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Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives
Hosted by Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives · EN
Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives is a podcast hosted by Drs. Diana Isaacs and Natalie Bellini aimed at providing a regular roundup of the latest clinically applicable insights across diabetes and metabolic diseases, with a focus on leveraging technology to improve care. A video version of each episode is available at HCPLive.com/Clinical/Endocrinology.
Please direct podcast-related inquiries to PCampbell@MJHLifesciences.com.
Editor's note: Episodes predating January 2023 were hosted by Endocrinology Network. Episodes predating March 2022 were titled The Endocrine Outlook.
Please direct podcast-related inquiries to PCampbell@MJHLifesciences.com.
Editor's note: Episodes predating January 2023 were hosted by Endocrinology Network. Episodes predating March 2022 were titled The Endocrine Outlook.
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Weekly Insulin Icodec Now Available for Type 2 Diabetes
Yesterday00:09:50Summary readyOnce-weekly basal insulin therapy has moved from clinical trial data to pharmacy shelves, offering clinicians a new option for patients who struggle with the daily burden of insulin injections. The shift addresses a persistent adherence problem in basal insulin therapy, where missed or inconsistent daily dosing undermines glycemic control.In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the pharmacy launch of insulin icodec (Awiqli), the first once-weekly basal insulin now available in the United States.The approval rests on data from approximately 4200 participants across the phase 2 and phase 3 ONWARDS program. In insulin-naive participants enrolled in ONWARDS 1, 3, and 5, insulin icodec produced superior reductions in hemoglobin A1c compared with once-daily basal insulin. Among participants switching from daily basal therapy in ONWARDS 2, icodec showed noninferior glycemic control alongside improved treatment satisfaction scores.Insulin icodec has also been studied in type 1 diabetes but did not receive approval in this population after trials showed higher rates of hypoglycemia relative to daily basal insulin. Additional studies in type 1 diabetes are ongoing, leaving open the possibility of future expansion beyond the current type 2 indication.Dosing requires new clinical habits, since insulin icodec is formulated as U-700, a concentration allowing a full week's dose to be delivered in a comfortable injection volume. Adjustments occur in 10-unit increments rather than the single-unit changes used with daily basal insulins, though the weekly total still translates into modest day-to-day changes of roughly one to two units. Patients switching from daily basal insulin require a loading dose, calculated by multiplying the total daily dose by 10.5, to reach steady state faster than a standard weekly conversion would allow.Titration follows fasting glucose. Clinicians add 20 units when readings exceed 130 mg/dL, maintain the dose between 80 and 130 mg/dL, and subtract 20 units below 80 mg/dL. Because increases and decreases are dosed in 20-unit blocks, most cycles are reassessed over two to four weeks rather than week to week.The reduced injection frequency carries particular relevance for older adults, caregivers, and patients whose adherence to daily regimens has proven inconsistent. As pharmacy access expands, coverage and prior authorization requirements will shape how quickly insulin icodec moves into routine practice, but early trial and satisfaction data point toward a meaningful shift in basal insulin management.
SummaryTech, Screening, and Care Highlights from ADCES 2026
Yesterday00:16:07Summary readyAdvances in diabetes care rarely arrive through a single channel, and the 2026 annual meeting of the Association of Diabetes Care and Education Specialists (ADCES) reflected this breadth, with new insulin delivery hardware, cardiometabolic risk management, and endocrine screening criteria all drawing attention from clinicians in Columbus, Ohio.On a recent episode of Diabetes Dialogue, recorded on-site at ADCES26, co-hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed sessions and exhibits spanning insulin delivery technology, cardio-kidney-metabolic (CKM) risk reduction, beta-cell preservation, ketone monitoring, and hypercortisolism screening.On the exhibit floor, 2 simplified insulin delivery devices signaled a push toward patients still managing diabetes on multiple daily injections. Pivot, a tubeless patch pump from Modular Medical, holds up to 300 units of insulin, delivers preset 2-unit boluses, and supports 2 distinct basal rates, though it is not yet an automated insulin delivery (AID) system. CeQur's Simplicity bolus-only patch has moved toward 7-day wear with up to 240 units of capacity and a one-unit dosing option, positioning it alongside once-weekly basal and incretin therapies on a shared weekly schedule.A case-based