Diana Isaacs, PharmD, is an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic.

Linda DiMeglio, MD, MPH, is a professor of pediatrics and the division chief at Indiana University School of Medicine.

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

Diabetes Dialogue: The Push for Early-Stage T1D Screening and Treatment, With Linda DiMeglio, MD, MPH

In this episode of Diabetes Dialogue recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, interview Linda DiMeglio, MD, MPH, professor of pediatrics and division chief at Indiana University School of Medicine, following her plenary keynote and receipt of the Ellen Garber Award. DiMeglio outlines her broad work in type 1 diabetes research, including prevention strategies, beta cell preservation, diabetes technology, TrialNet leadership, and neurocognitive studies in young children living with diabetes.

The discussion centers on early-stage type 1 diabetes, with DiMeglio reviewing the evolving framework of risk identification and staging, from genetic predisposition and single autoantibody positivity through stage 1, stage 2, and stage 3 disease. She highlights the growing momentum behind both general population and family-based screening, emphasizing the importance of early detection not only to prevent diabetic ketoacidosis but also to enable timely intervention with disease-modifying therapies. She notes the recent expansion of teplizumab approval down to age 1 for stage 2 disease as a major milestone and describes the broader therapeutic goal as ultimately ending insulin dependence for people living with type 1 diabetes.

DiMeglio and the hosts discuss how the field has shifted significantly over the past decade, particularly with the reframing of “cure” as a combination of multiple targeted approaches rather than a single intervention. She underscores the importance of combination immunotherapy strategies, citing recent TrialNet work using rituximab followed by abatacept, as well as the need for more personalized approaches based on individual disease etiology and immune characteristics. She also stresses the need for better intermediate endpoints beyond the traditional 2-year C-peptide model to accelerate therapeutic development and trial efficiency.

The group also examines the increasing role of patient and family perspectives in clinical trial design, particularly through TrialNet’s community advisory board, which DiMeglio believes will improve recruitment and trial execution. They discuss the broader implications of immune-modifying therapies in type 1 diabetes, including parallels with oncology treatment models and the potential for these advances to inform management strategies for other autoimmune diseases. DiMeglio also reflects on how these therapies are reshaping endocrinology practice itself, requiring clinicians to become more familiar with immunomodulation, cytokine management, and interdisciplinary care.

A major focus of the conversation addresses the complexity of autoantibody interpretation, particularly around GAD antibodies and low-titer positivity. DiMeglio emphasizes that a single positive islet autoantibody test should never be considered definitive and should always be repeated, ideally in a separate gold-standard laboratory such as TrialNet. She explains that antibody specificity varies by type and titer, with higher titers often offering greater diagnostic confidence, while acknowledging ongoing uncertainty around interpretation in adults, diverse populations, and long-standing diabetes. The hosts also discuss the practical challenges of coding, insurance coverage, and patient counseling as early-stage diabetes diagnosis becomes more common.

The episode concludes with a discussion of emerging questions around antibody fluctuation over time, circadian variation in antibody measurements, and the role of genetic screening. DiMeglio notes that antibody status may shift over years and may even vary by time of day, introducing additional complexity into monitoring strategies. While genetic risk screening remains promising, she explains that large-scale antibody-based population screening may currently be more practical from a public health perspective. She closes by reinforcing that although much remains nuanced and unresolved, the field is rapidly advancing toward earlier intervention, more individualized treatment, and a fundamentally different future for type 1 diabetes care.

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. DiMeglio reports disclosures with Amgen, Lilly, Mannkind, Medtronic, Merck, Ascendis, and others.

DiMeglio L. Early-Stage Type 1 Diabetes: Screening, Monitoring, Treatments and Future Directions (Alan J. Garber, MD Lectureship). Presented at the American Association of Clinical Endocrinology Annual Meeting 2026, Las Vegas, NV. April 22-24, 2026.

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Linda DiMeglio, MD, MPH, joins the show to discuss the growing movement towards screening and testing for T1D at an early stage.

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Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

GLP-1 receptor agonists (GLP-1 RAs) have become among the most prescribed drug classes in modern endocrinology, reshaping the management of 

 through benefits extending beyond glycemic control, including cardiovascular risk reduction, renal protection, and weight loss.

 has remained largely uncharted. Despite the growing prevalence of obesity in the type 1 population, estimated at approximately 37% in recent data, GLP-1 RAs currently do not carry a US Food and Drug Administration approval for this indication, and type 1 diabetes was excluded from the pivotal trials underpinning their commercial approval.

GLP-1 receptor agonist use was not associated with increased rates of DKA or pancreatitis in adults with type 1 diabetes in this real-world, single-center cohort.

