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.

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

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

Once-weekly basal insulin therapy has moved from clinical trial data to pharmacy shelves, offering clinicians a new option for patients who struggle with the daily burden of insulin injections. The shift addresses a persistent adherence problem in basal insulin therapy, where missed or inconsistent daily dosing undermines glycemic control.

Diabetes Dialogue: Weekly Insulin Icodec Now Available for Type 2 Diabetes

On this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discussed the pharmacy launch of insulin icodec (Awiqli), the first once-weekly basal insulin now available in the United States.

The approval rests on data from approximately 4200 participants across the phase 2 and phase 3 ONWARDS program. In insulin-naive participants enrolled in ONWARDS 1, 3, and 5, insulin icodec produced superior reductions in hemoglobin A1c compared with once-daily basal insulin. Among participants switching from daily basal therapy in ONWARDS 2, icodec showed noninferior glycemic control alongside improved treatment satisfaction scores.

Insulin icodec has also been studied in type 1 diabetes but did not receive approval in this population after trials showed higher rates of hypoglycemia relative to daily basal insulin. Additional studies in type 1 diabetes are ongoing, leaving open the possibility of future expansion beyond the current type 2 indication.

Dosing requires new clinical habits, since insulin icodec is formulated as U-700, a concentration allowing a full week's dose to be delivered in a comfortable injection volume. Adjustments occur in 10-unit increments rather than the single-unit changes used with daily basal insulins, though the weekly total still translates into modest day-to-day changes of roughly one to two units. Patients switching from daily basal insulin require a loading dose, calculated by multiplying the total daily dose by 10.5, to reach steady state faster than a standard weekly conversion would allow.

Titration follows fasting glucose. Clinicians add 20 units when readings exceed 130 mg/dL, maintain the dose between 80 and 130 mg/dL, and subtract 20 units below 80 mg/dL. Because increases and decreases are dosed in 20-unit blocks, most cycles are reassessed over two to four weeks rather than week to week.

The reduced injection frequency carries particular relevance for older adults, caregivers, and patients whose adherence to daily regimens has proven inconsistent. As pharmacy access expands, coverage and prior authorization requirements will shape how quickly insulin icodec moves into routine practice, but early trial and satisfaction data point toward a meaningful shift in basal insulin management.

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.

Novo Nordisk. Novo Nordisk’s Awiqli, the first once-weekly basal insulin for adults with type 2 diabetes, now available in the US. 

. August 11, 2026. Accessed August 11, 2026. 

https://www.prnewswire.com/news-releases/novo-nordisks-awiqli-the-first-once-weekly-basal-insulin-for-adults-with-type-2-diabetes-now-available-in-the-us-302847645.html

Podcasts

Once-weekly insulin icodec hits US pharmacies, simplifying basal dosing for type 2 diabetes with new titration rules and promising A1c results.

Advances in diabetes care rarely arrive through a single channel, and the 2026 annual meeting of the Association of Diabetes Care and Education Specialists (ADCES) reflected this breadth, with new insulin delivery hardware, cardiometabolic risk management, and endocrine screening criteria all drawing attention from clinicians in Columbus, Ohio.

Diabetes Dialogue: Tech, Screening, and Care Highlights from ADCES 2026

On a recent episode of Diabetes Dialogue, recorded on-site at ADCES26, co-hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed sessions and exhibits spanning insulin delivery technology, cardio-kidney-metabolic (CKM) risk reduction, beta-cell preservation, ketone monitoring, and hypercortisolism screening.

On the exhibit floor, 2 simplified insulin delivery devices signaled a push toward patients still managing diabetes on multiple daily injections. Pivot, a tubeless patch pump from Modular Medical, holds up to 300 units of insulin, delivers preset 2-unit boluses, and supports 2 distinct basal rates, though it is not yet an automated insulin delivery (AID) system. CeQur's Simplicity bolus-only patch has moved toward 7-day wear with up to 240 units of capacity and a one-unit dosing option, positioning it alongside once-weekly basal and incretin therapies on a shared weekly schedule.

A case-based session on CKM syndrome, built around a patient newly diagnosed with 

 and discharged on insulin without pen needles, illustrated how risk calculators such as PREVENT can guide therapy beyond glycemic control. The case incorporated glucose-lowering therapy alongside GLP-1 and SGLT2 inhibitor use for cardiorenal protection, discontinuation of an unindicated beta blocker masking hypoglycemia symptoms, and a plan to taper insulin as other agents took effect.

