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

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

Diabetes Dialogue: Expanding GLP-1 Usage Into Type 1 Diabetes With Viral Shah, MD

In this episode of Diabetes Dialogue, recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Viral Shah, MD, professor of endocrinology at Indiana University, for a discussion centered on the evolving role of GLP-1 receptor agonists and broader diabetes classification in type 1 diabetes care. Shah challenges the traditional distinction between type 1 and type 2 diabetes, emphasizing that type 2 diabetes lacks a definitive diagnostic test and is instead a diagnosis of exclusion based on phenotypic characteristics. He explains that patients with type 1 diabetes can also exhibit features of type 2 diabetes, making these categories non–mutually exclusive and supporting the rationale for dual diagnoses when clinically appropriate.

The group explores how this framework informs the use of GLP-1 receptor agonists in type 1 diabetes, particularly for patients with obesity, cardiovascular disease, heart failure, or chronic kidney disease. Shah notes that while obesity provides a clear indication for GLP-1 therapy, he is also comfortable using these agents in patients with lower BMI when cardiovascular or renal protection is the primary goal, with careful attention to dose adjustment and avoidance of excessive weight loss or muscle mass reduction. He adds that SGLT2 inhibitors may be preferable in some leaner patients, particularly when renal indications predominate, and highlights recent clarification that SGLT2 inhibitor use for CKD in type 1 diabetes is not considered off-label when prescribed for kidney protection rather than glycemic control.

The conversation then shifts to Shah’s broader view that type 1 and type 2 diabetes differ more in pathophysiology than in long-term disease course. He argues that both conditions share progressive beta cell dysfunction and overlapping complication risks, suggesting the field should move away from rigid separation and toward a more unified understanding of diabetes progression.

This perspective leads into a discussion of “prediabetes,” a term Shah critiques as outdated and insufficient. He reviews its historical origins as a label for intermediate hyperglycemia and argues that it has unintentionally minimized urgency by framing the condition as merely a risk factor rather than part of the disease continuum. Citing evidence of significantly elevated cardiovascular, kidney, and mortality risk in people with prediabetes, he advocates for staging type 2 diabetes similarly to type 1 diabetes, rather than maintaining an artificial threshold between “no disease” and diabetes. He notes that while therapies such as metformin, semaglutide, and tirzepatide have demonstrated benefit in delaying progression, regulatory limitations persist because prediabetes is not formally recognized as a disease state.

The episode concludes with a discussion of autoantibody screening in adults labeled with prediabetes. Shah supports broader antibody testing, particularly in younger adults, to identify individuals with early-stage type 1 diabetes who may otherwise be misclassified and present later with DKA. He emphasizes that accessible antibody testing and therapies such as teplizumab make earlier identification increasingly meaningful, while also acknowledging the importance of patient preference and individualized decision-making. Across the discussion, Shah calls for greater flexibility in diabetes classification, earlier intervention across the disease spectrum, and a more proactive approach to preventing complications rather than waiting for traditional diagnostic thresholds to be crossed.

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. Shah reports disclosures with Sanofi, Novo Nordisk, Lilly, Dexcom, Insulet, Tandem Diabetes Care, and others.

Shah V. Beyond Type 2: Evaluating GLP-1 Use in Type 1 Diabetes and Obesity. Presented at the American Association of Clinical Endocrinology Annual Meeting 2026 in Las Vegas, NV. April 22-24, 2026.

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Viral Shah, MD, joins the show to break down his AACE 2026 presentation on the benefits of using GLP-1 RAs in patients with T1D.

Diabetes Dialogue: Nutrition, Medication, and Treatment in Obesity With Elizabeth Bauer, MD

In this episode of Diabetes Dialogue, recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Elizabeth Bauer, MD, a clinical endocrinologist and obesity specialist, to discuss key updates in obesity management presented during her “Year in Review” session at the AACE Annual Meeting. Bauer opens by highlighting AACE’s updated obesity algorithm, released in late 2024, which builds on the organization’s prior adiposity-based chronic disease framework and shifts obesity care further away from BMI-centered diagnosis toward a more comprehensive, disease-centric model. She explains the algorithm’s emphasis on anthropometric assessment, adiposity distribution, and obesity staging, noting that clinicians must move beyond weight alone to better identify obesity-related complications and personalize treatment decisions.

The discussion focuses on the algorithm’s practical value, particularly its structured staging system and medication tables that help clinicians match pharmacotherapy to obesity-related comorbidities such as diabetes, MASLD, and obstructive sleep apnea. Bauer emphasizes that treatment goals should be complication-specific—for example, modest weight loss may improve glycemia, while greater total body weight reduction is needed for meaningful improvement in MASH. She and the hosts stress that obesity management should prioritize whole-person health rather than weight alone, drawing parallels to the evolution of diabetes treatment toward complication-driven care.

