#24 - Twiist reviews, Tzield fast-track 🎉

Hey readers! 🎉

This week brings a fascinating mix of real-world experiences, cutting-edge research, and practical tools that could reshape how we think about T1D management. From early users sharing their honest takes on new insulin pumps to groundbreaking immunotherapy advances, there's a lot to unpack—and plenty of reasons to feel hopeful about where diabetes care is heading.

One Month Using The Twiist Insulin Pump offers candid early impressions of Sequel Med Tech's newest automated insulin delivery system. Powered by Tidepool's FDA-cleared Loop algorithm and paired with the Libre 3 Plus CGM, Twiist adjusts insulin every five minutes and brings some genuinely clever features to the table—smartwatch bolusing, customizable workout targets, retroactive carb edits, and even emoji-based meal bolusing to signal how fast your food will hit. Users report smoother nights, fewer stubborn highs, and improved overall control, though the rechargeable battery system and Cleo infusion set draw mixed reviews. Insurance coverage remains variable but is expanding, making this a system worth watching as it matures. – Diabetech

A New Drug Slows the Worsening of Type 1 Diabetes explores how teplizumab is changing the conversation around T1D treatment and even cure. Approved in late 2022, this monoclonal antibody can reduce the risk of progressing from stage 2 to stage 3 diabetes by 59% and double the time before insulin becomes necessary. What's equally exciting is how teplizumab's approval has energized the entire research community, sparking new work on immune therapies, cell transplants, and gene editing. The article acknowledges real barriers—high costs, complex administration, and access challenges—but the momentum is undeniable. – Tara Haelle, Scientific American

Building on that momentum, Tzield receives voucher for expedited review in stage 3 T1D reports that the FDA has accepted Tzield (teplizumab) into its National Priority Voucher program, potentially slashing the review timeline from 10–12 months to just 1–2 months. If approved for stage 3, this would be the first therapy beyond insulin available at diagnosis—a genuine paradigm shift. The PROTECT study showed Tzield significantly slows beta cell decline in newly diagnosed patients, and this expedited review reflects the urgent unmet need in our community. – Brian Herrick, Breakthrough T1D

How Exercise Impacts Blood Sugar: Tips for Balancing Activity and Glucose Levels breaks down a topic that often gets overlooked in diabetes education. Certified Diabetes Care and Education Specialist Jennifer Smith explains that aerobic exercise typically lowers blood sugar while anaerobic or high-intensity activity can raise it via adrenaline—and everyday activities like mowing the lawn or chasing kids count too. The 15–20 minute mark during aerobic activity is a common danger window for lows if you have active insulin on board, so planning ahead (carrying fast carbs, adjusting basal or meal boluses) is essential. Competition or intense efforts can trigger adrenaline spikes that require a small bolus. The key takeaway: exercise isn't off-limits—it just requires awareness and planning. – JUICEBOXPODCAST.com

New-Onset T1D Trials serves as a comprehensive directory of immunotherapy trials for people recently diagnosed with type 1 diabetes. The page lists multiple studies exploring diverse mechanisms—B-cell and T-cell modulation, antigen-specific therapies, and metabolic strategies—all aimed at preserving beta cell function and slowing disease progression. Participating centers include Joslin Diabetes Center, Boston Children's Hospital, Naomi Berrie Diabetes Center, and Yale, with trials testing therapies like GNTI-122 (POLARIS), frexalimab (FABULINUS), Diamyd (DIAGNODE-3), and JAK inhibitors (JAKPOT). Several trials are actively recruiting, making this a valuable resource for anyone interested in contributing to T1D research. – T1D Trials

