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

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, 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.

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.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

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

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

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, 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

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. A significant portion of the conversation centers on management of GI side effects from GLP-1 receptor agonists. Bauer explains her clinical philosophy of treating obesity like any other chronic disease—avoiding the routine practice of prescribing one medication to manage side effects caused by another whenever possible. While she may prescribe small, limited quantities of ondansetron during titration, she emphasizes that persistent nausea should prompt dose adjustment or medication changes rather than indefinite antiemetic use. The hosts discuss how slower titration strategies in real-world practice often improve tolerability compared with rigid clinical trial protocols and may help optimize long-acting monthly GLP-1 agents currently in development.The episode also reviews bariatric surgery data, including randomized trials comparing laparoscopic banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. Bauer notes that both sleeve gastrectomy and Roux-en-Y demonstrated superior efficacy and fewer complications compared with lap band procedures, while long-term comparisons between sleeve and bypass showed strong outcomes for both, with Roux-en-Y numerically favoring weight loss but often without statistically significant superiority. She also discusses higher reoperation rates among patients initially undergoing sleeve gastrectomy, often due to inadequate weight loss or significant reflux requiring conversion to bypass.The conversation concludes with an important discussion on post-bariatric surgery weight regain and the growing use of GLP-1–based therapies after surgery. Bauer challenges the misconception that surgery “cures” obesity, emphasizing that obesity remains a chronic disease driven by persistent biology, inflammation, and environmental factors even after anatomical intervention. She notes emerging evidence suggesting that GLP-1 therapies used before or after bariatric surgery may improve long-term outcomes and reduce weight regain. She closes by reinforcing the need for clinicians to approach obesity with the same chronic disease mindset applied to diabetes—recognizing that durable management requires ongoing treatment, not a one-time intervention.

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.

The US Food and Drug Administration approval of orforglipron (Fondayo) in April 2026 may mark a pivotal shift in obesity care—particularly as the first oral GLP-1 option designed for flexible, real-world use. Within days, Eli Lilly and Company announced broad availability, including a same-day delivery partnership with Amazon Pharmacy, signaling a rapid move toward improved access following years of supply constraints affecting agents like tirzepatide.Watch on HCPLiveIn this episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, Diana Isaacs, PharmD, and Natalie Bellini, DNP, break down the clinical and logistical implications of launch. They highlight a key development nuance: marketed tablet doses (0.8 mg–17.2 mg) are dose-equivalent to capsule formulations used in phase 3 trials, supporting scalable manufacturing without compromising pharmacokinetics.Access and affordability remain central. Pricing caps out-of-pocket costs at $299/month for higher doses, with lower-cost entry tiers and expanded distribution positioning orforglipron among the most accessible GLP-1 therapies to date. With uptake already high—approximately 1 in 8 adults reporting prior GLP-1 use—the hosts emphasize potential for further acceleration.The discussion also extends beyond obesity and type 2 diabetes, exploring early real-world signals in type 1 diabetes suggesting possible cardiovascular and renal benefits without increased safety risks, underscoring the broader clinical trajectory of GLP-1–based therapies.

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!On March 26, 2026, the US Food and Drug Administration (FDA) approved Novo Nordisk's insulin icodec-abae under the name Awiqli for patients with type 2 diabetes (T2D).1,2In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, highlight the FDA approval of once-weekly insulin icodec, emphasizing its significance as a major advancement in insulin therapy. They begin by addressing practical considerations, including its high concentration (U-700) and the implications for dosing, noting that weekly administration necessitates substantially higher unit doses compared with daily basal insulin.The discussion focuses on dosing strategy, particularly the need to scale weekly doses approximately sevenfold relative to daily regimens, as well as the rationale for an initial loading dose of 1.5 times the calculated weekly requirement to more rapidly achieve steady state. Isaacs underscores the pharmacokinetic basis for this approach, given the drug's long half-life and delayed time to steady state, while also noting the constraints of dosing in 10-unit increments.Bellini and Isaacs explore the clinical implications of once-weekly insulin, with particular attention to adherence and treatment burden. Bellini emphasizes the potential benefit for insulin-naive patients and those struggling with daily injection adherence, framing weekly insulin as a means to significantly reduce injection frequency and improve consistency. Isaacs expands on this, arguing that reduced dosing frequency may mitigate missed doses and glycemic variability, especially in patients with irregular routines. Both highlight the flexibility afforded by the long half-life, allowing for minor deviations in dosing timing without substantial impact on glycemic control.The conversation also addresses potential risks, including delayed titration and the possibility of over-basalization, particularly in patients with fluctuating nutritional intake or socioeconomic instability. They stress the importance of careful patient selection and monitoring, given the longer interval required to adjust doses.Reviewing clinical trial data from the ONWARDS phase 3 program, the hosts note that once-weekly insulin demonstrated modestly greater A1C reduction compared with daily basal insulin in treat-to-target trials, reinforcing the hypothesis that improved adherence may translate into better glycemic outcomes.They further discuss implementation considerations across care settings, highlighting potential advantages for older adults, caregivers, and patients in long-term care, where reduced injection burden may improve safety, independence, and medication management. The episode also touches on current regulatory limitations, noting that while approval is presently limited to type 2 diabetes in the United States, ongoing studies may expand its indication to type 1 diabetes, with off-label use anticipated in select cases.The hosts conclude by situating weekly insulin within the broader therapeutic landscape, emphasizing renewed innovation in insulin development alongside incretin-based therapies. They note that additional agents in development may soon expand options within this class, signaling a meaningful shift in the management of diabetes toward more patient-centered, lower-burden treatment paradigms.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.References1: Novo Nordisk. Awiqli approved in the US, the first and only once-weekly basal insulin treatment for adults with type 2 diabetes. March 26, 2026. Accessed April 3, 2026. https://ml-eu.globenewswire.com/Resource/Download/cb9dda59-1286-4718-a7e5-4256e2397b0c2: Kunzmann K. FDA Approves Insulin Icodec (Awiqli) as First Once-Weekly Basal Insulin for Type 2 Diabetes. HCPLive. March 26, 2026. Accessed April 3, 2026. https://www.hcplive.com/view/fda-approves-awiqli-insulin-icodec-first-once-weekly-basal-insulin-for-type-2-diabetes