The group then turns to emerging pharmacotherapies, with Bauer reviewing several phase 2 and 3 obesity trials involving newer incretin-based agents. She highlights mazdutide, a once-weekly GLP-1–based therapy studied in Chinese populations using lower BMI thresholds more reflective of Asian obesity risk, as well as combination therapies such as semaglutide plus cagrilintide, which demonstrated greater efficacy than semaglutide alone but with substantially higher gastrointestinal adverse effects. Bauer notes that while these agents show impressive weight loss potential, tolerability remains a major clinical challenge, particularly with nausea and dose escalation.

A significant portion of the conversation centers on management of GI side effects from GLP-1 receptor agonists. Bauer explains her clinical philosophy of treating obesity like any other chronic disease—avoiding the routine practice of prescribing one medication to manage side effects caused by another whenever possible. While she may prescribe small, limited quantities of ondansetron during titration, she emphasizes that persistent nausea should prompt dose adjustment or medication changes rather than indefinite antiemetic use. The hosts discuss how slower titration strategies in real-world practice often improve tolerability compared with rigid clinical trial protocols and may help optimize long-acting monthly GLP-1 agents currently in development.

The episode also reviews bariatric surgery data, including randomized trials comparing laparoscopic banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. Bauer notes that both sleeve gastrectomy and Roux-en-Y demonstrated superior efficacy and fewer complications compared with lap band procedures, while long-term comparisons between sleeve and bypass showed strong outcomes for both, with Roux-en-Y numerically favoring weight loss but often without statistically significant superiority. She also discusses higher reoperation rates among patients initially undergoing sleeve gastrectomy, often due to inadequate weight loss or significant reflux requiring conversion to bypass.

The conversation concludes with an important discussion on post-bariatric surgery weight regain and the growing use of GLP-1–based therapies after surgery. Bauer challenges the misconception that surgery “cures” obesity, emphasizing that obesity remains a chronic disease driven by persistent biology, inflammation, and environmental factors even after anatomical intervention. She notes emerging evidence suggesting that GLP-1 therapies used before or after bariatric surgery may improve long-term outcomes and reduce weight regain. She closes by reinforcing the need for clinicians to approach obesity with the same chronic disease mindset applied to diabetes—recognizing that durable management requires ongoing treatment, not a one-time intervention.

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. Bauer reports no relevant disclosures.

Bauer E. DSN Year in Review: Nutrition & Obesity. Presented at the American Association of Clinical Endocrinology, Las Vegas, NV. April 22-24, 2026.

Elizabeth Bauer, MD, joins the show to discuss her AACE 2026 presentation on key updates in obesity management and nutrition.

Diabetes Dialogue: The Push for Early-Stage T1D Screening and Treatment, With Linda DiMeglio, MD, MPH

In this episode of Diabetes Dialogue recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, interview Linda DiMeglio, MD, MPH, professor of pediatrics and division chief at Indiana University School of Medicine, following her plenary keynote and receipt of the Ellen Garber Award. DiMeglio outlines her broad work in type 1 diabetes research, including prevention strategies, beta cell preservation, diabetes technology, TrialNet leadership, and neurocognitive studies in young children living with diabetes.

The discussion centers on early-stage type 1 diabetes, with DiMeglio reviewing the evolving framework of risk identification and staging, from genetic predisposition and single autoantibody positivity through stage 1, stage 2, and stage 3 disease. She highlights the growing momentum behind both general population and family-based screening, emphasizing the importance of early detection not only to prevent diabetic ketoacidosis but also to enable timely intervention with disease-modifying therapies. She notes the recent expansion of teplizumab approval down to age 1 for stage 2 disease as a major milestone and describes the broader therapeutic goal as ultimately ending insulin dependence for people living with type 1 diabetes.

DiMeglio and the hosts discuss how the field has shifted significantly over the past decade, particularly with the reframing of “cure” as a combination of multiple targeted approaches rather than a single intervention. She underscores the importance of combination immunotherapy strategies, citing recent TrialNet work using rituximab followed by abatacept, as well as the need for more personalized approaches based on individual disease etiology and immune characteristics. She also stresses the need for better intermediate endpoints beyond the traditional 2-year C-peptide model to accelerate therapeutic development and trial efficiency.

The group also examines the increasing role of patient and family perspectives in clinical trial design, particularly through TrialNet’s community advisory board, which DiMeglio believes will improve recruitment and trial execution. They discuss the broader implications of immune-modifying therapies in type 1 diabetes, including parallels with oncology treatment models and the potential for these advances to inform management strategies for other autoimmune diseases. DiMeglio also reflects on how these therapies are reshaping endocrinology practice itself, requiring clinicians to become more familiar with immunomodulation, cytokine management, and interdisciplinary care.

