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!

Diabetes Dialogue: 2026 Technology Updates and American Diabetes Association Standards of Care

00:00:00 - Intro & Agenda: New Tech + 2026 ADA Standards

00:00:45 - Dexcom G7 15‑Day Sensor & G6 Retirement

00:15:45 - Expanding Diabetes Tech Options

00:21:19 - Endorsement of Earlier AID and Open-Source AID Support

, 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, discuss major diabetes technology updates alongside key technology-related changes in the 2026 American Diabetes Association Standards of Care. The conversation highlights how rapidly evolving devices and updated guidelines are converging to reduce treatment burden and expand access to advanced diabetes management tools.

The discussion opens with updates from Dexcom, notably the launch of the Dexcom G7 15-day sensor, which incorporates an updated algorithm and is already integrating with Omnipod 5 and iLet systems, with Tandem integration expected soon. The hosts also address the announcement that the Dexcom G6 will be retired in July 2026, acknowledging the emotional and practical challenges this poses for patients who prefer the G6’s connectivity and perceived accuracy. While the transition may be difficult for some, the longer wear time and algorithm improvements of the G7 are framed as an opportunity to reassess CGM options and prepare thoughtfully for change.

Attention then shifts to Omnipod 5, with anticipation around a forthcoming software update planned for 2026. This update will introduce a lower glucose target of 100 mg/dL, down from 110 mg/dL, and significantly reduce automated-mode “kick-outs.” The hosts emphasize that minimizing time out of automated insulin delivery is critical for improving time in range and lowering patient burden, noting that excessive safety-driven exits can paradoxically worsen glycemic control.

A substantial portion of the episode is devoted to technology-focused updates in the 2026 ADA Standards of Care, reflecting Bellini’s perspective as a guideline committee member. Key changes include the removal of C-peptide and autoantibody requirements as barriers to insulin pump and automated insulin delivery (AID) access, reinforcing that insulin use, not diabetes type, should guide eligibility. The guidelines now include a Level A recommendation for AID use in type 2 diabetes, supported by recent clinical trial data and regulatory approvals. Additional updates expand support for CGM use during pregnancy beyond type 1 diabetes, reduce reliance on confirmatory fingerstick language, and strengthen recommendations for connected insulin pens for individuals on multiple daily injections when AID is not preferred or feasible.

The episode concludes with discussion of expanded guidance on open-source AID systems, underscoring the importance of clinician understanding and patient support regardless of FDA approval status. Collectively, Isaacs and Bellini frame the 2026 updates as a decisive step toward earlier, broader, and more individualized use of diabetes technology across care settings.

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.

American Diabetes Association. The American Diabetes Association Releases “Standards of Care in Diabetes—2026” | American Diabetes Association. Diabetes.org. Published December 8, 2025. Accessed December 17, 2025. https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2026

American Diabetes Association Professional Practice Committee for Diabetes*. Summary of Revisions: Standards of Care in Diabetes-2026. 

. 2026;49(1 Suppl 1):S6-S12. doi:10.2337/dc26-SREV

Podcasts

Explore the latest advancements in diabetes technology, including updates on CGMs and insulin pumps, enhancing patient care and management.

Diabetes Dialogue: Reacting to Retatrutide and TRIUMPH-4 Topline Data

 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, share early  impressions of topline phase 3 results from the TRIUMPH-4 trial of retatrutide, a once-weekly triple agonist targeting GIP, GLP-1, and glucagon receptors. Recorded from the ADCES Technology Conference, the conversation frames retatrutide as a potential next step beyond current GLP-1 and dual incretin options, while emphasizing that detailed trial data remain pending.

TRIUMPH-4 was a phase 3 study enrolling patients with obesity and osteoarthritis. Topline data suggests participants receiving retatrutide 12 mg achieved a mean weight loss of 28.7% at 68 weeks. Among this population, the trial also reported a 75.8% reduction in WOMAC pain scores from baseline, with approximately 1 in 8 participants reporting complete pain freedom at week 68. Isaacs highlights how striking these figures are in light of the already high bar set by semaglutide and tirzepatide, noting that confirmation in phase 3 heightens anticipation for full publications and future readouts.

The hosts connect these findings to evolving clinical priorities reflected in the American Diabetes Association’s expanding attention to obesity-related comorbidities, including osteoarthritis, MASLD/MASH, sleep apnea, and kidney disease. They note the broader retatrutide phase 3 program includes studies in type 2 diabetes, moderate-to-severe obstructive sleep apnea, chronic low back pain, MASLD/MASH, and planned cardiovascular and renal outcomes trials. Isaacs underscores the ongoing question of whether benefits across these conditions will be primarily molecule-specific or largely driven by the magnitude of weight loss, particularly given the inclusion of glucagon receptor activity.

