About

Michael R. Rickels, M.D., M.S., is the Willard and Rhoda Ware Professor in Diabetes and Metabolic Diseases at the Perelman School of Medicine at the University of Pennsylvania. He serves as Medical Director of the Pancreatic Islet Cell Transplant Program at the Hospital of the University of Pennsylvania and is the Associate Director of the Center for Human Phenomic Science. Dr. Rickels also directs the Translational Research Program at the Institute for Diabetes, Obesity & Metabolism and oversees the Radioimmunoassay and Biomarkers Core at the Diabetes Research Center. His research focuses on patient-oriented diabetes studies aimed at understanding the pathogenesis of diabetes and hypoglycemia, as well as the in vivo mechanisms of new diabetes treatments. His work investigates islet function, glucose counterregulation, and the physiology of islet replacement, particularly in type 1 diabetes and pancreatogenic forms such as cystic fibrosis-related diabetes. Dr. Rickels employs methodologies including glucose tolerance tests, hyperinsulinemic clamps, and stable isotope tracers to quantify insulin secretion, sensitivity, and glucose fluxes. He is dedicated to translating research into clinical practice, especially in the areas of islet transplantation, cellular and artificial pancreas therapies, and improving diabetes care through innovative approaches.

Research topics

• Medicine
• Endocrinology
• Internal medicine
• Surgery
• Intensive care medicine

Selected publications

• SAT-621 Real World Utilization of GLP-1 Agonists in Adolescents and Young Adults With Type 1 Diabetes (T1D) and Obesity

  Journal of the Endocrine Society · 2025-10-01

  articleOpen access

  Abstract Disclosure: M. Munoz: None. T. Maxwell: None. S.M. Willi: None. M.R. Rickels: None. L. Katz: None. Background: Individuals with type 1 diabetes (T1D) face ongoing challenges to achieve recommended targets for glycemic control, further complicated by obesity and insulin resistance. Approximately 20% of individuals with T1D are obese. Glucagon-like peptide-1 receptor agonists (GLP1-RA), approved for type 2 diabetes and obesity, have emerged as potential adjunct therapies in T1D. Recent studies in adults with T1D and obesity demonstrate a reduction in HbA1c, weight, and total insulin dose (TDD). Hypothesis: We hypothesize that GLP1-RA are safe and effective in reducing weight and improving glycemic control in adolescents and young adults with T1D and obesity without increasing hypoglycemia. Methods: This retrospective cohort study was conducted at a large, urban academic children’s and adult hospitals. Patients were identified by an electronic health record search for GLP1-RA prescriptions between 2014 and 2024. Inclusion criteria were age 10-35 years with a diagnosis of T1D requiring insulin, obesity, and GLP1-RA treatment for 3 months.Primary outcomes included changes in BMI, and glucose time in range (TIR, 70-180 mg/dL) and time below range (TBR, <70 mg/dL) on continuous glucose monitor (CGM). Secondary outcomes included TDD, HbA1c, and weight change. Outcomes were analyzed by paired t-test two sample for Means. Results: We identified 24 individuals (14 F, 10 M; mean age 19.4 yrs and diabetes duration 10.7 yrs). Charts were reviewed on the date of GLP1-RA initiation and two subsequent follow up visits: 3-5 months and 6-10 months after GLP1-RA initiation.Pre-treatment values: HbA1c 8.0% (n=22), weight 105.3 kg (n=23), BMI 37.1 (n=24), TDD 1.04 units/kg (n=18), TIR 55% (n=20), TBR 3.2% (n=20). At 1st follow-up: HbA1c 7.5% (n=16, p=0.05*), weight -4.4% (n=22, p=0.04*), BMI -4.8% (n=21, p=0.04*), TDD 0.95 units/kg (n=18, p=0.06), TIR 62.9% (n=19, p=0.06), TBR 2.1% (n=19, p=0.56). At 2nd follow-up: HbA1c 7.4% (n=16, p=0.21), weight -5.6% (n=16, p=0.03*), BMI -6.1% (n=16, p=0.01*), TDD 1.0 units/kg (n=12, p=0.07), TIR 63.3% (n=15, p=0.06), TBR 2.8% (n=15, p=0.35). Values of statistical significance (p<0.05) marked by *.Side effects were predominantly gastrointestinal that were self-reported and without hospitalization. No episodes of severe hypoglycemia requiring assistance were documented and only 1 episode of DKA was observed in a patient with a history of insulin non-compliance. Conclusion: In this case series, patients experienced improvements in BMI and initial improvement in HbA1C. This study is limited due to size, documentation inconsistencies, and incomplete follow up from patients. Further studies should focus on larger populations powered to detect statistical differences and long-term effects. GLP1-RA offers a promising and safe adjunctive therapy for patients with T1D and obesity due to its effects on weight, BMI, and HbA1c. Presentation: Saturday, July 12, 2025

