#54 - 🧪 All 12 off insulin + GLP-1 guidelines

Hey readers! 🌟 What a week - ADA 2026 Scientific Sessions dropped a mountain of T1D news, and we've been sifting through it all so you don't have to. From islet transplant participants ditching external insulin to the first expert guidelines for GLP-1 use in T1D, plus a flurry of new tech updates, there's a lot to unpack. Grab your coffee (or juice box) and let's dive in.

All 12 trial participants off external insulin: New tegoprubart data - In a pilot islet transplant study, all 12 participants with long-standing T1D are now off external insulin using tegoprubart instead of tacrolimus, with zero rejection episodes and no kidney toxicity. – Brian Herrick, Breakthrough T1D

The key here is what tegoprubart does differently: rather than broadly suppressing the immune system (which is rough on the body long-term), it blocks a specific rejection signal. That means transplanted islets survived better than historical controls, and participants avoided the well-known toxicities of tacrolimus. Next steps include studies in people with T1D and chronic kidney disease, plus efforts to scale islet availability.

First dual GLP-1/GIP receptor agonist for T1D shows promising results - Acmopatide (CT-868), the first once-daily dual GLP-1/GIP agonist developed specifically for T1D, reduced A1C, body weight (up to ~7%), and insulin requirements (up to ~15%) in a Phase 2 trial of 111 adults. – American Diabetes Association

At the 4.1 mg dose, 56% of participants hit A1C below 7%, which is notable for an adjunct therapy. However, there's a frustrating twist: Roche has decided not to advance acmopatide into Phase 3 for T1D, despite the encouraging data and no serious safety signals. Researchers expressed real disappointment, and honestly, it's hard not to share that feeling given how few non-insulin options exist for our community. – Healio

First expert recommendations for safe GLP-1 use in Type 1 diabetes - A new global consensus statement with 35 recommendations provides a practical framework for off-label GLP-1 use in T1D, emphasizing continued insulin therapy, DKA risk mitigation, and individualized care. – diaTribe

This matters because people with T1D are already using these medications off-label, often without structured guidance. The consensus, endorsed by multiple major diabetes organizations, covers everything from safe initiation and titration to screening, monitoring, drug interactions, and when to stop (pregnancy, surgery). If you or your clinician are considering a GLP-1, this is essential reading.

Diabetes technology highlights from ADA 2026 - A comprehensive roundup covering Abbott's Libre Duo (dual glucose-ketone sensor), expanded CGM benefits for T2D, and next-gen systems like Omnipod 6 and Tandem Control-IQ+. – diaTribe

The dual glucose-ketone wearable sensor is particularly interesting for T1D, since it could flag DKA risk earlier, including euglycemic DKA cases that are easy to miss.

Sequel Med Tech CMO on twiist's expanding ecosystem - Twiist is building interoperability with Abbott's Libre 3 Plus, Senseonics' Eversense 365, and Diabeloop's algorithm, while expanding toward T2D support. – Sean Whooley

Omnipod 5 enhanced algorithm rolling out in the U.S. - The biggest algorithm update since launch adds a 100 mg/dL target glucose option, improved alarm handling, and FreeStyle Libre 3 Plus compatibility. – Insulet Corporation

The race toward fully closed-loop systems - Multiple companies are developing no-meal-announcement AID systems, but experts caution that "fully closed loop" is a misnomer since users still need to stay engaged for exercise, illness, and sensor issues. – MedTech Dive

Teplizumab and beta-cell function in newly diagnosed T1D - The PROTECT Phase 3 trial showed teplizumab preserved beta-cell function at 78 weeks in newly diagnosed children and adolescents, but key clinical endpoints like insulin dose, A1C, and time-in-range did not differ significantly from placebo. – NEJM

This is a nuanced result. Preserving C-peptide is meaningful biologically, but the lack of clinical endpoint improvement raises questions about what that preservation translates to in daily life. Worth watching as longer-term data emerge.

Engineered stem cells reverse new-onset T1D in mice - MUSC researchers showed that MSCs engineered to produce alpha-1 antitrypsin reversed T1D in mice by reprogramming the immune response, boosting regulatory T cells while reducing killer T cells. – Medical University of South Carolina

Retraining the immune system to protect transplanted islets - University of Missouri researchers engineered islets with thrombomodulin and CD47, achieving normal glucose levels in over 72% of preclinical recipients without immunosuppression. – University of Missouri

Predicting genetic risk for T1D just got more accurate - UC San Diego's machine-learning model identifies four genetic sub-types of T1D and improves risk prediction across diverse populations, potentially enabling earlier screening and personalized prevention. – UC San Diego

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