A separate discussion focused on C-peptide, a marker of residual endogenous insulin production, as an emerging clinical trial endpoint in type 1 diabetes. Patients who retain measurable C-peptide despite long-standing autoimmune beta cell loss appear to experience fewer cardiovascular events, less diabetic ketoacidosis, and less severe hypoglycemia, reinforcing interest in beta-cell-preserving therapies during early-stage disease.

Continuous ketone monitoring, an emerging sensor category, was covered through patient cases including pregnancy-related nutritional ketosis and a case of latent autoimmune diabetes in adults treated with an SGLT2 inhibitor without insulin, a combination carrying risk for euglycemic diabetic ketoacidosis. The hosts noted real-time ketone data could eventually clarify when SGLT2 inhibitor use is appropriate in insulin-requiring patients despite this risk.

A well-attended early-morning session addressed hypercortisolism as an underrecognized driver of treatment-resistant hypertension and hyperglycemia. Updated American College of Endocrinology guidance now recommends screening when hemoglobin A1c remains >7.5% or blood pressure remains uncontrolled despite maximal glucagon-like peptide-1, SGLT2 inhibitor, and multidrug antihypertensive therapy, with diabetes care and education specialists playing a growing role in identifying candidates and coordinating referral.

The hosts also highlighted Blue Circle Health, a nonprofit offering ≤6 months of virtual bridge care, including dietitian visits, social work support, and insurance navigation, for people with type 1 diabetes across 20 states. Collectively, the sessions underscored a field advancing simultaneously on device design, risk stratification, biomarker science, and access to supportive care.

Ndumele CE, Rodriguez F, Dixon DL, et al. 2026 AHA/ACC/ADA/ASN guideline for the prevention, detection, evaluation, and management of cardiovascular-kidney-metabolic syndrome: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;154(4). doi:10.1161/cir.0000000000001453

Taylor PN, Collins KS, Lam A, et al. C-peptide and metabolic outcomes in trials of disease modifying therapy in new-onset type 1 diabetes: An individual participant meta-analysis. The Lancet Diabetes &amp; Endocrinology. 2023;11(12):915-925. doi:10.1016/s2213-8587(23)00267-x

Articles

ADCES26 highlighted multidimensional progress in diabetes management, spanning simplified insulin delivery hardware, CKM risk reduction strategies, and emerging endocrine screening thresholds. New patch-based devices targeted patients on MDI with higher capacities and weekly-wear concepts. Case discussions emphasized use of PREVENT and cardiorenal-protective therapies, insulin de-intensification, and avoidance of agents that mask hypoglycemia. C-peptide gained visibility as a type 1 diabetes endpoint linked to fewer adverse outcomes. Continuous ketone monitoring and updated hypercortisolism screening criteria broadened practical clinical vigilance, alongside bridge-care support models.

Diabetes Dialogue hosts recap ADCES26 highlights on insulin delivery tech, CKM care, C-peptide science, ketone monitoring, and hypercortisolism screening.

Retatrutide Cuts Weight, Cardiovascular Disease Risk in TRIUMPH-3

Triple hormone receptor agonism continues to show cardiometabolic promise in 

 treatment, with new phase 3 data indicating retatrutide can pair substantial weight loss with meaningful reductions in cardiovascular risk factors among patients with established 

On a recent episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed topline results from the phase 3 TRIUMPH-3 trial evaluating retatrutide, a glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptor triple agonist, in adults with obesity and cardiovascular disease.

Watch the full episode on the TRIUMPH-2 and TRIUMPH-3 data

TRIUMPH-3 enrolled >1900 participants with class II or III obesity (body mass index of 35 or higher) and established cardiovascular disease, randomizing them across global sites to 9 mg, 12 mg, or placebo over 80 weeks. The 9 mg dose produced average weight loss of 22%, or 53 pounds, and the 12 mg dose produced 23%, or 56 pounds, compared with 3% among patients receiving placebo. Weight loss was somewhat less pronounced than in TRIUMPH-1, where the highest dose reached 28.3%, a difference investigators partly attributed to inclusion of some participants with 

The 12 mg dose was also associated with a 37% reduction in triglycerides, a 17% reduction in non-high-density lipoprotein cholesterol, a 9.3 mmHg reduction in systolic blood pressure, a 19 cm reduction in waist circumference, and a 51% reduction in high-sensitivity C-reactive protein. 3-point and 5-point major adverse cardiovascular event outcomes trended favorably but did not reach statistical significance, a limitation the hosts attributed to the trial's relatively short 80-week duration compared with dedicated cardiovascular outcomes trials such as the 5-year REWIND study of dulaglutide. A properly designed cardiovascular outcomes trial will be needed to confirm whether the risk-factor improvements translate into fewer events.

