ADA Scientific Sessions 2026
By Gary Scheiner, MS, CDCES, FADCES
Another year, not just another ADA Scientific Sessions. This year’s meeting was marred by a standoff between ADA staff and some highly reputable scientists who were trying to distribute copies of an editorial that was published in an ADA journal without “express written consent” – a situation that escalated and required police involvement. There were also rumors swirling about the hostile takeover of one of Breakthrough T1D’s major fundraising entities and its own parent company.
Political skirmishes aside, this year’s meeting was nothing short of fantastic. Despite the continued one-upmanship of the drug companies competing to meet your weight loss needs, there was considerable news, research, and product development in the type-1 diabetes space.
Here, in no particular order, is a summary of my key findings from ADA 2026.
Keep in mind that I’m only one person (although some people think they saw me in multiple places at the same time), so I could not attend every research session, since they ran 4-8 at a time for 5 days, or visit every research poster in the enormous poster hall. But believe me… I tried! My average step count was over 15,000 per day, for those who might be wondering.
AID Optimization:
Automated insulin delivery systems can certainly improve glucose control while taking some of the self-management burden off the user. However, getting the best results from them takes a little finesse.
To achieve maximal “time in-range”, experts recommend using tight targets andaggressive bolus settings (insulin-to-carb ratios and correction factors), and to
actually GIVE boluses when eating. Some systems claim to be able to bolus
automatically for meals, but post-meal glucose is almost always better when meals
are announced (and boluses given) prior to the meal by the user.
Another way to optimize AID systems is to ensure that the CGM signal is reaching
the pump and working properly. Experts suggest wearing the CGM very close to the pump (or vice versa) and performing fingersticks (with calibration as
needed/allowed) on day one of new sensors.
Pumps & Pregnancy:
Based on a combination of retrospective data analysis and expert clinical experience, in order to meet the stringent glucose targets during pregnancy, the following strategies are recommended:
- MiniMed780G – Set the active insulin time to 2 hours
- Tandem – Use “sleep mode” around-the-clock
- OmniPod 5 – Set the lowest possible target and turn reverse correction off. Set active insulin time to 2-3 hours.
- Twiist and Open-Source Loop – use the “premeal temporary target” feature as often as possible. Set the maximum basal for at least 5X the highest programmed basal rate. Set a very short absorption time.
Other general recommendations:
- Be cautious of prolonged basal shut-offs when the CGM is producing false lows, as this can lead to ketone production.
- Insulin absorption is delayed during the 2nd & 3rd trimesters; earlier pre-bolusing is suggested.
- Consider inhaled insulin (Afrezza) to prevent post-meal glucose spikes. Afrezza will be receiving FDA clearance for use in pregnancy shortly.
- Consider using “super boluses” to prevent post-meal glucose spikes. This involves adding 2-3 hours of basal insulin to a meal bolus, and then turning the basal down by 80-90% for the next 2-3 hours.
BTW, Tandem’s Control-IQ algorithm has been approved for use during pregnancy. This marks the first time that any automated insulin delivery system has received FDA approval for pregnancy use.
New Product Development:
Tandem’s tubeless Mobi pump –
I had a chance to interact (a nice way to say “play”) with Tandem’s tubeless Mobi pump. All I can say is WOW.
Highly innovative design. The pump snaps into a patch on the skin, and can be removed temporarily. Current Mobi users will only need new/updated cartridges to transition over; the pump will remain the same. The on-pump bolus button allows the user to bolus in fixed increments in case they don’t have their phone handy.
The patch adhesive holds quite well and only had a 1.4% irritation rate in clinical studies. And perhaps best of all, the extended-wear cannula built into the patch lasted seven full days for 84% of users. The “Steadiset” canula is kink-proof and inserts at an angle very easily using an automated inserter. The cannula has multiple openings along its length, distributing insulin like a “sprinkler” below the skin, which can result in improved and more consistent absorption.
