Once-weekly basal insulin therapy has moved from clinical trial data to pharmacy shelves, offering clinicians a new option for patients who struggle with the daily burden of insulin injections. The shift addresses a persistent adherence problem in basal insulin therapy, where missed or inconsistent daily dosing undermines glycemic control.

In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the pharmacy launch of insulin icodec (Awiqli), the first once-weekly basal insulin now available in the United States.

The approval rests on data from approximately 4200 participants across the phase 2 and phase 3 ONWARDS program. In insulin-naive participants enrolled in ONWARDS 1, 3, and 5, insulin icodec produced superior reductions in hemoglobin A1c compared with once-daily basal insulin. Among participants switching from daily basal therapy in ONWARDS 2, icodec showed noninferior glycemic control alongside improved treatment satisfaction scores.

Insulin icodec has also been studied in type 1 diabetes but did not receive approval in this population after trials showed higher rates of hypoglycemia relative to daily basal insulin. Additional studies in type 1 diabetes are ongoing, leaving open the possibility of future expansion beyond the current type 2 indication.

Dosing requires new clinical habits, since insulin icodec is formulated as U-700, a concentration allowing a full week's dose to be delivered in a comfortable injection volume. Adjustments occur in 10-unit increments rather than the single-unit changes used with daily basal insulins, though the weekly total still translates into modest day-to-day changes of roughly one to two units. Patients switching from daily basal insulin require a loading dose, calculated by multiplying the total daily dose by 10.5, to reach steady state faster than a standard weekly conversion would allow.

Titration follows fasting glucose. Clinicians add 20 units when readings exceed 130 mg/dL, maintain the dose between 80 and 130 mg/dL, and subtract 20 units below 80 mg/dL. Because increases and decreases are dosed in 20-unit blocks, most cycles are reassessed over two to four weeks rather than week to week.

The reduced injection frequency carries particular relevance for older adults, caregivers, and patients whose adherence to daily regimens has proven inconsistent. As pharmacy access expands, coverage and prior authorization requirements will shape how quickly insulin icodec moves into routine practice, but early trial and satisfaction data point toward a meaningful shift in basal insulin management.

Advances in diabetes care rarely arrive through a single channel, and the 2026 annual meeting of the Association of Diabetes Care and Education Specialists (ADCES) reflected this breadth, with new insulin delivery hardware, cardiometabolic risk management, and endocrine screening criteria all drawing attention from clinicians in Columbus, Ohio.

On a recent episode of Diabetes Dialogue, recorded on-site at ADCES26, co-hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed sessions and exhibits spanning insulin delivery technology, cardio-kidney-metabolic (CKM) risk reduction, beta-cell preservation, ketone monitoring, and hypercortisolism screening.

On the exhibit floor, 2 simplified insulin delivery devices signaled a push toward patients still managing diabetes on multiple daily injections. Pivot, a tubeless patch pump from Modular Medical, holds up to 300 units of insulin, delivers preset 2-unit boluses, and supports 2 distinct basal rates, though it is not yet an automated insulin delivery (AID) system. CeQur's Simplicity bolus-only patch has moved toward 7-day wear with up to 240 units of capacity and a one-unit dosing option, positioning it alongside once-weekly basal and incretin therapies on a shared weekly schedule.

A case-based session on CKM syndrome, built around a patient newly diagnosed with type 2 diabetes and discharged on insulin without pen needles, illustrated how risk calculators such as PREVENT can guide therapy beyond glycemic control. The case incorporated glucose-lowering therapy alongside GLP-1 and SGLT2 inhibitor use for cardiorenal protection, discontinuation of an unindicated beta blocker masking hypoglycemia symptoms, and a plan to taper insulin as other agents took effect.

A separate discussion focused on C-peptide, a marker of residual endogenous insulin production, as an emerging clinical trial endpoint in type 1 diabetes. Patients who retain measurable C-peptide despite long-standing autoimmune beta cell loss appear to experience fewer cardiovascular events, less diabetic ketoacidosis, and less severe hypoglycemia, reinforcing interest in beta-cell-preserving therapies during early-stage disease.

Continuous ketone monitoring, an emerging sensor category, was covered through patient cases including pregnancy-related nutritional ketosis and a case of latent autoimmune diabetes in adults treated with an SGLT2 inhibitor without insulin, a combination carrying risk for euglycemic diabetic ketoacidosis. The hosts noted real-time ketone data could eventually clarify when SGLT2 inhibitor use is appropriate in insulin-requiring patients despite this risk.

A well-attended early-morning session addressed hypercortisolism as an underrecognized driver of treatment-resistant hypertension and hyperglycemia. Updated American College of Endocrinology guidance now recommends screening when hemoglobin A1c remains >7.5% or blood pressure remains uncontrolled despite maximal glucagon-like peptide-1, SGLT2 inhibitor, and multidrug antihypertensive therapy, with diabetes care and education specialists playing a growing role in identifying candidates and coordinating referral.

The hosts also highlighted Blue Circle Health, a nonprofit offering ≤6 months of virtual bridge care, including dietitian visits, social work support, and insurance navigation, for people with type 1 diabetes across 20 states. Collectively, the sessions underscored a field advancing simultaneously on device design, risk stratification, biomarker science, and access to supportive care.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

Triple hormone receptor agonism is emerging as a frontier in metabolic disease treatment, and topline phase 3 results for retatrutide suggest the strategy can push weight loss and glycemic control beyond current incretin therapies, even as a separate JAMA analysis raises questions about oversight in online GLP-1 prescribing.1,2

On the latest episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed topline results from the TRIUMPH-2 and TRIUMPH-3 trials of retatrutide, a glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptor triple agonist.

TRIUMPH-2 enrolled 1000 participants with type 2 diabetes across 98 centers and tested 4 mg, 9 mg, and 12 mg doses against placebo over 80 weeks. The 12 mg dose produced weight loss up to 21% from a baseline of 106 kg, or roughly 23 kg. Hemoglobin A1C fell between 1.4 and 1.6 percentage points from a baseline of 7.7%, versus 0.2 points with placebo, a large glycemic effect given the near-normal starting A1C and discontinuation of 14% at the highest dose.

TRIUMPH-3 enrolled over 1900 participants with class II or III obesity (body mass index of 35 or higher) and established cardiovascular disease, randomized to 9 mg, 12 mg, or placebo over 80 weeks. The 12 mg dose delivered 23% weight loss versus 3% with placebo, alongside a 37% reduction in triglycerides, 17% reduction in non-high-density lipoprotein cholesterol, and 9.3 mmHg reduction in systolic blood pressure. Major adverse cardiovascular event outcomes trended favorably but did not reach significance, an expected limitation of an 80-week trial.

Gastrointestinal effects were common across both trials, including diarrhea in up to 34% of participants and nausea in up to 28%, consistent with the broader incretin class.

Isaacs and Bellini also discussed a JAMA secret-shopper study, led by Ashwin Chetty, MD, examining online GLP-1 prescribing across 49 telehealth websites. Of these, 92% prescribed the requested medication and 70% mailed it, often without required photo verification, blood work, or clinician video visits, in some cases within five minutes. Compounded formulations, including unproven sublingual drops, were frequently offered alongside add-on supplements marketed as personalization, a workaround linked to compounding rules requiring documented medical need.

