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

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

Diabetes Dialogue: Understanding Semaglutide (Ozempic) in CKD and T2D

 approval of semaglutide 1.0 (Ozempic) for reducing the risk of 

 marks a significant advance in the treatment landscape.

The decision, which was announced on January 28, 2025, was based on the phase 3b FLOW trial, which showed semaglutide reduced the risk of kidney disease worsening, end-stage kidney disease, and cardiovascular death by 24% compared to placebo when added to standard of care (Hazard Ratio [HR], 0.76; 95% Confidence Interval [CI], 0.66 to 0.88; 

The trial enrolled 3533 adults and was stopped early due to meeting efficacy criteria after a median follow-up of 3.4 years. Additional analyses showed a 21% risk reduction for kidney-specific events (HR, 0.79; 95% CI, 0.66 to 0.94), and a 29% reduction in cardiovascular death versus placebo (HR, 0.71; 95% CI, 0.56 to 0.89). In their announcement of the approval, Novo Nordisk noted that this approval makes semaglutide the most broadly indicated GLP-1 receptor agonist in its class.

To celebrate the approval and breakdown what the latest semaglutide approval means for clinicians and patients with type 2 diabetes, hosts hosts 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, convened for a special edition episode of 

During the episode, hosts dive into the approved indication, supporting data from the FLOW trial, how the new indication might influence where semaglutide fits into treatment algorithms, and what type of potential semaglutide could have in populations with chronic kidney disease without type 2 diabetes.

Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

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In this episode, hosts discuss the approval of semaglutide (Ozempic) for reducing the progression of kidney disease in type 2 diabetes. 

Diabetes Dialogue: ADA’s 2025 Standards of Care in Diabetes Therapeutics

 GLP-1 Agonists and SGLT2 Inhibitors Combination Therapy

 Heart Failure Stratification and Obesity-Associated Heart Failure

 Introduction of Liver Disease into Algorithms

 Screening for Type 1 Diabetes and New Guidelines

 Guidelines for Pre-Symptomatic Type 1 Diabetes

 Vitamin D Monitoring and Supplementation

In this episode of Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives, hosts 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, explore the updated American Diabetes (ADA) 2025 Standards of Care, focusing on therapeutic advancements in 

Hosts discussed the significant changes to treatment algorithms and new guidance designed to enhance outcomes for people with diabetes and related conditions. One of the major updates discussed is the expanded flexibility in the treatment algorithm for 

, including glucagon-like peptide-1 receptor agonists (GLP-1 RA), such as semaglutide, as an alternative to patients who may not tolerate sodium-glucose co-transporter 2 (SGLT2) inhibitors.

Isaacs and Bellini emphasized the complementary benefits of combining these therapies, particularly for kidney protection and glucose management. The episode also highlighted updates on the use of GLP-1 RAs for patients with obesity-related heart failure with preserved ejection fraction (HFpEF), underscoring the evolving role of these medications beyond glucose lowering.

The discussion then shifted to the introduction of recommendations for metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). GLP-1 RAs, dual GLP-1/GIP agonists, and combinations with pioglitazone are now recognized as promising treatment options to mitigate these risks. Hosts delved into the importance of identifying disease severity using FIB-4 scores and how these guidelines aim to address the rising prevalence of fatty liver disease among people with diabetes.

Another noteworthy update focused on screening for type 1 diabetes (T1D), particularly in first-degree relatives of individuals with the disease. Isaacs and Bellini review the new staging framework, which classifies T1D progression into three distinct stages, and the inclusion of ICD-10 codes for accurate diagnosis. They also discussed the role of teplizumab (TZIELD) in delaying disease progression in individuals aged ≥8 years and what this could represent for early intervention.

With practical insights and real-world applications, this episode provided a comprehensive look at how these updates from the ADA’s 2025 Standards of Care will shape therapeutic decision-making and improve care for people with diabetes.

In this episode, hosts explore the latest updates to the ADA Standards of Care on therapeutic innovations and their real-world impact on diabetes management.



