What's New at Medtronic Diabetes With Bob Vigersky, MD

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!The US Food and Drug Administration (FDA) has approved orforglipron (Foundayo), a once-daily oral GLP-1 RA, for chronic weight management in adults with obesity or overweight and ≥1 weight-related comorbidity.1In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the FDA’s decision and the myriad new treatment opportunities afforded by orforglipron’s clearance for entry into the market.The approval of orforglipron is supported by the phase 3 ATTAIN clinical development program, which includes 2 global, randomized, double-blind, placebo-controlled trials evaluating efficacy and safety over 72 weeks.¹ The ATTAIN-1 trial enrolled 3,127 adults with obesity or overweight without diabetes, while ATTAIN-2 enrolled more than 1,600 adults with obesity or overweight and type 2 diabetes.1In ATTAIN-1, participants receiving the highest dose of orforglipron achieved a mean weight reduction of approximately 12.4% from baseline at 72 weeks among those who remained on treatment, compared with 0.9% in the placebo group. Reported average absolute weight loss was 27.3 lb versus 2.2 lb, respectively. Across all randomized participants regardless of completion status, mean weight loss was 11.1% with orforglipron compared with 2.1% with placebo.1Secondary outcomes included improvements in cardiometabolic risk markers such as waist circumference, non–high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure. However, detailed peer-reviewed data from ATTAIN-1 and ATTAIN-2 remain limited at the time of reporting, and full efficacy and safety results have not yet been widely published in the medical literature.The safety profile of orforglipron appears consistent with the GLP-1 receptor agonist class. Common adverse events include gastrointestinal symptoms such as nausea, diarrhea, constipation, vomiting, and abdominal pain. A boxed warning highlights a potential risk of thyroid C-cell tumors, based on findings observed with other GLP-1 receptor agonists in rodent studies, though human relevance remains uncertain.1,2The magnitude of weight loss observed with orforglipron in ATTAIN-1 appears clinically meaningful but may be modest relative to leading injectable agents. Cross-trial comparisons should be interpreted cautiously due to differences in study populations and designs. Additionally, treatment persistence rates and discontinuation due to adverse events will be important considerations in real-world use.Ongoing and planned studies are evaluating orforglipron across additional indications, including type 2 diabetes and other cardiometabolic conditions. Future comparative trials against established GLP-1 and dual incretin therapies may help define its role in treatment algorithms.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.References1: Eli Lilly. 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-pill2: US Food and Drug Administration. FDA Approves First New Molecular Entity Under National Priority Voucher Program. April 1, 2026. Accessed April 1, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!Expanding access to and optimizing use of automated insulin delivery (AID) systems remains a central priority in diabetes care, with recent discussions highlighting practical strategies to improve outcomes across diverse patient populations.In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Laurel Messer, PhD, RN, vice president of medical affairs at Tandem Diabetes Care, to examine evolving approaches to insulin pump optimization and the broader implications for reducing patient burden.

Advances in artificial intelligence, automated insulin delivery, and sensor integration were central to discussions at the 2026 International Conference on Advanced Technologies & Treatments for Diabetes (ATTD), where clinicians highlighted how emerging technologies may further reduce diabetes management burden while improving glycemic outcomes.In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed key highlights from the meeting, with particular emphasis on AI-driven tools and evolving closed-loop systems.A major theme was the growing role of artificial intelligence, including the concept of “digital twins”—virtual models built from patient-specific data such as glucose trends, insulin dosing, and behavioral inputs. These models allow clinicians and patients to simulate therapy adjustments, such as changes in insulin sensitivity or basal rates, before applying them in practice. Data presented at the meeting suggested use of digital twin modeling improved time in range, whereas providing data feedback alone did not meaningfully change outcomes.The discussion also examined real-world performance data from newer automated insulin delivery platforms. Early data from the Twiist system demonstrated time in range approaching 76% to 77% across initial user cohorts, with higher time in range observed among individuals using lower glucose targets, albeit with an expected increase in hypoglycemia. Expanded analyses in larger populations showed similarly strong outcomes, reinforcing the importance of target selection and individualized system settings.Sensor performance and reliability also emerged as a key topic. Investigators presented data suggesting unrecognized infusion set occlusions may contribute to unexplained hyperglycemia, highlighting potential advantages of newer pump technologies designed to detect occlusions more rapidly. In parallel, comparative analyses of sensor integration in hybrid closed-loop systems demonstrated consistent glycemic outcomes across multiple sensor platforms, suggesting algorithm performance, rather than sensor variability alone, plays a dominant role in achieving time in range.Lastly, hosts shared early data from fully closed-loop systems in type 2 diabetes, including a small trial evaluating automated insulin delivery without meal bolusing. Participants achieved substantial improvements in time in range, increasing from approximately 44% at baseline to 68%, with minimal hypoglycemia. Although not yet achieving traditional glycemic targets, these findings underscore the potential for reducing patient burden while maintaining clinically meaningful glucose control.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.References: Senseonics. First Ever Real-World Evidence of Eversense 365 Presented at ATTD Demonstrates Sustained Performance and Positive Impact Throughout One-Year of Wear. Senseonics.com. Published March 14, 2026. Accessed March 18, 2026. https://www.senseonics.com/investor-relations/news-releases/2026/03-14-2026-141507610 Insulet Corporation. Insulet Presents Promising Study Results for Fully Closed-Loop Automated Insulin Delivery System for Adults with Type 2 Diabetes. Insulet.com. Published March 10, 2026. Accessed March 18, 2026. https://investors.insulet.com/news/news-details/2026/Insulet-Presents-Promising-Study-Results-for-Fully-Closed-Loop-Automated-Insulin-Delivery-System-for-Adults-with-Type-2-Diabetes/default.aspx

