How Metabolic Effects Could Shape Future Diabetes Care: Anne Komé, PharmD

At the American Diabetes Association 2026 Scientific Sessions, emerging research highlighted how diabetes therapies and metabolic hormones may offer insights beyond glucose control, according to Anne Komé, PharmD, CPP, BCACP, CDCES, a clinical pharmacist practitioner in the Endocrinology Clinic at the UNC Chapel Hill Medical Center, and moderator of the session “Perturb & Observe: What Pharmacologic Challenges Reveal about Human Metabolism.”

The oral session focused on how existing therapies and naturally occurring hormones affect metabolic pathways that could influence outcomes in patients with type 2 diabetes and related comorbidities.

One study she highlighted examined the use of oral ketones in patients with both type 2 diabetes and heart failure. Previous evidence had suggested that intravenous ketones may improve cardiac function in these patients, prompting investigators to explore whether oral formulations could provide similar benefits. According to Komé, the findings suggested comparable efficacy, raising the possibility of a more practical therapeutic option for patients managing both conditions.

Another presentation focused on irisin, a hormone released by skeletal muscle following physical activity. People with type 2 diabetes often have lower baseline levels of irisin, which has been associated with improved energy expenditure and enhanced insulin secretion. Researchers found that glucagon-like peptide-1 (GLP-1) receptor agonists may increase irisin levels at the molecular level, potentially contributing to the broad metabolic benefits already observed with these therapies.

The session also featured research investigating why sodium-glucose cotransporter 2 (SGLT2) inhibitors generally do not cause hypoglycemia. Investigators examined the effects of empagliflozin on processes such as gluconeogenesis and lipolysis to better understand the mechanisms that allow these agents to lower glucose while maintaining a low risk of hypoglycemia.

Komé said the findings reflected a broader shift in diabetes care toward selecting therapies based not only on glycemic control but also on comorbid conditions such as heart failure, chronic kidney disease, atherosclerotic cardiovascular disease, and obesity.

“What I love about diabetes is it's not one-size-fits-all, and you know what works now may not be the best option,” she said. “We can always pivot.”