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

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

Diabetes Dialogue: Biolinq Shine, Insulin Icodec, and Eli Lilly's Pipeline

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore 3 significant developments shaping diabetes care: a novel glucose-sensing technology, the return of once-weekly insulin icodec to the 

, and changes to Eli Lilly’s metabolic research pipeline.

00:05:59 The Practicality of Monitoring Glucose

00:06:55 Wishlist for the Biolinq's Future

00:15:28 Eli Lilly Cancels Bimagrumab for T2D

00:18:36 Bimagrumab Still in Testing for Obesity

The discussion opens with the Biolinq Shine, a new glucose range monitoring system that recently received FDA de novo classification. Unlike traditional continuous glucose monitors that rely on interstitial fluid, Biolinq Shine is intradermal, using a micro-sensor array that sits within the skin—no introducer needle required. Bellini highlights this as a potential breakthrough for individuals with 

 or prediabetes who are hesitant to use traditional sensors due to invasiveness. Instead of providing numerical glucose values, Biolinq Shine uses an intuitive color-coded LED display to indicate glucose ranges. Isaacs notes that this simplified feedback may reduce data overload for users while still promoting time-in-range awareness. The device has been studied extensively, with trials including a racially and ethnically diverse population, an encouraging development in diabetes research. Isaacs also points to the platform’s potential to measure other analytes—such as ketones or electrolytes—and integrate lifestyle data like sleep and activity, suggesting a more holistic user experience in future iterations.

The hosts then turn to Novo Nordisk’s resubmission of once-weekly insulin icodec for FDA review, this time focusing solely on type 2 diabetes after the initial application was declined. Both Isaacs and Bellini describe the approach as pragmatic, emphasizing that a once-weekly basal insulin could dramatically reduce treatment burden and improve adherence, particularly in older adults or those requiring caregiver support. They reference the product’s approval in several international markets and discuss the potential for combination therapy with once-weekly GLP-1 receptor agonists. While noting practical considerations—such as how clinicians might adjust dosing during hospitalizations—the hosts express optimism that U.S. approval would expand therapeutic flexibility and simplify diabetes management.

Finally, the episode covers Eli Lilly’s decision to discontinue its type 2 diabetes trial combining bimagrumab (a myostatin inhibitor) with tirzepatide, despite early evidence suggesting the dual therapy could preserve muscle mass during weight loss. Citing “strategic business reasons,” the company halted the diabetes study but continues to investigate the compound in obesity. Isaacs and Bellini discuss possible explanations, including cost, market focus, or differential efficacy in type 2 diabetes versus 

, and highlight the broader promise of precision medicine approaches in metabolic care.

The episode concludes with a look ahead to ongoing innovation—intradermal sensors, once-weekly insulins, and novel combination therapies—underscoring how rapidly the field of diabetes technology and therapeutics continues to evolve.

Podcasts

This episode covers the upcoming glucose monitor Biolinq Shine, the Insulin Icodec FDA resubmission, and the end of Eli Lilly's work in T2D.

Diabetes Dialogue: 150th Episode Special

In this milestone 150th episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, 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, reflect on 3 and a half years of transformation in 

 care and the evolution of their podcast since its launch in early 2022. 

What began as a modest plan for monthly discussions rapidly expanded into a weekly forum driven by an ever-accelerating pace of clinical innovation and the hosts’ shared enthusiasm for translating emerging science into practice.

Isaacs and Bellini revisit their earliest episode, which featured discussions on the then newly available implantable 180-day CGM and the Dexcom G7’s CE-mark approval—milestones that have since evolved into a landscape of year-long CGM systems and broader global access. They note how these conversations have paralleled major shifts across the therapeutic spectrum, including the rise of GLP-1 receptor agonists and dual incretin therapies, exemplified by tirzepatide and semaglutide, which have demonstrated benefits extending beyond glycemic control to encompass 

Reflecting on some of their most popular episodes, the hosts emphasize the significance of the discussion with Timothy Garvey, MD, on the future of incretin therapies—one that accurately anticipated the widespread adoption and subsequent shortages of these agents. They also highlight their recurring Standards of Care update episodes, which distill extensive guideline revisions into clinically actionable insights. Drawing from their dual roles as practicing clinicians and contributors to these guidelines, Isaacs and Bellini underscore the importance of bridging evidence with real-world applicability—ensuring that new data meaningfully influence patient outcomes.