  PublisherOA PDFDOI

• Interoceptive Awareness Moderates the Relationship Between Hypoglycemia Exposure and Symptom Recognition in Adults with Type 1 Diabetes

  2025-12-30

  articleOpen access

  <p dir="ltr">Objective: Hypoglycemia exposure lowers the glycemic threshold for symptom recognition, contributing to impaired awareness of hypoglycemia (IAH). Interoceptive awareness, the ability to sense and interpret internal bodily sensations, is associated with lower risk of IAH. We tested the hypothesis that interoceptive awareness moderates the association between hypoglycemia exposure and glycemic threshold for autonomic symptom recognition.</p><p dir="ltr">Research Design and Methods: Adults with type 1 diabetes completed validated surveys assessing interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness, Version 2 [MAIA-2]) and the glycemic threshold for autonomic symptom recognition (Hypoglycemia Awareness Questionnaire [HypoA-Q] ‘Symptom Level’ subscale) and provided 30-day continuous glucose monitoring data. We used proportional odds logistic regression to examine whether the MAIA-2 “Attention Regulation” scale score (measuring the ability to sustain and control attention to bodily sensations) moderated the association between hypoglycemia exposure (%Time <60 mg/dL) and Symptom Level, adjusting for covariates.</p><p dir="ltr">Results: Among 717 participants (94% White, 52% female; mean±SD age: 44±15 years; diabetes duration: 25±15 years; 17% with IAH), 30-day hypoglycemia exposure (%Time <60 mg/dL) was 0.8±1.4% (11.5±20.2 minutes/day). Higher hypoglycemia exposure was associated with lower Symptom Levels (OR: 0.45, 95%CI [0.31, 0.66], P<0.001). Interoceptive awareness alone was not associated with Symptom Level (OR: 0.93, 95%CI [0.78, 1.12]), but higher interoceptive awareness attenuated the association between hypoglycemia exposure and Symptom Level (OR:1.14, 95%CI [1.01, 1.27], P< 0.05).</p><p dir="ltr">Conclusions: Interoceptive awareness moderated the association between hypoglycemia exposure and glycemic threshold for symptom recognition. Research is needed to examine whether interventions can improve interoceptive awareness and, thereby, restore awareness of hypoglycemia. </p>

  PublisherDOI

• Adults with Type 2 Diabetes Benefit from Automated Insulin Delivery Irrespective of C-peptide Level

  2025-09-15

  articleOpen access

  <p dir="ltr">Objective: The Center for Medicare and Medicaid Services (CMS) requires a low C-peptide level for insulin pump coverage unless the individual is beta cell autoantibody positive, which precludes coverage of automated insulin delivery (AID) systems for many people with type 2 diabetes.</p><p dir="ltr">Research Design and Methods: In the 2IQP randomized trial evaluating the t:slim X2 insulin pump with Control-IQ+ technology, adults with insulin-treated type 2 diabetes were categorized into ‘high C peptide’ (N=195) and ‘low C-peptide’ (N=59) groups based on CMS criteria. </p><p dir="ltr">Results: In the AID group, mean HbA1c decreased from baseline by 0.8% which was significantly greater than the control group with both high (P<0.001) and low C-peptide (P=0.02). Results were similar in participants ≥65 years old.</p><p dir="ltr">Conclusions: The benefit of AID is present with high and low C-peptide levels. Thus, requiring a low C-peptide level as a prerequisite for AID therapy is not warranted.</p><p><br></p>

