Alternative Endpoints for and Approaches to Metabolic Health, With Daria Igudesman, PhD, MS

Type 1 diabetes (T1D) increasingly affects people with overweight or obesity, leading to a push for lifestyle and pharmacological interventions in these patients to avoid increasing risks of mortality.1

At the Endocrine Society (ENDO) Annual Meeting 2026 in Chicago, Illinois, Daria Igudesman, PhD, MS, a postdoctoral research fellow at AdventHealth, gave a presentation regarding the critical importance of lifestyle interventions alongside clinical and pharmacological approaches to managing obesity in T1D. In an exclusive interview, Igudesman spoke with HCPLive about the potential for meaningful intervention in diet quality.1

“On average, people with type 1 diabetes are scoring between a 50 or a 60, which, out of 100, is unfortunately not a high grade,” Igudesman told HCPLive. “There’s an opportunity there to intervene, to prevent some of the potential weight gain that can occur after the transition to automated insulin delivery.”

Dietary changes have long been the backbone of obesity care; however, with the advent of GLP-1 receptor agonists and similar therapies, this and other lifestyle interventions have somewhat fallen by the wayside. Additionally, strategies for “healthy eating” in recent years have become hyper-focused on carbohydrates, fats, or other individual components and nutrients, rather than maintaining a well-balanced diet. Igudesman emphasizes the resurgent awareness of the importance of overall diet quality.1

Recent research focusing on T1D in children has emphasized the importance of prioritizing foods with a low glycemic index, aiming to improve glycemic stability while minimizing postprandial hyperglycemic peaks. However, much like adults, the main challenge for pediatric patients in maintaining diet quality is adherence. These studies suggest that clinicians and parents alike aim to provide a balanced diet including low-, moderate-, and high-glycemic-index food, prioritizing the former. These data are equally applicable to adult patients.2

Igudesman also cautioned regarding the potential for major lean mass loss when using pharmacological methods to lose weight. Macronutrient deficiency risk also increases substantially in these cases. To this end, Igudesman points out that a patient losing a substantial amount of weight does not immediately translate into clinical benefit or improved metabolic health.1

Additionally, Igudesman calls for further research into other potential markers of health in T1D, including satiety. High fiber intake, which is historically lacking in diets across the US, is a major contributor to satiety, which in turn results in slow gastric emptying, better blood sugar management, and increased release of satiety hormones like GLP-1. However, very few clinical trials have investigated this particular aspect of dietary health and its impact on T1D, let alone the broad range of metabolic diseases beyond diabetes.1

“I believe that these endpoints need to be included in all studies related to weight management in type 1 diabetes,” Igudesman said. “Not just in weight management, either, but trials related to metabolic endpoints in general.”

Editors’ Note: Igudesman reports no relevant disclosures.

References

1. Igudesman D. Weight Management in T1D: Current Challenges and Novel Perspectives. Presented at the Endocrine Society (ENDO) Annual Meeting 2026, Chicago, IL. June 13-15, 2026.

2. Quarta A, Guarino M, Tripodi R, Giannini C, Chiarelli F, Blasetti A. Diet and Glycemic Index in Children with Type 1 Diabetes. Nutrients. 2023;15(16):3507. Published 2023 Aug 9. doi:10.3390/nu15163507