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

Diabetes Dialogue: Evolving Wearable Insulin Delivery Devices - AID, CGM, and More

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

To begin the episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the rapidly evolving landscape of wearable insulin delivery, focusing on recent developments in patch pump technology and the growing number of tubeless insulin delivery systems entering the market. The conversation centers on the recent FDA clearance of the Pivot patch pump from Modular Medical, which the hosts describe as an important addition to a field that has historically been dominated by a single tubeless option.

Isaacs reviews the design of the Pivot system, explaining that while it is a tubeless insulin pump, it differs from current automated insulin delivery (AID) systems because it does not communicate with a continuous glucose monitor (CGM) or use an insulin-dosing algorithm. Instead, the device delivers programmable basal insulin with ≤2 selectable basal rates and allows users to administer manual bolus doses. The hosts note its 300-unit insulin reservoir, highlighting the larger capacity as a potential advantage for individuals with higher daily insulin requirements.

Bellini discusses where Pivot may fit into current clinical practice, suggesting it could provide an option for people who are unwilling or unable to use CGM technology but would still benefit from wearable insulin delivery. She also points to the possibility of future partnerships with commercially available AID algorithms, which could allow the platform to evolve into a more automated system. The hosts acknowledge that current diabetes guidelines generally favor AID for individuals with type 1 diabetes but recognize that simplified technologies continue to have an important role for select patient populations.

The discussion expands to the broader pipeline of tubeless insulin pumps currently under development. Isaacs and Bellini review anticipated products from Tandem, Beta Bionics, and Medtronic, noting that virtually every major insulin pump manufacturer is now investing in patch pump technology. They compare reservoir capacities, expected timelines, and device designs while emphasizing the increasing demand for tubeless systems that improve convenience and reduce many of the practical challenges associated with traditional tubing.

The hosts also examine several practical design considerations. They discuss Pivot's reusable and disposable components, explaining that many newer patch pumps incorporate reusable elements because of existing intellectual property surrounding fully disposable tubeless systems. While reusable components may lower manufacturing costs, they also introduce considerations such as the potential for patients to misplace components or inadvertently lose them during hospitalizations. Isaacs adds that the simplified design and absence of an onboard algorithm may ultimately make the device more affordable, although real-world pricing remains to be determined.

Attention then shifts to recent updates from CeQur Simplicity, which recently announced a 7-day bolus-only patch featuring an expanded 240-unit insulin reservoir and a new one-unit dosing option for individuals requiring smaller mealtime insulin doses. The hosts discuss how these enhancements could broaden the device's applicability while maintaining its emphasis on simplicity, requiring neither smartphone connectivity nor a dedicated mobile application.

Bellini highlights the potential synergy between the 7-day patch and emerging once-weekly basal insulin formulations, suggesting that synchronizing weekly basal insulin administration with weekly patch replacement could simplify treatment routines and improve adherence. She emphasizes that insulin therapy should continue to complement guideline-directed pharmacologic management, including GLP-1 receptor agonists, SGLT2 inhibitors, and other glucose-lowering therapies when appropriate.

The episode concludes with an optimistic assessment of the future of insulin delivery technology. Isaacs and Bellini emphasize that increasing competition among manufacturers is likely to expand patient choice, improve affordability, and accelerate innovation. They express particular enthusiasm for the continued growth of tubeless insulin delivery, broader pharmacy benefit coverage, and the next generation of AID systems, all of which they believe will further individualize diabetes management and improve outcomes for people requiring insulin therapy.

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.

Modular Medical. Modular Medical Announces Commercial Availability of Pivot Tubeless Insulin Patch Pump Ahead of Commercial Expansion. June 24, 2026. Accessed June 30, 2026. 

https://ir.modular-medical.com/press-release-details.php?newsId=d46022bc-e9fc-4bbc-97c7-1cbaf07e9c22

CeQur Simplicity. Extended 7-Day Wear and 1-Unit Dosing Clearances, and Two ADA Posters Signal a New Standard for Mealtime Insulin Management. June 4, 2026. Accessed June 30, 2026. 

https://myceqursimplicity.com/cequr-announces-exciting-advancements-2-recent-fda-clearances-and-new-clinical-evidence-to-be-presented-at-ada/

Podcasts

This episode covers the recent commercial availability of the Pivot patch pump and the upcoming 7-day bolus patch from CeQur.

