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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 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 Introduction00:00:27 Background of Bob Vigersky, MD00:02:40 Updates from Medtronic Diabetes00:08:02 The Instinct Sensor00:10:20 Calibrating New Devices00:12:27 Moving to Type 200:15:00 Bolusing with New Devices00:17:39 Looking Down the Pipeline00:22:07 Prescribing the MiniMed00:35:45 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