0 DKA or pancreatitis admissions were recorded among 255 type 1 diabetes patients on GLP-1 RA therapy over a 1-year period, compared to rates of 0.39% and 0.55%, respectively, in non-users.

GLP-1 RA users had a significantly lower overall hospital admission rate than non-users (7.45% vs. 13.11%; 

= .01), consistent with hospitalization reductions seen in type 2 diabetes outcome trials.

Chief among the concerns limiting off-label use has been the potential risk of diabetic ketoacidosis (DKA). In patients with type 1 diabetes, a population who depends entirely on exogenous insulin, there are concerns regarding the appetite-suppressing and gastric-slowing effects of GLP-1 RAs potentially prompting inappropriate reductions in insulin dosing and precipitating ketoacidosis. Pancreatitis has also been raised as a safety signal across the GLP-1 RA class.

However, without dedicated trial data in this population, clinicians prescribing these agents off-label have had little real-world evidence to guide risk counseling. New data presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 begin to address that gap.

Justin Do, DO, an endocrinology fellow at Loma Linda University Medical Center, presented findings from a retrospective, cross-sectional analysis of 7377 adults with type 1 diabetes seen at a single academic center between July 2024 and July 2025. The primary outcome was hospital admission for DKA or pancreatitis based on ICD-10 coding.

Of the included patients, 255 were on a GLP-1 RA, either semaglutide (n = 167), tirzepatide (n = 60), dulaglutide (n = 19), or liraglutide (n = 9). Patients in the GLP-1 RA group were older on average (mean age 45 vs 37 years), had higher mean BMI (33.4 vs 26.6 kg/m²), and were predominantly female (65.2%).

Among GLP-1 RA users, there were 0 admissions for either DKA or pancreatitis during the study period. In the non-GLP-1 group, DKA admission rates were 0.39% and pancreatitis admissions were 0.55%, although investigators noted neither difference reached statistical significance (

= .64, respectively). Overall hospital admission rate was investigated as an exploratory finding of potential clinical relevance, which was significantly lower in GLP-1 RA users compared to non-users (7.45% vs 13.11%l χ²=6.52; 

However, investigators acknowledged meaningful limitations, including the retrospective, single-center design limiting generalizability and the relatively small GLP-1 RA cohort potentially being underpowered to detect rare events. Additionally, dosing and duration of GLP-1 RA therapy were not captured, and the study relied on ICD-10 coding rather than chart-confirmed diagnoses. Selection bias is also a concern, as patients prescribed GLP-1 RAs off-label may represent a more closely monitored or metabolically managed subset of the type 1 population.

“GLP-1 RA therapy may offer meaningful clinical benefit in adults with type 1 diabetes,” Do and colleagues wrote. “However, further studies are warranted in this population.”

Resnick O, Bril F, Beauchamp G. Glucagon-like peptide-1 receptor agonists and type 1 diabetes: a potential game changer?. Front Endocrinol (Lausanne). 2025;15:1520313. Published 2025 Jan 21. doi:10.3389/fendo.2024.1520313

Do J, Seidel V, Hassan B. Diabetic Ketoacidosis and Safety Outcomes with GLP-1 Agonists in Type 1 Diabetes Mellitus. Presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, April 22-24, 2026.

Articles

GLP-1 receptor agonists have transformed type 2 diabetes care, yet their use in type 1 diabetes remains off-label amid concerns for DKA and pancreatitis, particularly if insulin is inappropriately reduced. A retrospective single-center analysis of 7377 adults with type 1 diabetes identified 255 GLP-1 RA users, predominantly semaglutide or tirzepatide, who were older with higher BMI. No DKA or pancreatitis admissions occurred among GLP-1 RA users, and overall hospitalization was lower versus non-users, despite important methodological limitations.

New real world data suggest GLP-1 RAs do not drive DKA or pancreatitis risk in adult patients with type 1 diabetes and may reduce hospital admissions.

GLP-1 RAs Do Not Raise Diabetic Ketoacidosis, Pancreatitis Risk in Type 1 Diabetes

Beyond Insulin: GLP-1 Receptor Agonists in Type 1 Diabetes

 has centered almost exclusively on insulin delivery. Even as automated insulin delivery (AID) technology has advanced, a substantial proportion of patients fail to achieve time in range > 70%, driven in part by rising rates of 

, which increase insulin resistance and total daily insulin requirements. Insulin alone also does not address 

, which in T1D is 6 to 8 times greater than in people without diabetes.

