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. FDA Approves Novo Nordisk’s Insulin Icodec-abae (Awiqli) for T2D

    23H AGO

    FDA Approves Novo Nordisk’s Insulin Icodec-abae (Awiqli) for T2D

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

    13 min

  2. 2D AGO

    2026 AACE Guidelines for Type 2 Diabetes

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

    36 min
  3. Orforglipron Receives FDA Approval for Chronic Weight Management

    3D AGO

    Orforglipron Receives FDA Approval for Chronic Weight Management

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!The US Food and Drug Administration (FDA) has approved orforglipron (Foundayo), a once-daily oral GLP-1 RA, for chronic weight management in adults with obesity or overweight and ≥1 weight-related comorbidity.1 In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the FDA’s decision and the myriad new treatment opportunities afforded by orforglipron’s clearance for entry into the market. The approval of orforglipron is supported by the phase 3 ATTAIN clinical development program, which includes 2 global, randomized, double-blind, placebo-controlled trials evaluating efficacy and safety over 72 weeks.¹ The ATTAIN-1 trial enrolled 3,127 adults with obesity or overweight without diabetes, while ATTAIN-2 enrolled more than 1,600 adults with obesity or overweight and type 2 diabetes.1 In ATTAIN-1, participants receiving the highest dose of orforglipron achieved a mean weight reduction of approximately 12.4% from baseline at 72 weeks among those who remained on treatment, compared with 0.9% in the placebo group. Reported average absolute weight loss was 27.3 lb versus 2.2 lb, respectively. Across all randomized participants regardless of completion status, mean weight loss was 11.1% with orforglipron compared with 2.1% with placebo.1 Secondary outcomes included improvements in cardiometabolic risk markers such as waist circumference, non–high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure. However, detailed peer-reviewed data from ATTAIN-1 and ATTAIN-2 remain limited at the time of reporting, and full efficacy and safety results have not yet been widely published in the medical literature. The safety profile of orforglipron appears consistent with the GLP-1 receptor agonist class. Common adverse events include gastrointestinal symptoms such as nausea, diarrhea, constipation, vomiting, and abdominal pain. A boxed warning highlights a potential risk of thyroid C-cell tumors, based on findings observed with other GLP-1 receptor agonists in rodent studies, though human relevance remains uncertain.1,2 The magnitude of weight loss observed with orforglipron in ATTAIN-1 appears clinically meaningful but may be modest relative to leading injectable agents. Cross-trial comparisons should be interpreted cautiously due to differences in study populations and designs. Additionally, treatment persistence rates and discontinuation due to adverse events will be important considerations in real-world use. Ongoing and planned studies are evaluating orforglipron across additional indications, including type 2 diabetes and other cardiometabolic conditions. Future comparative trials against established GLP-1 and dual incretin therapies may help define its role in treatment algorithms. Editor’s Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.References1: Eli Lilly. FDA approves Lilly’s Foundayo (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions. April 1, 2026. Accessed April 1, 2026. https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill2: US Food and Drug Administration. FDA Approves First New Molecular Entity Under National Priority Voucher Program. April 1, 2026. Accessed April 1, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program

    13 min
  4. Q1 2026 Updates from Tandem Diabetes Care, with Laurel Messer, PhD, RN

    4D AGO

    Q1 2026 Updates from Tandem Diabetes Care, with Laurel Messer, PhD, RN

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!Expanding access to and optimizing use of automated insulin delivery (AID) systems remains a central priority in diabetes care, with recent discussions highlighting practical strategies to improve outcomes across diverse patient populations. In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Laurel Messer, PhD, RN, vice president of medical affairs at Tandem Diabetes Care, to examine evolving approaches to insulin pump optimization and the broader implications for reducing patient burden.

    35 min

  5. MAR 19

    ATTD 2026 Recap

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

    33 min
  6. Orforglipron, Retatrutide, and Other GLP-1 Updates

    MAR 2

    Orforglipron, Retatrutide, and Other GLP-1 Updates

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a comprehensive update on the rapidly evolving landscape of incretin-based therapies, focusing on newly published and top-line clinical trial data across oral GLP-1 receptor agonists and emerging triple agonists. Key Episode Timestamps00:00:01 Intro00:00:22 Orforglipron in the ACHIEVE-3 trial00:03:30 Side effects from orforglipron00:10:28 Retatrutide in the TRIUMPH-4 trial00:18:26 Topline data on Novo Nordisk's UBT25100:21:47 Price cuts on Ozempic, Rybelsus, and Wegovy in 202700:26:26 Outro

    27 min
  7. Launch of the Zepbound KwikPen

    FEB 23

    Launch of the Zepbound KwikPen

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a detailed update on evolving incretin-based therapies, with a primary focus on a significant formulation change for tirzepatide. Key Episode Timestamps00:00:01 Intro00:00:11 Zepbound in the KwikPen00:01:25 Vials versus pens00:02:55 Environmental benefits00:03:53 Pen needles sold separately00:06:30 LillyDirect availability00:07:20 Europe approves 7.2 mg injectable semaglutide00:09:08 Reusable pen concerns00:10:55 Outro

    11 min
  8. Implantable Insulin Pumps and Interoperability

    FEB 21

    Implantable Insulin Pumps and Interoperability

    Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore advances in implantable diabetes technologies, focusing on a novel implantable insulin pump from Portal Diabetes that has received FDA Breakthrough Device designation. Key Timestamps00:00:01 Intro00:00:14 Implantable insulin pumps00:01:06 What is breakthrough status?00:03:00 How the pump works00:03:41 What makes it different from MiniMed?00:07:36 How does it administer insulin?00:09:47 The Twiist pump with EverSense00:13:30 Outro

    14 min
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Ratings & Reviews

4.7
out of 5
15 Ratings

About

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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