Diabetes Dialogue: GLP-1s, SGLT2s, and Diabetes Barbie at ENDO 2025

Welcome back to Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives!

In this episode of Diabetes Dialogue, cohosts 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, recapped highlights from the 2025 Endocrine Society annual meeting. They spotlighted advances, controversies, and ongoing unmet needs in type 1 diabetes care.

They highlight Dr. Caitlin Love’s presentation on GLP-1 receptor agonists in type 1 diabetes, noting the small size and limitations of existing randomized controlled trials, most of which used liraglutide—a daily injectable with lower adherence and modest efficacy compared to newer, weekly agents. Despite inconsistent A1c reductions, trials showed meaningful weight loss and insulin dose reductions. However, they also lacked important endpoints such as time-in-range and treatment burden.

Isaacs and Bellini then turn to the regulatory landscape, where they reflect on the current lack of FDA-approved GLP-1 receptor agonists for type 1 diabetes, despite widespread off-label use. In contrast, pramlintide remains approved for type 1 despite being more difficult to administer and offering less meaningful glycemic benefits. The hosts underscore the pressing need for robust cardiovascular outcomes trials in the type 1 population, and they express optimism about an upcoming trial of tirzepatide led by Dr. Viral Shah. They note that this trial could mark a pivotal step toward gaining formal approval for this class in type 1 diabetes.

Expanding the discussion to kidney and cardiovascular protection, the hosts highlight the importance of studying therapies already approved in type 2 diabetes within the type 1 population. They note the significance of ongoing studies with finerenone, an MRA currently approved for CKD in type 2 diabetes. The conversation also touches on the continued hesitancy around SGLT2 inhibitors in type 1 diabetes due to euglycemic DKA risk, positioning finerenone as a potentially safer alternative if efficacy is confirmed.

Dr. Anders Carlson’s keynote presentation is another focal point. The hosts praise his sweeping review of the DCCT and EDIC studies, now extending over 40 years, and his framing of glycemic control—particularly time-in-range—as the single most important determinant of long-term outcomes in type 1 diabetes. They reflect on the evolving definition of glycemic success, including the growing importance of time-in-tight-range (e.g., 70–140 mg/dL), and the implications for future regulatory endpoints and therapeutic goals. Carlson’s retrospective highlighted how far the field has come—from a focus on A1c to a more nuanced understanding of glycemic patterns, glucose variability, and the real-world challenges patients face.

The hosts also touch on public perception and advocacy, with the recent launch of a type 1 diabetes Barbie receiving both acclaim and controversy online. The doll, equipped with an insulin pump and CGM, was launched to promote visibility of the disease and normalization of its treatment. However, the hosts address problematic social media reactions—such as misinformed comments conflating type 1 and type 2 diabetes—and use the opportunity to emphasize the ongoing need for public education.

The episode closes with a nod to ENDO’s expanded efforts in provider education, particularly a dedicated fellows’ session on type 1 diabetes. Topics included accurate diagnosis, staging, the importance of antibody testing, and family screening. Isaacs and Bellini stress how essential it is for endocrinology fellows—many of whom may focus on other areas—to be equipped with the knowledge and tools to care for patients with type 1 diabetes in general practice. They also highlight evolving epidemiologic trends: most new-onset cases now occur in adults, and a substantial proportion of individuals with type 1 diabetes live with overweight or obesity—challenging outdated stereotypes and reinforcing the need for precise diagnosis and individualized treatment.