Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives

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Jun 2026

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Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives is a podcast hosted by Drs. Diana Isaacs and Natalie Bellini aimed at providing a regular roundup of the latest clinically applicable insights across diabetes and metabolic diseases, with a focus on leveraging technology to improve care. A video version of each episode is available at HCPLive.com/Clinical/Endocrinology . Please direct podcast-related inquiries to PCampbell@MJHLifesciences.com. Editor's note: Episodes predating January 2023 were hosted by Endocrinology Network. Episodes predating March 2022 were titled The Endocrine Outlook.

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June 11, 202613 min

CONNECT, TRANSCEND, and TRIUMPH at ADA 2026

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.

June 10, 202617 min

The International Diabetes Federation and Care Access in India, With Amit Gupta, MBBS, DNB

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this special episode, shot live at the American Diabetes Association (ADA) Scientific Sessions 2026 in Ner Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Amit Gupta, MBBS, DNB, diabetologist, executive director of the Global Metabolic Health Alliance, and chair of the International Diabetes Federation (IDF) Education Committee, to discuss the state of diabetes care and treatment in India compared to the US.To begin the episode, Gupta introduces the mission of the IDF, highlighting its role as a worldwide federation of scientific societies and patient organizations focused on improving diabetes education, policy, advocacy, and access to care. The conversation explores how diabetes management differs across regions, emphasizing that while the underlying disease mechanisms and available therapies may be similar, access to medications, technologies, healthcare infrastructure, and education varies significantly between countries.Gupta discusses the impact of semaglutide becoming available as a generic therapy in India following patent expiration, describing how reduced costs have improved access to a medication previously limited by affordability barriers. The group considers how increased availability of GLP-1 receptor agonists may transform diabetes and obesity management, while also emphasizing that pharmacologic therapies alone cannot address the global metabolic health crisis. Gupta notes the importance of maintaining focus on long-term lifestyle changes, including nutrition, physical activity, and sustainable weight management, as essential components of comprehensive care.The discussion then shifts to diabetes education and the need for more individualized, patient-centered approaches. Gupta highlights that education must be adapted to regional and cultural contexts, explaining that the challenges faced by a person with diabetes in the United States, Africa, India, or other parts of the world may differ substantially, even though diabetes distress and the burden of daily decision-making are shared experiences. He emphasizes that access to technology, such as continuous glucose monitoring, does not eliminate the need for education and support.Isaacs, Bellini, and Gupta also address the growing challenge of misinformation online and the role of healthcare professionals in helping patients navigate unreliable sources of health information. Gupta explains that clinicians must approach misinformation constructively by providing evidence-based guidance rather than simply dismissing patients’ beliefs, reinforcing the importance of translating scientific evidence into practical recommendations that patients can incorporate into their daily lives.The group further examines disparities in the availability of diabetes educators worldwide. Gupta notes that while some regions have established professional pathways for diabetes care and education specialists, many areas lack standardized training, recognition, or policy support to sustain these roles. He stresses that building effective diabetes education systems requires collaboration with policymakers to demonstrate the long-term benefits of structured education programs.The episode concludes with Gupta discussing his work developing a global consensus framework on lifestyle as the foundation of metabolic health. The conversation reinforces that advances in medications and technology must be paired with equitable access, effective education, and sustainable lifestyle interventions to reduce the global burden of diabetes and improve outcomes for people living with metabolic conditions.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. Gupta reports disclosures with Lilly, Abbott Diabetes, and the International Diabetes Federation.

June 8, 202628 min

Diabetes Technology and Treatment in the UK, With Ketan Dhatariya, MD, PhD, MS

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.

June 8, 202623 min

Omnipod and AID Advancements at Insulet, With Trang Ly, PhD, MBBS

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.References1: 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

June 6, 202624 min

The ADA’s Statement on Diabetes Tech Integration, With Eugene Wright Jr., MD

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this special episode recorded on-site at the American Diabetes Association (ADA) Scientific Sessions 2026 in New Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Dr. Eugene Wright Jr., MD, the principal of Wright Health Care Solutions and a consulting associate in the department of medicine at Duke University Medical Center, to discuss the development of the ADA scientific statement on diabetes technology implementation in primary care. To begin the episode, Wright reflects on his career as an internist caring for patients with diabetes across diverse settings, including underserved communities where patients often faced significant barriers to accessing care. He describes how his experiences challenged assumptions about which patients would benefit from diabetes technology, noting that many under-resourced patients demonstrated strong engagement and improved self-management when given access to tools such as continuous glucose monitoring (CGM).The discussion focuses on the origins of the ADA scientific statement, which emerged from efforts to identify and overcome barriers limiting the adoption of diabetes technology in primary care. Wright explains that while diabetes technology has demonstrated significant benefits in improving outcomes and patient behaviors, implementation has remained slow in the settings where most people with diabetes receive care. The statement brought together key stakeholders, including clinicians, pharmacists, diabetes care and education specialists, patient representatives, and other experts, to develop practical strategies addressing policy, insurance, workflow, and clinical challenges.Isaacs, Bellini, and Wright explore how CGM can be successfully integrated into primary care by shifting the focus from simply providing access to using data effectively. Wright emphasizes that CGM and ambulatory glucose profile (AGP) reports allow clinicians to transform complex glucose data into actionable insights, helping identify patterns that may not be captured through A1C measurements or traditional glucose monitoring. The group discusses how CGM enables clinicians to ask better questions, uncover barriers to treatment, and engage patients in collaborative conversations without judgment.The hosts highlight the importance of building sustainable workflows, including preparing AGP reports before visits, assigning responsibilities across the care team, and identifying technology champions within practices. Wright explains that successful implementation requires recognizing the unique needs and resources of each primary care setting rather than applying a single model. They discuss the role of telehealth, clinical pharmacists, medical assistants, and other team members in supporting CGM initiation, interpretation, and ongoing management. The conversation also addresses how partnerships with technology manufacturers can simplify onboarding, training, troubleshooting, and patient support.The discussion then expands to insulin pumps and automated insulin delivery systems, with the group noting how advances in technology have reduced complexity and made these therapies more accessible for people with type 2 diabetes. Wright describes how newer systems can help reduce the daily burden of diabetes management by automating adjustments and supporting patients in achieving their goals. The hosts emphasize that diabetes care should move beyond focusing only on glucose metrics and instead consider the lived experience of patients, including the constant decision-making and emotional burden associated with managing diabetes.The episode concludes with a broader call to action for expanding access to diabetes technology across all healthcare settings. Wright emphasizes that many patients do not have access to endocrinology care but still deserve the benefits of modern diabetes tools. The scientific statement represents the beginning of an ongoing effort to improve implementation, strengthen collaboration among stakeholders, and ensure that diabetes technology reaches all patients who can benefit from it.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. Wright Jr. reports disclosures with Abbott Diabetes, Bayer AG, Boehringer Ingelheim, Lilly, and Sanofi.ReferencesSection 7: Diabetes technology. Diabetes Obesity and Cardiometabolic CARE. Published online March 23, 2026. doi:10.2337/doc26-a007