Functional Cures for T1D: Insulin Independence Through Islet Transplantation

On June 8, 2026, parent company Eledon Pharmaceuticals announced new updated data from their islet cell transplant trial of tegoprubart in patients with type 1 diabetes. The investigational anti-CD40L antibody allowed all 12 patients to achieve insulin independence and an HbA1c <6.5% while exhibiting no hypoglycemic events post-transplant.

Diabetes Dialogue cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss tegoprubart and other potential functional cures for type 1 diabetes through islet cell transplantation.

Check out the full episode on potential T1D cures 

In this segment, Isaacs and Bellini, prompted by increasing discussion on social media and presentations at the American Diabetes Association Scientific Sessions and the AACE Annual Meeting, focus on encouraging early results from an ongoing clinical trial in which all 12 participants have achieved insulin independence following allogeneic islet cell transplantation.

Isaacs explains that the transplanted islet cells restore endogenous insulin production, allowing participants to discontinue insulin therapy while maintaining near-normal glycemic control. She emphasizes that participants have achieved HbA1c values in the 5% range without the restrictive dietary approaches or intensive diabetes management typically required in type 1 diabetes. Several trial participants have also publicly shared their experiences, describing a return to normal eating patterns and sustained euglycemia.

A central focus of the discussion is the novel immunosuppression strategy used in the study. Historically, islet transplantation has required calcineurin inhibitors such as tacrolimus, which are associated with significant toxicities, particularly nephrotoxicity. Isaacs describes the investigational anti-CD40 ligand agent tegoprubart, which was developed to provide effective immunosuppression with a more favorable safety profile. Although the medication is currently administered as an intravenous infusion every three weeks, the hosts note that future subcutaneous or oral formulations could improve long-term feasibility if the therapy reaches broader clinical use.

The hosts also discuss the durability of the response. Participants continue to be followed for up to three years, with several maintaining insulin independence for nearly two years. Bellini describes the finding that all 12 participants achieved insulin independence as particularly noteworthy, especially when compared with earlier islet transplantation efforts such as the Edmonton Protocol, which demonstrated promise but failed to produce similarly consistent outcomes. She characterizes the current findings as among the most encouraging advances she has seen during more than 50 years of living with type 1 diabetes.

Despite the enthusiasm, the conversation also addresses the practical challenges that remain before this approach could become widely available. Bellini highlights the continued dependence on donor pancreatic tissue, emphasizing the importance of increasing awareness around pancreatic donation. She also notes that the trial is currently being conducted at a single center, underscoring the need for larger studies, expanded access, and longer follow-up to confirm the durability of the results. Cost, treatment accessibility, and the long-term burden of chronic immunosuppression are also identified as important considerations for future implementation.

The hosts further explore several intriguing observations from the trial. Two participants required a second islet cell infusion before achieving insulin independence, and both had higher body mass index values, suggesting that greater islet mass may be necessary in individuals with increased insulin resistance. Isaacs also notes that two participants are receiving tirzepatide following transplantation, raising questions about the potential role of adjunctive therapies in optimizing metabolic outcomes after islet replacement.

The episode concludes with a discussion of how these early findings may shape future research. The hosts suggest that patient characteristics such as BMI may eventually inform individualized transplantation strategies, including the amount of transplanted islet tissue required. While emphasizing that important hurdles remain, they agree that these results represent one of the most promising advances toward a functional cure for type 1 diabetes and offer renewed optimism for the future of beta-cell replacement therapy.

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.

Breakthrough T1D. All 12 Clinical Trial Participants Off External Insulin: New Data on Tegoprubart Continues to Impress. June 7, 2026. Accessed June 29, 2026. https://www.breakthrought1d.org/news-and-updates/tegoprubart-islet-transplant-all-participants-off-external-insulin/

Videos

Diabetes Dialogue cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, cover recent data released by Eledon regarding tegoprubart for type 1 diabetes.

