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: Signos and the Science of Weight Loss

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

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss new real-world data evaluating the Signos platform, an FDA-cleared digital weight-loss solution that combines the Dexcom Stelo continuous glucose monitor (CGM) with artificial intelligence–driven behavioral coaching. The platform delivers personalized recommendations based on glucose responses, dietary intake, physical activity, and user-entered data to support lifestyle modification and weight management.

Bellini begins by highlighting the challenges many individuals face in accessing traditional weight-management programs. While in-person and virtual classes can be effective, participation is often limited by time and accessibility. She notes that digital tools such as Signos may offer a scalable alternative by providing continuous support and accountability outside of the clinic setting.

The study included adults aged 18 years and older with obesity (BMI >30 kg/m²) who did not have diabetes. Researchers evaluated whether engagement with the platform was associated with weight-loss outcomes, using a metric called “total meaningful actions per day” to measure how frequently participants interacted with the app and its coaching features.

Among more than 3,000 participants, periods of active engagement were associated with significantly greater weight loss than periods of low or no engagement. Researchers also evaluated a 180-day cohort of 1,147 participants and found a mean total body weight loss of 5.14% over six months. Participants with higher engagement achieved nearly 6% weight loss, compared with approximately 4.3% among those with lower engagement levels. Bellini emphasizes that these results were achieved without the use of weight-loss medications, underscoring the potential impact of personalized behavioral support combined with CGM data.

Isaacs notes that individuals taking anti-obesity medications, including GLP-1 receptor agonists, were excluded from the study. She points out that many patients prefer to pursue weight loss through lifestyle modification rather than long-term pharmacologic therapy, making these findings particularly relevant. At the same time, both hosts suggest that digital coaching platforms could complement GLP-1 therapies by reinforcing nutrition, physical activity, and other healthy behaviors that remain essential for long-term success.

The conversation also addresses cost and accessibility. Isaacs notes that while Dexcom Stelo can be purchased independently at a lower monthly cost, access to the full Signos platform requires a higher subscription fee. Although this may be a barrier for some patients, the hosts compare the expense to other commercial weight-management programs and view it as another option within a broader obesity treatment strategy.

Throughout the discussion, Isaacs and Bellini emphasize the importance of accountability and ongoing engagement in achieving sustainable weight loss. They highlight the platform’s use of AI-generated prompts, reminders, and behavioral challenges designed to keep users engaged and motivated. The episode concludes with optimism about the growing role of digital health technologies in obesity care and the potential for AI-driven, CGM-informed interventions to provide personalized, scalable support for individuals seeking meaningful weight loss.

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.

Signos. Latest Study Shows Signos Drives Up to 7% Weight Loss Over 6 Months, Rivaling Real-World GLP-1 Weight Loss. 

. June 23, 2026. Accessed June 23, 2026. 

https://www.businesswire.com/news/home/20260623955669/en/Latest-Study-Shows-Signos-Drives-Up-to-7-Weight-Loss-Over-6-Months-Rivaling-Real-World-GLP-1-Weight-Loss

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This episode covers the recent trial of the Signos weight loss platform, indicating weight loss that could challenge GLP-1 receptor agonists.

Diabetes Dialogue: Teplizumab, Stelo, and Inhaled Insulin Afrezza for Pediatric Patients

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss a series of major pediatric diabetes advancements announced around the American Diabetes Association (ADA) Scientific Sessions 2026, highlighting how recent regulatory decisions are expanding treatment options and improving access to diabetes technologies.

The conversation opens with the expanded FDA indication for teplizumab in children and adolescents with newly diagnosed stage 3 type 1 diabetes. Bellini reviews findings from the PROTECT trial, which evaluated teplizumab in patients ages 8 to 17 years within six weeks of diagnosis. She explains that treatment with two 12-day infusion courses resulted in significant preservation of endogenous insulin production, with 95% of participants maintaining peak C-peptide levels above the study threshold at week 78. The hosts discuss the importance of preserving residual beta-cell function, emphasizing its potential role in improving glycemic stability, reducing hypoglycemia risk, and supporting better long-term outcomes for individuals who will live with type 1 diabetes for decades.

Isaacs and Bellini explore how this new indication may change the approach to type 1 diabetes screening, particularly among first-degree relatives and individuals at higher risk for autoimmune disease. They note that identifying people in stage 2 type 1 diabetes remains challenging because patients are typically asymptomatic, but the availability of treatment at stage 3 provides clinicians with a new opportunity to intervene soon after diagnosis.

The hosts discuss how having an approved therapy may encourage more families to pursue screening and identify additional individuals with early-stage disease. They also address practical considerations, including the importance of starting treatment within the appropriate window, coordinating the two infusion courses, supporting families through treatment logistics, and ensuring access through insurance coverage.