Together, the findings illustrate a widening gap between the therapeutic ceiling GLP-1-based agents are reaching in controlled trials and the variable oversight surrounding real-world access to these drugs, underscoring the need for clinicians to proactively screen patients for unsupervised use.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

To begin the episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the rapidly evolving landscape of wearable insulin delivery, focusing on recent developments in patch pump technology and the growing number of tubeless insulin delivery systems entering the market. The conversation centers on the recent FDA clearance of the Pivot patch pump from Modular Medical, which the hosts describe as an important addition to a field that has historically been dominated by a single tubeless option.

Isaacs reviews the design of the Pivot system, explaining that while it is a tubeless insulin pump, it differs from current automated insulin delivery (AID) systems because it does not communicate with a continuous glucose monitor (CGM) or use an insulin-dosing algorithm. Instead, the device delivers programmable basal insulin with ≤2 selectable basal rates and allows users to administer manual bolus doses. The hosts note its 300-unit insulin reservoir, highlighting the larger capacity as a potential advantage for individuals with higher daily insulin requirements.

Bellini discusses where Pivot may fit into current clinical practice, suggesting it could provide an option for people who are unwilling or unable to use CGM technology but would still benefit from wearable insulin delivery. She also points to the possibility of future partnerships with commercially available AID algorithms, which could allow the platform to evolve into a more automated system. The hosts acknowledge that current diabetes guidelines generally favor AID for individuals with type 1 diabetes but recognize that simplified technologies continue to have an important role for select patient populations.

The discussion expands to the broader pipeline of tubeless insulin pumps currently under development. Isaacs and Bellini review anticipated products from Tandem, Beta Bionics, and Medtronic, noting that virtually every major insulin pump manufacturer is now investing in patch pump technology. They compare reservoir capacities, expected timelines, and device designs while emphasizing the increasing demand for tubeless systems that improve convenience and reduce many of the practical challenges associated with traditional tubing.

The hosts also examine several practical design considerations. They discuss Pivot's reusable and disposable components, explaining that many newer patch pumps incorporate reusable elements because of existing intellectual property surrounding fully disposable tubeless systems. While reusable components may lower manufacturing costs, they also introduce considerations such as the potential for patients to misplace components or inadvertently lose them during hospitalizations. Isaacs adds that the simplified design and absence of an onboard algorithm may ultimately make the device more affordable, although real-world pricing remains to be determined.

Attention then shifts to recent updates from CeQur Simplicity, which recently announced a 7-day bolus-only patch featuring an expanded 240-unit insulin reservoir and a new one-unit dosing option for individuals requiring smaller mealtime insulin doses. The hosts discuss how these enhancements could broaden the device's applicability while maintaining its emphasis on simplicity, requiring neither smartphone connectivity nor a dedicated mobile application.

Bellini highlights the potential synergy between the 7-day patch and emerging once-weekly basal insulin formulations, suggesting that synchronizing weekly basal insulin administration with weekly patch replacement could simplify treatment routines and improve adherence. She emphasizes that insulin therapy should continue to complement guideline-directed pharmacologic management, including GLP-1 receptor agonists, SGLT2 inhibitors, and other glucose-lowering therapies when appropriate.

The episode concludes with an optimistic assessment of the future of insulin delivery technology. Isaacs and Bellini emphasize that increasing competition among manufacturers is likely to expand patient choice, improve affordability, and accelerate innovation. They express particular enthusiasm for the continued growth of tubeless insulin delivery, broader pharmacy benefit coverage, and the next generation of AID systems, all of which they believe will further individualize diabetes management and improve outcomes for people requiring insulin therapy.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

To begin the episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss recent advances in type 1 diabetes (T1D) research following presentations at the American Diabetes Association (ADA) Scientific Sessions and the American Association of Clinical Endocrinology (AACE) Annual Meeting. They focus on promising data from an islet cell transplantation study in which all 12 participants achieved insulin independence, with some maintaining normal glycemia for up to 2 years after transplantation.

Isaacs explains that the transplanted islet cells restore endogenous insulin production and emphasizes that the study’s most notable innovation is its immunosuppression strategy. Rather than relying on calcineurin inhibitors such as tacrolimus, which are associated with significant toxicities, particularly nephrotoxicity, the investigators used the investigational anti-CD40 ligand therapy tegoprubart. The hosts discuss how this approach may improve the long-term safety and feasibility of islet transplantation and note ongoing efforts to develop more convenient formulations beyond the current intravenous infusion administered every 3 weeks.

The conversation then turns to the clinical significance of the findings. Bellini highlights that all 12 enrolled participants achieved insulin independence, distinguishing these results from earlier transplantation efforts such as the Edmonton protocol. The hosts also describe the substantial improvements in quality of life reported by participants, including sustained HbA1c values in the normal range without restrictive dietary practices and complete resolution of severe hypoglycemia. Because the trial enrolled individuals with recurrent, life-threatening hypoglycemia, they emphasize that the observed benefits are particularly meaningful for this high-risk population.

The hosts also examine several unanswered questions that remain before this approach can become widely available. They discuss the durability of insulin independence, the long-term need for immunosuppressive therapy, treatment costs, and the challenges associated with scaling islet transplantation beyond specialized research centers. Additional findings are reviewed, including the need for repeat transplantation in 2 participants and observations suggesting that individuals with higher body mass index may require greater islet mass to achieve insulin independence. They also discuss the use of tirzepatide in 2 participants, raising questions about the role of insulin resistance and adjunctive therapies following transplantation.

Broadening the discussion, Isaacs and Bellini review several emerging strategies aimed at expanding access to curative therapies. These include stem cell-derived islets, large-scale beta cell manufacturing, gene-editing approaches, and encapsulation technologies intended to protect transplanted cells while reducing or eliminating the need for chronic immunosuppression. Drawing on presentations from Aaron Kowalski, PhD, and Laura Jacobsen, MD, they emphasize that despite major advances in continuous glucose monitoring, automated insulin delivery systems, and adjunctive pharmacotherapy, subcutaneous insulin administration remains fundamentally nonphysiologic and cannot fully eliminate long-term complications or disease burden.

The episode concludes with a broader discussion of the future of type 1 diabetes research. The hosts highlight efforts to expand eligibility for islet transplantation trials, including studies involving individuals with chronic kidney disease who were previously excluded because of concerns surrounding traditional immunosuppressive therapies. They also underscore the importance of continuing to pursue disease-modifying therapies despite improvements in diabetes technology, emphasizing that glycemic targets alone do not eliminate complications or address disparities in access to care. While acknowledging that a universally applicable cure remains years away, Isaacs and Bellini conclude that the field is making meaningful progress toward safe, durable, and scalable therapies capable of fundamentally changing the treatment of type 1 diabetes.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss new real-world data evaluating the Signos platform, an FDA-cleared digital weight-loss solution that combines the Dexcom Stelo continuous glucose monitor (CGM) with artificial intelligence–driven behavioral coaching. The platform delivers personalized recommendations based on glucose responses, dietary intake, physical activity, and user-entered data to support lifestyle modification and weight management.

Bellini begins by highlighting the challenges many individuals face in accessing traditional weight-management programs. While in-person and virtual classes can be effective, participation is often limited by time and accessibility. She notes that digital tools such as Signos may offer a scalable alternative by providing continuous support and accountability outside of the clinic setting.

