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

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

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.

  1. 5d ago

    Building A Consensus Definition for Fully Closed-Loop Systems

    On this episode of Diabetes Dialogue, Diana Isaacs, PharmD, and Natalie Bellini, DNP, talk with Brynn Marks, MD, MSHPEd, of Breakthrough T1D about where automated insulin delivery is headed. They discuss how next-generation systems might be evaluated and what the shift could mean for people with diabetes and the clinicians who support them. Full episode: https://www.hcplive.com/view/diabetes-dialogue-a-consensus-definition-for-fully-closed-loop-systems

  2. Oct 23

    MiniMed Vivera Data and Twiist Type 2 Clearance

    Automated insulin delivery keeps moving toward systems that ask less of the people using them. In this episode of Diabetes Dialogue, Diana Isaacs, PharmD, and Natalie Bellini, DNP, look at two recent developments and talk through what they mean for clinical practice. In this episode: First-in-human results for the MiniMed Vivera algorithm, and how it performed when participants skipped meal announcements What the trial population can and can’t tell us about real-world patients The FDA clearance of the twiist AID system for adults with insulin-treated type 2 diabetes How the twiist algorithm differs from other systems, and tips for setting it up Where reduced-burden AID could go next

  3. Oct 16

    Twiist AID Data and the New ADA/EASD Type 2 Algorithm

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!Automated insulin delivery (AID) is becoming the standard approach for insulin-requiring type 2 diabetes (T2D), and new pivotal data suggest a fourth system may soon join the 3 already cleared for this population.On a recent episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed 2 updates in T2D care. The discussion covered the Twiist AID trial and the new joint management algorithm from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD).The single-arm, multicenter trial, published in Diabetes Care, enrolled 307 adults aged 19 to 85 years with insulin-treated T2D who used the system for 13 weeks. Mean HbA1c fell 0.7%, from 8.1% to 7.4%, while continuous glucose monitoring time in range rose from 57% to 73%. Because every 5% gain in time in range carries clinical weight, a 16-point increase represents a substantial shift.Similar benefits appeared in adults older than 65 years, those using >100 units of insulin daily, and those taking glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose cotransporter 2 (SGLT2) inhibitors. Participants kept background therapy, and few counted carbohydrates at baseline. Fixed meal announcements, such as 45 g per meal with carbohydrate ratios adjusted behind them, and an extended-absorption bolus for gastroparesis or grazing patterns may simplify use.The ADA/EASD algorithm now integrates comorbidity assessment with glycemic and weight goals rather than splitting them into parallel pathways. Medical nutrition therapy, 24-hour physical activity behaviors, self-management education, and social determinants of health sit at the top. Directly below, the algorithm calls for early SGLT2 inhibitor and/or GLP-1-based therapy to modify disease and complication risk, a position metformin once held.A footnote extends the atherosclerotic cardiovascular disease recommendation to dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists such as tirzepatide (Mounjaro), reflecting SURPASS-CVOT. Metabolic dysfunction-associated steatotic liver disease and steatohepatitis now sit beside chronic kidney disease and heart failure, with GLP-1-based therapy, low-dose pioglitazone, or SGLT2 inhibitors as options. An evidence graphic also links each additional 500 to 1,000 daily steps with lower all-cause and cardiovascular mortality.Collectively, the updates mark a move away from stepwise treat-to-fail escalation toward earlier organ-protective therapy and, once insulin is needed, automated delivery as the default.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.