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!On March 17, 2026, the American Association of Clinical Endocrinology (AACE) released a consensus statement, which features an algorithm for the management of type 2 diabetes (T2D) in adult patients.1In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, review the newly released 2026 American Association of Clinical Endocrinology (AACE) type 2 diabetes treatment algorithm, positioning it as an evolution of the 2023 update that integrates a growing body of clinical trial evidence into a more comprehensive, complications-focused framework. They emphasize a paradigm shift away from glucose-centric management alone, highlighting the importance of addressing comorbidities, including cardiovascular disease, chronic kidney disease, obesity, obstructive sleep apnea, and metabolic dysfunction–associated steatotic liver disease (MASLD), as central to optimizing outcomes.The discussion outlines the guideline's structure, including its 10 guiding principles, which reinforce lifestyle intervention as foundational, promote individualized glycemic targets (with a preference for A1c ≤6.5% when safely achievable), and strongly encourage early use of continuous glucose monitoring (CGM). The hosts underscore the emphasis on avoiding therapeutic inertia, minimizing hypoglycemia risk, and managing cardiometabolic comorbidities alongside glycemia as part of routine care.A key highlight is the introduction of a diabetes classification algorithm aimed at reducing misdiagnosis, particularly distinguishing type 1 from type 2 diabetes and identifying less common etiologies. Within this framework, the guidelines newly prioritize screening for hypercortisolism, informed by findings from the CATALYST trial, which demonstrated a higher-than-expected prevalence among patients with difficult-to-control diabetes. Isaacs and Bellini note that recognizing and treating underlying hypercortisolism may significantly improve glycemic control and, in some cases, reduce the need for diabetes-specific therapies.The episode further reviews updated algorithms for cardiovascular risk reduction, dyslipidemia, and hypertension, emphasizing aggressive, individualized targets and the continued central role of lifestyle modification. Pharmacologic recommendations reflect robust recent evidence, prioritizing SGLT2 inhibitors and GLP-1 receptor agonists (including dual GIP/GLP-1 agents) for patients with cardiorenal or metabolic comorbidities, while also incorporating emerging indications such as heart failure with preserved ejection fraction and MASLD.Isaacs and Bellini also discuss the guideline's glucose-centric algorithm for patients without major comorbidities, highlighting patient-centered decision-making based on factors such as hypoglycemia risk, weight considerations, and cost/access. They reinforce recommendations for early combination therapy when A1c is significantly above target and appropriate use of insulin, including guidance on avoiding overbasalization and incorporating prandial strategies.The conversation concludes with commentary on the guideline's practical strengths, including clear visual algorithms, concise format, and detailed pharmacotherapy tables summarizing efficacy, safety, and organ-specific benefits. The hosts emphasize that the updated AACE algorithm provides clinicians with an actionable, evidence-based roadmap for delivering holistic, individualized diabetes care that extends beyond glycemic control to address the full spectrum of cardiometabolic risk.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.ReferencesSamson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes - 2026 Update. Endocr Pract. Published online March 17, 2026. doi:10.1016/j.eprac.2026.01.006

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.1In 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.1In 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.1Secondary 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.1,2The 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.References1: 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-pill2: 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.