Safety is discussed cautiously, given the limited nature of top-line disclosures. The hosts note that discontinuation due to adverse events appeared higher with retatrutide than placebo, and they emphasize the need for full reporting on gastrointestinal tolerability and other adverse events. Bellini also points to an intriguing subgroup signal suggesting lower discontinuation rates among participants with higher baseline BMI, while acknowledging this could reflect chance in a modestly sized trial population.

Overall, Isaacs and Bellini characterize retatrutide’s TRIUMPH-4 update as an important milestone, while stressing that interpretation should remain measured until complete efficacy and safety data are available.

Eli Lilly and Company. Lilly's triple agonist, retatrutide, delivered weight loss of up to an average of 71.2 lbs along with substantial relief from osteoarthritis pain in first successful Phase 3 trial. December 11, 2025. Accessed December 11, 2025. 

https://investor.lilly.com/news-releases/news-release-details/lillys-triple-agonist-retatrutide-delivered-weight-loss-average

American Diabetes Association. The American Diabetes Association Launches a New Obesity Division | ADA. diabetes.org. Published June 21, 2024. Accessed December 16, 2025. 

https://diabetes.org/newsroom/press-releases/american-diabetes-association-launches-new-obesity-division

Discover the latest advancements in diabetes treatment with retatrutide, a promising triple agonist showing significant weight loss and pain relief.

Diabetes Dialogue: Celebrating 2025 as The Year of the Incretin Therapy

The rise of GLP-1 receptor agonists across a multitude of specialties and into the public consciousness has been meteoric and while many specialties now marvel at the effects of the class, endocrinology has been bearing witness to this ascent for years.

In 2025, several regulatory decisions and clinical trials have been nothing short of practice-changing, emphasizing the broad applicability of this medication across diabetes, obesity, chronic kidney disease, heart failure, and a variety of other conditions. Additionally, key approvals from the US Food and Drug Administration have positioned GLP-1 agents as critical components in the ongoing effort to lastingly and effectively treat obesity.

In this special edition of Diabetes Dialogue recorded for HCPLive’s 

, cohosts 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, review an unprecedented year of advances in incretin-based therapies in 2025.

Isaacs and Bellini open this episode by highlighting a landmark milestone from January 2025: the FDA’s approval of semaglutide for patients with type 2 diabetes and CKD, based on the FLOW trial. Bellini emphasizes how FLOW reshaped treatment algorithms by definitively establishing renal protection as a primary, not incidental, benefit of semaglutide. With clear evidence that GLP-1 receptor agonists can slow progression to advanced CKD—even when SGLT2 inhibitors are not tolerated—the hosts note this represents a genuine paradigm shift toward confident combination therapy.

February: FDA Ends the Semaglutide Shortage

Isaacs and Bellini also highlighted the end of the global semaglutide shortage in February 2025. During the shortage, clinicians were often forced to switch patients between multiple medications to achieve similar treatment with a limited supply. Oftentimes, as Bellini notes, patients using a 2 mg dose were moved to 1 mg when the former ran out, and then to an 0.5 mg dose when the 1 mg dose ran out. Novo Nordisk’s ultimate decision to ramp up production of semaglutide significantly alleviated the pressures of the shortage, and since then, the field has seen a substantial decrease in usage of compounding pharmacies.

March: STRIDE and Semaglutide in Peripheral Artery Disease

Conversation turns to March and the STRIDE trial, where semaglutide significantly improved pain-free walking distance in patients with peripheral artery disease. Isaacs and Bellini underscore how this data reinforces GLP-1 agents as cardiometabolic therapies with broad vascular relevance, particularly given the accessibility of walking as a functional endpoint. Additionally, the trial highlighted the cardiovascular aspect of diabetes, as it substantially increases heart attack and stroke risk – making diabetes the ideal crosspoint for adopting GLP-1 agents into cardiovascular care.

June: The American Diabetes Association Scientific Sessions

June’s ADA Scientific Sessions brought an “explosive” volume of incretin data. They spotlight the monthly GLP-1 candidate MariTide, producing ~16% weight loss in early studies; the oral GLP-1 orforglipron, which delivered strong A1c and weight reductions without dosing-timing constraints; and the dual amylin/GLP-1 combination Cagri-Sema (semaglutide and cagrilintide) in the REDEFINE program, with weight-loss results surpassing 20% in people without diabetes and nearly 14% in those with type 2 diabetes. They also discuss STEP UP, where a higher 7.2-mg semaglutide dose achieved a 21% weight reduction with acceptable tolerability, and the SLIMMER trial’s glucagon/GLP-1 dual-agonist ecnoglutide, which delivered more than 13% mean weight loss. The hosts emphasize that, taken together, these studies signal a future defined by combination incretin pharmacology and diversified receptor targeting.