session on CKM syndrome, built around a patient newly diagnosed with type 2 diabetes and discharged on insulin without pen needles, illustrated how risk calculators such as PREVENT can guide therapy beyond glycemic control. The case incorporated glucose-lowering therapy alongside GLP-1 and SGLT2 inhibitor use for cardiorenal protection, discontinuation of an unindicated beta blocker masking hypoglycemia symptoms, and a plan to taper insulin as other agents took effect.A separate discussion focused on C-peptide, a marker of residual endogenous insulin production, as an emerging clinical trial endpoint in type 1 diabetes. Patients who retain measurable C-peptide despite long-standing autoimmune beta cell loss appear to experience fewer cardiovascular events, less diabetic ketoacidosis, and less severe hypoglycemia, reinforcing interest in beta-cell-preserving therapies during early-stage disease.Continuous ketone monitoring, an emerging sensor category, was covered through patient cases including pregnancy-related nutritional ketosis and a case of latent autoimmune diabetes in adults treated with an SGLT2 inhibitor without insulin, a combination carrying risk for euglycemic diabetic ketoacidosis. The hosts noted real-time ketone data could eventually clarify when SGLT2 inhibitor use is appropriate in insulin-requiring patients despite this risk.A well-attended early-morning session addressed hypercortisolism as an underrecognized driver of treatment-resistant hypertension and hyperglycemia. Updated American College of Endocrinology guidance now recommends screening when hemoglobin A1c remains >7.5% or blood pressure remains uncontrolled despite maximal glucagon-like peptide-1, SGLT2 inhibitor, and multidrug antihypertensive therapy, with diabetes care and education specialists playing a growing role in identifying candidates and coordinating referral.The hosts also highlighted Blue Circle Health, a nonprofit offering ≤6 months of virtual bridge care, including dietitian visits, social work support, and insurance navigation, for people with type 1 diabetes across 20 states. Collectively, the sessions underscored a field advancing simultaneously on device design, risk stratification, biomarker science, and access to supportive care.
SummaryDiabetes Dialogue: Retatrutide Phase 3 Data Show Major Weight Loss
1w ago00:24:38Summary readyWelcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!Triple hormone receptor agonism is emerging as a frontier in metabolic disease treatment, and topline phase 3 results for retatrutide suggest the strategy can push weight loss and glycemic control beyond current incretin therapies, even as a separate JAMA analysis raises questions about oversight in online GLP-1 prescribing.1,2On the latest episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed topline results from the TRIUMPH-2 and TRIUMPH-3 trials of retatrutide, a glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptor triple agonist.TRIUMPH-2 enrolled 1000 participants with type 2 diabetes across 98 centers and tested 4 mg, 9 mg, and 12 mg doses against placebo over 80 weeks. The 12 mg dose produced weight loss up to 21% from a baseline of 106 kg, or roughly 23 kg. Hemoglobin A1C fell between 1.4 and 1.6 percentage points from a baseline of 7.7%, versus 0.2 points with placebo, a large glycemic effect given the near-normal starting A1C and discontinuation of 14% at the highest dose.TRIUMPH-3 enrolled over 1900 participants with class II or III obesity (body mass index of 35 or higher) and established cardiovascular disease, randomized to 9 mg, 12 mg, or placebo over 80 weeks. The 12 mg dose delivered 23% weight loss versus 3% with placebo, alongside a 37% reduction in triglycerides, 17% reduction in non-high-density lipoprotein cholesterol, and 9.3 mmHg reduction in systolic blood pressure. Major adverse cardiovascular event outcomes trended favorably but did not reach significance, an expected limitation of an 80-week trial.Gastrointestinal effects were common across both trials, including diarrhea in up to 34% of participants and nausea in up to 28%, consistent with the broader incretin class.Isaacs and Bellini also discussed a JAMA secret-shopper study, led by Ashwin Chetty, MD, examining online GLP-1 prescribing across 49 telehealth websites. Of these, 92% prescribed the requested medication and 70% mailed it, often without required photo verification, blood work, or clinician video visits, in some cases within five minutes. Compounded formulations, including unproven sublingual drops, were frequently offered alongside add-on supplements marketed as personalization, a workaround linked to compounding rules requiring documented medical need.Together, the findings illustrate a widening gap between the therapeutic ceiling GLP-1-based agents are reaching in controlled trials and the variable oversight surrounding real-world access to these drugs, underscoring the need for clinicians to proactively screen patients for unsupervised use.Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.
