Rachael Sood, NP, is a diabetes nurse practitioner and Owner and CEO of The Diabetes Collective.

Rachael Sood, NP

Diabetes Technology at a Turning Point: What’s New and What’s Next

The rapid evolution of diabetes technology is continuing to reshape patient care, with advances in automated insulin delivery (AID), continuous glucose monitoring (CGM), and emerging cell-based therapies offering new possibilities for people living with 

86th Scientific Sessions of the American Diabetes Association (ADA 2026)

 in New Orleans, Louisiana, Rachael Sood, NP, The Diabetes Collective, highlighted automated insulin delivery (AID) as the single most transformative advancement in diabetes management — a view now codified in the 2026 ADA Standards of Care, which formally designate AID as the preferred approach to insulin delivery in both type 1 and type 2 diabetes.

The 2026 ADA Standards of Care designate AID as the preferred insulin delivery method for type 1 and type 2 diabetes, removing prior eligibility barriers.

Insulet's Omnipod 5 update, announced at ADA 2026, introduces a 100 mg/dL target glucose floor and Libre 3 Plus compatibility.

Continuous ketone monitoring is gaining consensus support as a tool for earlier DKA detection, including euglycemic DKA tied to SGLT2 inhibitor use.

Structural barriers — insurance gaps, DME confusion, cost — remain the primary obstacles to AID adoption.

Cell-based and immunomodulatory therapies are advancing a disease-modification pipeline Sood described as approaching clinical prescribability within a decade.

The 2026 guidelines also eliminate prior requirements for AID initiation in type 1 diabetes, such as minimum C-peptide levels and the presence of islet autoantibodies, changes designed to expand access and support individualized care. Announced simultaneously with ADA 2026, Insulet Corporation also unveiled a significant update to Omnipod 5, including expanded CGM compatibility and algorithm enhancements, reinforcing a week defined by accelerating convergence across device platforms.

Sood identified the growing interoperability of AID systems and CGMs as the most clinically meaningful shift for patients. No longer constrained to single-brand pairings, clinicians can now match pumps and sensors to individual patient preferences.

"We're seeing different brands integrate with different brand pumps," Sood said. "Not every pump is for every patient, and it's fine, because everybody has a choice now of what works for them."

Among the technology updates highlighted at ADA 2026, Sood pointed to Omnipod 5 enhancements as particularly noteworthy. Insulet characterized the update as the most significant algorithm advancement since the system's 2022 launch, following FDA 510(k) clearance in December 2025. The update introduces a new 100 mg/dL target glucose option, expanding available settings to six across a range of 100 to 150 mg/dL.

Omnipod 5 is now also compatible with Abbott's Libre 3 Plus sensor in the US, allowing caregivers to follow patients through Abbott's LibreLinkUp app, the first time Insulet's tubeless system has integrated with the Abbott ecosystem.

While the 10 mg/dL reduction from the prior 110 mg/dL floor may appear modest, the clinical implications extend well beyond the numerical shift. Real-world evidence cited by Insulet shows lowering the target glucose increases time in range without a clinically meaningful rise in time below range. The enhanced algorithm is also designed to reduce automated-mode interruptions during prolonged hyperglycemia, keeping more patients in closed-loop control throughout the day.

Looking ahead, Sood identified dual glucose-ketone monitoring as among the most clinically significant near-term developments.

"We want to prevent people from going into DKA, we want to prevent hospitalization," Sood said. "The glucose ketone monitor I would say is number one."

A 2026 international expert consensus published in 

 identified continuous ketone monitoring (CKM) as having the potential to reduce DKA risk and noted the increasing occurrence of euglycemic DKA as making CKM an important addition to the diabetes management toolkit. Data from dual glucose-ketone monitoring systems reveal significant variability in how glucose and ketone levels interact, with investigators suggesting continuous ketone data could shift management paradigms by incorporating dynamic factors such as rate of change and duration of ketone elevation, enabling earlier detection and intervention.

Sood also described growing momentum around dual-hormone closed-loop systems combining insulin and glucagon delivery, noting early data have been presented at international meetings and are expected to receive additional attention during ADA 2026. Research published in 

 found a dual-hormone closed-loop system reduced hypoglycemia compared with a single-hormone system during and after exercise, though some increase in hyperglycemia was observed with glucagon delivery.