Advances in artificial intelligence, automated insulin delivery, and sensor integration were central to discussions at the 2026 International Conference on Advanced Technologies & Treatments for Diabetes (ATTD), where clinicians highlighted how emerging technologies may further reduce diabetes management burden while improving glycemic outcomes.In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed key highlights from the meeting, with particular emphasis on AI-driven tools and evolving closed-loop systems.A major theme was the growing role of artificial intelligence, including the concept of “digital twins”—virtual models built from patient-specific data such as glucose trends, insulin dosing, and behavioral inputs. These models allow clinicians and patients to simulate therapy adjustments, such as changes in insulin sensitivity or basal rates, before applying them in practice. Data presented at the meeting suggested use of digital twin modeling improved time in range, whereas providing data feedback alone did not meaningfully change outcomes.The discussion also examined real-world performance data from newer automated insulin delivery platforms. Early data from the Twiist system demonstrated time in range approaching 76% to 77% across initial user cohorts, with higher time in range observed among individuals using lower glucose targets, albeit with an expected increase in hypoglycemia. Expanded analyses in larger populations showed similarly strong outcomes, reinforcing the importance of target selection and individualized system settings.Sensor performance and reliability also emerged as a key topic. Investigators presented data suggesting unrecognized infusion set occlusions may contribute to unexplained hyperglycemia, highlighting potential advantages of newer pump technologies designed to detect occlusions more rapidly. In parallel, comparative analyses of sensor integration in hybrid closed-loop systems demonstrated consistent glycemic outcomes across multiple sensor platforms, suggesting algorithm performance, rather than sensor variability alone, plays a dominant role in achieving time in range.Lastly, hosts shared early data from fully closed-loop systems in type 2 diabetes, including a small trial evaluating automated insulin delivery without meal bolusing. Participants achieved substantial improvements in time in range, increasing from approximately 44% at baseline to 68%, with minimal hypoglycemia. Although not yet achieving traditional glycemic targets, these findings underscore the potential for reducing patient burden while maintaining clinically meaningful glucose control.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: Senseonics. First Ever Real-World Evidence of Eversense 365 Presented at ATTD Demonstrates Sustained Performance and Positive Impact Throughout One-Year of Wear. Senseonics.com. Published March 14, 2026. Accessed March 18, 2026. https://www.senseonics.com/investor-relations/news-releases/2026/03-14-2026-141507610 Insulet Corporation. Insulet Presents Promising Study Results for Fully Closed-Loop Automated Insulin Delivery System for Adults with Type 2 Diabetes. Insulet.com. Published March 10, 2026. Accessed March 18, 2026. https://investors.insulet.com/news/news-details/2026/Insulet-Presents-Promising-Study-Results-for-Fully-Closed-Loop-Automated-Insulin-Delivery-System-for-Adults-with-Type-2-Diabetes/default.aspx

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 Timestamps00:00:01 Intro00:00:22 Orforglipron in the ACHIEVE-3 trial00:03:30 Side effects from orforglipron00:10:28 Retatrutide in the TRIUMPH-4 trial00:18:26 Topline data on Novo Nordisk's UBT25100:21:47 Price cuts on Ozempic, Rybelsus, and Wegovy in 202700:26:26 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 Timestamps00:00:01 Intro00:00:11 Zepbound in the KwikPen00:01:25 Vials versus pens00:02:55 Environmental benefits00:03:53 Pen needles sold separately00:06:30 LillyDirect availability00:07:20 Europe approves 7.2 mg injectable semaglutide00:09:08 Reusable pen concerns00:10:55 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 Timestamps00:00:01 Intro00:00:14 Implantable insulin pumps00:01:06 What is breakthrough status?00:03:00 How the pump works00:03:41 What makes it different from MiniMed?00:07:36 How does it administer insulin?00:09:47 The Twiist pump with EverSense00:13:30 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 Timestamps00:00:01 Intro00:00:25 Oral Wegovy and oral Ozempic00:03:04 Why Rybelsus didn't work00:05:33 The importance of administration00:06:56 Compounding drugs - the Hims and Hers drama00:07:56 The danger of unregulated compound drugs00:11:50 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 Timestamps00:00:01 Intro00:00:19 The Sequel Twiist00:01:05 Diabeloop's new algorithm00:09:01 Leaving CamAPS behind?00:09:57 Eversense approaching a spring launch00:12:27 MiniMed Go and the InPen00:17:40 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 Timestamps00:00:01 Intro00:01:00 The new food pyramid and a history of diet guidelines00:03:36 Shortcomings of the new guidelines00:09:33 The headache of food labeling00:11:11 New alcohol guidelines00:13:26 How the guidelines form policy00:14:55 How professional organizations deal with the guidelines00:17:38 Linoleic acid in processed foods00:25:15 Too much protein?00:30:32 Translating the guidelines for patients00:37:11 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, review key therapy-focused updates from the 2026 ADA Standards of Care, emphasizing areas they view as practice-changing. Key Episode Timestamps 00:00:01 Intro 00:00:29 Adding GLP-1 RAs to heart failure 00:02:45 GLP-1s in glycemic management 00:04:36 Time in range targets in glycemic management 00:08:10 ADA recommends GLP-1s for T1D 00:12:00 GLP-1s in MASH and MASLD 00:12:57 Changes in kidney protection guidelines 00:14:40 New therapeutic guidance for T1D and T2D 00:17:57 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at the University Hospitals Diabetes and Metabolic Care Center, review major therapeutic and technology updates in diabetes care, beginning with newly announced topline phase 3 data for orforglipron, the first oral nonpeptide GLP-1 receptor agonist submitted to the FDA. Key Episode Timestamps 00:00:01 Intro 00:00:15 Orforglipron and ATTAIN-MAINTAIN 00:07:33 Cagrelinitide with semaglutide at the FDA 00:10:26 The Libre Assist 00:18:31 Outro