Tandem is hoping to launch the tubeless Mobi in the 4th quarter of 2026, along with the Steadiset cannula. Users of the Tandem T:slim pump should be able to access the Steadiset a few months later.
ICODEC –
Novo Nordisk reported continued progress towards bringing their once-weekly basal insulin ICODEC to market.
Recently approved only for treatment of T2D, icodec is 7X more concentrated than traditional insulin, and produced a slight improvement in A1c compared to traditional daily basal insulin. Users also experienced an uptick in hypoglycemia, thus the reason it was not also approved for use by people with T1D.
MiniMed Flex –
MiniMed’s Flex insulin pump (see below), which is about half the size of their 780G pump, is now available. Flex has no buttons or controls on the pump itself – it uses a smartphone app equipped with MiniMed’s SmartGuard automation technology.
OmniPod6
Insulet unveiled plans for their OmniPod6 system. Improvements include improved CGM signal reception, less time out of automated mode, and a more robust algorithm that minimizes the glucose rise from unannounced meals and snacks.
Tegoprubart –
One of the more exciting recent developments involves a new immunosuppressant, tegoprubart (simply called “tego” by those who have better things to do than pronounce “tegoprubart”). Tego has been used in select cases to protect transplanted beta cells from rejection by the body’s immune system. The really exciting news: tego lacks many of the toxic side effects associated with other immunosuppressants. Early recipients have responded well. If this continues, we will likely see a sharp increase in islet cell transplants using cells generated by Vertex.
“Other” Medications:
SGLT-2 inhibitors –
SGLT-2 inhibitors are oral medications that lower the renal threshold for glucose. They lower blood sugar levels by facilitating the loss of glucose in the urine. They are used in the treatment of T2D, but are not approved for treatment of T1D due to an increased risk of ketoacidosis. Nevertheless, researchers at Johns Hopkins University studied outcome data from T1 users of SGLT-2 inhibitors who were educated on strategies to minimize the risk of DKA. Compared to use of other add-on oral medications, users of SGLT-2 inhibitors experienced a 22% reduction in cardiovascular events, a 28% reduction in kidney problems, and NO increased risk of DKA.
Acmopatide –
Acmopatide is an investigative medication that combines a GLP-1 with a GIP (Glucose-dependent insulinotropic polypeptide… let’s just stick with “GIP”), similar to the commercially available products Mounjaro and Zepbound. Developed by a subsidiary of Roche, acmopatide was studied in overweight adults with T1D for a period of 16 weeks.
It produced nearly 7% weight loss, a 0.34% reduction in A1c, 15% insulin dose reduction, and at higher doses, a decrease in post-meal glucose spikes. No epidoses of DKA or severe hypoglycemia occurred during the phase-2 study. Unfortunately, Roche has announced that they will NOT be moving forward with phase 3 trials, but there is hope that this lays the groundwork for other incretin-based medications for type 1 diabetes.
Mounjaro –
Eli Lilly is currently conducting a phase 3 trial assessing the safety and efficacy of Mounjaro for people with type 1 diabetes. Not that it will matter if every company takes Roche’s approach. Boooooo Roche!
Berobenatide –
Pfizer announced phase-2 study results for a once-MONTHLY GLP-1 medication, berobenatide. Studied in overweight/obese people with T2D for 28 weeks, berobenatide produced over 10% weight loss and an A1c reduction of 2.2%, with a similar safety and side-effect profile as current weekly GLP-1s.
Integrated Islet Distribution Program (IIDP) –
And finally… not sure what to buy for that special someone with T1D who already has everything? Consider giving the gift of human islet cells! That’s right… There was an organization in the exhibit hall, the Integrated Islet Distribution Program (IIDP), offering human islets and “related tissues” to the highest bidder. Well, actually, just for the diabetes research community. But my, how far we’ve come.