  PublisherDOI

• Interoceptive Awareness Moderates the Relationship Between Hypoglycemia Exposure and Symptom Recognition in Adults With Type 1 Diabetes

  Diabetes Care · 2025-12-30

  articleOpen access

  OBJECTIVE: Hypoglycemia exposure lowers the glycemic threshold for symptom recognition, contributing to impaired awareness of hypoglycemia (IAH). Interoceptive awareness, the ability to sense and interpret internal bodily sensations, is associated with a lower risk of IAH. We tested the hypothesis that interoceptive awareness moderates the association between hypoglycemia exposure and glycemic threshold for autonomic symptom recognition. RESEARCH DESIGN AND METHODS: Adults with type 1 diabetes completed validated surveys assessing interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness, Version 2 [MAIA-2]) and the glycemic threshold for autonomic symptom recognition (Hypoglycemia Awareness Questionnaire Symptom Level subscale) and provided 30-day continuous glucose monitoring data. We used proportional odds logistic regression to examine whether the MAIA-2 Attention Regulation scale score (measuring the ability to sustain and control attention to bodily sensations) moderated the association between hypoglycemia exposure (percent time [%-time] <60 mg/dL) and symptom level, adjusting for covariates. RESULTS: Among 717 participants (94% White, 52% female, mean [SD] age 44 [15] years; diabetes duration 25 [15] years; 17% with IAH), 30-day hypoglycemia exposure (%-time <60 mg/dL) was 0.8 (1.4%) (11.5 [20.2] min/day). Higher hypoglycemia exposure was associated with lower symptom levels (odds ratio [OR] 0.45; 95% CI 0.31, 0.66; P < 0.001). Interoceptive awareness alone was not associated with symptom level (OR 0.93; 95% CI 0.78, 1.12), but higher interoceptive awareness attenuated the association between hypoglycemia exposure and symptom level (OR 1.14; 95% CI 1.01, 1.27; P < 0.05). CONCLUSIONS: Interoceptive awareness moderated the association between hypoglycemia exposure and glycemic threshold for symptom recognition. Research is needed to examine whether interventions can improve interoceptive awareness and, thereby, restore awareness of hypoglycemia.

  PublisherOA PDFDOI

• 45-OR: Evaluating the Effects of Hypoglycemia on Plasma Beta Amyloid in Type 1 Diabetes (T1D)