In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, discuss major diabetes technology updates alongside key technology-related changes in the 2026 American Diabetes Association Standards of Care. The conversation highlights how rapidly evolving devices and updated guidelines are converging to reduce treatment burden and expand access to advanced diabetes management tools. The discussion opens with updates from Dexcom, notably the launch of the Dexcom G7 15-day sensor, which incorporates an updated algorithm and is already integrating with Omnipod 5 and iLet systems, with Tandem integration expected soon. The hosts also address the announcement that the Dexcom G6 will be retired in July 2026, acknowledging the emotional and practical challenges this poses for patients who prefer the G6's connectivity and perceived accuracy. While the transition may be difficult for some, the longer wear time and algorithm improvements of the G7 are framed as an opportunity to reassess CGM options and prepare thoughtfully for change. Attention then shifts to Omnipod 5, with anticipation around a forthcoming software update planned for 2026. This update will introduce a lower glucose target of 100 mg/dL, down from 110 mg/dL, and significantly reduce automated-mode “kick-outs.” The hosts emphasize that minimizing time out of automated insulin delivery is critical for improving time in range and lowering patient burden, noting that excessive safety-driven exits can paradoxically worsen glycemic control. A substantial portion of the episode is devoted to technology-focused updates in the 2026 ADA Standards of Care, reflecting Bellini's perspective as a guideline committee member. Key changes include the removal of C-peptide and autoantibody requirements as barriers to insulin pump and automated insulin delivery (AID) access, reinforcing that insulin use, not diabetes type, should guide eligibility. The guidelines now include a Level A recommendation for AID use in type 2 diabetes, supported by recent clinical trial data and regulatory approvals. Additional updates expand support for CGM use during pregnancy beyond type 1 diabetes, reduce reliance on confirmatory fingerstick language, and strengthen recommendations for connected insulin pens for individuals on multiple daily injections when AID is not preferred or feasible. The episode concludes with discussion of expanded guidance on open-source AID systems, underscoring the importance of clinician understanding and patient support regardless of FDA approval status. Collectively, Isaacs and Bellini frame the 2026 updates as a decisive step toward earlier, broader, and more individualized use of diabetes technology across care settings. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. References: American Diabetes Association. The American Diabetes Association Releases “Standards of Care in Diabetes—2026” | American Diabetes Association. Diabetes.org. Published December 8, 2025. Accessed December 17, 2025. https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2026 American Diabetes Association Professional Practice Committee for Diabetes*. Summary of Revisions: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(1 Suppl 1):S6-S12. doi:10.2337/dc26-SREV Chapters 00:00:00 - Intro & Agenda: New Tech + 2026 ADA Standards 00:00:45 - Dexcom G7 15‑Day Sensor & G6 Retirement 00:04:40 - OmniPod Algorithm Update 00:09:27 - 2026 ADA Standards of Care 00:15:45 - Expanding Diabetes Tech Options 00:21:19 - Endorsement of Earlier AID and Open-Source AID Support

In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, share early impressions of topline phase 3 results from the TRIUMPH-4 trial of retatrutide, a once-weekly triple agonist targeting GIP, GLP-1, and glucagon receptors.  Recorded from the ADCES Technology Conference, the conversation frames retatrutide as a potential next step beyond current GLP-1 and dual incretin options, while emphasizing that detailed trial data remain pending. TRIUMPH-4 was a phase 3 study enrolling patients with obesity and osteoarthritis. Topline data suggests participants receiving retatrutide 12 mg achieved a mean weight loss of 28.7% at 68 weeks. Among this population, the trial also reported a 75.8% reduction in WOMAC pain scores from baseline, with approximately 1 in 8 participants reporting complete pain freedom at week 68. Isaacs highlights how striking these figures are in light of the already high bar set by semaglutide and tirzepatide, noting that confirmation in phase 3 heightens anticipation for full publications and future readouts. The hosts connect these findings to evolving clinical priorities reflected in the American Diabetes Association's expanding attention to obesity-related comorbidities, including osteoarthritis, MASLD/MASH, sleep apnea, and kidney disease. They note the broader retatrutide phase 3 program includes studies in type 2 diabetes, moderate-to-severe obstructive sleep apnea, chronic low back pain, MASLD/MASH, and planned cardiovascular and renal outcomes trials. Isaacs underscores the ongoing question of whether benefits across these conditions will be primarily molecule-specific or largely driven by the magnitude of weight loss, particularly given the inclusion of glucagon receptor activity. Safety is discussed cautiously, given the limited nature of top-line disclosures. The hosts note that discontinuation due to adverse events appeared higher with retatrutide than placebo, and they emphasize the need for full reporting on gastrointestinal tolerability and other adverse events. Bellini also points to an intriguing subgroup signal suggesting lower discontinuation rates among participants with higher baseline BMI, while acknowledging this could reflect chance in a modestly sized trial population. Overall, Isaacs and Bellini characterize retatrutide's TRIUMPH-4 update as an important milestone, while stressing that interpretation should remain measured until complete efficacy and safety data are available. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. References: Eli Lilly and Company. Lilly's triple agonist, retatrutide, delivered weight loss of up to an average of 71.2 lbs along with substantial relief from osteoarthritis pain in first successful Phase 3 trial. December 11, 2025. Accessed December 11, 2025. https://investor.lilly.com/news-releases/news-release-details/lillys-triple-agonist-retatrutide-delivered-weight-loss-average American Diabetes Association. The American Diabetes Association Launches a New Obesity Division | ADA. diabetes.org. Published June 21, 2024. Accessed December 16, 2025. https://diabetes.org/newsroom/press-releases/american-diabetes-association-launches-new-obesity-division