Diabetes Dialogue: Tegoprubart and Freedom from Insulin in Type 1 Diabetes

To begin the episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss recent advances in type 1 diabetes (T1D) research following presentations at the American Diabetes Association (ADA) Scientific Sessions and the American Association of Clinical Endocrinology (AACE) Annual Meeting. They focus on promising data from an islet cell transplantation study in which all 12 participants achieved insulin independence, with some maintaining normal glycemia for up to 2 years after transplantation.

Isaacs explains that the transplanted islet cells restore endogenous insulin production and emphasizes that the study’s most notable innovation is its immunosuppression strategy. Rather than relying on calcineurin inhibitors such as tacrolimus, which are associated with significant toxicities, particularly nephrotoxicity, the investigators used the investigational anti-CD40 ligand therapy tegoprubart. The hosts discuss how this approach may improve the long-term safety and feasibility of islet transplantation and note ongoing efforts to develop more convenient formulations beyond the current intravenous infusion administered every 3 weeks.

The conversation then turns to the clinical significance of the findings. Bellini highlights that all 12 enrolled participants achieved insulin independence, distinguishing these results from earlier transplantation efforts such as the Edmonton protocol. The hosts also describe the substantial improvements in quality of life reported by participants, including sustained HbA1c values in the normal range without restrictive dietary practices and complete resolution of severe hypoglycemia. Because the trial enrolled individuals with recurrent, life-threatening hypoglycemia, they emphasize that the observed benefits are particularly meaningful for this high-risk population.

The hosts also examine several unanswered questions that remain before this approach can become widely available. They discuss the durability of insulin independence, the long-term need for immunosuppressive therapy, treatment costs, and the challenges associated with scaling islet transplantation beyond specialized research centers. Additional findings are reviewed, including the need for repeat transplantation in 2 participants and observations suggesting that individuals with higher body mass index may require greater islet mass to achieve insulin independence. They also discuss the use of tirzepatide in 2 participants, raising questions about the role of insulin resistance and adjunctive therapies following transplantation.

Broadening the discussion, Isaacs and Bellini review several emerging strategies aimed at expanding access to curative therapies. These include stem cell-derived islets, large-scale beta cell manufacturing, gene-editing approaches, and encapsulation technologies intended to protect transplanted cells while reducing or eliminating the need for chronic immunosuppression. Drawing on presentations from Aaron Kowalski, PhD, and Laura Jacobsen, MD, they emphasize that despite major advances in continuous glucose monitoring, automated insulin delivery systems, and adjunctive pharmacotherapy, subcutaneous insulin administration remains fundamentally nonphysiologic and cannot fully eliminate long-term complications or disease burden.

The episode concludes with a broader discussion of the future of type 1 diabetes research. The hosts highlight efforts to expand eligibility for islet transplantation trials, including studies involving individuals with chronic kidney disease who were previously excluded because of concerns surrounding traditional immunosuppressive therapies. They also underscore the importance of continuing to pursue disease-modifying therapies despite improvements in diabetes technology, emphasizing that glycemic targets alone do not eliminate complications or address disparities in access to care. While acknowledging that a universally applicable cure remains years away, Isaacs and Bellini conclude that the field is making meaningful progress toward safe, durable, and scalable therapies capable of fundamentally changing the treatment of type 1 diabetes.

Breakthrough T1D. All 12 Clinical Trial Participants Off External Insulin: New Data on Tegoprubart Continues to Impress. June 7, 2026. Accessed June 29, 2026. 

https://www.breakthrought1d.org/news-and-updates/tegoprubart-islet-transplant-all-participants-off-external-insulin/

This episode covers the recent release of new data on Eledon’s tegoprubart for islet cell transplantation in patients with T1D.

Diabetes Dialogue: Signos and the Science of Weight Loss

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.

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

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

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

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