In this week’s issue of The Savvy Diabetic:
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- What’s Next for Omnipod
- BetaBionics’ iLet and MAUDE Red Flag on Severe Hypos
- Breakthrough T1D Awards $1.5 Million Grant to Blue Circle Health
- Fully closed-loop systems: can people with type 1 diabetes just do it?
- Standard of Care: Who Defines it, How, and Why it Matters
- Microbiome study hints that fibre could be linked to better sleep
- How small changes to the way you breathe can transform your health
What’s Next for Omnipod by Justin Eastzer for Diabetech.com, 16 January 2026.
Insulet’s Chief Operating Officer, Eric Benjamin, at CES 2026, breaks down the company’s latest announcements and future roadmap for automated insulin delivery, including a new lower glucose target of 100 mg/dL. Explore Omnipod Discover, a new data and insights platform designed for both users and healthcare providers. And learn about Omnipod 6, including a next-generation algorithm, a single pod platform, and improved connectivity. Finally, what’s beyond Omnipod 6, including the future of fully closed-loop insulin delivery on Omnipod.
BetaBionics’ iLet and the MAUDE Red Flag: The Severe Hypo Signal You Can’t Ignore by Tim Street for Diabettech.com, 22 January 2026.
Earlier in January, BetaBionics’ share price took a very visible hit. The immediate catalyst was a “numbers” story: the company pre-announced Q4 revenue and disclosed that new patient starts (a key leading indicator for future pump+consumables revenue) came in below Street expectations, prompting at least one prominent downgrade and a sharp move in the stock. But in parallel, a different story was bubbling up in patient channels: posts about insulin overdosing, “the algorithm chased me into the floor,” and—on the flip side—periods of stubborn hyperglycemia after corrections, suspends, or after the system “learned” the wrong thing.
On Reddit, the iLet conversation often bifurcates. Some users describe a genuine reduction in cognitive load and better outcomes. But a recurring critical theme is perceived over-delivery around small snacks/meal announcements (“no true snack mode”), followed by volatility: lows → defensive suspension → rebound highs → more corrections.
This discussion is rather technical … follow the link below to dive into issues with both Beta Bionics and Insulet.
Why this matters for uptake: This is where the January share price story and the MAUDE story collide. People don’t churn AID systems because the algorithm isn’t perfect. They churn because the system is unpredictably scary or predictably annoying. AID adoption is a trust economy: users will tolerate quirks if they feel in control; they will not tolerate repeated events they interpret as the system trying to kill them. If the early iLet experience is mixed and a subset of users repeatedly run into “over-delivery” dynamics, you get the commercial pattern investors hate: early adopters sign up because the promise is compelling; some have a rough start; they post about it publicly; clinicians become cautious; uptake softens.
What do we take from this? Two things can be true at the same time: iLet is an ambitious attempt to simplify AID by removing the settings burden, and insulin pharmacodynamics punishes brave automation when it commits early and learns fast. You can’t unsend insulin. As David Kliff (Diabetic Investor) has said on multiple occasions: “These systems are 90% autopilot, but the patient still has to be the pilot for that critical 10%.”
As we said earlier in this article, removing knobs reduces burden on good days — but it can increase helplessness on bad days. Serious MAUDE narratives are not uniform across AID ecosystems: Let’s injury/death reports are disproportionately rich in UltraTier1 hypoglycemia escalation markers, while Omnipod’s serious narratives skew more toward DKA language under the same denominator lens. That’s not a scoreboard. It’s a set of failure-mode signatures worth interrogating further.
Read more: BetaBionics’ iLet and the MAUDE Red Flag: The Severe Hypo Signal You Can’t Ignore
Breakthrough T1D Awards $1.5 Million Grant to Blue Circle Health to Expand Access to Care for Underserved Adults with Type 1 Diabetes by BreakthroughT1D, 15 January 2026.
Breakthrough T1D, the leading global type 1 diabetes (T1D) research and advocacy organization, today announced a $1.5 million, three-year grant to Blue Circle Health, a nonprofit providing free, virtual care and support to adults living with T1D. The grant will expand access to care for underserved populations by assisting with navigation of Medicaid and other insurance coverage and strengthening continuity of care.