  Diabetes · 2025-06-13

  article

  Introduction and Objective: Insulin-induced hypoglycemia is a risk factor for cognitive decline and augments Alzheimer’s disease (AD) associated proteins in people with type 2 diabetes. During hyperinsulinemia, insulin and beta-amyloid (Aβ) may compete for insulin-degrading enzyme, possibly resulting in Aβ accumulation. We tested the effect of hyperinsulinemia and hypoglycemia on circulating Aβ (Aβ40 and Aβ42) in people with T1D. Methods: Plasma samples from people with T1D who underwent a hyperinsulinemic-hypoglycemic clamp were evaluated for Aβ and inflammatory markers at baseline, euglycemia, and hypoglycemia. Results: Of the 33 participants with T1D (mean age 29.3 years, diabetes duration 5.8 years), 49% were female. Aβ40 and Aβ42 (AD biomarkers) were significantly (p&amp;lt;0.001) upregulated between euglycemia and hypoglycemia but were unchanged between baseline and euglycemia (Figure 1A), indicating no effect of hyperinsulinemia per se. Levels of IL-8, IL-10, TNF-α, and pancreatic polypeptide were also significantly (p&amp;lt;0.05) altered between euglycemia and hypoglycemia (Figure 1B). The increase in Aβ42 correlated with age of the participant, decreased insulin sensitivity, and lower IL-2. Aβ40 was negatively correlated with IL-6 only. Conclusion: In people with T1D, hypoglycemia increases plasma Aβ40 and Aβ42 independent of hyperinsulinemia and appears unrelated to biomarkers of inflammation. Disclosure C. Glass: None. A. Bilal: None. F. Yi: None. C. Rowe: None. Y.O. Nunez Lopez: None. M.R. Rickels: Consultant; Vertex Pharmaceuticals Incorporated, Sernova, Corp. Research Support; Dompé, Tandem Diabetes Care, Inc. Consultant; Novo Nordisk. R.E. Pratley: Consultant; AbbVie Inc. Stock/Shareholder; Altanine, Inc. Consultant; Amgen Inc, AstraZeneca. Other Relationship; Bayer AG, Bayer Pharmaceuticals, Inc, Biomea Fusion. Consultant; Boehringer-Ingelheim. Other Relationship; Carmot Therapeutics, Inc, Corcept Therapeutics, Dompé, Eli Lilly and Company, Endogenex. Consultant; Endogenex. Other Relationship; Fractyl Health, Inc., Gasherbrum Bio, Inc. Consultant; Genprex, Getz Pharma, Hanmi Pharm. Co., Ltd, Intas Pharmaceuticals Ltd, Lexicon Pharmaceuticals, Inc, Lilly USA LLC. Speaker's Bureau; Lilly USA LLC. Other Relationship; Metavention, Novo Nordisk, Novo Nordisk. Speaker's Bureau; Novo Nordisk. Other Relationship; Pfizer Inc, Poxel SA. Consultant; Regeneron Pharmaceuticals. Other Relationship; Sanofi. Consultant; Scholar Rock. Other Relationship; Sun Pharmaceutical Industries Ltd.

  PublisherDOI

• Setting Expectations for Metabolic Outcomes of Total Pancreatectomy With Islet Autotransplantation: Validation From a Multicenter Cohort Study

  Diabetes Care · 2025-08-20

  letterOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Adults With Type 2 Diabetes Benefit From Automated Insulin Delivery Irrespective of C-Peptide Level

  Diabetes Care · 2025-09-15 · 6 citations

  article

  OBJECTIVE: The Centers for Medicare & Medicaid Services (CMS) requires a low C-peptide level for insulin pump coverage unless the individual is β-cell autoantibody positive, which precludes coverage of automated insulin delivery (AID) systems for many people with type 2 diabetes. RESEARCH DESIGN AND METHODS: In the Randomized Trial Evaluating the Efficacy and Safety of Control-IQ+ Technology in Adults With Type 2 Diabetes Using Basal-Bolus Insulin Therapy study evaluating the t:slim X2 insulin pump with Control-IQ+ technology, adults with insulin-treated type 2 diabetes were categorized into high C-peptide (n = 195) and low C-peptide (n = 59) groups based on CMS criteria. RESULTS: In the AID group, mean HbA1c decreased from baseline by 0.8%, which was significantly greater than in the control group with both high (P < 0.001) and low (P = 0.02) C-peptide levels. Results were similar in participants ≥65 years old. CONCLUSIONS: The benefit of AID is present with high and low C-peptide levels. Thus, requiring a low C-peptide level as a prerequisite for AID therapy is not warranted.

  PublisherDOI

• The Physiology of the WEight-Reduced State (POWERS) study: environmental, psychological, and social determinants of health

  International Journal of Obesity · 2025-09-25 · 1 citations

  articleOpen access

  Intentional weight loss is often followed by unintentional weight regain. The causes of weight regain are uncertain but may include a myriad of responses that result in increased hunger and decreased energy expenditure. An individual's psychological state and social and physical environments are also thought to influence weight regain in ways that can either support or derail weight loss maintenance. Funded by the National Institutes of Health, the Physiology of the WEight Reduced State (POWERS) study is a multi-center clinical trial aimed at describing the molecular, cellular, physiological, behavioral, environmental and psychosocial factors that may be associated with an individual's ability to maintain their new weight after weight loss. This report provides the rationale for and describes the environmental, psychological and social determinants of health measures used in the POWERS study.