July: SURPASS-CVOT and Tirzepatide in Cardiovascular Disease

The July discussion centers on the SURPASS-CVOT top-line results. Although tirzepatide did not demonstrate superiority over dulaglutide, it achieved cardiovascular noninferiority, reinforcing clinical comfort in using tirzepatide for patients with elevated CV risk. They highlight the pre-specified indirect comparison suggesting a potential 28% reduction in three-point MACE and 39% reduction in all-cause mortality relative to a putative placebo. Additional analyses indicating slowed eGFR decline in high-risk CKD populations further broaden the therapeutic rationale.

August: Semaglutide in MASH and Orforglipron in Obesity

August delivered another milestone with semaglutide gaining FDA approval for metabolic dysfunction–associated steatohepatitis (MASH), becoming only the second therapy approved for this increasingly recognized condition. The hosts describe how this approval is already changing clinical workflows—with broader screening, routine incorporation of FIB-4 scoring, and stronger justification for GLP-1–based therapy in metabolic liver disease. In parallel, orforglipron produced 12% weight loss in obesity trials, signaling likely future broad utility.

By October, oral semaglutide achieved its own cardiovascular-risk-reduction indication via the SOUL trial, alleviating long-standing concerns about the CV efficacy of oral formulations. This new data also opened a new potential treatment pathway for patients unwilling or unable to receive injectable agents. Semaglutide is now the only oral GLP-1 receptor agonist currently available, but the promising results of SOUL promise more to come.

November: Semaglutide in Alzheimer’s Disease

Isaacs and Bellini review November’s disappointing termination of Novo Nordisk’s oral semaglutide Alzheimer’s disease trial, in which the GLP-1 agent was unable to prevent disease progression to a statistically significant degree. While progression was not slowed, the hosts point to expert commentary suggesting the possibility that therapy must begin earlier or use injectable formulations to meaningfully influence neurodegenerative pathways, leaving the door open for future investigation.

December: SURMOUNT-4 and Weight Gain After Withdrawal from Tirzepatide

The episode concludes with new post-hoc findings from SURMOUNT-4, showing that more than 80% of individuals withdrawing from tirzepatide regained at least 25% of their prior weight loss, accompanied by reversal of cardiometabolic improvements. Isaacs and Bellini stress the core message: obesity is a chronic disease requiring chronic treatment, and the accumulating benefits of incretin-based therapies—in renal protection, cardiovascular risk reduction, liver disease, and weight management—reinforce the importance of long-term continuity.

Novo Nordisk. FDA approves Ozempic® (semaglutide) as the only GLP-1 RA to reduce the risk of worsening kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease. January 28, 2025. Accessed January 28, 2025. 

https://www.novonordisk-us.com/media/news-archive/news-details.html?id=915253

Novo Nordisk. FDA declares Wegovy® and Ozempic® shortage is over and that Novo Nordisk is fully meeting or exceeding nationwide demand for all doses. PR Newswire: press release distribution, targeting, monitoring and marketing. February 21, 2025. Accessed February 21, 2025. 

https://www.prnewswire.com/news-releases/fda-declares-wegovy-and-ozempic-shortage-is-over-and-that-novo-nordisk-is-fully-meeting-or-exceeding-nationwide-demand-for-all-doses-302382370.html

Bonaca MP, Catarig A, Houlind K. Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial. 

Johnson V. ADA 2025 Recap: 5 Studies on Obesity to Know. Hcplive.com. Published June 25, 2025. Accessed December 3, 2025. 

https://www.hcplive.com/view/ada-2025-recap-5-studies-on-obesity-to-know

Eli Lilly and Company. Lilly's Mounjaro (tirzepatide), a GIP/GLP-1 dual agonist, demonstrated cardiovascular protection in landmark head-to-head trial, reinforcing its benefit in patients with type 2 diabetes and heart disease. July 31, 2025. Accessed July 31, 2025. 

https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated

Novo Nordisk. Wegovy® approved by FDA for the treatment of adults with noncirrhotic MASH with moderate to advanced liver fibrosis. August 15, 2025. Accessed August 15, 2025. 