In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, breakdown recent trial news from the 2 most popular incretin therapies: semaglutide and tirzepatide. First, hosts breakdown the November 24, 2025 announcement from Novo Nordisk disclosing their evoke and evoke+ trials of oral semaglutide in early symptomatic Alzheimer Disease failed to slow disease progression. Next, hosts break down the TIRTLE study, which examined use of tirzepatide in patients with type 1 diabetes. Semaglutide Misses Mark in Alzheimer Disease Novo Nordisk announced top-line results from the evoke and evoke+ phase 3 trials showing oral semaglutide 14 mg did not slow disease progression over 2 years in adults with early symptomatic Alzheimerdisease, with no significant difference in CDR-SB change versus placebo. Despite improvements in Alzheimer-related biomarkers across both studies, neither trial demonstrated a slowing of clinical decline. evoke was a global, randomized, double-blind, placebo-controlled trial enrolling 1,855 participants aged 55–85 with amyloid-positive CDR 0.5 MCI or CDR 1.0 mild dementia, treated 1:1 with semaglutide or placebo for 104 weeks plus a planned 52-week extension. evoke+ mirrored this design, randomizing 1,953 participants with the same eligibility criteria to daily semaglutide 14 mg or placebo for a total planned duration of 156 weeks. Findings from the trials will be presented at the 2025 Clinical Trials in Alzheimer's Disease (CTAD) conference on December 3, 2025. The lack of efficacy led to discontinuation of the planned 1-year extension period across both trials, though safety and tolerability remained consistent with prior semaglutide experience in diabetes and obesity. TIRTLE: Tirzepatide Shows Benefit in Type 1 Diabetes In a 12-week, double-blind, placebo-controlled phase 2 trial of 24 adults with type 1 diabetes and BMI >30 kg/m², tirzepatide produced a 10.3-kg mean weight loss versus 0.7 kg on placebo, an −8.7-kg treatment difference (P < 0.0001) corresponding to 8.8% total body weight reduction. All tirzepatide-treated participants achieved ≥5% weight loss, and 45% achieved ≥10%, compared with 9% and 0% in the placebo group. Eligibility criteria required patients to be 18 years of age or older, with confirmed type 1 diabetes, obesity (BMI >30), and stable insulin therapy. Tirzepatide also improved glycemic control, reducing HbA1c by 0.4%, and decreased total daily insulin dose by 35% relative to placebo (−24.2 vs −0.3 units/day). Safety data suggested no significant adverse events occurred, with 22 of the 24 participants completing the study. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. References: Novo Nordisk. Novo Nordisk A/S: Evoke phase 3 trials did not demonstrate a statistically significant reduction in Alzheimer's disease progression. Novo Nordisk. November 24, 2025. Accessed November 24, 2025. https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916462. Snaith JR, Frampton R, Samocha-Bonet D, Greenfield JR. Tirzepatide in Adults With Type 1 Diabetes: A Phase 2 Randomized Placebo-Controlled Clinical Trial. Diabetes Care. Published online November 20, 2025. doi:10.2337/dc25-2379

In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, review two major developments in diabetes care: the forthcoming 15-day Dexcom G7 continuous glucose monitor (CGM) and significant new price reductions for semaglutide as Ozempic and Wegovy. Key Episode Timestamps 00:00:01 Introduction 00:00:30 Dexcom G7 00:01:55 A 15-Day Sensor With a 12-Hour Grace Period 00:04:27 Seamless transition to the new G7 00:05:23 Looking back at Dexcom's advancements 00:06:34 Dexcom's Smart Basal feature 00:10:34 Price cuts for semaglutide - Wegovy and Ozempic 00:14:54 Cheaper GLP-1s on the pharmacies' end 00:20:33 Outro

In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, meet in person at the Diabetes Technology Meeting (DTM) in San Francisco to discuss the latest clinical and regulatory advances surrounding semaglutide. Key Episode Timestamps 00:00:01 Introduction 00:00:42 Oral semaglutide's FDA approval 00:02:02 The SOUL trial and Rybelsus's cardiovascular indication 00:03:35 Dosing for Rybelsus 00:06:18 The SELECT trial 00:08:29 Can GLP-1s be cardiovascular treatments? 00:14:08 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore 3 significant developments shaping diabetes care: a novel glucose-sensing technology, the return of once-weekly insulin icodec to the US Food and Drug Administration (FDA), and changes to Eli Lilly's metabolic research pipeline. 00:00:01 Introduction 00:00:18 The Biolinq Shine 00:05:59 The Practicality of Monitoring Glucose 00:06:55 Wishlist for the Biolinq's Future 00:08:38 Insulin Icodec Resubmission 00:10:21 Benefits of Once-Weekly Insulin 00:14:00 International Success Stories 00:15:28 Eli Lilly Cancels Bimagrumab for T2D 00:18:36 Bimagrumab Still in Testing for Obesity 00:22:49 Outro