The grant aims to eliminate barriers to consistent, specialized care for adults living with T1D. Many individuals face coverage gaps, high costs, and insurance disruptions—challenges that have become more pressing amid recent changes to Medicaid and the Affordable Care Act marketplace. This investment is designed to help close those gaps by advancing Blue Circle Health’s community-centred care model, ensuring that people navigating periods of insurance instability can maintain access to the high-quality, specialized support they need.
“For adults living with type 1 diabetes, changes in insurance can mean losing access to the care and support they depend on every day,” said Lynn Starr, Chief Global Advocacy Officer at Breakthrough T1D. “This grant is about helping people stay connected to care when coverage changes or becomes harder to navigate. By supporting Blue Circle Health, we’re helping more adults, including those in underserved communities, get the guidance they need to manage their diabetes and stay healthy, especially during times of uncertainty.”
Read more: Breakthrough T1D Awards $1.5 Million Grant to Blue Circle Health
Fully closed-loop systems: can people with type 1 diabetes just do it? by Rayhan Lal, Katarina Braune, Dana M. Lewis, Lenka Petruzelkova, Martin de Bock & Sufyan Hussain and published in Diabetologia-Journal.org, 19 January 2026.
Automated insulin delivery (AID) systems have significantly advanced diabetes management, progressively reducing user interactions required for optimal glucose management. This review evaluates the current landscape and future potential of AID systems without meal announcement, with a particular focus on real-world insights from open-source AID (OS-AID) technologies.
Although commercial AID systems operating in hybrid closed-loop (HCL) mode have improved glycaemic outcomes, they remain dependent on manual meal announcement and user-driven actions, limiting their real-world utility. Current versions of OS-AID systems, developed by the diabetes community, can operate without meal announcements, offering an opportunity to move closer to truly automated diabetes management.
Recent clinical trials suggest that OS-AID systems can effectively manage glucose levels without meal announcements, achieving glucose levels comparable to those obtained with AID systems in HCL mode, with the potential to reduce management burden for users. However, practical challenges persist, including the need for expert configuration and handling of rapid changes in insulin sensitivity, such as during exercise or rapid glucose fluctuations following predicted low-glucose.
Read more: Fully closed-loop systems: can people with type 1 diabetes just do it?
Standard of Care: Who Defines it, How, and Why it Matters by Dan Heller for DanHeller.substack.com, 24 January 2026. A primer on the ADA’s “recommendations” … THIS IS AN EXCELLENT explanation and cautions!!!
Illustration source unknown
The American Diabetes Association’s “Standard of Care” audience is not your average consumer. It’s clinicians. The intention is that clinicians treat ratings as a starting point, then consider exceptions and carve-outs to determine whether the intervention is appropriate for a given patient. With very few exceptions, the term “standard of care” is rarely ever a simple statement of support with no carve-outs.
What is the ADA’s Authority? The ADA (founded 1940) is a professional medical association whose members are physicians who pay dues. Those dues-paying members are the intended recipients of the ADA’s communications. The ADA publishes peer-reviewed journals (Diabetes Care, Diabetes, Clinical Diabetes, and hers) and has established credentialing within the broader medical establishment. The ADA’s primary function, as it were, is to develop public policy that its members can use broadly and generally to address the entire population of people with various forms of diabetes. The ADA derives its influence from a combination of factors rather than any legal charter:
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- Professional legitimacy
- Institutional adoption: The real power comes from downstream adoption.
- Payer alignment
- The target audience is health care providers (HCPs), who are dues-paying members of the ADA and most of whom are either not trained in diabetes management, or (even if they are) don’t have the time and/or experience to give focused, dedicated attention to individuals, due to their overload of patients.
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According to a report by The American Diabetes Association, “the vast majority of individuals with diabetes receive care in primary care settings—not endocrinologists.” In America, the number of endocrinologists is at an all-time low and dropping fast, as medical students are not entering the field. Of those endocrinologists who do treat diabetes, the overwhelming majority treat Type 2 diabetes, which represents approximately 91% of all diabetes cases versus just 6% for Type 1. Given that T2D prevalence is roughly 20-25 times that of T1D, this leaves perhaps 15-25% of endocrinologists with meaningful T1D caseloads.
Put it all together: It’s a reasonable inference that only 5-10% of all endocrinologists are truly proficient in modern T1D management (AID systems, CGM interpretation, exercise physiology, carb-ratio optimization). With 2.1 million T1Ds in the US, chances are pretty high that your doctor is not in that 5-10% of endos that are truly experienced in T1D management.
