the SOUL trial, orforglipron has not completed a cardiovascular outcomes trial ^[1]. It launched in April 2026 at $149 a month for self-pay patients ^[1].

Retatrutide, an investigational once-weekly injection and the first candidate to activate GIP, GLP-1 and glucagon receptors at once, produced average weight loss of 28.3% at 80 weeks in TRIUMPH-1, which enrolled 2,339 adults ^[1]. On the highest dose, 45.3% of participants lost at least 30% of their body weight ^[1]. In the companion diabetes trial TRANSCEND-T2D-1, published at the same time in The Lancet, A1C fell by up to 2.0% and participants lost up to 36.6 pounds over 40 weeks, with up to 46% reaching a normal A1C ^[1]. Urinary tract infections appeared in 7.5% to 8.8% of retatrutide participants versus 5.3% on placebo, a signal investigators flagged for further evaluation ^[1]. Retatrutide is not FDA-approved; Eli Lilly is expected to file a new drug application in 2026, with approval most likely in 2027 or 2028 ^[1].

Also presented: CagriSema, a fixed-dose combination of cagrilintide and semaglutide, met primary A1C endpoints and secondary weight endpoints in three REIMAGINE trials, and Novo Nordisk has targeted a US launch for early 2027 ^[1]. Survodutide achieved 16.6% placebo-adjusted weight reduction at 76 weeks, with most of the loss coming from fat ^[1]. In a prespecified subgroup of the VESALIUS-CV trial, evolocumab cut LDL cholesterol by more than 50%, to an average of 45 milligrams per deciliter, and reduced three-point major adverse cardiovascular events by 29% in high-risk patients with type 2 diabetes who had never had a heart attack or stroke ^[1].

Speakers at a separate ADA symposium focused on what weight loss takes with it. Ian Neeland, MD, of University Hospitals Harrington Heart & Vascular Institute, said roughly 25% of weight lost on any intervention comes from lean body mass, and that the share can climb to 40% or more with higher-dose GLP-1 drugs ^[2]. He said each kilogram of muscle lost reduces resting energy expenditure by 13 kilocalories, against 4 for fat ^[2].

Why it matters for patients

The revised standards steer doctors toward weighing heart and kidney risk alongside A1C, which can affect which drug is chosen and what gets tracked over time. Specific recommendations from the 2026 Standards of Care have not been reported ^[1].

The pipeline is broad but uneven. Orforglipron offers oral convenience with no fasting or food restrictions, and its lack of completed cardiovascular outcomes data is a trade-off for patients at high cardiovascular risk ^[1].

Muscle loss is a practical concern. Supervised resistance and aerobic training plus protein intake of about 1.2 to 1.6 grams per kilogram per day has been shown to preserve or even increase lean mass in a trial combining liraglutide with exercise ^[2]. Whether muscle function improves, not just muscle mass, has not been well studied, Neeland said ^[2]. In one Phase 2 trial, adding the myostatin inhibitor bimagrumab to semaglutide reduced the lean-mass share of weight loss from roughly 21% to 7% ^[2].

For joint pain, semaglutide produced a 41.7-point improvement in knee osteoarthritis pain scores versus 27.5 points with structured care in the STEP 9 trial, with less use of pain medicines including opioids. Tirzepatide's larger weight loss did not produce proportionally greater pain relief, a finding researchers say needs more study ^[2].

What happens next

Lilly is expected to file a new drug application for retatrutide in 2026 ^[1]. Novo Nordisk has filed CagriSema with the FDA for a weight-loss indication based on earlier REDEFINE data, with a US launch targeted for early 2027 ^[1]. Approval timing for retatrutide and the effective dates for the revised Standards of Care have not been disclosed ^[1].