In this milestone 150th episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, reflect on three and a half years of transformation in diabetes care and the evolution of their podcast since its launch in early 2022. What began as a modest plan for monthly discussions rapidly expanded into a weekly forum driven by an ever-accelerating pace of clinical innovation and the hosts' shared enthusiasm for translating emerging science into practice.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, sit down with Bob Vigersky, MD, Chief Medical Officer of Medtronic Diabetes, to discuss major developments in diabetes technology, regulatory approvals, and the company's future direction. 00:00:00 Introduction 00:00:27 Background of Bob Vigersky, MD 00:02:40 Updates from Medtronic Diabetes 00:08:02 The Instinct Sensor 00:10:20 Calibrating New Devices 00:12:27 Moving to Type 2 00:15:00 Bolusing with New Devices 00:17:39 Looking Down the Pipeline 00:22:07 Prescribing the MiniMed 00:35:45 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospital Diabetes and Metabolic Care Center, discuss the recently published results of the ATTAIN-1 and STEP UP clinical trials, both of which were presented at the European Association for the Study of Diabetes (EASD) 2025 Conference. 00:00:00 Introduction 00:00:32 ATTAIN-1 00:04:07 GLP-1s as a Daily Pill 00:08:20 Possible Lower GLP-1 Prices 00:09:03 STEP UP 00:11:41 Cardiovascular Protection with GLP-1s 00:12:48 GI Side Effects of Semaglutide 7.2 00:16:16 3 Times the Dose, 3 Times the Cardiovascular Protection? 00:17:20 Outro

In this episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, breakdown recent diabetes technology updates from late August and early September 2025.

At ESC 2025, a pair of presentations highlighted the ongoing debate over cardiovascular risk reduction with semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound), yielding conflicting signals that clinicians will need to interpret carefully. In this special edition episode, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, explore these studies: SURMOUNT-5 and STEER. A post hoc analysis of SURMOUNT-5 compared the 10-year predicted CV risk reduction between the 2 agents. Using the Framingham Risk Calculator in 751 patients with obesity, tirzepatide was associated with greater benefit than semaglutide. From baseline risks of ~9%, tirzepatide was projected to lower absolute 10-year CV risk by 2.4% (23% relative reduction) compared with 1.4% (13% relative reduction) for semaglutide. Investigators attributed the advantage largely to greater weight and glycemic reductions. In contrast, the STEER study, a real-world analysis of more than 21,000 patients with a mean follow-up of 8.5 months, suggested semaglutide was associated with lower rates of major adverse cardiovascular events (MACE) than tirzepatide. Semaglutide users had a 29% risk reduction in nonfatal MI, nonfatal stroke, or CV death compared with tirzepatide. Limitations included short follow-up, relatively few CV events, and the inherent confounding of observational data. Both Isaacs and Bellini emphasized that while weight and glycemic improvements with tirzepatide appear robust, CV benefits may be molecule-specific. The ongoing SURPASS-CVOT, comparing tirzepatide with dulaglutide, should provide more clarity when full data are released at EASD. In the interim, the hosts advised prescribing based on labeled indications supported by randomized outcomes data—semaglutide for CV and kidney risk reduction, tirzepatide for obesity and sleep apnea—while awaiting definitive trial results. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. References: Mamas M. SURMOUNT-5: Tirzepatide compared to Semaglutide in obesity for 10-year CVD risk reduction .Presented at the European Society of Cardiology (ESC) Congress 2025. Madrid, Spain. August 29- September 1, 2025. Novo Nordisk. Novo Nordisk's Wegovy® cuts risk of heart attack, stroke or death by 57% compared to tirzepatide in real-world study of people with obesity and cardiovascular disease. Novo Nordisk. Published August 31, 2025. Accessed September 5, 2025. https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916422

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, explore the latest milestone for semaglutide (Wegovy): US Food and Drug Administration (FDA) approval for the treatment of metabolic dysfunction–associated steatohepatitis (MASH) with moderate to advanced fibrosis. They frame the decision as a breakthrough in addressing a disease that affects an estimated 6% of the U.S. population, with even higher prevalence among individuals with type 2 diabetes and obesity. MASH, often underrecognized and asymptomatic in its early stages, carries serious long-term consequences, including cirrhosis, hepatocellular carcinoma, liver transplantation, and premature mortality. 00:00:00 Introduction 00:00:32 Semaglutide (Wegovy) Approval 00:06:31 Novo Nordisk Announces Ozempic Price Change 00:08:21 Compounding Pharmacies 00:10:57 The Future of Semaglutide

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, shared highlights on several major insulin delivery updates making waves at recent meetings. 00:00:00 Introduction 00:00:20 Pivot by Modular Medical 00:07:13 Medtronic's Partnership with Abbott - the Instinct Sensor 00:09:04 Tandem's One-Handed Insert 00:10:14 Tandem's Mobi Patch Pump

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! In this episode, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, highlight key advancements in diabetes management, particularly in continuous glucose monitoring (CGM) during pregnancy and the anticipated future of continuous ketone monitoring, from Association of Diabetes Care and Education Specialists (ADCES) 2025 annual meeting. 00:00:00 Introduction 00:00:30 Continuous Glucose Monitoring in Pregnancy 00:04:59 Stello versus Finger Sticks for Insulin Dosing 00:13:43 Innovative Presentations at ADCES 00:14:36 Ketone Monitoring 00:18:15 Product Theaters and Gamification at ADCES