Gastrointestinal effects were common, with diarrhea reported in up to 34% of participants, nausea in up to 28%, constipation in 17%, decreased appetite in 17%, and vomiting in up to 16%, a profile consistent with other incretin-based therapies. Discontinuation rates were 3.8% with the 4 mg dose, 11% with 9 mg, and 7.7% with 12 mg, compared with nearly 5% among patients receiving placebo. The hosts noted patients who discontinue 1 incretin agent because of side effects may tolerate a different 1, underscoring the value of having multiple agents available in practice.

The findings add to a growing body of evidence supporting triple agonist therapy as a tool for addressing weight and cardiometabolic risk together in patients with established cardiovascular disease, even as the topline data lacked continuous glucose monitoring metrics investigators hope will appear in the trial's full readout. As increasingly potent incretin-based agents advance through a crowded pipeline, the field is beginning to weigh whether older, less potent molecules will retain a lasting clinical role.

Eli Lilly. Lilly’s triple agonist, retatrutide, successful in two additional Phase 3 obesity trials, delivering significant improvements in weight and A1C. July 23, 2026. Accessed August 4, 2026. 

https://investor.lilly.com/news-releases/news-release-details/lillys-triple-agonist-retatrutide-successful-two-additional

Videos

In this segment from the latest episode of Diabetes Dialogue, Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss topline data from the TRIUMPH-3 trial of retatrutide.

TRIUMPH-2: Retatrutide Reduces Weight, A1C in Patients With Obesity

Triple hormone receptor agonism continues to advance obesity and diabetes care, with new phase 3 data suggesting retatrutide can drive substantial glycemic improvement alongside major weight loss in people with 

On a recent episode of Diabetes Dialogue, cohosts Natalie Bellini, DNP, and Diana Isaacs, PharmD, reviewed topline results from the phase 3 TRIUMPH-2 trial evaluating retatrutide, a glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptor triple agonist, in patients with type 2 diabetes.

Watch the full episode on the TRIUMPH-2 and TRIUMPH-3 data 

The trial enrolled roughly 1000 participants across 98 centers worldwide beginning in 2023, testing 4 mg, 9 mg, and 12 mg doses against placebo over 80 weeks. Weight loss proved dose-dependent, reaching up to 21% of body weight, with participants on the 12 mg dose losing an average of 23 kg from a baseline of 106 kg. Glycemic control improved in parallel, with A1C reductions of 1.4% to 1.6% compared with 0.2% in the placebo group.

The trial population entered with a mean A1C of 7.7%, a starting point closer to target than many incretin trials, which typically enroll patients nearer 9%. This finding echoes early data from the SURPASS program, where tirzepatide likewise produced pronounced A1C lowering in populations without markedly elevated baseline values, hinting the profile may extend to earlier-stage disease.

Discontinuation at the highest dose reached 14%, translating to 86% treatment continuation, a rate considered favorable given the magnitude of weight loss achieved. Investigators noted flexible titration strategies, including slower dose escalation and antiemetic support, can mitigate gastrointestinal tolerability issues seen across incretin-based therapies. Mandatory forced titration used in trial protocols contrasts with real-world practice, where clinicians often individualize dosing pace.

Collectively, the findings position retatrutide among the most potent agents yet studied for type 2 diabetes and obesity, with real-world dosing flexibility likely to shape adoption. The prospect of pairing dramatic weight loss with near-normalization of glycemic control has fueled interest in introducing triple agonist therapy earlier in the disease course, potentially blunting long-term complications.

In this segment from the latest episode of Diabetes Dialogue, cohosts Natalie Bellini, DNP, and Diana Isaacs, PharmD, discuss the topline results of the TRIUMPH-2 trial of retatrutide.