SummaryEvolving Wearable Insulin Delivery Devices - AID, CGM, and More
Jun 3000:13:58Summary readyTo begin the episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the rapidly evolving landscape of wearable insulin delivery, focusing on recent developments in patch pump technology and the growing number of tubeless insulin delivery systems entering the market. The conversation centers on the recent FDA clearance of the Pivot patch pump from Modular Medical, which the hosts describe as an important addition to a field that has historically been dominated by a single tubeless option.Isaacs reviews the design of the Pivot system, explaining that while it is a tubeless insulin pump, it differs from current automated insulin delivery (AID) systems because it does not communicate with a continuous glucose monitor (CGM) or use an insulin-dosing algorithm. Instead, the device delivers programmable basal insulin with ≤2 selectable basal rates and allows users to administer manual bolus doses. The hosts note its 300-unit insulin reservoir, highlighting the larger capacity as a potential advantage for individuals with higher daily insulin requirements.Bellini discusses where Pivot may fit into current clinical practice, suggesting it could provide an option for people who are unwilling or unable to use CGM technology but would still benefit from wearable insulin delivery. She also points to the possibility of future partnerships with commercially available AID algorithms, which could allow the platform to evolve into a more automated system. The hosts acknowledge that current diabetes guidelines generally favor AID for individuals with type 1 diabetes but recognize that simplified technologies continue to have an important role for select patient populations.The discussion expands to the broader pipeline of tubeless insulin pumps currently under development. Isaacs and Bellini review anticipated products from Tandem, Beta Bionics, and Medtronic, noting that virtually every major insulin pump manufacturer is now investing in patch pump technology. They compare reservoir capacities, expected timelines, and device designs while emphasizing the increasing demand for tubeless systems that improve convenience and reduce many of the practical challenges associated with traditional tubing.The hosts also examine several practical design considerations. They discuss Pivot's reusable and disposable components, explaining that many newer patch pumps incorporate reusable elements because of existing intellectual property surrounding fully disposable tubeless systems. While reusable components may lower manufacturing costs, they also introduce considerations such as the potential for patients to misplace components or inadvertently lose them during hospitalizations. Isaacs adds that the simplified design and absence of an onboard algorithm may ultimately make the device more affordable, although real-world pricing remains to be determined.Attention then shifts to recent updates from CeQur Simplicity, which recently announced a 7-day bolus-only patch featuring an expanded 240-unit insulin reservoir and a new one-unit dosing option for individuals requiring smaller mealtime insulin doses. The hosts discuss how these enhancements could broaden the device's applicability while maintaining its emphasis on simplicity, requiring neither smartphone connectivity nor a dedicated mobile application.Bellini highlights the potential synergy between the 7-day patch and emerging once-weekly basal insulin formulations, suggesting that synchronizing weekly basal insulin administration with weekly patch replacement could simplify treatment routines and improve adherence. She emphasizes that insulin therapy should continue to complement guideline-directed pharmacologic management, including GLP-1 receptor agonists, SGLT2 inhibitors, and other glucose-lowering therapies when appropriate.The episode concludes with an optimistic assessment of the future of insulin delivery technology. Isaacs and Bellini emphasize that increasing competition among manufacturers is likely to expand patient choice, improve affordability, and accelerate innovation. They express particular enthusiasm for the continued growth of tubeless insulin delivery, broader pharmacy benefit coverage, and the next generation of AID systems, all of which they believe will further individualize diabetes management and improve outcomes for people requiring insulin therapy.Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.
SummaryTegoprubart and Freedom from Insulin in Type 1 Diabetes
Jun 2900:18:39Summary readyWelcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!To begin the episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss recent advances in type 1 diabetes (T1D) research following presentations at the American Diabetes Association (ADA) Scientific Sessions and the American Association of Clinical Endocrinology (AACE) Annual Meeting. They focus on promising data from an islet cell transplantation study in which all 12 participants achieved insulin independence, with some maintaining normal glycemia for up to 2 years after transplantation.Isaacs explains that the transplanted islet cells restore endogenous insulin production and emphasizes that the study’s most notable innovation is its immunosuppression strategy. Rather than relying on calcineurin inhibitors such as tacrolimus, which are associated with significant toxicities, particularly nephrotoxicity, the investigators used the investigational anti-CD40 ligand therapy tegoprubart. The hosts discuss how this approach may improve the long-term safety and feasibility of islet transplantation and note ongoing efforts to develop more convenient formulations beyond the current intravenous infusion administered every 3 weeks.The conversation then turns to the clinical significance of the findings. Bellini highlights that all 12 enrolled participants achieved