In this episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, share key insights and takeaways from the Association of Diabetes Care and Education Specialists (ADCES) 2025 annual meeting. 00:00:00 Introduction 00:00:25 Orforglipron and the ATTAIN-1 study 00:01:29 Why orforglipron is exciting 00:04:21 ADCES - Incredible Incretins 00:10:33 ADCES - AI in diabetes management 00:12:59 New AI tools for endocrinology 00:19:01 ADCES - Implicit bias 00:21:30 Closing

On July 31, 2025, Eli Lilly and Company announced topline data from the SURPASS‑CVOT trial comparing tirzepatide (Mounjaro) to dulaglutide (Trulicity) in adults with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD). According to the data, tirzepatide met the primary non‑inferiority endpoint for 3-point major adverse cardiovascular events (MACE) (hazard ratio [HR], 0.92; 95.3% CI, 0.83 to 1.01), while also showing additional benefits in A1C, weight reduction, renal preservation, and a 16% reduction in all‑cause mortality (HR, 0.84; 95.0% CI, 0.75 to 0.94). In the latest episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, unpacked the top-line results of the SURPASS-CVOT trial. Eli Lilly and Company owns both drugs, which belong to the incretin class, but tirzepatide is a dual GIP/GLP-1 receptor agonist, while dulaglutide is a GLP-1 RA. The trial included over 13,000 adults with type 2 diabetes and either established cardiovascular disease or at high risk. During a median follow-up of 4.5 years, the primary endpoint, which was a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke, was reduced by 8% in the tirzepatide group relative to dulaglutide. However, the result did not reach statistical superiority due to the confidence interval crossing unity. Isaacs and Bellini also highlighted significantly greater A1c (-1.73% vs -0.9%) and weight loss (12% vs 4.95%) with tirzepatide. Additional prespecified analyses comparing data with the placebo-controlled REWIND trial suggest tirzepatide could offer up to 28% MACE and 39% mortality risk reduction compared to theoretical placebo—findings that hint at broader cardiometabolic benefit. Before concluding, hosts speculated about the potential subgroup analyses of interest for the trial, including heart failure and renal outcomes, as well as a brief discussion around Eli Lilly and Company's intent to submit a regulatory application for a cardiovascular indication before the close of 2025. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. References: Eli Lilly and Company. Lilly's Mounjaro (tirzepatide), a GIP/GLP-1 dual agonist, demonstrated cardiovascular protection in landmark head-to-head trial, reinforcing its benefit in patients with type 2 diabetes and heart disease. July 31, 2025. Accessed July 31, 2025. https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated

Welcome back to Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives! In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the newly released Preexisting Diabetes in Pregnancy guidelines from The Journal of Clinical Endocrinology & Metabolism, which offer 10 key recommendations to improve outcomes in pregnant individuals with type 1 or type 2 diabetes. 00:00:00 Intro 00:01:25 Recommendations 1 and 2 00:02:27 Recommendation 3 00:07:11 Recommendation 4 00:09:58 Recommendation 5 00:14:51 Recommendations 6 and 7 00:19:05 Recommendation 8 00:23:11 Recommendation 9 00:25:11 Recommendation 10

Welcome back to Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives! In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, recapped highlights from the 2025 Endocrine Society annual meeting. They spotlighted advances, controversies, and ongoing unmet needs in type 1 diabetes care. 00:00:00 Intro 00:00:40 GLP-1 RAs in type 1 diabetes 00:05:50 Tirzepatide in type 1 diabetes 00:08:32 Cardioprotective therapies in type 1 diabetes 00:12:17 Type 1 diabetes Barbie and public education

In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, sit down with Carol Levy, MD, director of the Mount Sinai Diabetes Center and Type 1 Diabetes Clinical Research, to discuss the upcoming T1D Pregnancy and Me – or PRAM T1D – clinical study. Enrollment for T1D Pregnancy & Me is currently open. Interested listeners can enroll at https://www.mountsinai.org/clinical-trials/t1d-pregnancy-me. 00:00:00 Introduction 00:01:43 The "why" behind the trial 00:04:24 The structure of the study 00:07:37 Will maternal outcomes be collected? 00:08:12 Can patients enroll themselves in this trial? 00:12:40 No devices will be excluded 00:15:20 Dividing data based on first versus later pregnancies 00:18:14 Will you continue to enroll after the first 500?