The study included adults aged 18 years and older with obesity (BMI >30 kg/m²) who did not have diabetes. Researchers evaluated whether engagement with the platform was associated with weight-loss outcomes, using a metric called “total meaningful actions per day” to measure how frequently participants interacted with the app and its coaching features.

Among more than 3,000 participants, periods of active engagement were associated with significantly greater weight loss than periods of low or no engagement. Researchers also evaluated a 180-day cohort of 1,147 participants and found a mean total body weight loss of 5.14% over six months. Participants with higher engagement achieved nearly 6% weight loss, compared with approximately 4.3% among those with lower engagement levels. Bellini emphasizes that these results were achieved without the use of weight-loss medications, underscoring the potential impact of personalized behavioral support combined with CGM data.

Isaacs notes that individuals taking anti-obesity medications, including GLP-1 receptor agonists, were excluded from the study. She points out that many patients prefer to pursue weight loss through lifestyle modification rather than long-term pharmacologic therapy, making these findings particularly relevant. At the same time, both hosts suggest that digital coaching platforms could complement GLP-1 therapies by reinforcing nutrition, physical activity, and other healthy behaviors that remain essential for long-term success.

The conversation also addresses cost and accessibility. Isaacs notes that while Dexcom Stelo can be purchased independently at a lower monthly cost, access to the full Signos platform requires a higher subscription fee. Although this may be a barrier for some patients, the hosts compare the expense to other commercial weight-management programs and view it as another option within a broader obesity treatment strategy.

Throughout the discussion, Isaacs and Bellini emphasize the importance of accountability and ongoing engagement in achieving sustainable weight loss. They highlight the platform’s use of AI-generated prompts, reminders, and behavioral challenges designed to keep users engaged and motivated. The episode concludes with optimism about the growing role of digital health technologies in obesity care and the potential for AI-driven, CGM-informed interventions to provide personalized, scalable support for individuals seeking meaningful weight loss.Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1: Signos. Latest Study Shows Signos Drives Up to 7% Weight Loss Over 6 Months, Rivaling Real-World GLP-1 Weight Loss. BusinessWire. June 23, 2026. Accessed June 23, 2026. https://www.businesswire.com/news/home/20260623955669/en/Latest-Study-Shows-Signos-Drives-Up-to-7-Weight-Loss-Over-6-Months-Rivaling-Real-World-GLP-1-Weight-Loss

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss a series of major pediatric diabetes advancements announced around the American Diabetes Association (ADA) Scientific Sessions 2026, highlighting how recent regulatory decisions are expanding treatment options and improving access to diabetes technologies.

The conversation opens with the expanded FDA indication for teplizumab in children and adolescents with newly diagnosed stage 3 type 1 diabetes. Bellini reviews findings from the PROTECT trial, which evaluated teplizumab in patients ages 8 to 17 years within six weeks of diagnosis. She explains that treatment with two 12-day infusion courses resulted in significant preservation of endogenous insulin production, with 95% of participants maintaining peak C-peptide levels above the study threshold at week 78. The hosts discuss the importance of preserving residual beta-cell function, emphasizing its potential role in improving glycemic stability, reducing hypoglycemia risk, and supporting better long-term outcomes for individuals who will live with type 1 diabetes for decades.

Isaacs and Bellini explore how this new indication may change the approach to type 1 diabetes screening, particularly among first-degree relatives and individuals at higher risk for autoimmune disease. They note that identifying people in stage 2 type 1 diabetes remains challenging because patients are typically asymptomatic, but the availability of treatment at stage 3 provides clinicians with a new opportunity to intervene soon after diagnosis.

The hosts discuss how having an approved therapy may encourage more families to pursue screening and identify additional individuals with early-stage disease. They also address practical considerations, including the importance of starting treatment within the appropriate window, coordinating the two infusion courses, supporting families through treatment logistics, and ensuring access through insurance coverage.

The discussion then shifts to the FDA clearance of Dexcom Stelo, the first over-the-counter glucose biosensor cleared for pediatric use in children ages 2 years and older who do not use insulin. Isaacs highlights how this technology could improve access to glucose monitoring for children with prediabetes, type 2 diabetes, or those seeking greater insight into how food, activity, and lifestyle factors influence glucose patterns.

The hosts emphasize that expanded access to glucose monitoring could play an important role in helping families make informed decisions about diabetes management. However, they clarify that individuals using insulin require prescription continuous glucose monitoring systems with additional safety features, including hypoglycemia alerts and predictive low glucose notifications.

Finally, Isaacs and Bellini discuss the pediatric approval of inhaled insulin as another significant milestone in diabetes care. They review its potential as an alternative to mealtime injections and highlight the opportunity to provide more flexibility for children and families managing type 1 diabetes. The conversation also addresses implementation considerations, including baseline lung function testing, provider familiarity, and adapting clinical workflows to incorporate new treatment approaches.

The episode concludes by reflecting on the rapid progress occurring in pediatric diabetes care. With advances in immune-modulating therapies, glucose monitoring technology, and insulin delivery options, the hosts highlight a new era of personalized diabetes management focused on preserving insulin function, improving access, and optimizing outcomes for young people living with diabetes.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1: Sanofi. Press Release: Sanofi’s Tzield approved in the US as the first disease-modifying therapy for patients recently diagnosed with stage 3 type 1 diabetes. June 12, 2026. Accessed June 18, 2026. https://www.sanofi.com/en/media-room/press-releases/2026/2026-06-12-22-09-58-3311349

2: US Food and Drug Administration. FDA Clears First Over-the-Counter Continuous Glucose Monitor for Children. June 12, 2026. Accessed June 18, 2026. https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor-children

3: Livingston R. FDA Approves Inhaled Insulin Afrezza for Pediatric Patients With Diabetes. HCPLive. May 29, 2026. Accessed June 18, 2026. https://www.hcplive.com/view/fda-approves-inhaled-insulin-afrezza-pediatric-patients-diabetes

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, shot live at the American Diabetes Association (ADA) Scientific Sessions 2026 in New Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the latest major trial results like CONNECT, TRIUMPH, and TRANSCEND.

To begin the episode, Isaacs and Bellini, discuss major highlights from ADA Scientific Sessions, focusing first on the landmark CONNECT trial evaluating continuous glucose monitoring (CGM) in people with type 2 diabetes who are not treated with insulin. They reflect on the evolution of CGM technology, from its early use primarily in type 1 diabetes to its expanding role in type 2 diabetes management, and explain why this trial represents an important step forward for patients who have historically had limited access to CGM.

The hosts review the randomized controlled trial findings, emphasizing the significant improvements in glycemic outcomes, including a 1.6% reduction in A1c from baseline and an approximately 0.9% greater reduction compared with standard care. They also highlight the increase in time in range, with participants using CGM achieving roughly five additional hours per day in target glucose range. The magnitude of these findings is discussed as a practice-changing development, with the potential to influence future clinical guidelines and strengthen recommendations for CGM use among individuals with type 2 diabetes who are not using insulin.