https://www.novonordisk-us.com/media/news-archive/news-details.html?id=916417

Eli Lilly and Company. Lilly's oral GLP-1, orforglipron, delivers weight loss of up to an average of 27.3 lbs in first of two pivotal Phase 3 trials in adults with obesity. August 7, 2025. Accessed August 7, 2025. 

https://investor.lilly.com/news-releases/news-release-details/lillys-oral-glp-1-orforglipron-delivers-weight-loss-average-273

Novo Nordisk, Inc. FDA approves Novo Nordisk’s oral semaglutide for cardiovascular (CV) risk reduction in adults with type 2 diabetes who are at high risk, including those who have not had a prior CV event. PR Newswire. October 17, 2025. Accessed October 20, 2025. 

https://www.prnewswire.com/news-releases/fda-approves-novo-nordisks-oral-semaglutide-for-cardiovascular-cv-risk-reduction-in-adults-with-type-2-diabetes-who-are-at-high-risk-including-those-who-have-not-had-a-prior-cv-event-302588005.html

Novo Nordisk. Novo Nordisk A/S: Evoke phase 3 trials did not demonstrate a statistically significant reduction in Alzheimer’s disease progression. November 24, 2025. Accessed November 24, 2025. 

https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916462

Horn DB, Linetzky B, Davies MJ, et al. Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity: A Post Hoc Analysis of the SURMOUNT-4 Trial. 

 Published online November 24, 2025. doi:10.1001/jamainternmed.2025.6112

This special edition episode explores the advancements in incretin therapies that defined 2025.

Diabetes Dialogue hosts discuss November 2025 technology updates, including Omnipod updates from Insulet Corporation

Diabetes Dialogue: Upcoming Upgrades for Omnipod Technology

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, break down what Insulet Corporation’s announcements surrounding forthcoming updates to Omnipod mean for the diabetes community.

At its 2025 Innovation Showcase, Insulet Corporation highlighted a series of major product advancements that are expected to significantly expand the clinical utility of automated insulin delivery (AID) for both type 1 and 

. The company outlined 3 sequential product launches between 2026 and 2028, each designed to simplify therapy, enhance glycemic outcomes, and broaden access to AID across diverse clinical settings.

Pending FDA clearance, Insulet plans upgrades to the current Omnipod 5 system, which became the first FDA-approved AID system for type 2 diabetes in August 2024,  to strengthen glycemic control, improve usability, and expand ecosystem connectivity. Key clinical-facing improvements include:

Full interoperability with all major continuous glucose monitoring (CGM) systems.

Improved algorithmic performance designed to optimize time-in-range and reduce hypoglycemia.

Omnipod Discover, a new machine-learning insights platform, intended to streamline onboarding, simplify dose adjustment, and support clinical decision-making with real-time, data-driven recommendations.

Insulet’s next AID platform, Omnipod 6, introduces a redesigned system built to elevate both personalization and simplicity:

An adaptive insulin-dosing algorithm that continuously learns and adjusts to each user’s glucose patterns.

A configurable Pod engineered to function with 

A new app and controller interface emphasizing intuitive setup, patient autonomy, and reduced clinic training burden.

Omnipod 6 is intended for use in both type 1 and type 2 diabetes, expanding AID applicability to the large population of insulin-requiring type 2 patients who have had limited access to pump therapy.

Omnipod Fully Closed Loop for Type 2 Diabetes (Expected 2028)

Insulet also announced plans for the Omnipod Fully Closed Loop for Type 2, which is designed as the first out-of-the-box, fully automated insulin delivery system for type 2 diabetes:

No meal announcements, carb counting, or manual boluses required

An intelligent algorithm that autonomously manages basal and bolus insulin delivery

Zero-setup design intended to enable prescription and use in primary care, dramatically broadening AID access

Insulet Corporation. Insulet Outlines Long-Term Strategy to Drive Growth and Value Creation at 2025 Investor Day. Insulet.com. Published November 20, 2025. Accessed November 25, 2025. 

https://investors.insulet.com/news/news-details/2025/Insulet-Outlines-Long-Term-Strategy-to-Drive-Growth-and-Value-Creation-at-2025-Investor-Day/default.aspx

Insulet Corporation. Omnipod® 5 Automated Insulin Delivery System is now FDA-cleared for People with Type 2 Diabetes. Insulet.com. Published August 26, 2024. Accessed November 25, 2025. 

https://investors.insulet.com/news/news-details/2024/Omnipod-5-Automated-Insulin-Delivery-System-is-now-FDA-cleared-for-People-with-Type-2-Diabetes/default.aspx

Discover the latest advancements in diabetes technology from November 2025, including Omnipod updates and the new Pivot pump.

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

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