The discussion then shifts to the FDA clearance of Dexcom Stelo, the first over-the-counter glucose biosensor cleared for pediatric use in children ages 2 years and older who do not use insulin. Isaacs highlights how this technology could improve access to glucose monitoring for children with prediabetes, type 2 diabetes, or those seeking greater insight into how food, activity, and lifestyle factors influence glucose patterns.

The hosts emphasize that expanded access to glucose monitoring could play an important role in helping families make informed decisions about diabetes management. However, they clarify that individuals using insulin require prescription continuous glucose monitoring systems with additional safety features, including hypoglycemia alerts and predictive low glucose notifications.

Finally, Isaacs and Bellini discuss the pediatric approval of inhaled insulin as another significant milestone in diabetes care. They review its potential as an alternative to mealtime injections and highlight the opportunity to provide more flexibility for children and families managing type 1 diabetes. The conversation also addresses implementation considerations, including baseline lung function testing, provider familiarity, and adapting clinical workflows to incorporate new treatment approaches.

The episode concludes by reflecting on the rapid progress occurring in pediatric diabetes care. With advances in immune-modulating therapies, glucose monitoring technology, and insulin delivery options, the hosts highlight a new era of personalized diabetes management focused on preserving insulin function, improving access, and optimizing outcomes for young people living with diabetes.

Sanofi. Press Release: Sanofi’s Tzield approved in the US as the first disease-modifying therapy for patients recently diagnosed with stage 3 type 1 diabetes. June 12, 2026. Accessed June 18, 2026. 

https://www.sanofi.com/en/media-room/press-releases/2026/2026-06-12-22-09-58-3311349

US Food and Drug Administration. FDA Clears First Over-the-Counter Continuous Glucose Monitor for Children. June 12, 2026. Accessed June 18, 2026. 

https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor-children

Livingston R. FDA Approves Inhaled Insulin Afrezza for Pediatric Patients With Diabetes. 

https://www.hcplive.com/view/fda-approves-inhaled-insulin-afrezza-pediatric-patients-diabetes

This episode covers recent approvals and updated indications allowing more treatment options for children with diabetes.

Diabetes Dialogue: CONNECT, TRANSCEND, and TRIUMPH at ADA 2026

In this episode, shot live at the American Diabetes Association (ADA) Scientific Sessions 2026 in New Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the latest major trial results like CONNECT, TRIUMPH, and TRANSCEND.

To begin the episode, Isaacs and Bellini, discuss major highlights from ADA Scientific Sessions, focusing first on the landmark CONNECT trial evaluating continuous glucose monitoring (CGM) in people with type 2 diabetes who are not treated with insulin. They reflect on the evolution of CGM technology, from its early use primarily in type 1 diabetes to its expanding role in type 2 diabetes management, and explain why this trial represents an important step forward for patients who have historically had limited access to CGM.

The hosts review the randomized controlled trial findings, emphasizing the significant improvements in glycemic outcomes, including a 1.6% reduction in A1c from baseline and an approximately 0.9% greater reduction compared with standard care. They also highlight the increase in time in range, with participants using CGM achieving roughly five additional hours per day in target glucose range. The magnitude of these findings is discussed as a practice-changing development, with the potential to influence future clinical guidelines and strengthen recommendations for CGM use among individuals with type 2 diabetes who are not using insulin.

The discussion also explores the broader implications of the CONNECT trial for healthcare access and insurance coverage. The hosts note that randomized controlled trial evidence has historically played a key role in shaping standards of care and payer decisions, and they suggest that these results may help support wider adoption of CGM by demonstrating meaningful improvements in glucose control and patient outcomes.

The conversation then shifts to emerging pharmacologic advances, with a focus on retatrutide, a novel triple agonist targeting GLP-1, GIP, and glucagon pathways. The hosts discuss new data showing substantial metabolic benefits in people with type 2 diabetes, including up to 17% weight reduction and nearly 2% A1c lowering. They highlight how these findings represent a major advancement in diabetes and obesity treatment, particularly as clinicians continue to see increasingly powerful effects from next-generation incretin-based therapies.

Isaacs and Bellini explore how these therapies may reshape treatment strategies by allowing clinicians to tailor medication choices based on individual patient needs and goals. They discuss the importance of considering both glucose lowering and weight reduction effects, recognizing that some patients may benefit from significant weight loss while others may require a more balanced approach focused primarily on glycemic improvement.

The hosts also address important unanswered questions surrounding the use of highly effective weight-loss medications, including appropriate treatment targets, the limitations of BMI as a measure, and the importance of preserving muscle mass and overall function. They emphasize the need to consider body composition, physical activity, resistance training, and patient characteristics—particularly in older adults or those at risk for frailty—when developing long-term treatment plans.

The episode concludes with a reflection on the rapidly evolving landscape of diabetes care. The hosts highlight how advances in CGM technology and novel metabolic therapies are creating new opportunities to improve outcomes, personalize treatment approaches, and redefine the future management of people living with diabetes.