The discussion also explores the broader implications of the CONNECT trial for healthcare access and insurance coverage. The hosts note that randomized controlled trial evidence has historically played a key role in shaping standards of care and payer decisions, and they suggest that these results may help support wider adoption of CGM by demonstrating meaningful improvements in glucose control and patient outcomes.

The conversation then shifts to emerging pharmacologic advances, with a focus on retatrutide, a novel triple agonist targeting GLP-1, GIP, and glucagon pathways. The hosts discuss new data showing substantial metabolic benefits in people with type 2 diabetes, including up to 17% weight reduction and nearly 2% A1c lowering. They highlight how these findings represent a major advancement in diabetes and obesity treatment, particularly as clinicians continue to see increasingly powerful effects from next-generation incretin-based therapies.

Isaacs and Bellini explore how these therapies may reshape treatment strategies by allowing clinicians to tailor medication choices based on individual patient needs and goals. They discuss the importance of considering both glucose lowering and weight reduction effects, recognizing that some patients may benefit from significant weight loss while others may require a more balanced approach focused primarily on glycemic improvement.

The hosts also address important unanswered questions surrounding the use of highly effective weight-loss medications, including appropriate treatment targets, the limitations of BMI as a measure, and the importance of preserving muscle mass and overall function. They emphasize the need to consider body composition, physical activity, resistance training, and patient characteristics—particularly in older adults or those at risk for frailty—when developing long-term treatment plans.

The episode concludes with a reflection on the rapidly evolving landscape of diabetes care. The hosts highlight how advances in CGM technology and novel metabolic therapies are creating new opportunities to improve outcomes, personalize treatment approaches, and redefine the future management of people living with diabetes.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this special episode recorded live at the American Diabetes Association (ADA) Scientific Sessions 2026 in New Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Ketan Dhatariya, MD, PhD, MS, consultant physician at Norfolk and Norwich University Hospitals, to discuss the evolving landscape of diabetes care, technology access, and clinical implementation. 

To begin the episode, Dhatariya shares his perspective on the challenges facing diabetologists, including workforce pressures, specialist training, and the difficulty of translating rapidly expanding diabetes guidelines and innovations into everyday clinical practice. The conversation then shifts to the differences between healthcare systems and how those structures influence access to diabetes therapies. Dhatariya discusses the UK’s publicly funded healthcare model and the ongoing challenge of balancing the cost of emerging medications and technologies with their long-term benefits. He highlights the importance of demonstrating that investments in diabetes care today can reduce complications and healthcare costs in the future.

Dhatariya then reviews the progress of continuous glucose monitoring (CGM) and automated insulin delivery (AID) adoption in the UK. He explains that CGM use among people with type 1 diabetes has become widespread, particularly among children, and that access to closed-loop systems continues to expand through structured implementation plans. He emphasizes the meaningful improvements these technologies have provided, including better glycemic outcomes among children and pregnant individuals, who may experience significant benefits from improved glucose management.

The discussion explores how diabetes technology can support people with different lifestyles and challenges, while challenging assumptions about which patients may benefit most from advanced therapies. Dhatariya highlights that CGM and AID can provide valuable support for individuals who may struggle with traditional insulin management, while also emphasizing the need for appropriate education and follow-up to ensure safe and effective use.

The group also discusses CGM use in type 2 diabetes and the growing evidence supporting broader access. Dhatariya explains that adoption has been slower because of the larger population affected by type 2 diabetes but notes emerging data suggesting CGM may help reduce complications, hospitalizations, and long-term healthcare costs. He describes the impact of seeing real-time glucose data, explaining how personal experience with CGM can help people better understand the relationship between food, behavior, and glucose patterns.

The conversation then turns to access to GLP-1 receptor agonists in the UK and how healthcare systems determine eligibility for newer therapies. Dhatariya discusses the role of national guidance and health economic evaluations in balancing access, affordability, and sustainability. He highlights how improving obesity-related disease management may have broader benefits, including helping reduce the burden of diabetes, cardiovascular disease, and other chronic conditions.

The episode also explores inpatient diabetes care and the increasing presence of diabetes technology in hospital settings. Dhatariya discusses guidance developed by the Joint British Diabetes Societies for Inpatient Care to help clinicians safely manage patients admitted while using CGM, insulin pumps, and AID systems. He emphasizes that devices should not automatically be removed and that patients may be able to continue using technology when they are well enough and capable of managing their systems.

Finally, Dhatariya discusses the importance of structured diabetes education, including the DAFNE (Dose Adjustment For Normal Eating) program, which teaches carbohydrate counting, insulin adjustment, and self-management skills. He emphasizes that as diabetes technology becomes more advanced, education remains essential for both patients and clinicians. The episode concludes with a discussion of the need for continued advocacy, specialist care, and equitable access to ensure people with diabetes can benefit from ongoing advances in diabetes technology.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others. Dhatariya reports disclosures with AstraZeneca, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this special episode recorded live at the American Diabetes Association (ADA) Scientific Sessions 2026 in New Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Trang Ly, PhD, MBBS, senior vice president and Chief Medical Officer at Insulet, to discuss the continued evolution of automated insulin delivery (AID) technology and emerging developments across the Omnipod platform. 

To begin the episode, Ly first reviews updates to Omnipod 5, focusing on enhancements aimed at increasing time in automated mode and improving glucose management. She explains that user feedback identified opportunities to support lower glucose targets and reduce interruptions related to system alerts. Data from real-world evidence and computer simulations suggest that lowering the glucose target from 110 to 100 mg/dL may lead to meaningful improvements in time in range and time in tight range without increasing hypoglycemia risk.

The group discusses early clinical experience with these enhancements, including findings from users who transitioned to the updated system. Ly highlights that even a highly engaged population already using lower targets experienced additional improvements, including a 2% increase in time in range and a 5% increase in time in tight range over a short period of use. The conversation emphasizes the importance of making these improvements broadly available rather than waiting for routine follow-up visits, particularly given the potential benefits without additional safety concerns.

The discussion then turns to Omnipod 6, with Ly sharing newly presented clinical trial data evaluating the next-generation system. She describes the study design, which enrolled users already achieving strong glycemic control on Omnipod 5 and assessed whether further intensification through algorithm improvements could safely provide additional benefits. The results demonstrated a 4% improvement in time in range and up to a 7% increase in time in tight range, with particularly notable improvements among individuals with type 1 diabetes aged 14 years and older.

Ly explains that Omnipod 6 builds on previous technology through changes to the core algorithm, allowing the system to deliver more insulin when users do not bolus consistently. The panel explores how this approach may reduce the burden of diabetes management by allowing the algorithm to take on more responsibility while maintaining glycemic control. They discuss the potential psychological benefits of reducing the daily demands placed on people with diabetes, especially as sensor accuracy and automation continue to improve.

The conversation also highlights future opportunities for AID in type 2 diabetes. Ly shares early feasibility data from a fully closed-loop system designed specifically for individuals with type 2 diabetes, emphasizing its simplified approach without requiring traditional pump programming or meal bolusing. In this study, participants experienced improvements in time in range, demonstrating the potential for automated insulin delivery to reach broader populations.

Isaacs and Bellini discuss the need to reconsider barriers to insulin pump adoption in type 2 diabetes and recognize AID as an accessible option for patients who may benefit. Ly emphasizes that technology should support people across different levels of engagement, offering both highly customizable systems for those seeking intensive management and simpler automated approaches for those looking to reduce daily treatment demands.