Ketone (Sensing) Is Coming!:
Abbott’s dual glucose-ketone sensor was recently approved in Europe, so it won’t be long before it is available in the US. It helps to know more about the role and potential impact of ketones. Here are some key facts:
- DKA accounts for nearly 250,000 hospital admissions annually in the US.
- Incidence of DKA is highest during adolescence and advanced age (>75). It is higher in minorities and those with lower incomes.
- DKA is a leading cause of death among people with T1D. Risk of death increases with more frequent bouts of DKA.
- Leading causes of DKA:
- 50% Insulin omission
- 20% New-onset T1D
- 15% Infection
- 2-4% SGLT-2 inhibitor use
- Insulin pump malfunction, which used to be a common cause of DKA, now occurs in only 1.5% of pump users per year.
- CGM use is associated with a 50% reduction in DKA risk.
Continuous ketone monitoring has many potential applications, including:
- Hyperglycemia troubleshooting for pump users
- Managing glucose levels during an illness
- Pregnancy safety
- Safe use of SGLT-2 inhibitors
- Tracking stage changes in early T1D
- Implementation of ketogenic diets
Early detection of ketones allows for effective self-treatment. Experts recommend taking an insulin injection (10-20% greater than the usual correction dose), fluids, carbohydrate intake (15-30g every 2 hours), and switching to fresh insulin and a fresh infusion set if using a pump.
SGLT-2 users should discontinue use right away. Those who are ketotic should head for an emergency room or urgent care if the situation does not improve within a few hours.
Exercise Discoveries:
As an exercise physiologist (and workout fanatic), I was tickled to find a number of research presentations that focused specifically on exercise.
- The negative effects of long periods of sitting were emphasized. One study showed that taking short (1-5 min) activity breaks, also called exercise “snacks”, every 30 minutes or so helps to improve glycemic control and lowers overall risk of death. Another study showed that engaging in at least 150 minutes of moderate-to-vigorous physical activity offsets the effects of lots of sitting in terms of cardiovascular mortality and all-cause death – good news for those of us with sedentary jobs.
- Simulation models demonstrated that AID (automated insulin delivery) systems have the ability to prevent delayed-onset hypoglycemia following exercise in people with T1D simply by making automated adjustments based on heart rate changes. This could play a major role in someday linking AID systems with heart rate monitors.
- For those who wonder why their glucose tends to rise after a bout of prolonged exercise, the answer may have been found. It seems that depletion of glycogen (sugar stored in muscles and the liver), which is common during endurance sports, causes the body to switch over to fat metabolism for a period of time. Not only can this produce a short-term rise in blood sugar, it can also lead to modest ketone production.
- What is the best time of day to exercise? Many people find that early morning works best for long-term adherence as well as glucose control. But performance is another story. Apparently, peak cardiovascular performance takes place about 9-12 hours after waking (3-7pm for most people), as this is when the oxidative capacity of cellular mitochondria is maximized. Since this coincides with the ability to burn glucose at a rapid rate, this may also explain why glucose levels tend to drop significantly when exercise is performed later in the day.
- High-intensity interval training (HIIT) has become popular in recent years. Alternating brief periods of very-high-intensity exercise with longer periods of lower-intensity movement offers a number of important benefits. Compared to steady-state moderate-intensity exercise, HIIT produces:
- Better cardiac function
- Lower blood lipid levels
- Greater glucose time-in-range
- Improved fat and carbohydrate oxidation
- A higher level of insulin sensitivity
- Enhanced workout satisfaction, according to participant surveys
- How does long-term muscle health in people with T1D compare with people without diabetes? Generally quite well. Although people with T1D have fewer mitochondria (energy-burning apparatus within cells), they are still able to compete at high levels athletically, and both upper and lower body strength is equivalent between T1s and people with diabetes. One area where T1s come up short is the ability to regenerate damaged muscle cells, particularly after age 40. This can result in prolonged muscle soreness and stiffness after high-impact and resistance-training exercise, prompting the need to skip a day or two between exercising the same muscle groups.