Despite this technological momentum, Sood emphasized persistent structural barriers. Insurance coverage gaps, cost concerns, and confusion around device procurement pathways remain the primary impediments to adoption.

Beyond device innovation, Sood described a growing sense of optimism surrounding type 1 diabetes research. The T1D treatment landscape is entering what investigators have described as a transformative era, with teplizumab establishing the first immunotherapy approval to delay disease onset, other immune-based therapies advancing to preserve beta-cell function, and beta-cell replacement shifting from donor islet transplantation toward stem cell-derived approaches.

"We've been talking about a cure for a long time," Sood said. "I feel like I'm living in it, and in the next 5 to 10 years, I could be actually prescribing some of these therapies."

Insulet Corporation. Insulet announces U.S. rollout of enhanced Omnipod 5 algorithm and expands compatibility with Abbott's FreeStyle Libre 3 Plus sensor. Published June 3, 2026. Accessed June 5, 2026. 

https://investor.insulet.com/news/news-details/2026/Insulet-Announces-U-S--Rollout-of-Enhanced-Omnipod-5-Algorithm-and-Expands-Compatibility-with-Abbotts-FreeStyle-Libre-3-Plus-Sensor/default.aspx

Wilson LM, Jacobs PG, Ramsey KL, et al. Dual-hormone closed-loop system using a liquid stable glucagon formulation versus insulin-only closed-loop system compared with a predictive low glucose suspend system. 

. 2020;43(11):2721–2729. doi:10.2337/dc19-2267

Battelino T, Danne T, Edelman SV, et al. Continuous ketone monitoring: international expert recommendations on the application of a new technology. 

. 2026. doi:10.1016/S2213-8587(25)00331-6

American Diabetes Association Professional Practice Committee. Diabetes technology: Standards of Care in Diabetes — 2026. 

Videos

Sood discusses emerging diabetes technologies, from automated insulin delivery to dual glucose-ketone monitoring, at ADA 2026.

Diabetes Technology at a Turning Point: What’s New and What’s Next, With Rachael Sood, NP

FDA Proposes Exclusion of Multiple GLP-1 RAs from Bulks List, With Raechel Sood, NP

 semaglutide, tirzepatide, and liraglutide from the 503B bulks list.

The 503B bulks list collects bulk drug substances for compounding by outsourcing facilities, according to the conditions of section 503B of the Federal Food, Drug, and Cosmetic Act. These facilities can rarely compound drugs with these substances unless they appear on the list, or if the drug is on the FDA’s drug shortage list.

“Compounded medications have been around for a very long time,” Rachael Sood, NP, founder and chief executive officer of the Diabetes Collective and a speaker and clinical expert for Sanofi, Eli Lilly, Dexcom, and more, told 

 in an exclusive interview. “We’ve been using them in different spaces, not just in GLP-1s. This is not the first time, but there has certainly been some overuse and abuse, I believe, of some privileges and mass production of these medications, which can put patients at harm. The FDA is trying to take precautions.”

This announcement comes on the heels of a statement on April 1, 2026, in which the FDA clarified its policies for compounders as the national shortage of GLP-1 drugs and components stabilized. The statement emphasized the strict criteria for compounded drugs, including that the drug is compounded based on a received prescription and that the manufacturer does not compound drugs considered to be essentially copies of commercially available products.

From 2022 until February of 2025, the US experienced a nationwide shortage of semaglutide products, specifically Ozempic and Wegovy. This was largely attributed to increased demand, given the drugs’ efficacy and popularity following their release into the market. Prior research indicated that semaglutide prescription fills rose by roughly 442% between January 2021 and December 2023. During this shortage, pharmacies across the country created lower-cost, compounded versions of Ozempic and Wegovy, operating under an exception to produce copies of these drugs.

On February 21, 2025, the FDA announced the resolution of this shortage after reviewing data from Novo Nordisk regarding its production and inventory of Ozempic and Wegovy. Since then, the drugs have shown no sign of further shortages, and the release of multiple alternative GLP-1 RA treatments has provided a plethora of alternatives should the issue arise again. Sood also addressed this, commenting on the unlikelihood of needing compounded therapies to account for similar shortages in the future.