These limitations have fueled interest in adjunctive pharmacotherapy, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Accumulating data from observational studies and randomized controlled trials point to clinically meaningful improvements in HbA1c, time in range, and weight in T1D patients, without a demonstrated increase in severe hypoglycemia risk. Regulatory trials are now underway, raising the prospect of a formal T1D indication.

At the American Association of Clinical Endocrinology (AACE) 2026 Annual Meeting, Viral Shah, MD, a professor of medicine in the division of endocrinology & metabolism and director of Diabetes Clinical Research at the IU Center for Diabetes and Metabolic diseases at Indiana University, led a session on this topic, drawing on data from the ADJUST-T1D trial, which evaluated semaglutide in people with T1D, alongside other observational and controlled studies.

Across these data sources, HbA1c reductions ranged from approximately 0.4% to 1.0%, translating to time in range improvements of roughly 5% to 10% depending on baseline glycemic status. Weight loss outcomes appeared comparable to those observed in type 2 trials, though Shah noted that head-to-head comparisons have not been conducted.

He emphasized that the clinical benefit of GLP-1 RAs in T1D is inseparable from appropriate insulin titration. Initiating semaglutide at 0.25 mg or tirzepatide at 2.5 mg typically necessitates a 20% to 30% insulin reduction, but the appropriate degree of down-titration depends on baseline HbA1c and time in range.

Patients with an HbA1c of 8.5% to 9% may not require immediate insulin reduction, as the GLP-1 RA effect is needed to bring glycemia down. Conversely, patients already near target require proactive down-titration to avoid hypoglycemia. Shah recommended follow-up within 1 to 2 weeks of initiation and monthly thereafter to monitor and adjust.

Regarding safety, available data have not shown an increased rate of diabetic ketoacidosis (DKA) with GLP-1 RAs in T1D, though Shah noted that longer-duration trials will be needed to definitively characterize this risk. Gastrointestinal tolerability generally mirrors what is seen in type 2 populations, with one important distinction: patients with T1D appear to tolerate lower maximum doses, and clinicians should calibrate titration accordingly using established GI mitigation strategies.

Shah closed with a direct challenge to industry stakeholders, arguing that obesity in T1D deserves the same clinical priority it receives in type 2, and that the field has been too slow to generate the large-scale regulatory evidence needed to make these therapies available to T1D patients.

“Through your platform, I want to say that all industry, I want them not to ignore type 1 space and do something more so that we can utilize those drugs safely in people with type 1 diabetes as well,” Shah concluded

Editors’ note: Shah reports relevant disclosures with Sanofi, Novo Nordisk, Lilly, Dexcom, Insulet, Tandem Diabetes Care, Medtronic, Sequel Med Tech, Abbott Diabetes, Roche, Biomea Fusion, and T1D Scout.

 The emergence of obesity in type 1 diabetes. 

https://doi.org/10.1038/s41366-023-01429-8

Shah VN, Akturk HK, Kruger D, et al. Semaglutide in Adults with Type 1 Diabetes and Obesity. NEJM. doi:10.1056/EVIDoa2500173

Shah VN. Beyond Type 2: Evaluating GLP-1 Use in Type 1 Diabetes and Obesity. Presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, April 22-24, 2026.

Shah discusses the potential of GLP-1 receptor agonists as adjunctive therapy in type 1 diabetes, from glycemic control to cardiometabolic risk.

Beyond Insulin: Evaluating GLP-1 RAs as Adjunctive Therapy in Type 1 Diabetes, With Viral Shah, MD

Jeffrey Mechanick, MD, is the medical director of the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Fuster Heart Hospital and a professor of medicine at the Icahn School of Medicine at Mount Sinai.

Reemphasizing Nutrition and Diet in Managing Chronic Endocrine Disease, With Jeffrey Mechanick, MD

Despite taking a relative backseat in practice, diet and nutrition are still critically important in preventing and forestalling chronic endocrine diseases like 

Healthy diet patterns and the omission of detrimental eating behaviors play a major part in curbing a variety of endocrine diseases. While not single-handedly influencing the progress of obesity and diabetes, this lifestyle change is still foundational in preventing or reversing prediabetes, as well as avoiding adrenal fatigue, hyperuricemia, thyroid diseases, osteoporosis, and a laundry list of other conditions.

American Association of Clinical Endocrinology (AACE) Annual Meeting 2026

 in Las Vegas, Nevada, Jeffrey Mechanick, MD, medical director of the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Fuster Heart Hospital and a professor of medicine at the Icahn School of Medicine at Mount Sinai, broke down the importance of having endocrinologists return to prescribing dietary interventions for patients with or at risk of chronic metabolic diseases.

