Welcome to OneGuild Pulse. Once a month, I'll send you a short letter and three to five things from across the diabetes innovation landscape that I think are worth your attention. Five thousand papers a year in this field, and most of us only read the ones in our own corridor. Pulse is the corridor between corridors.
— Nadège Sheehan, PhD
Welcome to OneGuild Pulse. Once a month, I'll send you a short letter and three to five things from across the diabetes innovation landscape that I think are worth your attention. Five thousand papers a year in this field, and most of us only read the ones in our own corridor. Pulse is the corridor between corridors.
— Nadège Sheehan, PhD
In this Issue
A target trial emulation in *Nature Medicine* (March 2026) followed 174,678 adults with type 1 diabetes in a US electronic health record network. Patients who initiated a GLP-1 receptor agonist had a five-year MACE risk of 4.3% versus 5.0% on standard care (HR 0.85, 95% CI 0.77–0.95), and a meaningful reduction in end-stage kidney disease. T1D was excluded from every landmark GLP-1 cardiovascular outcomes trial; this is the first large signal that the cardiorenal benefit travels into a population the original evidence base ignored.
Observational, not randomized — the usual caveats apply, and the hypoglycemia and DKA signals from the older ADJUNCT trials still deserve attention. But for endocrinologists, nephrologists, and T1D registries, this is the kind of result that changes which questions get asked next.
A five-year retrospective from an NCI-designated comprehensive cancer center, published in the *Journal of the American Podiatric Medical Association* (2026), evaluated a coordinated podiatric care and patient-education program for type 2 diabetic patients undergoing active treatment for prostate, breast, colorectal, lymphoma, leukemia, thyroid, or lung cancers. The framing is what makes the study interesting: in this population, a minor foot infection can force suspension of chemotherapy. Limb preservation is no longer just about the limb. This is exactly the kind of cross-specialty work that rarely makes it into the high-impact journals and almost never travels from podiatry into oncology. Worth flagging to the oncology colleagues who don't yet think of the diabetic foot as their problem.
Sequel Med Tech's twiist AID system (powered by Tidepool) was recognized this spring in the 2026 MedTech Breakthrough Awards. The device's distinguishing feature is technical rather than commercial: it directly measures the volume of insulin actually delivered with every micro-dose, rather than inferring it from pump mechanics. For anyone who has spent time on closed-loop algorithm development, the implication is straightforward — you can close a loop more tightly when the input variable is measured rather than estimated.
Explore breakthroughs in diabetes treatment!A consolidated picture from 2025 and early 2026 is now visible: in Vertex's FORWARD-101 trial, ten of twelve participants with type 1 diabetes no longer required exogenous insulin following stem-cell- derived islet therapy. Sana Biotechnology has separately shown engineered islet survival without immunosuppression at six months, in a single patient. Breakthrough T1D-funded work at MUSC is now testing a two-part approach pairing lab-made beta cells with custom-engineered immune cells designed to protect them, again without systemic immunosuppression. The headlines write themselves. The science is harder: small numbers, short follow-up, and the immunological problem is the one that has defeated this field for forty years. But this is the first time in those forty years that "insulin independence" has appeared in trial data without a footnote about transplant immunosuppression.
A glucokinase activator approved in China — and what happens when it arrives. Hua Medicine's dorzagliatin is the world's first approved drug in this class for type 2 diabetes, on the market domestically since 2022. The company has now completed a phase 1a trial of a once-daily prodrug (HM-002-1005) in US patients with T2D, with a phase 1b multiple ascending dose study planned. Glucokinase activators have been a graveyard of side-effect failures for two decades; if this one survives the US clinical pathway, it matters not just because of the molecule but because of where the innovation came from. Worth keeping an eye on.