UCSF Diabetes Type 1 Clinical Trials highlights an impressive portfolio of 21 trials in progress, with 10 currently open to participants. The range is remarkable—cell therapies (VX-880, GNTI-122), immunomodulators (frexalimab, teplizumab, siplizumab, JAK inhibitors), islet transplantation, automated insulin delivery studies, and pregnancy outcome research. The DREAM project specifically targets device use disparities by supporting Latinx adolescents with virtual peer group interventions. Observational efforts like the TrialNet Pathway to Prevention and Registry for Stage 2 T1D focus on early detection and natural history, while extension studies track long-term outcomes of approved therapies. – UCSF

Type 1 Diabetes Clinical Trials - Mayo Clinic Research rounds out the trial landscape with 71 studies covering everything from insulin therapies and closed-loop systems to biomarkers, pregnancy outcomes, and diabetes-related complications. The breadth is impressive—new insulin formulations, advanced hybrid closed-loop systems, patient-centered outcomes including quality of life and treatment adherence, and investigations into complications like gastroparesis and neuropathy. Innovative technologies like CGM, sensor-augmented pumps, and smartphone apps for personalized care are all being tested. – Mayo Clinic

Screening for Type 1 Diabetes makes a compelling case for widespread autoantibody screening. Since about 90% of people with T1D have no family history and rates are rising, screening is recommended for all families—not just those with known risk. Early detection through a simple blood test reduces the risk of diabetic ketoacidosis and hospitalization at diagnosis, opens opportunities to participate in clinical trials aimed at preventing or delaying onset, and provides families with time to prepare. Beyond Type 1, in partnership with JDRF and Provention Bio, is working to expand access to programs like T1Detect. – Beyond Type 1

Mental Health + Type 1 Diabetes addresses the critical but often overlooked emotional challenges of living with T1D. Managing this chronic condition involves significant stress, burnout, diabetes distress, and eating disorders like diabulimia. Beyond Type 1 offers a wide range of resources—mindfulness courses, therapy support, and community connections—to help individuals and their support networks navigate these challenges. Special attention is given to mental health issues faced by boys and men with diabetes, as well as the impact of insulin affordability on emotional well-being. Personal stories and expert insights underscore that mental health and physical health are inseparable. – Beyond Type 1

#1654 Born This Way features Crystal, 33, sharing her journey with type 1 diabetes since age 12. Her story is raw and honest—years of unstable control, insulin restriction to lose weight, and a severe DKA episode (blood sugar around 918) that landed her in the ICU. She also describes multiple congenital health issues and diabetes complications including gastroparesis. Recently, she's made significant changes—pre-bolusing, cutting sugary foods and drinks, leaning on an online community—and lowered her A1c from around 13 to 10. She's now pursuing pump therapy (Omnipod 5 or Tandem) to continue improving her management. Scott Benner emphasizes throughout that restricting insulin is dangerous and offers practical advice on diet, hydration, and monitoring. – Scott Benner

#1648 Harper Valley PTA tells the story of Ashley, an ICU trauma nurse whose six-year-old daughter was diagnosed with T1D (and shortly after, celiac) following months of missed opportunities—13 pediatric visits before a DKA diagnosis with blood glucose 594 and ketones 4+. Ashley describes the shallow diabetes education families receive and a year-long fight with her school and public-health nurses to allow CGM monitoring at school. Using a pump and CGM plus hands-on, data-driven experiments, she's achieved strong control (A1c 6.0) and now advocates and mentors newly diagnosed families. Her persistence in the face of institutional resistance is both inspiring and infuriating. – Scott Benner

Savvy Update 10/13/25 compiles the latest diabetes news and research. Highlights include FDA clearance of Biolinq Shine, a color-changing, needle-free glucose sensor for non-insulin-using adults with type 2 diabetes; IU researchers' development of a lab-designed protein that mimics insulin and glucagon to regulate glucose and reduce hypoglycemia; and observations that GLP-1 therapies can alter taste and increase satiety. The update also covers gene-edited pig kidneys showing promise in transplantation, benefits and risks of GLP-1s in older adults, and the Nobel Prize recognizing advances in immune regulation relevant to autoimmune diseases. – The Savvy Diabetic

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