The episode concludes with a discussion of the future of diabetes technology, including improved connectivity, expanded device flexibility, and continued integration with complementary therapies such as GLP-1 receptor agonists. Ly underscores that innovation should not only improve clinical outcomes but also reduce the burden of care, allowing people with diabetes to spend less time managing their condition and more time living their lives.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others. Ly reports a disclosure with Insulet.
References
1: Insulet. Insulet Reveals New Data Supporting Breakthrough Omnipod 6 and Fully Closed-Loop AID Systems Designed to Improve Outcomes, Reduce Effort, and Unlock Barriers to Care. June 6, 2026. Accessed June 7, 2026. https://investors.insulet.com/news/news-details/2026/Insulet-Reveals-New-Data-Supporting-Breakthrough-Omnipod-6-and-Fully-Closed-Loop-AID-Systems-Designed-to-Improve-Outcomes-Reduce-Effort-and-Unlock-Barriers-to-Care/default.aspx

1. Section 7: Diabetes technology. Diabetes Obesity and Cardiometabolic CARE. Published online March 23, 2026. doi:10.2337/doc26-a007
   
   

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the recent FDA approval of MannKind’s inhaled insulin Afrezza for pediatric patients aged 6 years and older with both type 1 and type 2 diabetes, describing the decision as a major milestone in diabetes therapeutics and the first expansion of the therapy beyond adults. The episode centers on the clinical implications of the approval, the pharmacologic advantages of inhaled insulin, and the practical considerations surrounding implementation in pediatric care settings.

The hosts review findings from the INHALE-1 trial, which enrolled 230 pediatric participants aged 4 to 17 years and compared inhaled insulin used alongside basal insulin with standard multiple daily injection (MDI) therapy over 56 weeks. Bellini emphasizes that the study achieved its primary objective of demonstrating glycemic outcomes comparable to traditional insulin regimens, noting that insulin studies are generally designed to establish equivalence rather than superiority. Beyond similar glycemic control, the hosts highlight several clinically meaningful secondary observations, including stable BMI among participants receiving inhaled insulin compared with weight gain in the MDI cohort, increased treatment satisfaction reported by both adolescents and parents of younger children, comparable hypoglycemia rates, and the absence of new safety concerns. Bellini also notes that no decline in lung function was observed among participants using inhaled insulin, despite historical concerns surrounding pulmonary safety with inhaled therapies.

A major focus of the discussion is the physiologic pharmacokinetic profile of Afrezza, which Isaacs characterizes as the most physiologic insulin currently available. She explains that inhaled insulin demonstrates measurable activity within approximately 12 minutes, peaks within 35 to 45 minutes, and clears the bloodstream in roughly 90 minutes. The hosts contrast this with subcutaneous rapid-acting insulin analogs, including ultra-rapid formulations, which retain a prolonged “tail” of insulin activity that can increase hypoglycemia risk. Isaacs and Bellini suggest that the shorter duration of inhaled insulin may reduce the cycle of overtreating hypoglycemia and subsequent rebound hyperglycemia, thereby potentially contributing to the absence of weight gain observed in the trial. Bellini further emphasizes that the rapid onset and offset of inhaled insulin restore some of the flexibility and spontaneity often lost in intensive insulin therapy, particularly around meal dosing and correction strategies.

The conversation also situates inhaled insulin within the broader framework of individualized diabetes management and the ADA Standards of Care. Isaacs stresses that the approval should not be viewed as competing with automated insulin delivery (AID) systems, but rather as expanding patient choice. The hosts discuss how inhaled insulin may be especially valuable for individuals who do not wish to wear insulin pumps, desire periodic breaks from technology, or want to reduce the burden of injections. Isaacs additionally highlights the growing prevalence of pediatric type 2 diabetes and notes that, despite advances in incretin-based therapies, many youth still require insulin therapy. In that context, the possibility of pairing inhaled mealtime insulin with emerging once-weekly basal insulin formulations and GLP-1 receptor agonists is presented as a potentially transformative strategy for minimizing injection burden.

Bellini and Isaacs also address practical implementation challenges within school settings. Because inhaled insulin acts rapidly, Bellini notes that administration timing may need to shift from the nurse’s office to the cafeteria environment to avoid hypoglycemia if meals are delayed. At the same time, both hosts recognize that the flexibility of postprandial dosing could offer advantages for children with inconsistent eating patterns or concerns about privacy surrounding insulin administration. They further discuss the utility of inhaled insulin for rapid glucose corrections, noting that additional doses can be administered far sooner than with traditional injected rapid-acting insulin.

The episode concludes with discussion of anticipated affordability initiatives from MannKind Corporation, including bridge programs designed to improve early access and reduce financial barriers to therapy. Isaacs and Bellini commend the company’s efforts to secure pediatric approval and express optimism that broader availability of inhaled insulin will expand individualized treatment options, improve patient satisfaction, and enhance quality of life for children and adolescents living with diabetes.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1: HOLDER

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss several major developments in diabetes technology and obesity therapeutics, beginning with Abbott’s announcement that its dual glucose-ketone monitoring systems, Libre Duo and Libre Duo 10 Day, have received CE mark approval in Europe. The hosts describe the devices as the first continuous glucose-ketone monitors capable of simultaneously measuring glucose and ketone levels through a single wearable sensor, with real-time ketone monitoring intended to identify rising risk for diabetic ketoacidosis (DKA). Bellini explains the rationale for separate 15-day adult and 10-day pediatric sensors, noting higher sensor failure rates and greater activity levels in children. Both hosts emphasize the potential clinical significance of continuous ketone monitoring, particularly for individuals with type 1 diabetes (T1D) using insulin pumps, where interruptions in insulin delivery can rapidly precipitate DKA.

The discussion further explores how continuous ketone monitoring may expand the safe use of SGLT2 inhibitors in people with T1D and other high-risk populations. Bellini highlights concerns surrounding euglycemic DKA associated with SGLT2 inhibitor therapy and suggests that continuous ketone data could help clinicians identify susceptible individuals earlier, potentially enabling safer and more individualized dosing strategies. Isaacs underscores the limitations of current ketone testing methods, particularly urine ketone testing, which she characterizes as outdated and insufficient for modern diabetes management. The hosts also review additional patient populations that may benefit from continuous ketone monitoring, including individuals with recurrent DKA, pediatric patients with highly variable glycemic patterns, and hospitalized patients at elevated risk for ketosis due to prolonged fasting or treatment interruptions.

Isaacs and Bellini also consider practical questions surrounding implementation, including reimbursement, cost, workflow integration, and compatibility with automated insulin delivery systems. They discuss whether continuous ketone monitoring could eventually become standard of care in T1D and debate the broader implications of widespread ketone data availability, including potential consumer interest outside traditional diabetes populations. Both hosts stress the importance of prioritizing access for patients at highest risk for DKA while acknowledging that broader adoption could reshape diabetes monitoring paradigms similarly to the evolution of continuous glucose monitoring.