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a comprehensive update on the rapidly evolving landscape of incretin-based therapies, focusing on newly published and top-line clinical trial data across oral GLP-1 receptor agonists and emerging triple agonists.Key Episode Timestamps00:00:01 Intro00:00:22 Orforglipron in the ACHIEVE-3 trial00:03:30 Side effects from orforglipron00:10:28 Retatrutide in the TRIUMPH-4 trial00:18:26 Topline data on Novo Nordisk's UBT25100:21:47 Price cuts on Ozempic, Rybelsus, and Wegovy in 202700:26:26 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a detailed update on evolving incretin-based therapies, with a primary focus on a significant formulation change for tirzepatide.Key Episode Timestamps00:00:01 Intro00:00:11 Zepbound in the KwikPen00:01:25 Vials versus pens00:02:55 Environmental benefits00:03:53 Pen needles sold separately00:06:30 LillyDirect availability00:07:20 Europe approves 7.2 mg injectable semaglutide00:09:08 Reusable pen concerns00:10:55 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore advances in implantable diabetes technologies, focusing on a novel implantable insulin pump from Portal Diabetes that has received FDA Breakthrough Device designation.Key Timestamps00:00:01 Intro00:00:14 Implantable insulin pumps00:01:06 What is breakthrough status?00:03:00 How the pump works00:03:41 What makes it different from MiniMed?00:07:36 How does it administer insulin?00:09:47 The Twiist pump with EverSense00:13:30 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, explore major updates in the evolving GLP-1 receptor agonist landscape, with a particular focus on oral semaglutide formulations, branding changes, and regulatory concerns surrounding compounded alternatives.Key Episode Timestamps00:00:01 Intro00:00:25 Oral Wegovy and oral Ozempic00:03:04 Why Rybelsus didn't work00:05:33 The importance of administration00:06:56 Compounding drugs - the Hims and Hers drama00:07:56 The danger of unregulated compound drugs00:11:50 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide an in-depth review of several notable developments in diabetes technology, focusing on innovations in insulin pump interoperability, automated insulin delivery algorithms, continuous glucose monitoring, and decision-support tools for people using multiple daily injections (MDI).Key Episode Timestamps00:00:01 Intro00:00:19 The Sequel Twiist00:01:05 Diabeloop's new algorithm00:09:01 Leaving CamAPS behind?00:09:57 Eversense approaching a spring launch00:12:27 MiniMed Go and the InPen00:17:40 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Susan Weiner, MS, a nationally recognized dietitian and diabetes care and education specialist, for an in-depth discussion of the newly released US Dietary Guidelines and the inverted food pyramid. The conversation is framed for clinicians navigating nutrition counseling in diabetes and cardiometabolic care, with a focus on how these recommendations translate - or fail to translate - into real-world practice.Key Episode Timestamps00:00:01 Intro00:01:00 The new food pyramid and a history of diet guidelines00:03:36 Shortcomings of the new guidelines00:09:33 The headache of food labeling00:11:11 New alcohol guidelines00:13:26 How the guidelines form policy00:14:55 How professional organizations deal with the guidelines00:17:38 Linoleic acid in processed foods00:25:15 Too much protein?00:30:32 Translating the guidelines for patients00:37:11 Outro

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, review key therapy-focused updates from the 2026 ADA Standards of Care, emphasizing areas they view as practice-changing.Key Episode Timestamps00:00:01 Intro00:00:29 Adding GLP-1 RAs to heart failure00:02:45 GLP-1s in glycemic management00:04:36 Time in range targets in glycemic management00:08:10 ADA recommends GLP-1s for T1D00:12:00 GLP-1s in MASH and MASLD00:12:57 Changes in kidney protection guidelines00:14:40 New therapeutic guidance for T1D and T2D00:17:57 Outro