← Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives
Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives
Tech, Screening, and Care Highlights from ADCES 2026
00:16:07
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- [00:00]
A
Welcome to a very special episode of Diabetes Dialogue, Technology, Therapeutics and Real World Perspectives. I am Hannah Isaacs. I am with my co host Natalie Bellini. And we are not across the zoom.
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B
We are actually, we can touch each other right now.
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A
And that is because we are coming at you live from the ADCS conference in Columbus, Ohio. And so we thought we would do an episode on all of the great sessions that we've had the privilege to be a part of at this meeting and the great things that we've seen. So, Natalie, I'm going to start with you. Blue Circle Health, that was an incredible, incredible event and you were the guest star in their video and then you were on a panel. So can you talk a little bit about that?
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B
Absolutely. So Blue Circle Health is a nonprofit organization that is funded by other nonprofits, but also the bigger funder is the Leona Helmsley Trust. And what they offer in 20 different states now is support for people living with, specifically with type 1 diabetes. So for up to six months at a time, they do not take over care, they bridge care. So there are all kinds of services. Someone can see and it's all virtual. Someone can see a dietitian, someone can see a social worker. Someone can get help with insurance navigation. Someone can get help making decisions about just technology in general. I have a lot of questions. I'm uncomfortable. What's my risk of having like, things that I, that we struggle answering sometimes in the short visits that we have, even as a prescriber. So our, our entire system is a big supporter of theirs. And they actually came to our office, I don't know, late last year maybe or early this year and did and filmed us. And so part of what we did was I was part of their filming of just what's it like to actually live and struggle with, to, to have diabetes and thrive. So then we were on a panel kind of talking about how to help people with type 1 diabetes specifically, you know, all the co pays, deductibles, those kinds of rent, the job, the transitions. You know, for example, lots of my kids that are young adults that are 25, I will send there because they're going to lose their insurance from their parents at 26 to help them make difficult insurance decisions, for example. It was a lot of fun.
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It was great. We come to that event was very, very well attended.
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All right. There were so many other things. Tell me about that you've done. You did several talks while we were here. What was your favorite, like, what was the one that you went, this is different and innovative. And I mean, you did so many things.
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A
You're like, ah, but I know what was my favorite. Well, there was. I don't know, there were so many things that I love doing. I gave this one talk on cardio kidney metabolic care with Christy Schumacher, and we love. Yeah, she's a great pharmacist. And we started off kind of just going through what the updated guideline say. There's actually new CKM guidelines that just came out. But then we applied it all to a case. It was actually a case from her clinic. And it was a really good case. Like a person that was newly diagnosed type 2 diabetes, very high A1C, and then discharged from the hospital on tons, you know, of insulin, but wasn't even prescribed pen needles. So which we had a separate session on.
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B
Pen needle is right.
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Right.
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But also, this isn't. This is real. People get this happen all the time, right?
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Yeah. So anyway, she followed this patient, followed up with Christy in clinic. And we walked through and it was very interactive in terms of like, okay, well, this person started on insulin, which will help address glucose, but we use the prevent calculator to calculate the person's risk. And it was like a 40% risk of having a cardiovascular event in the next 10 years. And it's like, well, okay, what about. We gotta address lipids. Right. Blood pressure was a little bit elevated. Thinking about, like, cardiovascular kidney protection. Right. Use of GLP1 drugs and use of SGLT2 inhibitors. And so it was a really good discussion about getting those drugs on. How do we taper down the insulin? What do we even do, like, hypertension? The person was on a beta blocker. There was no indication for that that can mask symptoms of hypoglycemia. So it was like. It was. Even though it was like a large room and there was a lot of people, it was like super interactive and engaging. And so I, I thought it went well. And we actually talked about, like, next year we want to have less didactic at the beginning. And it like, all interactive with the
- [04:23]
B
case, case, case, case. I love that idea. And I think that that's a hard thing when you follow the guidelines. When they're. When someone's A1C is really high, you do start insulin, but that doesn't mean you keep them on it. What it means is you get them to. Out to outpatient care and then you slowly decide, is this the best drug for them? It is at the start. And. And we have to be using GLP1s. We have to be using SGLT2s as indicated. Especially if someone has hypertension, are they spilling protein in their urine? Do they have. And you have to treat the cholesterol. So it is these, it's really complex diabetes. Used to be get the A1C down and move on. And now it's all these other aspects of it.
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Yeah, I love it.
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I love it.