“In the old models, we really viewed nutrition as diet and dietary counseling, and the role of physicians was somewhat nebulous – they played a role, but we had dieticians who would handle the dietary counseling,” Mechanick told 

 in an exclusive interview. “If you had an individual endocrine disorder, there might be a set of dietary recommendations for that particular disorder. But in the new model, nutrition is more than just diet. Nutrition is the interaction of diet, which is the environment, and metabolism, which is really your body.”

Mechanick emphasized the need for further education on nutrition, particularly the interplay between the metabolic system and the exposome. Nutrition is far from limited to diet and exercise – environmental conditions and exposures can have a substantial impact on the development of chronic diseases.

“The problem that’s plaguing not just endocrinologists, but really the whole healthcare arena right now, is that we need more education on nutrition,” Mechanick said. “Not just dietary counseling or dietetics, but the interaction of these dietetics with metabolism, and that requires some formal education and experiential learning. It requires going to meetings and having good research.”

Additionally, a growing focus on “precision nutrition”, focusing on variability between metabolic systems rather than generalizing treatment across all patients or disease states. Many chronic diseases in endocrinology are also driven by genetic and environmental factors, making lifestyle interventions difficult to generalize. To that end, Mechanick encourages clinicians to tailor their diet and nutrition suggestions to each patient.

“In order to do precision nutrition or precision medicine, you must incorporate hidden variables,” Mechanick said. “Those hidden variables are not only some residual risk in terms of biological variables, but also social determinants of health – discrimination, crime, poverty, housing, education - and structural determinants of health – the policies and politics that create these social determinants. They need to be incorporated into any precision medicine plan to prevent chronic disease and mitigate its progression.”

Editors’ Note: Mechanick reports disclosures with Abbott Nutrition, Twin Health, and Merck.

Mechanick J. Keynote: Nutrition and Chronic Disease: A Hero’s Journey in AACE. Presented at the American Association of Clinical Endocrinology Annual Meeting 2026, Las Vegas, NV. April 22-24, 2026.

Soetedjo NN. The role of nutrition in various endocrine and metabolic diseases. Clinical Nutrition Open Science. 2025;62:164-188. 

Voruganti VS. Precision Nutrition: Recent Advances in Obesity. Physiology (Bethesda). 2023;38(1):0. 

Mechanick discusses the importance of dietary interventions in endocrinology and highlights the need for further education and awareness of metabolic function.

Type 2 Diabetes

Obesity Management

Obesity Management condition center page, resources on the topics of medical news and expert insight into clinical weight management can be found. Content includes articles, interviews, videos, podcasts, and breaking news on obesity research, treatment, and drug development.

Yun Liu, PhD, is a senior staff research scientist at Google Health/Research, focused on developing and validating machine learning models for medical imaging, including pathology, dermatology, and ophthalmology.

Rory Sayres, PhD, is a researcher in the Health AI group in Google Research who focuses on intelligence augmentation of medical experts using machine-learning-based assistance.

Are Improvements in AI Needed for Dermatology Patients? With Rory Sayres, PhD, and Yun Liu, PhD

, Rory Sayres, MD, and Yun Liu, PhD, outlined key areas for improvement in the use of artificial intelligence (AI)–powered tools within dermatology, noting the value of personalization, accuracy in predictions, and user-centered design in supporting the decision-making of patients.

A central theme of their interview was the necessity for AI systems to better guide patients on when to seek care. Sayres noted the wide spectrum of dermatologic conditions in terms of both severity and risk, making it critical for tools not only to identify possible diagnoses but also to help users determine whether specialist evaluation is warranted.

“You know, AI is probably already having some positive impact, helping people figure out how to manage things, “ Sayres said. “There are obviously other things where we know that the right path, for a great many dermatology conditions, is to see a specialist.”

He highlighted the dual challenge of optimizing care pathways, ensuring that patients who need specialist care are appropriately directed, while also reducing unnecessary visits in cases that could be managed conservatively. Improved triage, Sayres suggested, could help address both limited access to dermatology specialists and delays in care for high-risk conditions.

When discussing limitations, Liu pointed to several in how information is currently presented, noting their research’s prototype tool relied on static condition descriptions and images that did not adapt to individual cases. While these materials were dermatologist-informed and clinically accurate, they lacked contextual nuance, such as differentiating between mild and severe presentations of the same condition. Future iterations, he explained, will likely need to incorporate more dynamic, case-specific insights, such as severity assessment and tailored guidance, to better inform next-step decisions.