Slowing T1D Progression:
When caught before symptoms appear, the progression of type-1 diabetes can be slowed through use of the FDA-approved, IV-infused drug teplizumab (Tzield). Now, another medication appears to provide similar benefits.
Verapamil, an oral medication that has been used for decades to treat high blood pressure by reducing intracellular calcium levels, has been shown to impair the T-cells that contribute to beta cell destruction. In the CLEvr trial at Stanford University, low doses of verapamil given to children and adolescents with newly diagnosed (early Stage 3) T1D experienced a 30% increase in c-peptide levels, indicating an improvement in pancreatic insulin production.
What’s more, a positive c-peptide level was seen over the course of several years in kids who received the drug, indicating a prolonged “honeymoon” phase. Compared to other medications used to preserve beta-cell function, verapamil is very inexpensive and produces few side effects. Further studies will be conducted to explore verapamil as a potential treatment in the early stages of T1D.
And speaking of progression of T1D from Stage-2 (non-symptomatic) to Stage-3 (symptomatic), CGM can be an effective tool for determining the risk of imminent progression. Detailed analysis of CGM data among those who do and don’t progress within a given time frame has shown that:
- Average glucose is the worst predictor of progression to the next state of T1D
- Time in tight range (70-140) is a fair predictor
- Glucose variability (as measured by standard deviation) is the best predictor
Sleep Matters:
The role of sleep and circadian patterns in diabetes fascinates me to no end. As noted above, exercise performance is impacted by the time elapsed since waking up, and we have known for a long time that cortisol and leptin levels (which impair insulin action and appetite, respectively) and closely tied to sleep patterns. So I am always excited about any new research related to sleep.
Unfortunately, this session took place late in the afternoon, right in the middle of a thunderstorm. So I may have dozed off for a few minutes. Nevertheless, here’s what I was awake for.
For those who suspect that kids with T1D get less sleep than their peers, you’re right. About 30 minutes less per night, in fact. However, it is sleep quality, and not necessarily duration, that impacts glucose management. Research has shown that variability in the length/timing of sleep, and frequency of interruptions during sleep, both have a negative impact on time spent within one’s target glucose range.
Sleep duration, alone, does not. In fact, longer sleep duration actually correlates with less time-in-range among adolescents. Surprisingly, use of CGM and automated insulin delivery systems does not affect sleep duration or quality in kids (but we suspect it helps their parents!).
The goals, according to researchers, are to:
- Sleep about the same number of hours per night
- Go to sleep and wake up at about the same time each day
- Minimize the number of interruptions during the night
Finally… A Few of My Favorite Things:
Hardcore science and R&D aside, there were two things I uncovered at the ADA Scientific Sessions that hit me personally.
One is the news that the open-source (DIY) community has officially cracked the code to access Omnipod 5 insulin pumps. I even met a couple of programmers who were actually using Omnipod 5 with their Loop systems. This is big news for current and future users of open-source programs such as Loop, Trio, and Open-APS. We no longer need to worry about the availability of Dash pods (which Insulet plans to discontinue sometime in 2027). Next-gen iterations of the open-source apps should include OmniPod 5 as an option. So, if you’re the one hoarding all the Dash pods you can get your grubby hands on, you can stop.
Second, I found a hypo treatment that I actually like. So much so that I had to keep myself from snacking on it even when my blood sugar wasn’t low.
Produced by a German company called Zertus, Dextro Energy consists of 5gsquare tablets that are scored in the middle so that they are easy to break in half, and individually wrapped in cellophane packaging that is very easy to open when your dexterity ain’t all that great. 
Made of dextrose (with a tiny bit of vitamin C added), the tablets taste sweet and come in a variety of subtle flavors. And here’s something you old-timers can relate to: They taste like the white tablets BD used to make that came in foil blister packs. You’ll be hearing and seeing more from us about this product in the months ahead.