A major focus of the conversation addresses the complexity of autoantibody interpretation, particularly around GAD antibodies and low-titer positivity. DiMeglio emphasizes that a single positive islet autoantibody test should never be considered definitive and should always be repeated, ideally in a separate gold-standard laboratory such as TrialNet. She explains that antibody specificity varies by type and titer, with higher titers often offering greater diagnostic confidence, while acknowledging ongoing uncertainty around interpretation in adults, diverse populations, and long-standing diabetes. The hosts also discuss the practical challenges of coding, insurance coverage, and patient counseling as early-stage diabetes diagnosis becomes more common.

The episode concludes with a discussion of emerging questions around antibody fluctuation over time, circadian variation in antibody measurements, and the role of genetic screening. DiMeglio notes that antibody status may shift over years and may even vary by time of day, introducing additional complexity into monitoring strategies. While genetic risk screening remains promising, she explains that large-scale antibody-based population screening may currently be more practical from a public health perspective. She closes by reinforcing that although much remains nuanced and unresolved, the field is rapidly advancing toward earlier intervention, more individualized treatment, and a fundamentally different future for type 1 diabetes care.

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. DiMeglio reports disclosures with Amgen, Lilly, Mannkind, Medtronic, Merck, Ascendis, and others.

DiMeglio L. Early-Stage Type 1 Diabetes: Screening, Monitoring, Treatments and Future Directions (Alan J. Garber, MD Lectureship). Presented at the American Association of Clinical Endocrinology Annual Meeting 2026, Las Vegas, NV. April 22-24, 2026.

Linda DiMeglio, MD, MPH, joins the show to discuss the growing movement towards screening and testing for T1D at an early stage.

An episode focused on availability of orforglipron (Foundayo) in the United States.

Diabetes Dialogue: Orforglipron (Foundayo) Availability Marks Historic Shift for GLP-1 Access

In a therapeutic pipeline burgeoning with historic breakthrough after historic breakthrough in recent years, the 

 approval and announcement of availability for orforglipron (Fondayo) in April 2026 could set itself apart as a marked turning point in the fight against 

, Eli Lilly and Company announced availability of their oral GLP-1 receptor agonist, which carries no food or water restrictions, and a partnership with Amazon Pharmacy offering same-day delivery. This marks a major shift in accessibility for a therapeutic class where, less than 2 years ago, many GLP-1-based agents, including Eli Lilly’s tirzepatide (Mounjaro/Zepbound) were on the FDA drug shortage list.

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

, Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a clinically grounded overview of the agent’s launch and early implications for care delivery.

The discussion highlights a key nuance in its development: the marketed tablet doses (ranging from 0.8 mg to 17.2 mg) are “dose-equivalent” to capsule-based doses studied in the 

, reflecting a bridging strategy designed to enable scalable manufacturing while maintaining pharmacokinetic consistency.

Access considerations are central to the episode’s conversation. Pricing information released by Eli Lilly and Company details a cap on out-of-pocket costs at $299 per month for higher doses, with lower introductory dosing tiers priced below this threshold and broad distribution, including through platforms such as Amazon Pharmacy, positioning the therapy as one of the most accessible options in the GLP-1 class to date. The hosts note this evolving landscape may further accelerate already substantial uptake, with an estimated 1 in 8 adults having tried a GLP-1–based therapy.

Beyond obesity and type 2 diabetes, the episode explores emerging interest in extending GLP-1–based therapies into type 1 diabetes populations. Citing recent real-world analyses leveraging large electronic health record datasets, Isaacs and Bellini describe signals suggesting potential reductions in major adverse cardiovascular events and kidney outcomes among individuals with type 1 diabetes using GLP-1 receptor agonists, without clear increases in severe hypoglycemia or diabetic ketoacidosis.

Editor’s 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.

Eli Lilly and Company. FDA approves Lilly's Foundayo™ (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions/ April 1, 2026. Accessed April 1, 2026. 

https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill

 (orforglipron), Lilly’s new oral GLP-1 pill for weight loss, now available in the U.S. | Eli Lilly and Company. Eli Lilly and Company. Published April 9, 2026. Accessed April 16, 2026. 

https://investor.lilly.com/news-releases/news-release-details/foundayotm-orforglipron-lillys-new-oral-glp-1-pill-weight-loss

Amazon News. Amazon Pharmacy to Offer Eli Lilly and Company’s New GLP-1 Pill Foundayo via Same-Day Delivery. US Press Center. Published April 9, 2026. Accessed April 16, 2026. 

https://press.aboutamazon.com/2026/4/amazon-pharmacy-to-offer-eli-lilly-and-companys-new-glp-1-pill-foundayo-via-same-day-delivery

FDA’s Center for Drug Evaluation and Research (CDER). FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. U.S. Food and Drug Administration. Published April 1, 2026. Accessed April 16, 2026. 

https://www.fda.gov/drugs/drug-alerts-and-statements/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize

KFF. Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford | KFF. KFF. Published November 14, 2025. Accessed April 16, 2026. 

https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/

This episode explores the launch and accessibility of FDA-approved oral GLP-1 orforglipron, including availability through Amazon Pharmacy's same-day delivery service.

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

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