Dexcom. Dexcom CONNECT Study: The Most Significant Clinical Study Demonstrating CGM Benefits for People with Type 2 Diabetes Not Using Insulin. June 6, 2026. Accessed June 11, 2026. 

https://investors.dexcom.com/news/news-details/2026/Dexcom-CONNECT-Study-The-Most-Significant-Clinical-Study-Demonstrating-CGM-Benefits-for-People-with-Type-2-Diabetes-Not-Using-Insulin/default.aspx

Bajaj HS, Welch M, Shah P, et al. Efficacy and safety of retatrutide, a GIP, GLP-1, and glucagon receptor agonist, in people with type 2 diabetes and inadequate glycaemic control with diet and exercise (TRANSCEND-T2D-1): a double-blind, randomised, phase 3 trial. Lancet. Published online June 6, 2026. 

Livingston R. TRIUMPH-1: Retatrutide Substantially Lowers Weight, BMI in Patients With Obesity or Overweight. 

https://www.hcplive.com/view/triumph-1-retatrutide-substantially-lowers-weight-bmi-in-patients-with-obesity-or-overweight

This episode covers recently released data regarding the Dexcom G7 and Eli Lilly’s investigational triple agonist retatrutide from ADA 2026.

Diabetes Dialogue: The International Diabetes Federation and Care Access in India, With Amit Gupta, MBBS, DNB

In this special episode, shot live at the American Diabetes Association (ADA) Scientific Sessions 2026 in Ner Orleans, Louisiana, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Amit Gupta, MBBS, DNB, diabetologist, executive director of the Global Metabolic Health Alliance, and chair of the International Diabetes Federation (IDF) Education Committee, to discuss the state of diabetes care and treatment in India compared to the US.

To begin the episode, Gupta introduces the mission of the IDF, highlighting its role as a worldwide federation of scientific societies and patient organizations focused on improving diabetes education, policy, advocacy, and access to care. The conversation explores how diabetes management differs across regions, emphasizing that while the underlying disease mechanisms and available therapies may be similar, access to medications, technologies, healthcare infrastructure, and education varies significantly between countries.

Gupta discusses the impact of semaglutide becoming available as a generic therapy in India following patent expiration, describing how reduced costs have improved access to a medication previously limited by affordability barriers. The group considers how increased availability of GLP-1 receptor agonists may transform diabetes and obesity management, while also emphasizing that pharmacologic therapies alone cannot address the global metabolic health crisis. Gupta notes the importance of maintaining focus on long-term lifestyle changes, including nutrition, physical activity, and sustainable weight management, as essential components of comprehensive care.

The discussion then shifts to diabetes education and the need for more individualized, patient-centered approaches. Gupta highlights that education must be adapted to regional and cultural contexts, explaining that the challenges faced by a person with diabetes in the United States, Africa, India, or other parts of the world may differ substantially, even though diabetes distress and the burden of daily decision-making are shared experiences. He emphasizes that access to technology, such as continuous glucose monitoring, does not eliminate the need for education and support.

Isaacs, Bellini, and Gupta also address the growing challenge of misinformation online and the role of healthcare professionals in helping patients navigate unreliable sources of health information. Gupta explains that clinicians must approach misinformation constructively by providing evidence-based guidance rather than simply dismissing patients’ beliefs, reinforcing the importance of translating scientific evidence into practical recommendations that patients can incorporate into their daily lives.

The group further examines disparities in the availability of diabetes educators worldwide. Gupta notes that while some regions have established professional pathways for diabetes care and education specialists, many areas lack standardized training, recognition, or policy support to sustain these roles. He stresses that building effective diabetes education systems requires collaboration with policymakers to demonstrate the long-term benefits of structured education programs.

The episode concludes with Gupta discussing his work developing a global consensus framework on lifestyle as the foundation of metabolic health. The conversation reinforces that advances in medications and technology must be paired with equitable access, effective education, and sustainable lifestyle interventions to reduce the global burden of diabetes and improve outcomes for people living with metabolic conditions.

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. Gupta reports disclosures with Lilly, Abbott Diabetes, and the International Diabetes Federation.

Gupta A. IDF Perspective on Diabetes Self-Management Education and Support (DSMES): PWD Perspective. Abstract presented at the American Diabetes Association (ADA) Scientific Sessions 2026, New Orleans, LA. June 5-8, 2026.

Gupta A. Uptake of Continuous Glucose Monitoring in Under-Resourced Populations. Abstract presented at the American Diabetes Association (ADA) Scientific Sessions 2026, New Orleans, LA. June 5-8, 2026.

Amit Gupta, MBBS, DNB, joins the show to discuss diabetes treatment in a traditionally underserved population and to address the IDF’s work in moving it forward.

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

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