The episode then turns to recent reports involving Dexcom sensors that were reportedly stolen after being removed from the manufacturing process for quality concerns. Bellini explains that some of the affected sensors may not have completed sterility and quality assurance procedures before entering secondary markets. The hosts caution clinicians to review affected lot numbers and encourage ongoing vigilance until additional information becomes available. They also discuss the challenges of communicating recalls and safety alerts directly to patients, particularly for users relying on standalone receivers that may not connect to cloud-based notification systems.
Finally, Isaacs and Bellini review newly released topline results from the phase 3 TRIUMPH-1 trial evaluating retatrutide, Lilly’s investigational triple agonist targeting GLP-1, GIP, and glucagon receptors. Bellini summarizes findings demonstrating substantial weight reduction among adults with obesity or overweight without diabetes, including mean weight loss exceeding 28% at 80 weeks and continued weight reduction through 104 weeks without evidence of plateau. The hosts note that nearly half of participants achieved at least 30% weight loss, approaching outcomes historically associated with bariatric surgery. They also highlight low discontinuation rates and discuss the implications of future TRIUMPH studies evaluating retatrutide in patients with type 2 diabetes and cardiovascular disease. Isaacs concludes that the emerging data signal a transformative shift in obesity treatment, with pharmacologic therapies increasingly approaching surgical efficacy and potentially reshaping long-term obesity management strategies.
Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this special in-studio episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reflect on major themes and anticipated developments ahead of the upcoming American Diabetes Association (ADA) Scientific Sessions 2026.

The discussion opens with Bellini congratulating Isaacs on receiving the ADA Outstanding Educator in Diabetes Award, prompting a conversation centered on Isaacs’ forthcoming presentation, “Behind Every Number Is a Story: Transforming Diabetes Care and Education through Technology and Human Connection.” Isaacs reflects on the rapid evolution of diabetes technology over the last decade, from limited continuous glucose monitoring (CGM) access and the emergence of early automated insulin delivery (AID) systems to the integration of artificial intelligence into diabetes care, while emphasizing that successful care remains grounded in human connection and individualized patient experiences.

The hosts then preview several therapeutic areas expected to dominate discussion at ADA, particularly the expanding pipeline of incretin-based therapies. Bellini and Isaacs discuss growing excitement surrounding GLP-1, GIP, and glucagon receptor agonists, including anticipated data from triple agonist agents such as retatrutide and emerging oral therapies like orforglipron. They highlight the significance of improved weight-loss efficacy in people with type 2 diabetes (T2D), broader cardiometabolic applications, and the increasing importance of treatment accessibility and affordability. The conversation also explores the expanding role of these therapies in addressing cardiovascular disease, chronic kidney disease, sleep apnea, osteoarthritis, and other obesity-related comorbidities.

Technology advancements represent another major focus of the episode. Isaacs and Bellini discuss new CGM-driven insulin titration tools, including Dexcom’s Smart Basal feature, designed to address therapeutic inertia among people with T2D using basal insulin. They also examine the growing role of CGM in broader patient populations and discuss evolving ADA recommendations supporting CGM access for any individual likely to benefit from the technology. The hosts express particular enthusiasm for the anticipated arrival of continuous ketone monitoring, including dual glucose-ketone sensors, and consider how these devices may transform diabetic ketoacidosis prevention and patient education, particularly for individuals with type 1 diabetes (T1D).

The conversation also highlights continued innovation in insulin delivery systems and connected diabetes devices. Isaacs and Bellini discuss progress toward fully closed-loop AID systems, including ongoing studies evaluating meal-unannounced insulin delivery in T2D. They review emerging insulin pump technologies from Medtronic, including updates to the MiniMed platform and the integration of connected insulin pen systems with real-time CGM data through the MiniMed Go app. The hosts emphasize the importance of preserving therapeutic choice for people who prefer injections over pump therapy or who seek temporary alternatives to wearable devices.

Toward the conclusion of the episode, both hosts preview their own ADA presentations. Isaacs discusses an upcoming session on inhaled insulin that will use simulated patient scenarios to explore shared decision-making and individualized therapy selection. Bellini highlights her session focused on skin complications related to diabetes technologies, including allergic reactions and adhesive-related challenges that can interfere with sustained device use. Together, they underscore the importance of addressing practical barriers to technology adoption while continuing to expand therapeutic and technological options for people living with diabetes.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode of Diabetes Dialogue, recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Viral Shah, MD, professor of endocrinology at Indiana University, for a discussion centered on the evolving role of GLP-1 receptor agonists and broader diabetes classification in type 1 diabetes care. Shah challenges the traditional distinction between type 1 and type 2 diabetes, emphasizing that type 2 diabetes lacks a definitive diagnostic test and is instead a diagnosis of exclusion based on phenotypic characteristics. He explains that patients with type 1 diabetes can also exhibit features of type 2 diabetes, making these categories non–mutually exclusive and supporting the rationale for dual diagnoses when clinically appropriate.

The group explores how this framework informs the use of GLP-1 receptor agonists in type 1 diabetes, particularly for patients with obesity, cardiovascular disease, heart failure, or chronic kidney disease. Shah notes that while obesity provides a clear indication for GLP-1 therapy, he is also comfortable using these agents in patients with lower BMI when cardiovascular or renal protection is the primary goal, with careful attention to dose adjustment and avoidance of excessive weight loss or muscle mass reduction. He adds that SGLT2 inhibitors may be preferable in some leaner patients, particularly when renal indications predominate, and highlights recent clarification that SGLT2 inhibitor use for CKD in type 1 diabetes is not considered off-label when prescribed for kidney protection rather than glycemic control.

The conversation then shifts to Shah’s broader view that type 1 and type 2 diabetes differ more in pathophysiology than in long-term disease course. He argues that both conditions share progressive beta cell dysfunction and overlapping complication risks, suggesting the field should move away from rigid separation and toward a more unified understanding of diabetes progression.

This perspective leads into a discussion of “prediabetes,” a term Shah critiques as outdated and insufficient. He reviews its historical origins as a label for intermediate hyperglycemia and argues that it has unintentionally minimized urgency by framing the condition as merely a risk factor rather than part of the disease continuum. Citing evidence of significantly elevated cardiovascular, kidney, and mortality risk in people with prediabetes, he advocates for staging type 2 diabetes similarly to type 1 diabetes, rather than maintaining an artificial threshold between “no disease” and diabetes. He notes that while therapies such as metformin, semaglutide, and tirzepatide have demonstrated benefit in delaying progression, regulatory limitations persist because prediabetes is not formally recognized as a disease state.

The episode concludes with a discussion of autoantibody screening in adults labeled with prediabetes. Shah supports broader antibody testing, particularly in younger adults, to identify individuals with early-stage type 1 diabetes who may otherwise be misclassified and present later with DKA. He emphasizes that accessible antibody testing and therapies such as teplizumab make earlier identification increasingly meaningful, while also acknowledging the importance of patient preference and individualized decision-making. Across the discussion, Shah calls for greater flexibility in diabetes classification, earlier intervention across the disease spectrum, and a more proactive approach to preventing complications rather than waiting for traditional diagnostic thresholds to be crossed.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!
In this episode of Diabetes Dialogue, recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Elizabeth Bauer, MD, a clinical endocrinologist and obesity specialist, to discuss key updates in obesity management presented during her “Year in Review” session at the AACE Annual Meeting. Bauer opens by highlighting AACE’s updated obesity algorithm, released in late 2024, which builds on the organization’s prior adiposity-based chronic disease framework and shifts obesity care further away from BMI-centered diagnosis toward a more comprehensive, disease-centric model. She explains the algorithm’s emphasis on anthropometric assessment, adiposity distribution, and obesity staging, noting that clinicians must move beyond weight alone to better identify obesity-related complications and personalize treatment decisions.