“During the shortage, I would switch doses around. I would either increase or decrease a dose. I would try to go to a different pharmacy, I would change a medication we have,” Sood said. “We have 13, 14, maybe 15 different GLP-1s to prescribe now; we don’t have very many shortages of many of these medications, and now that we have so many options, I don’t really see this being a problem.”

Notably, this present announcement is not final – the FDA encourages parties to submit comments via the docket by June 29, 2026. According to the release, the FDA will consider these comments before a final determination is announced.

Editors’ Note: Sood reports no relevant disclosures.

US Food and Drug Administration. FDA Proposes to Exclude Semaglutide, Tirzepatide, and Liraglutide on 503B Bulks List. April 30, 2026. Accessed May 1, 2026. 

https://content.govdelivery.com/accounts/USFDA/bulletins/41537f8

US Food and Drug Administration. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. April 1, 2026. Accessed May 1, 2026. 

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

Billingsley A. Is Semaglutide in Shortage? The Latest on Ozempic and Wegovy Availability. 

. August 18, 2025. Accessed May 1, 2026. 

https://www.goodrx.com/classes/glp-1-agonists/semaglutide-shortage?srsltid=AfmBOorCqzazDrEXShxG2U7I3iOpYR7DXNspvQx0wpfw6xRG1rOGtZqW

US Food and Drug Administration. Declaratory Order: Resolution of Shortages of Semaglutide Injection Products (Ozempic and Wegovy). February 21, 2025. Accessed May 1, 2026. 

https://www.fda.gov/media/185526/download

Sood shares her thoughts on the recent announcement by the FDA, limiting pharmacies’ ability to compound semaglutide, tirzepatide, and liraglutide from bulk substances.

FDA Proposes Exclusion of Multiple GLP-1 RAs from Bulks List, With Rachael Sood, NP

The FDA has approved an expanded indication for teplizumab-mzwv (Tzield) to delay the onset of stage 3 

 in children as young as 1 year of age diagnosed with stage 2 disease, extending the therapy's reach from its prior lower age limit of 8 years. The approval, granted under priority review, makes teplizumab the first disease-modifying therapy indicated for this younger age group with stage 2 type 1 diabetes.

The expanded approval indicates teplizumab to delay progression to stage 3 type 1 diabetes in patients with stage 2 disease starting at age 1 year

The decision lowers the prior approved age threshold from 8 years to 1 year

Approval is supported by the PETITE-T1D phase 4, single-arm, open-label study in children under 8 years with stage 2 T1D

Teplizumab is the first disease-modifying therapy approved to delay progression from stage 2 to stage 3 type 1 diabetes

Type 1 diabetes is an autoimmune condition in which immune-mediated destruction of insulin-producing beta cells begins years before clinical symptoms emerge. In young children, this progression can be particularly rapid and difficult to detect, and the burden of stage 3 disease management is compounded by developmental factors including small body size and full dependence on caregivers. Stage 2 disease is defined by the presence of 2 or more type 1 diabetes-related autoantibodies alongside dysglycemia in the absence of symptoms.

The expanded indication is supported by 1-year data from PETITE-T1D, a phase 4 single-arm, open-label, multicenter study evaluating the safety and pharmacokinetics of teplizumab in 23 children < 8 years of age with stage 2 type 1 diabetes. The regimen consists of a once-daily intravenous infusion administered over 14 consecutive days. Parent company Sanofi noted that a supplemental review is also underway for a potential indication to delay progression of stage 3 disease in patients ≥ 8 years of age recently diagnosed with stage 3 type 1 diabetes.

Check out this interview with Rachael Sood, NP, where she discusses what this expanded approval means for clinical practice, how to identify and counsel families of young children with stage 2 type 1 diabetes, and the evolving role of disease-modifying therapy in this population.

: What is the clinical significance of expanding teplizumab use to children as young as 1 year with stage 2 type 1 diabetes?