  PublisherOA PDFDOI

• 370-P: Interoception Mitigates the Impact of Hypoglycemia Exposure on Symptom Recognition in Adults with Type 1 Diabetes

  Diabetes · 2025-06-13

  article

  Introduction and Objective: Hypoglycemia exposure lowers the glycemic threshold for symptom recognition (i.e., Symptom Level), contributing to impaired awareness of hypoglycemia (IAH). Interoception—the ability to sense and interpret bodily signals— is related to lower IAH risk. We tested the hypothesis that interoception moderates the association between hypoglycemia exposure and autonomic Symptom Level. Methods: Adults with type 1 diabetes (T1D) completed 30-day continuous glucose monitoring and assessments of interoception (MAIA-2) and Symptom Level (HypoA-Q). Proportional odds logistic regression tested if interoception moderated the association between hypoglycemia exposure (%Time &amp;lt;60 mg/dL) and Symptom Level, adjusting for covariates. Results: Among 717 adults with T1D (mean age: 44 ± 15 years; T1D duration: 25 ± 15 years), hypoglycemia exposure (%Time &amp;lt;60 mg/dL) was 0.8 ± 1.4%. Higher exposure was associated with lower Symptom Levels (OR: 0.48, CI: 0.33-0.71, p &amp;lt; 0.001). Interoception was not associated with Symptom Level (OR: 0.90, CI: 0.75-1.08). However, greater interoception reduced the impact of hypoglycemia exposure on Symptom Level (OR: 1.13, CI: 1.01-1.26, p &amp;lt; 0.05). Conclusion: Interoception moderated the association between hypoglycemia exposure and Symptom Level. Targeting interoception may offer a novel approach for prevention and management of IAH. Disclosure A.M. Matus: None. A. Agni: None. E. Hepworth: None. S.A. Amiel: Advisory Panel; Vertex Pharmaceuticals Incorporated. Other Relationship; Vertex Pharmaceuticals Incorporated. Research Support; National Institutes of Health. M.R. Rickels: Consultant; Vertex Pharmaceuticals Incorporated, Sernova, Corp. Research Support; Dompé, Tandem Diabetes Care, Inc. Consultant; Novo Nordisk. B. Riegel: None. J.A. Shaw: None. J. Speight: Advisory Panel; Vertex Pharmaceuticals Incorporated. Y. Lin: None. Funding National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007314); National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (U01DK135120); National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724)

  PublisherDOI

• A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes

  Obstetrical & Gynecological Survey · 2025-11-01

  article

  (Abstracted from N Engl J Med 2025;392:1801-1812) Automated insulin delivery (AID) systems improve outcomes in type 1 diabetes mellitus (T1DM), but their role in type 2 diabetes mellitus (T2DM) remains uncertain due to limited, small, or uncontrolled studies. Many patients achieve glycated hemoglobin (HbA1c) <7% with glucagon-like peptide 1 agonists or sodium-glucose cotransporter 2 inhibitors, but those who do not may benefit from AID.

  PublisherDOI

Recent grants

• University of Pennsylvania Diabetes Research Center

  NIH · $17.0M · 1997–2027

• Glucose counterregulation in long standing type 1 diabetes

  NIH · $3.8M · 2011–2023

• NIH Grant R01DK084383

  NIH · $1.9M · 2014

• NIH Grant M01RR000040

  NIH · $7.2M · 2007

• Evaluation of the entero-insular (incretin) axis in cystic fibrosis-competitive renewal.

  NIH · $147k · 2012–2020

Frequent coauthors

• Roy W. Beck

  Jaeb Center for Health Research

  161 shared

• Robin L. Gal

  Jaeb Center for Health Research

  147 shared

• Ruth S. Weinstock

  SUNY Upstate Medical University

  142 shared

• Linda A. DiMeglio

  Indiana University – Purdue University Indianapolis

  141 shared

• Eileen Markmann

  137 shared

• Davida F. Kruger

  Henry Ford Health System

  135 shared

• Grazia Aleppo

  135 shared

• Richard M. Bergenstal

  Park Nicollet Clinic

  132 shared