    Twiist AID Data and the New ADA/EASD Type 2 Algorithm

  4. Oct 15

    Screening, Cell Therapy, and Adjunctive Agents at Breakthrough-T1D

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives! Population-level screening for type 1 diabetes (T1D) is moving into clinical practice, raising questions about who to screen, how to stage results, and how to deliver disease-modifying therapy at scale. On a recent episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, recapped the inaugural Breakthrough T1D Clinical and Research Congress in Philadelphia. First-degree relatives carry up to a 15-fold increased risk, and screening children at ages two, six, and 10 years identifies roughly 80% of those who will develop the disease. Evidence guiding adult screening and staging remains limited. One health system estimated up to 45,000 candidates after counting relatives and people with autoimmune thyroid disease, celiac disease, or vitiligo. Placebo-controlled designs, such as the 14-day intravenous infusion regimen in the teplizumab (Tzield) TN10 trial, burden participants. An ongoing comparison of antithymocyte globulin with teplizumab gives every participant active therapy, and involving people with T1D in protocol development may improve enrollment. Eli Lilly is also investigating the Janus kinase inhibitor baricitinib (Olumiant) to delay progression from stage two to stage three disease. Stem cell-derived islet programs from Vertex aim to overcome donor scarcity, with gene editing intended to reduce immunosuppression requirements. Reports of insulin independence with tegoprubart, an anti-CD40 ligand antibody from Eledon, involve few patients receiving infusions every three weeks, and long-term toxicity of agents such as tacrolimus remains a concern. Long-term Edmonton protocol data show many recipients sustain time in range above 90% despite resuming insulin. Adjunctive agents layered on automated insulin delivery address residual cardiorenal risk. Dipeptidyl peptidase-4 inhibitors improve time in range without added hypoglycemia, while generic dapagliflozin lowers mean glucose but requires ketone monitoring given euglycemic diabetic ketoacidosis risk. Glucagon-like peptide-1 (GLP-1) and dual GIP/GLP-1 receptor agonists improve time in range, often at low doses such as tirzepatide (Mounjaro) 2.5 mg weekly. Finerenone (Kerendia) recently gained approval for chronic kidney disease associated with T1D. The 2026 American Diabetes Association Standards of Care also recognize coexisting type 1 and type 2 diabetes, supporting coverage for patients with insulin resistance. Supply policy compounds the clinical burden. Continuous glucose monitoring sensors frequently fail before their labeled wear time, leaving patients on standard monthly allotments without a sensor for meaningful stretches. Collectively, these developments point toward individualized T1D care matched to disease stage and residual beta-cell function, with screening infrastructure, trial access, and supply policy shaping how quickly patients benefit.

    Screening, Cell Therapy, and Adjunctive Agents at Breakthrough-T1D

  5. Sep 24

    Weekly Insulin Efsitora Alfa Gets FDA Approval for Type 2 Diabetes

    On this episode of Diabetes Dialogue, Diana Isaacs, PharmD, and Natalie Bellini, DNP, FNP-BC, talk through the latest addition to the weekly basal insulin landscape and what it means for clinicians starting or switching patients. Their conversation centers on real-world considerations for bringing a new insulin option into practice. Watch the video and get the full description: https://www.hcplive.com/view/diabetes-dialogue-weekly-insulin-efsitora-alfa-gets-fda-approval-for-type-2-diabetes #Diabetes #Endocrinology #DiabetesDialogue

  6. Sep 18

    Finerenone Approved for CKD in Type 1 Diabetes

    Chronic kidney disease remains a persistent risk for people with type 1 diabetes, with roughly 30% of this population in the US developing the complication despite optimized glucose, blood pressure, and lipid management. Until now, no therapy directly targeted the mineralocorticoid receptor pathway implicated in this progression for this group. On a recent episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discussed the US FDA approval of finerenone (Kerendia) for chronic kidney disease associated with type 1 diabetes. The approval marks the first new therapy in 30 years for this population and represents the third indication for finerenone, following its approvals for chronic kidney disease with type 2 diabetes in 2025 and for heart failure with left ventricular ejection fraction above 40%. Regulators granted priority review, and the decision draws on a broader evidence base spanning roughly 20,000 patients across five pivotal phase 3 trials of the nonsteroidal mineralocorticoid receptor antagonist class. The phase 3 FINE-ONE trial, a randomized, placebo-controlled, double-blind study, enrolled 242 adults with type 1 diabetes across nine countries and 80 sites and supported the approval. Finerenone added to standard of care reduced urine albumin-to-creatinine ratio (UACR) by 25% from baseline over six months compared with placebo. Overall, 68.1% of participants receiving finerenone achieved a UACR reduction of at least 30%, versus 46.6% with placebo, a threshold the American Diabetes Association associates with slowed CKD progression. Finerenone carries a risk of hyperkalemia, requiring potassium monitoring, and should not be combined with steroidal mineralocorticoid receptor antagonists such as spironolactone or with concurrent ACE inhibitor and angiotensin receptor blocker therapy. Unlike SGLT2 inhibitors, which remain unapproved in type 1 diabetes due to concerns about euglycemic diabetic ketoacidosis, finerenone offers clinicians a mechanistically distinct option with a defined safety profile in this population. The approval also renews attention on UACR screening, which remains underused in primary care despite annual screening recommendations for all patients with diabetes. Broader adoption of routine screening, paired with earlier mineralocorticoid receptor antagonist initiation, may extend the renoprotective gains demonstrated in FINE-ONE to more patients with type 1 diabetes.