: This is huge. This is huge news. When I woke up and saw this news, this is the hugest news, probably for this entire year. People that get diagnosed with type 1 diabetes have a complete change in lifestyle. They have to make so many extra decisions. They are dependent on insulin. They are traumatized. They are most often diagnosed in emergency rooms. Many times when we're talking about kids, people don't recognize symptoms early, because kids are kids. They don't really complain. They're just having fun. ‘Oh, I'm hungry, I'm dehydrated, oh, I'm always sick’ but, you know, they just don't complain. They don't recognize things, and we're definitely not getting to our children as quickly.

We also have an issue with access to care. In pediatric clinics, you're seeing 25-30 people a day, and it's really hard to keep up, so these people just go under the radar. Now that this indication is open, I'm hoping that it opens up the opportunity to maybe screen patients to see if they have type 1 diabetes, even early stages, because we actually do have a treatment for them now. I think maybe that was a barrier in some pediatric clinics, that we don't have anything to do about it except just insulin. So why screen or why recognize? I don't know. I don't know what the gate is to you know, but I'm hoping this opens it.

 How might this approval change the way clinicians approach early screening and identification of at-risk patients?

I'm hoping that this indication increases awareness that we do have a medication for this. And just going to the last point, I kind of jumped the gun, but now we have a medication, so let's screen and see, because if they are, then we know, and then we can get them this treatment if they desire it. Now we actually have another option to give them instead of just waiting or referral to clinical trials, or just waiting so your blood sugar gets high and you need insulin. You know, ‘come back when you need insulin.’ I hate that phrase, and I hope we start seeing and hearing less of it.

What factors should clinicians consider when selecting young patients for teplizumab therapy?

Factors to consider for teplizumab, so anyone that has type 1 diabetes stage 2 is going to be a candidate for teplizumab or Tzield, a CD3 directed monoclonal antibody. This is a medication that we make sure that someone is in good health. Obviously, when we give the medication, we do screen people to see if they have any really bad, active viral infections or things like that. It's very, very rare, so most people that are in type 1 stage 2 are candidates for this IV infusion.

How do you see this approval shaping the future of type 1 diabetes management and early intervention?

I think we're not ready, and I don't want to say that, but I'm going to be honest, because we are seeing an increase in type 1. We are seeing an increase in autoimmune diseases just across the US, here, where I am, and across the globe, we are seeing more autoimmune. I think more people are getting more aware of immunology, and we're starting to see that branch off just in the endocrine space, and really in the primary care space, people are getting more interested and invested in it.

I hope this FDA approval kind of kick starts that, hey, like, there's a medication for this. Like there was a reason that this came about. There was a reason to study this. There's a reason to screen, there's a reason to give people time. There's a reason to recognize and see that if we want to keep kids out the hospital, if we want to give mom a few extra years, even if this delays progression for a few years, maybe it doesn't hold the beta cells completely, but if it buys time, that time is so precious, and people deserve that time, kids, moms, parents, families. They deserve this time to not have the burden of having to take insulin and watching their blood sugar 24/7.

Editors’ note: Sood reports no relevant disclosures.

Campbell P. FDA Expands Teplizumab Approval to Children 1 Year & Older to Delay Type 1 Diabetes Onset. HCPLive. April 22, 2026. Accessed April 22, 2026. 

https://www.hcplive.com/view/fda-expands-teplizumab-approval-to-children-as-young-as-1-year-to-delay-type-1-diabetes-onset

US Centers for Disease Control and Prevention. Type 1 Diabetes. May 15, 2024. Accessed April 22, 2026. 

https://www.cdc.gov/diabetes/about/about-type-1-diabetes.html

Articles

FDA expanded teplizumab-mzwv’s indication to delay progression to stage 3 type 1 diabetes in children with stage 2 disease down to age 1 year, following priority review. Stage 2 is defined by multiple T1D autoantibodies with dysglycemia and no symptoms, a period when beta-cell destruction is already underway and can be rapid in very young children. Support comes from PETITE‑T1D (phase 4, single-arm; n=23; <8 years) evaluating safety and pharmacokinetics with a 14‑day IV infusion course. Expanded eligibility may catalyze earlier screening and counseling.

Sood discusses the FDA expansion of teplizumab to children as young as age 1 with stage 2 T1D and the implications for early intervention and delaying disease progression.