In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, continue their recap of ADA's 2025 Scientific Sessions, spotlighting 3 more of the top clinical trials focused on obesity and type 2 diabetes. 00:00:00 Intro 00:00:31 BELIEVE Trial 00:08:11 Phase 2 Maritide Trial 00:17:12 CATALYST-2

In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, recap some of the biggest clinical trials presented at the American Diabetes Association (ADA) 2025 conference in Chicago, Illinois. 00:00 Introduction 2:04 The Vertex Trial 6:57 The T1D Trial 15:23 The Achieve 1 Trial

In this episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, recorded during the 85th Scientific Sessions of the American Diabetes Association (ADA 2025) in Chicago, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, speak with Rachael Sood, RN, MSN, APRN, NP, CDCES, founder of The Diabetes Collective, about modern approaches to diabetes care, patient engagement, and the role of social media in education and advocacy. The discussion highlights Sood's innovative use of social media to make diabetes education accessible and engaging. Known for creative and widely shared content—such as her wedding-themed video announcing the Dexcom G7 and Omnipod 5 integration—Sood shares how spontaneous, relatable messaging can improve awareness and patient connection. Her content spans emerging therapeutics like GLP-1 receptor agonists, type 1 diabetes staging and screening, and technology updates such as ketone monitoring and CGM integration. Sood reflects on the emotional impact of recent ADA presentations, including advances in islet cell therapy and the evolving treatment landscape for both type 1 and type 2 diabetes. She emphasizes the importance of healthcare providers offering clear, empathetic, and tailored care, recounting a patient case where basic interventions—CGM use, education, and therapeutic escalation—had a transformative effect after years of clinical inertia. The episode underscores the value of clinician-led care, continuity, and communication, particularly in independent practices. Sood also points to the importance of collaborative energy within the diabetes community, noting the power of partnerships among healthcare professionals, patients, and advocacy groups to drive progress. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Sanofi, and others. Sood has no relevant disclosures to report.

In this episode of Diabetes Dialogue, recorded live at the 85th Scientific Sessions of the American Diabetes Association (ADA 2025), hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Jay Shubrook, DO, and Conan Tu, MD, to explore the mission and momentum of the American College of Diabetology. The conversation centers on addressing the national shortage of diabetes specialists. Shubrook, a primary care diabetologist and founding figure in diabetology training, details the evolution of fellowship programs dating back to 2004, with the current infrastructure supporting 11 programs and plans for further expansion. Tu, an internist from New York, shares his personal journey into diabetology, emphasizing the increasing demand for diabetes-focused care in primary settings and the transformative impact of timely, expert-level interventions. The guests outline how the American College of Diabetology is building a standardized, certified workforce through board certification, with an emphasis on team-based care. The College is also actively expanding to include pharmacists, nurse practitioners, and other healthcare professionals in its educational and certification efforts, helping to equip interdisciplinary teams to manage diabetes more effectively. Additional discussion highlights include the importance of continuity of care—particularly during the transition from pediatric to adult diabetes services—the integration of cardiometabolic risk management, and the critical need for scalable models of care. The speakers advocate for diabetologists to serve not only as direct providers but as in-house experts, mentors, and system-level educators capable of elevating care across large networks. Learn more about the American College of Diabetology. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Sanofi, and others. Relevant dislcures for Tu include AstraZeneca, Eli Lilly and Company, and Optum. Relevant disclosures for Shubrook include Abbott, AstraZeneca, Bayer, Eli Lilly and Company, and Novo Nordisk.

In this episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, speak with John Buse, MD, PhD, of the University of North Carolina School of Medicine, about the treatment phase of the CATALYST trial. Findings from the phase 4 CATALYST trial suggest that mifepristone (Korlym), a glucocorticoid receptor antagonist, significantly improves glycemic control, reduces body weight, and lowers waist circumference in patients with hypercortisolism and difficult-to-control type 2 diabetes—offering a promising therapeutic option for a population with limited treatment success. The two-part, multicenter study enrolled 1055 adults with type 2 diabetes and HbA1c >7.5% despite optimized therapy. In part 1, participants underwent dexamethasone suppression testing to identify hypercortisolism, defined by post-test cortisol levels >1.8 µg/dL and dexamethasone >140 ng/dL. Results revealed a 24% prevalence of hypercortisolism in this population (95% CI, 21.4–26.7%). Part 2 randomized 136 patients with confirmed hypercortisolism in a 2:1 ratio to receive mifepristone or placebo for 24 weeks. The primary endpoint was change in HbA1c. Mifepristone treatment led to a least squares mean HbA1c reduction of 1.3 percentage points compared to placebo (95% CI, –1.81 to –0.83; P < .001). Secondary endpoints also favored mifepristone: body weight decreased by 5.12 kg (95% CI, –8.20 to –2.03), and waist circumference dropped by 5.1 cm (95% CI, –8.23 to –1.99) relative to placebo. Despite its efficacy, 49% of mifepristone-treated patients discontinued therapy, compared to 18% on placebo. Adverse events included hypokalemia, fatigue, nausea, vomiting, and elevated blood pressure, consistent with the drug's known safety profile. During the episode, which was recorded during the 85th Scientific Sessions of the American Diabetes Association (ADA 2025), Buse provides hosts with a deep dive into the background of the trial, prevalence of hypercortisolism in difficult-to-control type 2 diabetes, and the historic relevance of the CATALYST results. Buse also discusses how the trial offers insight into dosing approaches with mifepristone and advocates for broader cortisol screening in patients with complex type 2 diabetes—suggesting that ADA Standards of Care should reflect these findings. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. Relevant disclosures for Buse include Altimmune, AstraZeneca, Boehringer-Ingelheim, CeQur, Corcept Therapeutics, Eli Lilly, embecta, Moderna, Novo Nordisk, Tandem, Vertex, and others.