Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES

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

Hosts explore the recent advancements in diabetes technology, including FDA-approved insulin pumps and innovative CGMs for weight management.

Diabetes Dialogue: Milestones for MiniMed 780G and Signos CGM for Weight Loss

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

, cohosts 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, breakdown recent diabetes technology updates from late August and early September 2025.

The first development discussed came from Medtronic—now branded as MiniMed—with the 

 clearance of its 780G automated insulin delivery (AID) system for adults with type 2 diabetes. While insulin pumps have long been used off-label in this population, official clearance expands access and allows company representatives to openly engage clinicians about pump use in type 2 diabetes.

The hosts noted, however, reimbursement remains a key challenge, as Medicare coverage for pumps in type 2 diabetes is still limited. Nevertheless, data demonstrating improved time-in-range and A1C reductions make a compelling case for broader adoption.

Another milestone for the 780G is its new interoperability designation, enabling integration with non-proprietary continuous glucose monitors (CGMs). This includes Abbott’s upcoming 15-day Libre sensor, Instinct, as well as Simplera, which is awaiting US launch. The ability to pair with widely used sensors could improve patient uptake, particularly among those already familiar with Libre technology.

The episode also highlighted the FDA clearance of Signos, the first FDA-cleared CGM specifically indicated for weight management. Built on Dexcom’s Stelo hardware but paired with a proprietary app, Signos delivers educational modules, behavior prompts, and unique metrics such as “spikes per day” and “latest spike time.” Positioned as a tool for individuals with prediabetes or those seeking structured support for lifestyle changes, it functions as both a glucose monitor and a coaching platform, drawing comparisons to digital health programs like Noom.

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.

 780G System to Enable Integration with the Instinct Sensor, Made by Abbott, and Approves Use in Type 2 Diabetes. Medtronic. Published September 2, 2025. Accessed September 6, 2025. 

https://news.medtronic.com/2025-09-02-FDA-Clears-MiniMed-TM-780G-System-to-Enable-Integration-with-the-Instinct-Sensor,-Made-by-Abbott,-and-Approves-Use-in-Type-2-Diabetes

Signos. Signos Unveils First Ever FDA-Cleared Glucose Monitoring Breakthrough for Weight Management, Enabling Millions of Americans to Take Control of Their Health. Prnewswire.com. Published August 20, 2025. Accessed September 7, 2025. 

https://www.prnewswire.com/news-releases/signos-unveils-first-ever-fda-cleared-glucose-monitoring-breakthrough-for-weight-management-enabling-millions-of-americans-to-take-control-of-their-health-302534147.html

Podcasts

Explore the latest advancements in diabetes technology, including FDA-approved insulin pumps and innovative CGMs for weight management.

Diabetes Dialogue episode spotlighting new data on semaglutide and tirzepatide at ESC Congress 2025.

Diabetes Dialogue: Semaglutide & Tirzepatide at ESC Congress 2025

At ESC 2025, a pair of presentations highlighted the ongoing debate over cardiovascular risk reduction with semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound), yielding conflicting signals that clinicians will need to interpret carefully. In this special edition episode, cohosts 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 these studies: SURMOUNT-5 and STEER.

A post hoc analysis of SURMOUNT-5 compared the 10-year predicted CV risk reduction between the 2 agents. Using the Framingham Risk Calculator in 751 patients with obesity, tirzepatide was associated with greater benefit than semaglutide. From baseline risks of ~9%, tirzepatide was projected to lower absolute 10-year CV risk by 2.4% (23% relative reduction) compared with 1.4% (13% relative reduction) for semaglutide. Investigators attributed the advantage largely to greater weight and glycemic reductions.

In contrast, the STEER study, a real-world analysis of more than 21,000 patients with a mean follow-up of 8.5 months, suggested semaglutide was associated with lower rates of major adverse cardiovascular events (MACE) than tirzepatide. Semaglutide users had a 29% risk reduction in nonfatal MI, nonfatal stroke, or CV death compared with tirzepatide. Limitations included short follow-up, relatively few CV events, and the inherent confounding of observational data.

Both Isaacs and Bellini emphasized that while weight and glycemic improvements with tirzepatide appear robust, CV benefits may be molecule-specific. The ongoing SURPASS-CVOT, comparing tirzepatide with dulaglutide, should provide more clarity when full data are released at EASD.

In the interim, the hosts advised prescribing based on labeled indications supported by randomized outcomes data—semaglutide for CV and kidney risk reduction, tirzepatide for obesity and sleep apnea—while awaiting definitive trial results.

Mamas M. SURMOUNT-5: Tirzepatide compared to Semaglutide in obesity for 10-year CVD risk reduction 

Presented at the European Society of Cardiology (ESC) Congress 2025. Madrid, Spain. August 29- September 1, 2025.

Novo Nordisk. Novo Nordisk’s Wegovy® cuts risk of heart attack, stroke or death by 57% compared to tirzepatide in real-world study of people with obesity and cardiovascular disease. Novo Nordisk. Published August 31, 2025. Accessed September 5, 2025. 

https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916422

Hosts explore the latest findings on GLP-1 medications, semaglutide and tirzepatide, from ESC Congress 2025.

