Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES

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

Diabetes Dialogue: ADA’s 2025 Standards of Care in Diabetes

 Introduction, Updates on CGM for Type 2 Diabetes

 Improved Guidelines for AID and Pregnancy

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, explore the updated American Diabetes (ADA) 2025 Standards of Care, focusing on technology advancements in diabetes management.

The discussion highlighted significant advancements and updated recommendations in diabetes care, particularly surrounding continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems. In particular, hosts pointed to stronger ADA recommendations for CGM use, including for individuals with type 2 diabetes (T2D) not on insulin therapy, and emphasized the importance of CGM for all patients on insulin therapy to reduce hypoglycemia risks. They also touched on the potential of over-the-counter CGMs to guide medication adjustments and lifestyle changes for prediabetes and T2D.

A notable topic is the ADA's revised stance on open-source AID systems, explicitly asking clinicians to support and guide patients who use these open-source systems. In particular, the organization recognized its potential to improve outcomes and urged providers to understand the underlying algorithms as they continue to advance. Isaacs and Bellini also highlighted the role of CGM and AID systems during pregnancy, emphasizing the early initiation of technology to achieve personalized glycemic targets and optimize outcomes.

The discussion expanded on the seamless integration of CGM during hospital discharge programs, as well as ADA recommendations that AID systems become the preferred insulin delivery method for people with type 1 diabetes (T1D), with growing support for their use in T2D on basal or multiple daily insulin injections. They addressed challenges such as Medicare restrictions on pump coverage for T2D, and insurance denial of test strips for CGM users, emphasizing the critical need for test strips as backups during CGM failures.

Their conversation also zeroed in on the ADA’s new guidance on allowing insulin pump use during hospitalization when clinically appropriate. Bellini stressed the importance of patient independence and education, advocating for hospitals to enable pump use if patients or caregivers can manage them. Hosts underscored the importance of patients bringing sufficient supplies to hospitals, as most facilities do not stock them.

Throughout the episode, Isaacs and Bellini emphasized the transformative potential of diabetes technology, urging clinicians to embrace and adapt to advancements to better support patients. They advocated for empowering individuals to manage their care, educate healthcare providers, and push for policy changes that improve access, equity, and outcomes in diabetes management.

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.

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In this episode, hosts explore ADA's evolving guidelines championing broader access to CGM and AID systems for personalized diabetes care.

Diabetes Dialogue: ADA’s 2025 Standards of Care in Diabetes Technology

Diabetes Dialogue: The Role of Dietitians in GLP-1 RA Use

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

, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Allison Evert, MS, RD, CDCES, and Savitha Subramanian, MD, co-authors of a recent publication on the evolving role of registered dietitian nutritionists (RDNs) in incretin-based therapies and obesity care, titled "

Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care

". The conversation explores how combining GLP-1 receptor agonists with lifestyle interventions can enhance long-term outcomes in diabetes and obesity management, focusing on the integral role of RDNs in addressing medication adherence, side effects, and patient education.

Evert and Subramanian highlight key findings from their paper, including strategies for mitigating side effects such as nausea, constipation, and diarrhea, which contribute significantly to high discontinuation rates during the first year of therapy. They stress the importance of counseling patients on appropriate dietary adjustments to prevent nutrient deficiencies and muscle loss during rapid weight loss, recommending an emphasis on protein intake and nutrient-dense food choices.

The discussion also delves into the practical challenges of integrating RDNs into care teams, particularly in systems with limited resources. To address this gap, the authors provide actionable tools in their paper, including figures and resources to guide clinicians in patient education and medication management. The hosts and guests agree that team-based care, including the use of pharmacists, advanced practice providers, and clinical protocols, is critical to improving outcomes and ensuring the long-term success of these therapies.

Gigliotti L, Warshaw H, Evert A, et al. Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care. 

. Published online November 7, 2024. doi:10.1016/j.jand.2024.10.023

Hosts are joined by a registered dietitian and practicing endocrinologist to discuss dietitians' role in managing patients receiving incretin therapies. 