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A
Yeah, yeah. We did several things together, a lot of things for industry. But I think, you know, I really enjoyed the Sanofi dinner program that we did together. And you sat discussion about C peptide and really this idea that it's becoming an important endpoint in clinical trials because
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B
like you always say every beta cell matters.
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Right. The protection in terms of, you know, improved outcomes like DKA and severe hypoglycemia. When you have some of that residual beta cell function. I think it's very interesting. And then it just guides kind of future state of like, what can we do to really protect those beta cells and prolong C peptide for as long as we can in type 1 diabetes?
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B
Yeah, I mean it's, you know, C peptide we. When I teach this, I. It's like the residual of beta cell function in your own body. So when you make ba, when you make insulin inside your body, this is what's broken off. So there's insulin and then the C peptide that you can measure basically. And so when you're making your own insulin, you have a C peptide level that is not zero. When you're done making insulin, there's a 0C peptide. So there are people with long standing type one that actually for some strange reason still have some C peptide even though it's an autoimmune disease. And they've found that these people actually have less cardiovascular events, they live longer, they have less kidney disease. And it's interesting, we can't predict like let's say you've had type one for 50 years, you still have beta cell. I have type one for 50 years and I have none. We don't know why someone still has a little bit, but what we have seen is that these people do better. So when we look at early treatment and early stage 2 and 3 type 1 diabetes, how do we then look at this differently? How do we measure it? How do we continue to follow it? Super interesting discussion. More to come. Right.
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Like this is one of those, like
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very early on we're using it.
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Right, Right. But not enough. Yeah. So the other thing we always love about these conferences is the exhibit hall sadly recently closed now. But you know, there's so much Interesting updates with technology and medications and all of the different things. So one company that's kind of up and coming that was here was Pivot. Oh yeah, the pivot inside. And so I went and spent some time talking to them because we're like what, what is this? Is already tons of inflow on pumps. Like what is this? And I kind of like the comment. I think our friends said that it's like Omnipod and Vigo had a baby. Right. And the Pivot is their baby, an aid system. But it is the pump that holds 300 units of insulin similar to a VGO. It does have a basal rate, but also similar to vgo. It's a two unit button press. Like you don't have. You don't put carbs in. There's not a bolus calculator. It's just press it. You get two units at a time. And the basal rates though, it's a little bit more advanced in that you can set two different basal rates. So the VGO was just, you know, one set. You pick a 20 unit, 30 or 40 per 24 hours. That's the rate that you get. So it's very interesting. It is a patch pump that can be worn up to three days and it is 300 units. On the flip side, like I know we also talked to our friends at Secure and they, you know, the Simplicity device is also updating to where there's going to be a seven day, 240 units and then they're also going to have the option for one or two unit bolus. Right, Right. So there's now there's truly is simplicity because there's no app, there's nothing. But you take a long acting insulin
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with it and every time you push the button you get two units.
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Right.
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Like or now one unit.
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Right.
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That's their new, that's their newer system, but it's seven days. So it's really nice if we have someone who for example uses a GLP1 and is going to use this as mealtime insulin or take say very soon to be announced once weekly insulins are going to start being used on the market and available rather that we could do everything on Sunday, for example, or everything on whatever day of the week it is. So you get your basil, if you're taking it, you get your new Secure and you get your, and you get your GLP1. Right. So we're giving you cardio protection. We're doing all these things and we're doing it once a week. Isn't that like even, you know, so that to me is a, is a big, like keep it as simple as possible and we tend to see more people able to do it.
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A
Right. Like. Yeah, yeah. So that was really interesting. That's totally brand new. They did say as I was talking with them that their ultimate plan is to go the aid route and you know, partner with an algorithm and have a full on aid. But it sounds like that may be, you know, that's going to be.
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We have to get that system to talk to a sensor, use an algorithm. Now right now the pivot pump doesn't
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have to have enough communicating drugs.
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So all it's doing is giving that basal that you told it to and then giving two units when you push the button. So now you gotta find an industry partner, you gotta create an algorithm or buy one and then do the studies and then produce. I mean I'm, I'm, my guess is two years.
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A
One other thing, I was a part of a program last night. Oh, a Medscape program. Talk to us about that and so on, kind of CGM continuous ketone monitoring. But I really appreciate, it's a very unique way of delivering education. We'd actually done a similar thing last year. So instead of just like sitting through
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a long Talk, yet another PowerPoint presentation,
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like this is really different. So they asked us for patient cases and so we did. I referred one. My particular case is actually one of my pregnant patients. She's pregnant with twins. Using an in pen and actually interview. They reached out to these patients, they did these wonderful videos with them and then they have the videos. And so when you walk in, you actually, you put headphones on and you see these three patient cases and like you listen to it and then you walk around and you think of questions that you want answered, that you want to hear from from the faculty. As people are walking around, we, the faculty walk around to like engage with them and they can directly ask us their questions. And then we get up there after everyone's seen the videos and we get all these note cards with all of their questions and we answer our answers to them.
