The landscape of diabetes management trials in the US
The past few years have produced a wave of clinical studies that target the two biggest frustrations people with type 2 diabetes face: keeping A1C in range and managing weight without turning life into a constant math problem. At the 2026 Scientific Sessions of the American Diabetes Association, held in New Orleans, researchers presented trial data for zenagamtide, a single-molecule peptide that activates both GLP-1 and amylin receptors. In a phase 2 dose-finding study, adults starting from a baseline A1C of 7.8 percent saw an estimated mean change of up to 1.71 points with the 40 mg dose, alongside weight loss reported as high as 14.6 percent. That combination is meaningful because it points toward a future where one injection could address blood sugar and weight in a single mechanism.
Equally striking is the shift toward oral options. The SOLSTICE trial, sponsored by AstraZeneca and presented in June 2026, enrolled 406 adults with type 2 diabetes across nine countries, including US sites, to test a new oral GLP-1 pill. The rationale is simple: many patients avoid injectable treatments because of injection anxiety or inconvenience. An oral pill that delivers comparable blood sugar control could remove a major barrier. Around the same time, another oral non-peptide GLP-1 medication called orforglipron was approved in the United States for weight management, signaling that regulators and manufacturers are both moving toward convenience without sacrificing effectiveness.
For people who already use insulin, the news is just as promising. A randomized trial published in the New England Journal of Medicine examined automated insulin delivery (AID) in adults with insulin-treated type 2 diabetes. Over 13 weeks, 319 patients were assigned either to an automated system paired with continuous glucose monitoring (CGM) or to their previous insulin method plus CGM. The AID group dropped A1C by 0.9 percentage points, from 8.2 to 7.3 percent, while the control group improved by only 0.3 points. Perhaps more telling, the percentage of time spent in the target glucose range of 70 to 180 mg/dL climbed from 48 to 64 percent in the AID group, versus a minimal change in the control group. These are the kinds of numbers that turn a theoretical gadget into a practical daily tool.
A comparison of emerging options from recent trials
| Option | What the trial showed | Best suited for | Strengths | Current limitations |
|---|
| Oral GLP-1 pill (SOLSTICE) | Improved blood sugar control with easier dosing in 406 adults | People avoiding injections | Pill format, strong glucose response, less injection burden | Newer product, long-term data still building |
| Zenagamtide injection | Up to 1.71-point A1C reduction and up to 14.6% weight loss | People with type 2 diabetes and weight concerns | Dual receptor action in one molecule | Requires injection, phase 2 stage |
| Automated insulin delivery (AID) | 0.6-point A1C advantage over standard care at 13 weeks | Insulin users with type 2 diabetes | More time in range, less daily guesswork | Requires training, device cost considerations |
| Omnipod M System | Feasibility and safety testing in adults aged 16-70 | Adults open to tubeless automation | No tubes, algorithm optimizes delivery | Early-stage trials, limited availability |
Practical takeaways from the trial data
1. Automated systems are no longer just for type 1 diabetes
For years, automated insulin delivery was framed almost exclusively around type 1 diabetes. The recent randomized trial flips that assumption. For an American adult with insulin-treated type 2 diabetes, the jump from 48 to 64 percent time in range is the difference between constant vigilance and nights of uninterrupted sleep. Insulet presented its EVOLUTION 3 feasibility study at the ADA 2026 sessions, exploring fully closed-loop technology for type 2 diabetes, and the company's STRIVE results for the Omnipod 6 are designed to deliver stronger glucose outcomes with less user effort. The direction is clear: devices are learning to do the adjusting, so patients do not have to.
2. Oral GLP-1 pills could widen the treatment door
Not everyone with type 2 diabetes wants to manage a syringe. Sarah, a 52-year-old teacher in Columbus, Ohio, told her endocrinologist she had put off GLP-1 therapy for two years because the idea of weekly injections made her uncomfortable. When her clinic enrolled her in a site associated with oral GLP-1 research, she saw her A1C move closer to her target range within a few months. Her story mirrors the core promise of the SOLSTICE results: if the pill performs in real-world settings the way it did in the trial, adherence could improve simply because the delivery method is less intimidating.
3. Weight and blood sugar are being treated as one problem
The zenagamtide data highlight a broader trend in diabetes management trials: researchers no longer treat glucose control and weight as separate tracks. A single molecule that hits both GLP-1 and amylin receptors offers a more streamlined approach, and the reported weight loss of up to 14.6 percent at higher doses is substantial for a population where excess weight often complicates insulin sensitivity. For Americans who have tried diet after diet, the possibility of a treatment that supports both goals is genuinely motivating.
How to use these findings in your own care plan
Reading trial results is useful, but applying them is what changes outcomes. Consider these steps when you talk to your care team:
- Ask about AID if you use insulin. If your A1C is above target despite multiple daily injections, ask your endocrinologist whether an automated insulin delivery system or a tubeless option like the Omnipod M System could fit your routine. The NEJM data suggest a real advantage in time in range.
- Bring up oral GLP-1 options. If injection anxiety has been your barrier, mention that oral GLP-1 pills are now in advanced trials and one weight-management version has already reached the US market. Your clinician can help you determine whether an oral option is appropriate and what coverage might look like under your plan.
- Use continuous glucose monitoring to see your own patterns. Several CGM systems are available in the United States, including options that require a prescription and over-the-counter versions for adults with type 2 diabetes who do not use insulin. Seeing your glucose in real time helps you and your doctor make decisions grounded in your actual daily life rather than a lab visit every three months.
- Check local trial participation. Major academic medical centers and regional diabetes clinics across the country host studies like the ones described here. ClinicalTrials.gov lists active and completed studies, and many sites cover the cost of study devices and monitoring supplies during participation. If you are interested, ask your care team whether they know of enrolling studies in your area.
Cost is often the first question that comes to mind, and the picture is evolving. Medicare has begun covering GLP-1 medications for eligible beneficiaries, with some qualifying enrollees seeing a monthly copay around $50 under the BALANCE Initiative, while the oral weight-management versions have been discussed at roughly $149 per month under negotiated agreements. For diabetes-indicated injectable GLP-1s, monthly out-of-pocket costs for Medicare and Medicaid enrollees have been described in the range of $245 under these arrangements. These figures vary by plan and eligibility, so the practical move is to check your own coverage rather than assume a number. What matters most is that cost conversations are happening openly, and trial participation can be one way to access newer technology while it is still being studied.
Moving from reading to doing
The trials described here share a common thread: they are designed around the real frustrations of people living with diabetes. Less injection burden, more automated support, and a clearer link between weight and glucose control are not abstract research goals. They are answers to the questions patients bring to clinic visits every week.
If your current routine leaves your A1C higher than you would like, or if you have been avoiding a treatment because of how it is delivered, the evidence now supports having a fresh conversation with your provider. Bring the numbers from these studies, ask what applies to your situation, and check whether a nearby site is enrolling participants. The science is moving quickly, and the most practical way to benefit from it is to put yourself in position to hear about options the moment they become available.
For Americans living with diabetes, the takeaway is encouraging: treatment is becoming more convenient, more automated, and more responsive to the whole person. The next step is a short one, and it starts with a single appointment.
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