Diabetes Dialogue: Semaglutide & Tirzepatide Updates at ESC Congress 2025

Diabetes Dialogue: FDA Approves Semaglutide (Wegovy) for MASH

In this episode, cohosts 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 latest milestone for semaglutide (Wegovy): 

metabolic dysfunction–associated steatohepatitis (MASH)

 with moderate to advanced fibrosis. They frame the decision as a breakthrough in addressing a disease that affects an estimated 6% of the U.S. population, with even higher prevalence among individuals with type 2 diabetes and obesity. MASH, often underrecognized and asymptomatic in its early stages, carries serious long-term consequences, including cirrhosis, hepatocellular carcinoma, liver transplantation, and premature mortality.

The hosts review key risk factors—including obesity, type 2 diabetes, hypertriglyceridemia, and elevated LDL cholesterol—emphasizing the need for clinicians to consider MASH in patients with complex cardiometabolic profiles. They highlight the ease of screening with the Fib-4 score, a tool now embedded in ADA Standards of Care that relies on routine laboratory tests. From there, patients at elevated risk can be referred to hepatology or assessed further with noninvasive imaging such as FibroScan. Isaacs and Bellini stress that the new indication not only broadens treatment options but also raises awareness of MASH as a progressive, life-limiting condition that warrants active management.

They position semaglutide as uniquely impactful in this setting, given its established role in improving glycemic control, reducing cardiovascular risk, and supporting weight management. By layering liver protection on top of these existing benefits, the drug represents a “holistic” therapeutic option. The discussion also touches on future directions, including the potential complementary use of semaglutide with resmetirom, a newly available agent for MASH that works through a different mechanism. Drawing parallels to the synergistic success of SGLT2 inhibitors and finerenone in chronic kidney disease, the hosts anticipate similar additive effects in liver disease management.

The conversation then shifts to accessibility, with Novo Nordisk’s recent announcement that Ozempic is now available at $499 through GoodRx. Isaacs and Bellini discuss how this move could reduce reliance on compounded alternatives and improve patient access to genuine, reliably manufactured products. They also note the practical advantages of multi-dose pens, which can be more cost-effective for patients and easier for prescribers to manage in routine clinical practice.

They conclude by situating semaglutide’s expanding therapeutic footprint—spanning diabetes, obesity, cardiovascular disease, kidney disease, and now MASH—within the broader evolution of GLP-1–based therapies. With each new indication, these agents are reshaping standards of care for interrelated metabolic and hepatic diseases, offering clinicians versatile tools to improve long-term outcomes across specialties.

US Food and Drug Administration. FDA Approves Treatment for Serious Liver Disease Known as ‘MASH’. August 15, 2025. Accessed August 22, 2025. 

https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-serious-liver-disease-known-mash

GoodRx. GoodRx Announces Collaboration with Novo Nordisk to Expand Access to Ozempic® and Wegovy® for $499-Per-Month. August 18, 2025. Accessed August 22, 2025.

 https://investors.goodrx.com/news-releases/news-release-details/goodrx-announces-collaboration-novo-nordisk-expand-access

This episode highlights the groundbreaking approval of semaglutide for metabolic dysfunction-associated steatohepatitis, as well as GoodRx’s new Ozempic pricing.

Diabetes Dialogue episode recapping ADCES 2025 and diabetes technology updates

Diabetes Dialogue: ADCES 2025 Part 3 and Diabetes Technology Updates

In this episode, 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, shared highlights on several major insulin delivery updates making waves at recent meetings.

They began with Modular Medical’s Pivot insulin pump, a new tubeless device that delivers both basal and bolus insulin with a 300-unit reservoir. Unlike automated insulin delivery (AID) systems, Pivot offers a simpler design with set basal rates and bolus dosing in fixed increments. Isaacs and Bellini noted it could appeal to people with type 2 diabetes who prefer a straightforward option without CGM integration, though they questioned how broad its market will be as AID systems become standard.

Next, attention turned to Medtronic’s partnership with Abbott and the announcement of the Instinct sensor, a 15-day CGM designed to work seamlessly with Medtronic pumps. The panelists welcomed the prospect of longer wear and tighter pump integration, especially for people who prefer fewer device changes.

The conversation then shifted to Tandem’s new infusion set, which extends wear to 7 days. With multiple side ports to reduce occlusions, a kink-resistant design, and a one-handed insertion system, the set addresses longstanding pain points with infusion sites. Both experts expressed excitement about how this could reduce burden and expand insertion site options for users. Before concluding, hosts highlight Tandem’s plans for a tubeless version of the Mobi pump, pairing its Control-IQ algorithm with a patch-style design.


Innovation Pipeline | Medtronic. Medtronicdiabetes.com. Published June 23, 2020. Accessed August 22, 2025. 

https://www.medtronicdiabetes.com/about-medtronic-innovation/innovation-pipeline#innovation-timeline

Whooley S. Tandem picks up FDA clearance for 7-day infusion set. Drug Delivery Business. Published August 19, 2025. Accessed August 22, 2025. 

https://www.drugdeliverybusiness.com/tandem-fda-clearance-7-day-infusion-set/

This episode is the final ADCES 2025 recap episode and includes a spotlight on diabetes technology updates. 

Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES

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