    Finerenone Approved for CKD in Type 1 Diabetes

  7. Sep 15

    Beta Bionics Mint Patch Pump Gains FDA Clearance

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!Tubeless insulin delivery is entering a new phase of competition, as Beta Bionics announced FDA clearance of Mint, its first patch pump, alongside a forthcoming algorithm update designed to individualize glycemic targets without carb counting.1,2 On a recent episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discussed the clearance and its implications for practice. The conversation centered on device specifications, insurance pathways, and an upcoming three-mode dosing algorithm called 3D Intelligence. Mint is a tubeless, three-day-wear pump holding 200 units of insulin, built around a nonrechargeable two-year battery and IPX8 water resistance rated to five feet for 60 minutes. It pairs with iOS and Android at launch and requires no phone for priming, addressing adherence barriers seen with existing automated insulin delivery systems. Sensor compatibility includes the Dexcom G7 and Abbott's Libre 3 Plus, with Libre Dual and Senseonics' Eversense integration planned to follow. Beta Bionics expects to begin shipments in the first quarter of 2027, targeting production of approximately 1.5 million units for the year, with at least 40% of payers anticipated to offer pharmacy-benefit coverage at launch. This model would allow patients on any current pump, including those previously limited to durable medical equipment acquisition, to access Mint through pharmacy channels once coverage is in place. The forthcoming 3D Intelligence update introduces three insulin-dosing profiles built on real-world data from more than 40,000 current iLet users, expanding on the meal-announcement-only interface which has defined the iLet since launch. The original mode preserves the existing algorithm, the optimized mode aims to reduce hypoglycemia while maintaining time above range, and the conservative mode delivers a more measured correction response for patients at higher hypoglycemia risk, such as older adults. The update remains pending FDA clearance but is expected to reach existing iLet users via software update around the Mint launch. Expanded sensor compatibility, dual-platform smartphone support, and pharmacy-benefit access position Mint to broaden automated insulin delivery uptake beyond populations previously constrained to durable medical equipment coverage. Combined with the 3D Intelligence update, the changes reflect a shift toward individualized dosing within a system historically defined by simplicity, without reintroducing manual basal rates or carb-ratio calculations. As competing patch pump programs advance through the FDA pipeline, the addition reinforces momentum toward algorithm-driven, low-burden insulin delivery across the type 1 diabetes population. 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.

    Beta Bionics Mint Patch Pump Gains FDA Clearance

  8. Sep 10

    Tirzepatide's New CV Indication and the STAREE Statin Trial

    In this episode of Diabetes Dialogue, co-hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, take on 2 recent developments that are reshaping how clinicians think about cardiovascular risk in people with diabetes. They start with a newly expanded indication for a dual incretin therapy, discussing what the supporting evidence means in practice and which patients may now be eligible. The hosts then turn to long-awaited trial evidence on statin therapy in older adults, a population historically underrepresented in this research. Along the way, they weigh open questions about mechanism, tolerability, and how to balance benefit against life expectancy and comorbidity. Throughout, Isaacs and Bellini emphasize individualized, shared decision-making when counseling patients on risk reduction at every age. References Eli Lilly and Company. FDA approves Lilly's Mounjaro (tirzepatide) to reduce cardiovascular risk in adults with type 2 diabetes. Press release. August 28, 2026. https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-mounjaro-tirzepatide-reduce-cardiovascular Zoungas S, Wolfe R, Moran C, et al. Atorvastatin, cardiovascular events, and disability-free survival in older adults. N Engl J Med. Published online August 28, 2026. doi:10.1056/NEJMoa2607314

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

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