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Right.
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And so I love it.
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So super interactive, right?
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Yeah. We don't know what to expect as faculty. Like don't know what questions they're going to have. Like we just got to be ready for anything. But also like on the faculty and you know, it's exciting. It was, you know, in some ways it was an easier lift because I didn't have to put together.
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There's nothing to do right now.
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Right. And so the topic know is really ketones and these different situations where you might check for ketones like in the case of of pregnancy making sure getting enough nutrition and being cautious about DKA. One of the patients was actually new onset type 1 like LADA and had was on an SGLT2 inhibitor. No insulin. Okay. So that was obviously high risk. She started checking ketones. They were moderate ketones. So that was like a whole discussion. Okay, when do we start insulin? Now.
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Right now. Right. Or at least when do we stop the SGLT2 inhibitor. Right. I mean that's that youth. Yeah. That risk of euglycemic DKA is there. Right. So that's a really great.
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I mean that's really good.
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One of the things we're looking forward to with the CKM is is actually being able to say is this risk of it should we be using SGLT2 inhibitors even half of a. The lowest dose there is to. To reduce the. That to slow down the kidney function in someone with type one. Well the challenge is that that increased risk of euglycemic decay and someone with. With type one. So this is a great example of where these are these sensors are going to make a difference.
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Oh I love it. And like in case like she was thin we didn't want to use the GLP one she had tried metformin didn't do well with it. So it's like all the cardiorenal protection of an SGLT 208 or. But in a case like that being able to continuously measure ketones would be so helpful. Right. And we had some very candid discussions about like we don't totally know what to expect from continuous ketone monitoring. Like we've never had access to that type of data all the time. So we're going to learn a lot as these devices become. Yep. And we hope we're going to put
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one on as soon as we get them.
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Yeah right.
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Like we'll be wearing them the next shot.
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Right.
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As soon as we can we'll wear them and tell you. Right, right.
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These radio right in your office.
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We hope it's going to be soon.
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Right? Yeah about it. Oh yeah. So I mean there was so much great stuff. I know we were right did more. We added more. We did several products.
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Really great networking. Really great. Just like meeting people where they are learning from each other has been the ADCS is just this special kind of meeting. Right.
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That people are. The hyperchord is always.
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Oh yeah.
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So we gave I talk and it was at 7:00am okay. So I'm thinking 7:00am like, people aren't going to come.
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Six people, right? Yeah.
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You know, why would they come? But the room was packed.
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It was packed.
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It was so packed. It was so great to see because we talked about how, you know, you can test for hypercortisolism and how that can be an underlying driver. Sometimes when someone's not able to reach their goals, their blood pressure glucose goals, that it actually could be that they have elevated cortisol and how. Now in the ACE guidelines, they mention that that's something that you should be
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ruling out or in, depending on what you're doing, it should be in your differential. So if you have an A1C greater than seven and a half, we are. How do we actually stratify a lot of it? What we say is, if their A1C is greater than seven and a half and they're on some of these most powerful medications, right. They're on, you know, once weekly GLP1s at the max dose, and it just doesn't respond the same way. Right. If they're on three or more blood pressure medications, if they're on maximum, once weekly GLP, GIP and a SGLT2 inhibitor and metformin. And it's just like something's not right. Then you start basal and it's still not right. Those people are the ones that we should be immediately screening and thinking, okay, let's just rule it out. Right? I think that's a big part of it is. So we had this great discussion about what is the role of a diabetes educator in that. So some diabetes educators, like you and I can prescribe and we can write for labs and do those things. Some diabetes educators can just put in their note, we should probably rule this out, that a differential could be this, and send it back to the true person that's prescribing and what our role would be in setting up a protocol so that if we do this, if we find this, then where are we going to go? If you're working in a group situation where you're just part of the cogwheel, but not the whole thing together, it was a great discussion.
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It really was. It was great being at this meeting. There's so much more to say. But, you know, I think that it was a pretty good.
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That was a great.
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A lot of the. We hope we'll see you here next year in Denver. Abc.
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Yeah, in Denver.
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But otherwise, we thank you for tuning in. And that wraps up this episode of Diabetes Dialogue, Technology, Therapeutics and Real World Perspectives.
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Thanks, everyone.