Both investigators emphasized that personalization will be a critical next step in the evolution of these tools. Sayres described real-world decision-making as inherently tricky, often requiring multiple concurrent concerns and individual patient factors. Moving past isolated case assessments toward more holistic, context-aware AI systems may help to improve both usability and clinical relevance.

The pair’s interview also highlighted the value of studying human factors alongside algorithmic performance. In particular, Liu described these data as representing a shift from assessing model accuracy in isolation to improving awareness of how real users interact with AI-generated information. By incorporating both a control arm and a “Wizard of Oz” arm via dermatologist-provided outputs, the trial was able to distinguish between limitations related to prediction accuracy and those tied to user interpretation or interface design.

Sayres and Liu framed their research as an early step in a more extensive trajectory. Although AI applications do show promise in improving consumer understanding of skin issues, additional refinements, especially in terms of personalization, accuracy, and decision support, may be needed before such tools can reliably guide patient care decisions in the real world.

The quotes contained in this summary were edited for the purposes of clarity.

Disclosures: Sayres and Liu reported stock ownership from Google outside the submitted work.

Sayres R, Jain A, Liu Y, et al. Consumer Understanding of Skin Concerns With an AI-Powered Informational Tool. JAMA Dermatol. 2026 Apr 15:e260597. 

. Epub ahead of print. PMID: 41984449; PMCID: PMC13084546.

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7. Epub 2018 Nov 8. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. 

In this segment of the interview, questions remaining about AI's effectiveness among patients in dermatology were explored.

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Rodolfo Galindo, MD, is an Associate Professor of Medicine at the University of Miami, and Director of the Comprehensive Diabetes Center of UHealth and the Director of Diabetes Management for Jackson Health System, in Miami.

Galindo describes how CKM may transform diabetes care by enabling real-time insights, improving DKA prevention, and advancing metabolic understanding.

Continuous Ketone Monitoring in Diabetes: Clinical Potential and Future Impact, With Rodolfo Galindo, MD

Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

FDA approved lunsotogene parvec for OTOF-related hearing loss based on phase 1/2 data showing improved hearing in a small cohort.

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FDA Approves Lunsotogene Parvec for OTOF-Related Genetic Hearing Loss

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Recent data presented at AACE 2026 have indicated the efficacy of GLP-1 RA treatment in reducing risk of diabetic retinopathy, renal disease, and others.

GLP-1 RAs Improve End-Organ Complications in Patients With Type 1 Diabetes

Alva outlines how general clinicians should address patient questions on psychedelic therapies, including risks, approvals, and referral pathways.


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Guidance for Clinicians on Patient Questions About Psychedelics, With Gus Alva, MD

Liu and Sayres emphasize that while AI tools improve consumer recognition of skin conditions, gaps remain in prediction accuracy and information.

Patient Awareness of Dermatologic Conditions Using AI, With Rory Sayres, PhD, and Yun Liu, PhD

A recent study presented at AACE 2026 has displayed the IGF-1R’s capacity for improving proptosis and disease activity in patients with poorly-controlled TED.

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IBI311 Efficacious and Safe in Reducing Proptosis in Thyroid Eye Disease

Learn how Leipzig scoring and genetic testing, plus labs and eye exams, help diagnose pediatric Wilson disease when symptoms are subtle.

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Addressing Diagnostic Challenges in Wilson Disease

Experts explain how deucravacitinib eases psoriasis itch fast, boosts quality of life, and why TB testing and boxed warnings matter.

Integrating TYK2 Inhibitors into the Psoriasis Treatment Algorithm

Learn a stepwise approach to evaluating EPI-like diarrhea—history, alarm features, fecal elastase and imaging—to rule out IBS, celiac, IBD.

Navigating the Differential: When EPI Looks Like Something Else

Joseph Leventhal, MD, PhD, is a Professor of Surgery and Director of the Kidney and Pancreas Transplant Programs within the Comprehensive Transplant Center of the Northwestern University Feinberg School of Medicine.

Levanthal describes the limits of current immunosuppression and the rationale behind early-phase clinical trials evaluating cellular therapies.

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Diabetes Dialogue: The Push for Early-Stage T1D Screening and Treatment, With Linda DiMeglio, MD, MPH

GLP-1 RAs Do Not Raise Diabetic Ketoacidosis, Pancreatitis Risk in Type 1 Diabetes

Beyond Insulin: Evaluating GLP-1 RAs as Adjunctive Therapy in Type 1 Diabetes, With Viral Shah, MD

Reemphasizing Nutrition and Diet in Managing Chronic Endocrine Disease, With Jeffrey Mechanick, MD

Are Improvements in AI Needed for Dermatology Patients? With Rory Sayres, PhD, and Yun Liu, PhD