The discussion focuses on the algorithm’s practical value, particularly its structured staging system and medication tables that help clinicians match pharmacotherapy to obesity-related comorbidities such as diabetes, MASLD, and obstructive sleep apnea. Bauer emphasizes that treatment goals should be complication-specific—for example, modest weight loss may improve glycemia, while greater total body weight reduction is needed for meaningful improvement in MASH. She and the hosts stress that obesity management should prioritize whole-person health rather than weight alone, drawing parallels to the evolution of diabetes treatment toward complication-driven care.

The group then turns to emerging pharmacotherapies, with Bauer reviewing several phase 2 and 3 obesity trials involving newer incretin-based agents. She highlights mazdutide, a once-weekly GLP-1–based therapy studied in Chinese populations using lower BMI thresholds more reflective of Asian obesity risk, as well as combination therapies such as semaglutide plus cagrilintide, which demonstrated greater efficacy than semaglutide alone but with substantially higher gastrointestinal adverse effects. Bauer notes that while these agents show impressive weight loss potential, tolerability remains a major clinical challenge, particularly with nausea and dose escalation.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode of Diabetes Dialogue recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, interview Linda DiMeglio, MD, MPH, professor of pediatrics and division chief at Indiana University School of Medicine, following her plenary keynote and receipt of the Alan Garber Award. DiMeglio outlines her broad work in type 1 diabetes research, including prevention strategies, beta cell preservation, diabetes technology, TrialNet leadership, and neurocognitive studies in young children living with diabetes.

The discussion centers on early-stage type 1 diabetes, with DiMeglio reviewing the evolving framework of risk identification and staging, from genetic predisposition and single autoantibody positivity through stage 1, stage 2, and stage 3 disease. She highlights the growing momentum behind both general population and family-based screening, emphasizing the importance of early detection not only to prevent diabetic ketoacidosis but also to enable timely intervention with disease-modifying therapies. She notes the recent expansion of teplizumab approval down to age 1 for stage 2 disease as a major milestone and describes the broader therapeutic goal as ultimately ending insulin dependence for people living with type 1 diabetes.

DiMeglio and the hosts discuss how the field has shifted significantly over the past decade, particularly with the reframing of “cure” as a combination of multiple targeted approaches rather than a single intervention. She underscores the importance of combination immunotherapy strategies, citing recent TrialNet work using rituximab followed by abatacept, as well as the need for more personalized approaches based on individual disease etiology and immune characteristics. She also stresses the need for better intermediate endpoints beyond the traditional 2-year C-peptide model to accelerate therapeutic development and trial efficiency.

The group also examines the increasing role of patient and family perspectives in clinical trial design, particularly through TrialNet’s community advisory board, which DiMeglio believes will improve recruitment and trial execution. They discuss the broader implications of immune-modifying therapies in type 1 diabetes, including parallels with oncology treatment models and the potential for these advances to inform management strategies for other autoimmune diseases. DiMeglio also reflects on how these therapies are reshaping endocrinology practice itself, requiring clinicians to become more familiar with immunomodulation, cytokine management, and interdisciplinary care.

A major focus of the conversation addresses the complexity of autoantibody interpretation, particularly around GAD antibodies and low-titer positivity. DiMeglio emphasizes that a single positive islet autoantibody test should never be considered definitive and should always be repeated, ideally in a separate gold-standard laboratory such as TrialNet. She explains that antibody specificity varies by type and titer, with higher titers often offering greater diagnostic confidence, while acknowledging ongoing uncertainty around interpretation in adults, diverse populations, and long-standing diabetes. The hosts also discuss the practical challenges of coding, insurance coverage, and patient counseling as early-stage diabetes diagnosis becomes more common.

The episode concludes with a discussion of emerging questions around antibody fluctuation over time, circadian variation in antibody measurements, and the role of genetic screening. DiMeglio notes that antibody status may shift over years and may even vary by time of day, introducing additional complexity into monitoring strategies. While genetic risk screening remains promising, she explains that large-scale antibody-based population screening may currently be more practical from a public health perspective. She closes by reinforcing that although much remains nuanced and unresolved, the field is rapidly advancing toward earlier intervention, more individualized treatment, and a fundamentally different future for type 1 diabetes care.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode of Diabetes Dialogue, host Diana Isaacs, PharmD, is joined by Jessica Castle, MD, vice president of medical affairs at Dexcom, to discuss the company’s recent innovations in continuous glucose monitoring (CGM) and their clinical implications.
To open the episode, Castle outlines the launch of the Dexcom G7 15-day system, highlighting its extended wear duration, improved accuracy (MARD ~8%), and strong early adoption among adults. She notes ongoing efforts to optimize sensor longevity, particularly through adhesive enhancements, while acknowledging that pediatric expansion remains under evaluation due to unique wear challenges in children. Integration with automated insulin delivery systems continues to evolve, with further updates anticipated.
The discussion then shifts to Dexcom’s newly cleared Smart Basal feature, designed to address persistent clinical inertia in basal insulin titration for type 2 diabetes. Castle explains how clinician-defined parameters within the Dexcom Clarity platform enable automated daily dose adjustments based on CGM data, with the goal of minimizing both hyperglycemia and hypoglycemia. Early data presented at ATTD demonstrate significant improvements in mean glucose (>40 mg/dL reduction) and time in range (>20 percentage point increase), without increased hypoglycemia, underscoring both the safety and efficacy of this approach.
Isaacs and Castle also explore recent advancements in Dexcom’s digital ecosystem, including AI-driven meal detection and nutritional analysis within the Stelo and G7 platforms. These tools facilitate real-time behavioral insights, reinforcing CGM’s role as a powerful driver of lifestyle modification. Castle emphasizes the growing integration of artificial intelligence to deliver actionable, personalized feedback while maintaining clinical reliability.
Expanding beyond glycemic metrics, Castle reviews emerging real-world evidence supporting CGM use across diverse populations. Retrospective analyses presented at ATTD demonstrate substantial reductions in diabetic ketoacidosis (DKA), including >90% risk reduction in pediatric type 1 diabetes following CGM initiation. Additional registry data in non-insulin-treated type 2 diabetes show meaningful A1C reductions (~0.6%) and associated weight loss, reinforcing the value of CGM beyond insulin-dependent populations. The conversation also highlights complementary benefits when CGM is used alongside newer pharmacotherapies, including GLP-1 receptor agonists and dual incretin agents.
The episode further addresses gaps in evidence, particularly in pregnancy. While CGM adoption is increasing and supported by growing data in gestational diabetes, Castle acknowledges limited evidence in preexisting type 2 diabetes during pregnancy. Ongoing studies, including the IMAGINE trial, aim to evaluate earlier CGM implementation and its potential to improve maternal and fetal outcomes, potentially reshaping current screening paradigms.
The discussion concludes with a forward-looking perspective on Dexcom’s innovation pipeline. Castle highlights Smart Basal and the G7 15-day system as near-term practice-changing tools, alongside continued advancements in sensor design, accuracy, and usability. Both speakers emphasize the expanding role of CGM as a foundational technology in diabetes management, supporting a more proactive, data-driven, and patient-centered approach to care across clinical settings.