What to Know about Sequel Med Tech's twiist AID System, with Alan Lotvin, MD

What to Know about the iLet Bionic Pancreas

CATALYST Trial and Hypercortisolism in T2D, with John Buse, MD, PhD

FLOW Trial and Semaglutide's Benefit in Chronic Kidney Disease

The conversation expands to the remarkable progression of diabetes technology, including episodes featuring experts such as Alan Lotvin, MD, Laurel Messer, PhD, RN, and Robert Vigersky, MD, discussing next-generation insulin pumps, automated insulin delivery algorithms, and strategies for optimizing time in range. They recall early access interviews with leaders from Medtronic, Tandem, Beta Bionics, and Dexcom, highlighting the privilege of sharing breaking innovations directly with healthcare professionals. Coverage has also extended to landmark clinical trials such as CATALYST, FLOW, and INHALE, where firsthand discussions with investigators have illuminated how new therapies—from semaglutide’s kidney and cardiovascular benefits to inhaled insulin’s renewed clinical role—are reshaping contemporary practice.

Tirzepatide and the Future of Incretin Therapies, with Timothy Garvey, MD

Key Updates in ADA Standards of Care--2024

Understanding Control-IQ+ AID Algorithm with Laurel Messer, PhD, RN

Diabetes Technology Updates in January 2024

Semaglutide & Tirzepatide Updates at ESC Congress 2025

Closing on a personal and celebratory note, Isaacs and Bellini express gratitude to their listeners and collaborators, recalling their journey from long-distance colleagues to near neighbors, friends, and co-educators. Looking ahead to upcoming meetings—including the Diabetes Technology Meeting, ADCES Technology Conference, and ATTD 2026 in Barcelona—they reaffirm their commitment to advancing evidence-based, patient-centered diabetes care through continued dialogue, discovery, and connection.

Celebrate 150 episodes of Diabetes Dialogue as hosts reflect on advancements in diabetes technology and impactful discussions in patient care.

Diabetes Dialogue: Celebrating 150 Episodes! 

Diabetes Dialogue: What's New at Medtronic Diabetes With Bob Vigersky, MD

In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, sit down with Bob Vigersky, MD, Chief Medical Officer of Medtronic Diabetes, to discuss major developments in diabetes technology, regulatory approvals, and the company’s future direction.

Vigersky begins by highlighting Medtronic’s newest CGM technologies. The Instinct sensor, developed in collaboration with Abbott, is a 15-day, factory-calibrated sensor that represents a significant step forward in wear duration and convenience. Alongside it is the Simplera Sync sensor, a fully disposable 7-day option that integrates seamlessly with Medtronic’s MiniMed 780G automated insulin delivery system. Together with the Guardian 4 sensor, these options provide patients and providers with unprecedented flexibility and choice, enabling customization based on lifestyle needs, preferences, and infusion set change schedules. Importantly, all three sensors will be interoperable with the 780G system.

The discussion also addresses recent regulatory milestones. In Europe, the 780G system is now approved for children as young as two, for use during pregnancy in women with 

. In the U.S., data from Medtronic’s pivotal type 2 diabetes trial demonstrated nearly 80% time in range among largely pump-naïve participants, with sustained benefits at 12 months. These findings underscore the algorithm’s robustness, adaptability, and ability to reduce barriers for individuals transitioning from multiple daily injections to automated insulin delivery.

The conversation also offers a glimpse into Medtronic’s pipeline. Innovations on the horizon include a screenless pump controlled via smartphone, a patch pump with a 300-unit reservoir aimed at addressing the needs of individuals requiring higher insulin volumes, and a next-generation algorithm designed to further reduce the burden of meal management. Vigersky notes that the company’s advanced in silico modeling tools are accelerating the refinement of these algorithms, allowing rapid iteration and validation before clinical deployment.

The episode concludes with an optimistic look forward to future data on 780 to be presented at upcoming conferences. Vigersky closes with a restatement of Medtronic Diabetes' message, stating that the technological advancements the company has developed will allow for a faster cadence of producing and distributing the devices patients need.