May 29, 202611 min

FDA Approves Afrezza Inhaled Insulin for Pediatric Patients

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.References1: HOLDER

May 28, 202618 min

CKM Systems, Triple Agonists, and a Sensor Scandal Ahead of ADA

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.

May 18, 202617 min

ADA Scientific Sessions 2026 Preview

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.

May 8, 202621 min

Updates for T1D Treatment in Pregnancy and Pediatrics

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss a slew of advances in diabetes technology and treatments, starting with the US Food and Drug Administration (FDA)’s recent approval of the Tandem automated insulin delivery system for use during pregnancy in individuals with type 1 diabetes. The conversation centers on findings from the CIRCUIT trial, which demonstrated significant improvements in time in range among pregnant patients, a population historically challenging to manage because of stringent glycemic targets. Isaacs and Bellini review practical considerations from the study, including the use of continuous sleep mode to target tighter glucose ranges and proactive optimization of basal rates, correction factors, and carbohydrate ratios to improve outcomes. They emphasize that FDA approval now allows clinicians and manufacturers to openly discuss evidence-based best practices for pregnancy management using automated insulin delivery systems.The hosts also highlight the importance of clinician comfort with aggressive insulin automation during pregnancy, noting that increased basal modulation, suspensions, and automated adjustments should be expected as physiologic insulin needs fluctuate throughout gestation. Bellini stresses the importance of reducing patient burden while maintaining intensive glycemic management, tying this theme into Tandem’s newly announced compatibility with the Dexcom G7 15-day sensor. Both hosts note strong patient enthusiasm for extending sensor wear time, framing reduced device maintenance as an important quality-of-life improvement even when the practical change appears modest.The discussion then shifts to immunotherapy in type 1 diabetes, focusing on the expanded approval of teplizumab to include children as young as 1 year old for delaying progression from stage 2 to stage 3 disease. Isaacs and Bellini underscore how broader eligibility may strengthen adoption of autoantibody screening among relatives of patients with type 1 diabetes. They review evidence showing that screening substantially lowers rates of diabetic ketoacidosis at diagnosis and discuss the broader clinical significance of delaying symptomatic disease onset, even when delays are shorter than the median duration reported in trials. The hosts note that many families value the possibility of a more gradual transition into insulin dependence, often requiring only minimal insulin therapy initially rather than presenting with severe metabolic decompensation.The conversation also addresses ongoing regulatory developments surrounding teplizumab for newly diagnosed stage 3 type 1 diabetes. Although the anticipated expedited review pathway has been withdrawn, the hosts remain optimistic about eventual approval, citing encouraging data and the growing role of precision medicine approaches in identifying patients most likely to benefit from immune intervention.To conclude the episode, Isaacs and Bellini examine a post hoc analysis from the SURMOUNT-5 trial comparing tirzepatide and semaglutide in adults with obesity and prediabetes. They discuss findings showing high rates of reversion to normoglycemia in both treatment groups, with tirzepatide demonstrating greater efficacy overall. The hosts frame these data within the broader movement to reconceptualize prediabetes as an earlier stage of type 2 diabetes and cardiovascular disease risk rather than a benign precursor state. They emphasize the potential value of earlier therapeutic intervention to prevent progression and reduce long-term cardiometabolic complications while also acknowledging the importance of maintaining multiple treatment options because of variability in medication tolerability and patient response.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.References1: Tandem Diabetes Care. Tandem Diabetes Care’s Control-IQ+ Automated Insulin Delivery Technology Now FDA Cleared for Pregnancy in Type 1 Diabetes. April 27, 2026. Accessed May 8, 2026. https://investor.tandemdiabetes.com/news-releases/news-release-details/tandem-diabetes-cares-control-iq-automated-insulin-delivery2: Sanofi. Press Release: Sanofi’s Tzield approved in the US to delay the onset of stage 3 type 1 diabetes in young children. April 22, 2026. Accessed May 8, 2026. https://www.sanofi.com/en/media-room/press-releases/2026/2026-04-22-05-05-00-32786503: Galindo RJ, Aronne LJ, Horn DB, et al. Reversion to normoglycemia with tirzepatide vs semaglutide in participants with obesity and prediabetes: a post hoc analysis of SURMOUNT-5. J Endocrinol Invest. Published online April 20, 2026. doi:10.1007/s40618-026-02895-3

April 27, 202623 min

Expanding GLP-1 Usage Into Type 1 Diabetes With Viral Shah, MD

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.