insulin independence, distinguishing these results from earlier transplantation efforts such as the Edmonton protocol. The hosts also describe the substantial improvements in quality of life reported by participants, including sustained HbA1c values in the normal range without restrictive dietary practices and complete resolution of severe hypoglycemia. Because the trial enrolled individuals with recurrent, life-threatening hypoglycemia, they emphasize that the observed benefits are particularly meaningful for this high-risk population.The hosts also examine several unanswered questions that remain before this approach can become widely available. They discuss the durability of insulin independence, the long-term need for immunosuppressive therapy, treatment costs, and the challenges associated with scaling islet transplantation beyond specialized research centers. Additional findings are reviewed, including the need for repeat transplantation in 2 participants and observations suggesting that individuals with higher body mass index may require greater islet mass to achieve insulin independence. They also discuss the use of tirzepatide in 2 participants, raising questions about the role of insulin resistance and adjunctive therapies following transplantation.Broadening the discussion, Isaacs and Bellini review several emerging strategies aimed at expanding access to curative therapies. These include stem cell-derived islets, large-scale beta cell manufacturing, gene-editing approaches, and encapsulation technologies intended to protect transplanted cells while reducing or eliminating the need for chronic immunosuppression. Drawing on presentations from Aaron Kowalski, PhD, and Laura Jacobsen, MD, they emphasize that despite major advances in continuous glucose monitoring, automated insulin delivery systems, and adjunctive pharmacotherapy, subcutaneous insulin administration remains fundamentally nonphysiologic and cannot fully eliminate long-term complications or disease burden.The episode concludes with a broader discussion of the future of type 1 diabetes research. The hosts highlight efforts to expand eligibility for islet transplantation trials, including studies involving individuals with chronic kidney disease who were previously excluded because of concerns surrounding traditional immunosuppressive therapies. They also underscore the importance of continuing to pursue disease-modifying therapies despite improvements in diabetes technology, emphasizing that glycemic targets alone do not eliminate complications or address disparities in access to care. While acknowledging that a universally applicable cure remains years away, Isaacs and Bellini conclude that the field is making meaningful progress toward safe, durable, and scalable therapies capable of fundamentally changing the treatment of type 1 diabetes.Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.
SummarySignos and the Science of Weight Loss
Jun 2300:08:39Summary readyWelcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss new real-world data evaluating the Signos platform, an FDA-cleared digital weight-loss solution that combines the Dexcom Stelo continuous glucose monitor (CGM) with artificial intelligence–driven behavioral coaching. The platform delivers personalized recommendations based on glucose responses, dietary intake, physical activity, and user-entered data to support lifestyle modification and weight management.Bellini begins by highlighting the challenges many individuals face in accessing traditional weight-management programs. While in-person and virtual classes can be effective, participation is often limited by time and accessibility. She notes that digital tools such as Signos may offer a scalable alternative by providing continuous support and accountability outside of the clinic setting.The study included adults aged 18 years and older with obesity (BMI >30 kg/m²) who did not have diabetes. Researchers evaluated whether engagement with the platform was associated with weight-loss outcomes, using a metric called “total meaningful actions per day” to measure how frequently participants interacted with the app and its coaching features.Among more than 3,000 participants, periods of active engagement were associated with significantly greater weight loss than periods of low or no engagement. Researchers also evaluated a 180-day cohort of 1,147 participants and found a mean total body weight loss of 5.14% over six months. Participants with higher engagement achieved nearly 6% weight loss, compared with approximately 4.3% among those with lower engagement levels. Bellini emphasizes that these results were achieved without the use of weight-loss medications, underscoring the potential impact of personalized behavioral support combined with CGM data.Isaacs notes that individuals taking anti-obesity medications, including GLP-1 receptor agonists, were excluded from the study. She points out that many patients prefer to pursue weight loss through lifestyle modification rather than long-term pharmacologic therapy, making these findings particularly relevant. At the same time, both hosts suggest that digital coaching platforms could complement GLP-1 therapies by reinforcing nutrition, physical activity, and other healthy behaviors that remain essential for long-term success.The conversation also addresses cost and accessibility. Isaacs notes that while Dexcom Stelo can be purchased independently at a lower monthly cost, access to the full Signos platform requires a higher subscription fee. Although this may be a barrier for some patients, the hosts compare the expense to other commercial weight-management programs and view it as another option within a broader obesity treatment strategy.Throughout the discussion, Isaacs and Bellini emphasize the importance of accountability and ongoing engagement in achieving sustainable weight loss. They highlight the platform’s use of AI-generated prompts, reminders, and behavioral challenges designed to keep users engaged and motivated. The episode concludes with optimism about the growing role of digital health technologies in obesity care and the potential for AI-driven, CGM-informed interventions to provide personalized, scalable support for individuals seeking meaningful weight loss.Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.References1: Signos. Latest Study Shows Signos Drives Up to 7% Weight Loss Over 6 Months, Rivaling Real-World GLP-1 Weight Loss. BusinessWire. June 23, 2026. Accessed June 23, 2026. https://www.businesswire.com/news/home/20260623955669/en/Latest-Study-Shows-Signos-Drives-Up-to-7-Weight-Loss-Over-6-Months-Rivaling-Real-World-GLP-1-Weight-Loss