Diabetes Dialogue:  The Evolving Role of Registered Dietitian Nutritionists in Obesity

Diabetes Dialogue: Leveraging Smart Algorithms for Insulin Optimization with Eran Atlas

 Introduction and Background of DreaMed Diabetes

 Current Functionality and Features of DreaMed Diabetes Platform

 Cloud-to-Cloud Integration and User Engagement

 Financial Benefits and Budget Neutrality

 Future Enhancements and Broader Applications

In this episode of Diabetes Dialogue, hosts 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, speak with Eran Atlas, chief executive officer of DreaMed Diabetes, on the evolution and current functionality of his company’s automated insulin technology, originally developed within a prominent diabetes treatment center in Israel, and now integrated with Medtronic’s 780G system.

Atlas Described how DreaMed Diabetes started focusing on automated insulin delivery but has expanded into developing a comprehensive digital care platform. This platform, called endo.digital, is designed to optimize insulin therapy for people with diabetes using AI-driven algorithms. It can gather data from various devices, including continuous glucose monitors (CGMs) and insulin pumps, analyze it, and offer tailored insulin recommendations to providers, which can be automatically integrated into the patient’s medical records.

Atlas further explained how the platform supports both insulin pump users and those on multiple daily injections (MDI). Hosts discussed how this algorithm could detect potential issues, such as incorrect carb ratios, missed insulin doses, or improper basal insulin adjustments, and subsequently provide actionable recommendations for providers. These insights are aimed at improving the quality of care and increasing accessibility to expert care for people with diabetes, especially in settings where endocrinologists are not readily available. Currently, the system is FDA-cleared to work with glucose data and doesn’t require direct insulin data input, as it can infer insulin events from glucose trends.

The company’s platform is currently deployed in multiple health systems, including the Yale University health system and Boston Children’s Hospital, with a focus on increasing its reach to primary care providers. Atlas indicated one key benefit of the platform is its ability to save providers significant time by automating documentation and visit summaries, which has already resulted in hundreds of hours saved in health systems.

Looking forward, Atlas described how DreamMed Diabetes is expanding its offerings, including working on solutions for basal-only insulin patients and enhancing the platform’s capabilities to include other diabetes therapies, such as GLP-1 medications. Atlas emphasized the company's mission to improve care access and outcomes, particularly in underserved populations.

In this episode, hosts discuss optimizing insulin therapy for people with diabetes using AI-driven algorithms with Eran Atlas, CEO of DreaMed Diabetes.

Diabetes Dialogue: Insights on INHALE-1 and CATALYST Trials

, hosts 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 the increasing focus on the connection between 

, including the latest advancements in glucagon-like peptide-1 (GLP-1) receptor agonist therapies, the use of inhaled insulin, and the recent addition of hypercortisolism to the “Ominous Octet”, creating the “Noxious Nine.”

Although obesity rates in the US have been rising steadily globally, hosts pointed to a recent CDC report reporting a slight decrease in obesity rates. They suggest that this may be partially attributed to the impact of GLP-1 drugs, which have become increasingly popular in managing obesity and related metabolic disorders, including type 2 diabetes (T2D). With these drugs continuing to show promising results, the hosts express optimism about their potential to reduce obesity and improve long-term patient health outcomes.

Their conversation shifted to a detailed discussion of the INHALE-1 trial, which evaluated the effectiveness of inhaled insulin in children with type 1 diabetes (T1D) and T2D. The trial, designed to evaluate the non-inferiority of inhaled insulin compared to traditional subcutaneous injections, found that inhaled insulin provided similar efficacy without significant differences in lung function or hypoglycemia occurrence. Isaacs and Bellini highlighted the implications of these findings, emphasizing that inhaled insulin could offer an alternative treatment option for pediatric patients, particularly those who struggle with needle phobia or the burden of multiple daily injections (MDIs).

The episode concluded with a deep dive into the Catalyst study, which explored the use of mifepristone in patients with T2D complicated by hypercortisolism. The second phase of the Catalyst trial found a significant reduction in HbA1C levels, showing a 1.5% decrease in patients treated with mifepristone compared with the placebo group. Isaacs and Bellini discussed the potential clinical applications of these results, particularly for patients with difficult-to-control diabetes who may have an underlying hormonal issue contributing to their condition. Overall, hosts encouraged clinicians to consider hypercortisolism in their differential diagnosis for patients with challenging diabetes cases, noting the promise that mifepristone could offer as an adjunctive treatment.

In this episode, hosts discuss a slight dip in US obesity rates, the use of inhaled insulin, and the benefit of mifepristone for HbA1c reduction.

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES

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