Diabetes Dialogue: ADA’s 2025 Standards of Care in Diabetes

 Introduction, Updates on CGM for Type 2 Diabetes

 Improved Guidelines for AID and Pregnancy

In this episode of Diabetes Dialogue, hosts 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, explore the updated American Diabetes (ADA) 2025 Standards of Care, focusing on technology advancements in diabetes management.

The discussion highlighted significant advancements and updated recommendations in diabetes care, particularly surrounding continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems. In particular, hosts pointed to stronger ADA recommendations for CGM use, including for individuals with type 2 diabetes (T2D) not on insulin therapy, and emphasized the importance of CGM for all patients on insulin therapy to reduce hypoglycemia risks. They also touched on the potential of over-the-counter CGMs to guide medication adjustments and lifestyle changes for prediabetes and T2D.

A notable topic is the ADA's revised stance on open-source AID systems, explicitly asking clinicians to support and guide patients who use these open-source systems. In particular, the organization recognized its potential to improve outcomes and urged providers to understand the underlying algorithms as they continue to advance. Isaacs and Bellini also highlighted the role of CGM and AID systems during pregnancy, emphasizing the early initiation of technology to achieve personalized glycemic targets and optimize outcomes.

The discussion expanded on the seamless integration of CGM during hospital discharge programs, as well as ADA recommendations that AID systems become the preferred insulin delivery method for people with type 1 diabetes (T1D), with growing support for their use in T2D on basal or multiple daily insulin injections. They addressed challenges such as Medicare restrictions on pump coverage for T2D, and insurance denial of test strips for CGM users, emphasizing the critical need for test strips as backups during CGM failures.

Their conversation also zeroed in on the ADA’s new guidance on allowing insulin pump use during hospitalization when clinically appropriate. Bellini stressed the importance of patient independence and education, advocating for hospitals to enable pump use if patients or caregivers can manage them. Hosts underscored the importance of patients bringing sufficient supplies to hospitals, as most facilities do not stock them.

Throughout the episode, Isaacs and Bellini emphasized the transformative potential of diabetes technology, urging clinicians to embrace and adapt to advancements to better support patients. They advocated for empowering individuals to manage their care, educate healthcare providers, and push for policy changes that improve access, equity, and outcomes in diabetes management.

In this episode, hosts explore ADA's evolving guidelines championing broader access to CGM and AID systems for personalized diabetes care.

Diabetes Dialogue: ADA’s 2025 Standards of Care in Diabetes Technology

Diabetes Dialogue: The Role of Dietitians in GLP-1 RA Use

Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives

, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by Allison Evert, MS, RD, CDCES, and Savitha Subramanian, MD, co-authors of a recent publication on the evolving role of registered dietitian nutritionists (RDNs) in incretin-based therapies and obesity care, titled "

Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care

". The conversation explores how combining GLP-1 receptor agonists with lifestyle interventions can enhance long-term outcomes in diabetes and obesity management, focusing on the integral role of RDNs in addressing medication adherence, side effects, and patient education.

Evert and Subramanian highlight key findings from their paper, including strategies for mitigating side effects such as nausea, constipation, and diarrhea, which contribute significantly to high discontinuation rates during the first year of therapy. They stress the importance of counseling patients on appropriate dietary adjustments to prevent nutrient deficiencies and muscle loss during rapid weight loss, recommending an emphasis on protein intake and nutrient-dense food choices.

The discussion also delves into the practical challenges of integrating RDNs into care teams, particularly in systems with limited resources. To address this gap, the authors provide actionable tools in their paper, including figures and resources to guide clinicians in patient education and medication management. The hosts and guests agree that team-based care, including the use of pharmacists, advanced practice providers, and clinical protocols, is critical to improving outcomes and ensuring the long-term success of these therapies.

Gigliotti L, Warshaw H, Evert A, et al. Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care. 

. Published online November 7, 2024. doi:10.1016/j.jand.2024.10.023

Hosts are joined by a registered dietitian and practicing endocrinologist to discuss dietitians' role in managing patients receiving incretin therapies. 

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

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