Editor’s Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

The US Food and Drug Administration (FDA) has approved orforglipron (Foundayo), a once-daily oral GLP-1 RA, for chronic weight management in adults with obesity or overweight and ≥1 weight-related comorbidity.1

In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the FDA’s decision and the myriad new treatment opportunities afforded by orforglipron’s clearance for entry into the market.

The approval of orforglipron is supported by the phase 3 ATTAIN clinical development program, which includes 2 global, randomized, double-blind, placebo-controlled trials evaluating efficacy and safety over 72 weeks.¹ The ATTAIN-1 trial enrolled 3,127 adults with obesity or overweight without diabetes, while ATTAIN-2 enrolled more than 1,600 adults with obesity or overweight and type 2 diabetes.1

In ATTAIN-1, participants receiving the highest dose of orforglipron achieved a mean weight reduction of approximately 12.4% from baseline at 72 weeks among those who remained on treatment, compared with 0.9% in the placebo group. Reported average absolute weight loss was 27.3 lb versus 2.2 lb, respectively. Across all randomized participants regardless of completion status, mean weight loss was 11.1% with orforglipron compared with 2.1% with placebo.1

Secondary outcomes included improvements in cardiometabolic risk markers such as waist circumference, non–high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure. However, detailed peer-reviewed data from ATTAIN-1 and ATTAIN-2 remain limited at the time of reporting, and full efficacy and safety results have not yet been widely published in the medical literature.

The safety profile of orforglipron appears consistent with the GLP-1 receptor agonist class. Common adverse events include gastrointestinal symptoms such as nausea, diarrhea, constipation, vomiting, and abdominal pain. A boxed warning highlights a potential risk of thyroid C-cell tumors, based on findings observed with other GLP-1 receptor agonists in rodent studies, though human relevance remains uncertain.1,2

The magnitude of weight loss observed with orforglipron in ATTAIN-1 appears clinically meaningful but may be modest relative to leading injectable agents. Cross-trial comparisons should be interpreted cautiously due to differences in study populations and designs. Additionally, treatment persistence rates and discontinuation due to adverse events will be important considerations in real-world use.

Ongoing and planned studies are evaluating orforglipron across additional indications, including type 2 diabetes and other cardiometabolic conditions. Future comparative trials against established GLP-1 and dual incretin therapies may help define its role in treatment algorithms.

Editor’s Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References
1: Eli Lilly. FDA approves Lilly’s Foundayo (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions. April 1, 2026. Accessed April 1, 2026. https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill
2: US Food and Drug Administration. FDA Approves First New Molecular Entity Under National Priority Voucher Program. April 1, 2026. Accessed April 1, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

Expanding access to and optimizing use of automated insulin delivery (AID) systems remains a central priority in diabetes care, with recent discussions highlighting practical strategies to improve outcomes across diverse patient populations.

In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Laurel Messer, PhD, RN, vice president of medical affairs at Tandem Diabetes Care, to examine evolving approaches to insulin pump optimization and the broader implications for reducing patient burden.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a comprehensive update on the rapidly evolving landscape of incretin-based therapies, focusing on newly published and top-line clinical trial data across oral GLP-1 receptor agonists and emerging triple agonists.

Key Episode Timestamps
00:00:01 Intro
00:00:22 Orforglipron in the ACHIEVE-3 trial
00:03:30 Side effects from orforglipron
00:10:28 Retatrutide in the TRIUMPH-4 trial
00:18:26 Topline data on Novo Nordisk's UBT251
00:21:47 Price cuts on Ozempic, Rybelsus, and Wegovy in 2027
00:26:26 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a detailed update on evolving incretin-based therapies, with a primary focus on a significant formulation change for tirzepatide.

Key Episode Timestamps
00:00:01 Intro
00:00:11 Zepbound in the KwikPen
00:01:25 Vials versus pens
00:02:55 Environmental benefits
00:03:53 Pen needles sold separately
00:06:30 LillyDirect availability
00:07:20 Europe approves 7.2 mg injectable semaglutide
00:09:08 Reusable pen concerns
00:10:55 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore advances in implantable diabetes technologies, focusing on a novel implantable insulin pump from Portal Diabetes that has received FDA Breakthrough Device designation.

Key Timestamps
00:00:01 Intro
00:00:14 Implantable insulin pumps
00:01:06 What is breakthrough status?
00:03:00 How the pump works
00:03:41 What makes it different from MiniMed?
00:07:36 How does it administer insulin?
00:09:47 The Twiist pump with EverSense
00:13:30 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore major updates in the evolving GLP-1 receptor agonist landscape, with a particular focus on oral semaglutide formulations, branding changes, and regulatory concerns surrounding compounded alternatives.

Key Episode Timestamps
00:00:01 Intro
00:00:25 Oral Wegovy and oral Ozempic
00:03:04 Why Rybelsus didn't work
00:05:33 The importance of administration
00:06:56 Compounding drugs - the Hims and Hers drama
00:07:56 The danger of unregulated compound drugs
00:11:50 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide an in-depth review of several notable developments in diabetes technology, focusing on innovations in insulin pump interoperability, automated insulin delivery algorithms, continuous glucose monitoring, and decision-support tools for people using multiple daily injections (MDI).

Key Episode Timestamps
00:00:01 Intro
00:00:19 The Sequel Twiist
00:01:05 Diabeloop's new algorithm
00:09:01 Leaving CamAPS behind?
00:09:57 Eversense approaching a spring launch
00:12:27 MiniMed Go and the InPen
00:17:40 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Susan Weiner, MS, a nationally recognized dietitian and diabetes care and education specialist, for an in-depth discussion of the newly released US Dietary Guidelines and the inverted food pyramid. The conversation is framed for clinicians navigating nutrition counseling in diabetes and cardiometabolic care, with a focus on how these recommendations translate - or fail to translate - into real-world practice.

Key Episode Timestamps
00:00:01 Intro
00:01:00 The new food pyramid and a history of diet guidelines
00:03:36 Shortcomings of the new guidelines
00:09:33 The headache of food labeling
00:11:11 New alcohol guidelines
00:13:26 How the guidelines form policy
00:14:55 How professional organizations deal with the guidelines
00:17:38 Linoleic acid in processed foods
00:25:15 Too much protein?
00:30:32 Translating the guidelines for patients
00:37:11 Outro

• Key outcome: CagriSema led to a mean weight loss of 20.4%, vs 3.0% with placebo.
• Over 50% of participants on CagriSema reached a non-obese BMI.
• Gastrointestinal side effects were common (80%), but mostly mild to moderate.

• Key outcome: CagriSema led to 13.7% mean weight loss, vs 3.4% with placebo.
• 73.5% achieved an HbA1c ≤6.5% vs 15.9% on placebo.
• Significant improvements were seen across all weight loss and glycemic endpoints.

• Be diagnosed with Type 1 Diabetes
• Be 18 years or older
• Speak English and/or Spanish
• Have access to the internet and a smart phone or computer to do video calls with the care team
• Have a primary care provider or are willing to be connected to one
• Are not currently pregnant