Nothing in medicine is universally beneficial, and there are often hotly debated topics that are left unresolved. The takeaway is that “standard of care” is a phrase that deserves scrutiny, not reflexive acceptance. Who’s saying it? Based on what evidence? With what accountability? And—perhaps most importantly—does it apply to you? The best defense against borrowed authority is informed skepticism. Understand the difference between advocacy and clinical recommendation guidelines. Read the primary sources.
Read more: Standard of Care: Who Defines it, How, and Why it Matters
Microbiome study hints that fibre could be linked to better sleep by Chris Simms for NewScientist.com, 9 January 2026.
Links have previously been found between several sleep conditions and the gut microbiome, especially a lack of bacterial species diversity, suggesting that better eating might help you sleep better. A new systematic review of earlier studies might help plug that gap. Conducted by Zhe Wang at Shandong First Medical University in China and colleagues, it included 53 previous observational studies that compared the gut microbiota of people who experienced sleep disturbances with those of people who didn’t.
The researchers found that the overall number of different bacterial species – known as alpha diversity – was lower in people with a sleep condition. And in people with insomnia, obstructive sleep apnea or REM sleep behaviour disorder – a condition in which the muscle paralysis typical of REM sleep fails to occur, meaning sleepers physically act out their dreams – there was also a consistent reduction in the relative abundance of anti-inflammatory, butyrate-producing bacteria such as Faecalibacterium, and an increase of pro-inflammatory bacteria like Collinsella.
This suggests that dietary fibre is important because it is through the fermentation of such foods that Faecalibacterium produces butyrate. The butyrate then serves as an energy source for colon cells, strengthens the gut barrier and reduces inflammation. The results add weight to the importance of the gut microbiome to our sleep health and help shed light on potentially influential shifts in gut microbial signalling pathways linked to sleep-affecting processes such as hormone release, metabolism and inflammation, says Katherine Maki at the US National Institutes of Health in Maryland.
Read more: Microbiome study hints that fibre could be linked to better sleep
How small changes to the way you breathe can transform your health by Helen Pilcher for ScienceFocus.com, 2 January 2026.
With fancy names like coherent breathing or cyclic sighing, breathwork has become one of the fastest-growing trends in the wellness industry. Breathing studios are popping up in cities all over the world, and breathwork gurus, such as extreme sub-temperature athlete Wim Hof, are becoming household names. Bold claims are being made. “There’s a lot of hype about breathwork changing your life,” says Dr Guy Fincham from the University of Sussex, who studies the health benefits of breathwork. Some say it can boost the immune system, banish ill health and, perhaps, even lengthen life. But can it? What’s the truth behind these breathwork fads? And could we all benefit from breathing a little differently?
We all take about 20,000 breaths per day, but we don’t all breathe the same. In a recent study, scientists found that patterns of inhalation and exhalation are so distinct that they can be used to predict people’s identity, as well as health-related factors, such as depression and body mass index. Now, researchers are becoming increasingly interested in how people’s breathing patterns affect their bodies, as well as their state of mental and physical well-being. “Scientists have been studying breath in the context of meditation for decades,” says Dr Guy Fincham from the University of Sussex, “but now it’s being studied in its own right. I think we’re at a cusp where the amount of research is going to explode.”
Dr Richard Brown began using breathing techniques in his clinical practice in New York, as did his wife, fellow psychiatrist, Dr Patricia Gerbarg. Drawing on the latest neuroscientific research, Brown and Gerbarg put forward an explanation that helps to regulate two key parts of the nervous system: the sympathetic and parasympathetic systems.
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- The sympathetic system controls the body’s fight-or-flight reaction. It kicks in when we’re stressed, and it’s great in small doses. Adrenaline levels spike, heart rate speeds up, and inflammation levels decrease. This primes the body for action, but if we stay stressed for too long, pro-inflammatory pathways become activated, and inflammation levels rise.
- The parasympathetic system, on the other hand, calms the sympathetic system down. Controlled by the vagus nerve, which sends signals from the brain to the body, this system slows the heart rate and eases inflammation.
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According to their theory, breathwork helps these two systems balance, making everything optimal. Not too much sympathetic activation and just the right amount of parasympathetic activity.
Read more: How small changes to the way you breathe can transform your health