In-Home Study with MiniMed 780G Pump Automated Control in Type 2-Evaluation of the AHCL System in Adults with Insulin-Requiring Type 2 Diabetes. ClinicalTrials.gov identifier: NCT05238142. Updated February 21, 2025. Accessed October 2, 2025. 

https://www.clinicaltrials.gov/study/NCT05238142

FDA Clears MiniMed 780G System to Enable Integration with the Instinct Sensor, Made by Abbott, and Approves Use in Type 2 Diabetes. Medtronic Newsroom. September 2, 2025. Accessed October 2, 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

This episode highlights the recent technological advancements made by Medtronic Diabetes in treating type 1 and 2 diabetes.

Diabetes Dialogue: What's New at Medtronic Diabetes, With Bob Vigersky, MD

Diabetes Dialogue: Results of ATTAIN-1 and STEP UP Phase 3 GLP-1 Trials

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 Hospital Diabetes and Metabolic Care Center, discuss the recently published results of the ATTAIN-1 and STEP UP clinical trials, both of which were presented at the European Association for the Study of Diabetes (EASD) 2025 Conference.

The hosts highlight the success of orforglipron, a non-peptide oral GLP-1 receptor agonist, in patients with 

 or overweight with a weight-related medical problem and without 

. The size of the study, as well as the various doses of orforglipron included, were also discussed as key factors in ATTAIN-1’s importance. Additionally, orforglipron is intended solely for weight loss, and can be taken orally, revolutionizing the standard GLP-1 RA field. Isaacs and Bellini also comment on the significant weight loss over the 72-week trial duration, with a 6mg orforglipron dose resulting in 7.5% weight loss on average, a 12mg dose resulting in 8.4% weight loss, and 36mg showing an 11.2% average loss, compared to 2.1% with placebo. Orforglipron also exhibited few adverse effects while leading to significant weight drops in the majority of patients enrolled in the study.

Orforglipron’s status as an oral medication as opposed to an injection will likely make it more enticing to patients and clinicians alike, as it will reduce treatment burden across the board. Isaacs and Bellini also highlight the ease with which the medication can be taken, as injections are more time-consuming than a daily pill. Bellini noted the benefit of additional alternate therapies, as patients experiencing gastrointestinal effects with semaglutide or tirzepatide now may have another potential route to receiving the same treatment.

The hosts then addressed the phase 3 STEP UP trial, which investigated semaglutide 7.2 mg in adults with obesity. Isaacs notes this being a significantly higher dose of semaglutide than what is currently approved by the US Food and Drug Administration (FDA). Of the 1407 patients treated in STEP UP, mean body weight change was higher among the semaglutide 7.2 cohort than those receiving semaglutide 2.4. The 7.2 cohort exhibited an 18.7% body weight reduction versus 15.6% with 2.4. Bellini notes the significantly better outcomes in weight loss as a result of this dose versus the approved 2.4 mg amount. Additionally, she discusses semaglutide’s cardiovascular risk reduction indication, presenting the treatment as an alternative to poorly-tolerated GLP-1 RAs in patients with cardiovascular conditions.

The hosts closed out the episode by discussing their hopes for a gradual reduction in GLP-1 RA cost, allowing for more ease of access among underserved populations. Bellini mentions the potential for superior cardiovascular health improvements in patients taking semaglutide 7.2. With both of these medications moving further down the pipeline, the potential for more GLP-1 RAs entering the market may trigger a greater overhaul of the endocrinology industry’s approach to weight loss drugs.

Eli Lilly. 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. Lilly Investors. August 7, 2025. Accessed September 24, 2025. 

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

Wharton S, Freitas P, Hjelmesæth J, et al. Once-weekly semaglutide 7.2 mg in adults with obesity (STEP UP): a randomized, controlled, phase 3b trial. 

, 0(0). September 14, 2025. Accessed September 24, 2025. 

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(25)00226-8/abstract

This episode highlights the results of the ATTAIN-1 and STEP UP clinical trials, examining the potential of their respective GLP-1 RA subjects.

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

Articles