SummaryTeplizumab, Stelo, and Inhaled Insulin Afrezza for Pediatric Patients
Jun 1800:27:28Summary readyWelcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss a series of major pediatric diabetes advancements announced around the American Diabetes Association (ADA) Scientific Sessions 2026, highlighting how recent regulatory decisions are expanding treatment options and improving access to diabetes technologies.The conversation opens with the expanded FDA indication for teplizumab in children and adolescents with newly diagnosed stage 3 type 1 diabetes. Bellini reviews findings from the PROTECT trial, which evaluated teplizumab in patients ages 8 to 17 years within six weeks of diagnosis. She explains that treatment with two 12-day infusion courses resulted in significant preservation of endogenous insulin production, with 95% of participants maintaining peak C-peptide levels above the study threshold at week 78. The hosts discuss the importance of preserving residual beta-cell function, emphasizing its potential role in improving glycemic stability, reducing hypoglycemia risk, and supporting better long-term outcomes for individuals who will live with type 1 diabetes for decades.Isaacs and Bellini explore how this new indication may change the approach to type 1 diabetes screening, particularly among first-degree relatives and individuals at higher risk for autoimmune disease. They note that identifying people in stage 2 type 1 diabetes remains challenging because patients are typically asymptomatic, but the availability of treatment at stage 3 provides clinicians with a new opportunity to intervene soon after diagnosis.The hosts discuss how having an approved therapy may encourage more families to pursue screening and identify additional individuals with early-stage disease. They also address practical considerations, including the importance of starting treatment within the appropriate window, coordinating the two infusion courses, supporting families through treatment logistics, and ensuring access through insurance coverage.The discussion then shifts to the FDA clearance of Dexcom Stelo, the first over-the-counter glucose biosensor cleared for pediatric use in children ages 2 years and older who do not use insulin. Isaacs highlights how this technology could improve access to glucose monitoring for children with prediabetes, type 2 diabetes, or those seeking greater insight into how food, activity, and lifestyle factors influence glucose patterns.The hosts emphasize that expanded access to glucose monitoring could play an important role in helping families make informed decisions about diabetes management. However, they clarify that individuals using insulin require prescription continuous glucose monitoring systems with additional safety features, including hypoglycemia alerts and predictive low glucose notifications.Finally, Isaacs and Bellini discuss the pediatric approval of inhaled insulin as another significant milestone in diabetes care. They review its potential as an alternative to mealtime injections and highlight the opportunity to provide more flexibility for children and families managing type 1 diabetes. The conversation also addresses implementation considerations, including baseline lung function testing, provider familiarity, and adapting clinical workflows to incorporate new treatment approaches.The episode concludes by reflecting on the rapid progress occurring in pediatric diabetes care. With advances in immune-modulating therapies, glucose monitoring technology, and insulin delivery options, the hosts highlight a new era of personalized diabetes management focused on preserving insulin function, improving access, and optimizing outcomes for young people living with diabetes.Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.References1: Sanofi. Press Release: Sanofi’s Tzield approved in the US as the first disease-modifying therapy for patients recently diagnosed with stage 3 type 1 diabetes. June 12, 2026. Accessed June 18, 2026. https://www.sanofi.com/en/media-room/press-releases/2026/2026-06-12-22-09-58-33113492: US Food and Drug Administration. FDA Clears First Over-the-Counter Continuous Glucose Monitor for Children. June 12, 2026. Accessed June 18, 2026. https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor-children3: Livingston R. FDA Approves Inhaled Insulin Afrezza for Pediatric Patients With Diabetes. HCPLive. May 29, 2026. Accessed June 18, 2026. https://www.hcplive.com/view/fda-approves-inhaled-insulin-afrezza-pediatric-patients-diabetes
SummaryCONNECT, TRANSCEND, and TRIUMPH at ADA 2026
Jun 1100:13:19Summary readyWelcome 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.
Summary
The International Diabetes Federation and Care Access in India, With Amit Gupta, MBBS, DNB
Jun 1000:17:58Tap to summarizeWelcome 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.
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Diabetes Technology and Treatment in the UK, With Ketan Dhatariya, MD, PhD, MS
Jun 800:28:45Tap to summarizeWelcome 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.
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