The Pediatric Artificial Pancreas Automated Initialization Trial

Not Applicable

Completed

• Conditions: Type 1 Diabetes
• Interventions: Device: AI-based Advisor system

• Registration Number: NCT06017089
• Lead Sponsor: Marc Breton

Brief Summary

The goal of this clinical trial is to obtain safety data and exploratory glycemic control data from use of an at-home closed loop control (CLC) system (t:slim X2 with Control-IQ Technology) with periodic parameter adjustments driven by an AI-based Advisor system in young children with Type 1 Diabetes. The main endpoints this study aims to answer is the safety and efficacy of the use of the AI-driven pump parameters. Participants will use the study system (pump and Continuous Glucose Monitor) in closed-loop mode for eight weeks.

Detailed Description

In this single-arm pilot study of an AI Advisor-driven closed loop system initiation and parameter adaptation in youth age 2 to \<6 years old, participants will use the Tandem t:slim X2 with Control-IQ and t:connect mobile application and Dexcom G6 or G7 system, connected to the University of Virginia (UVA) cloud-based Physician Dashboard for eight weeks at home.The key safety outcomes are adverse events related to hypoglycemia and hyperglycemia, CGM-measured time spent below 54mg/dL, and CGM-measured time spent above 250 mg/dL. CGM-measured endpoints will be tested against baseline for non-inferiority.Glycemic outcomes including time in target range 70-180 mg/dL (TIR) and various other CGM measures of hypo- and hyperglycemia will be assessed and tested for superiority against baseline and a matched historical control population from the prior PEDAP study that did not involve the use of any AI-driven pump parameters. Up to 45 screened participants with the goal of at least 30 participants completing the study pump use period.

Study Timeline

• Study First Submitted: 2023-08-18
• Study First Submitted QC: 2023-08-23
• Study First Posted: 2023-08-30
• Study Start: 2023-11-10
• Primary Completion: 2024-06-17
• Study Completion: 2024-06-17
• Status Verified: 2024-09
• Last Update Submitted: 2024-09-25
• Last Update Posted: 2024-09-30

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 33

Inclusion Criteria

1. Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least 1 month
2. Familiarity and use of a carbohydrate ratio for meal boluses
3. Age ≥2 and <6 years old
4. Using a Dexcom CGM at the time of enrollment, with use on at least 21 out of the prior 28 days
5. Living with one or more parent/legal guardian knowledgeable about emergency procedures for severe hypoglycemia and able to contact emergency services and study staff
6. Parent/guardian has a phone that can run the Tandem t:connect Mobile App (typically Android 10 or above or iPhone Operating System (iOS) 15 or above)
7. Willingness to use the t:connect Mobile App as needed during the study and ensure connectivity for a data upload at least once per day
8. Investigator has confidence that the parent can successfully operate all study devices and is capable of adhering to the protocol
9. Willingness to switch to lispro (Humalog) or aspart (Novolog) if not using already, and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study for participants using a study162 provided Tandem pump during the study
10. Total daily insulin dose (TDD) at least 5 Units/day
11. Body weight at least 20 pounds (lbs)
12. Willingness not to start any new non-insulin glucose-lowering agent during the course of the trial
13. Participant and parent(s)/guardian(s) willingness to participate in all training sessions as directed by study staff
14. Parent/guardian proficient in reading and writing English
15. Live in the United States, with no plans to move outside the United States during the study period

Exclusion Criteria

1. Concurrent use of any non-insulin glucose-lowering agent (including GLP-1 agonists, Symlin, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylureas)
2. Hemophilia or any other bleeding disorder
3. History of >1 severe hypoglycemic event with seizure or loss of consciousness in the last 3 months
4. History of >1 DKA event in the last 6 months not related to illness, infusion set failure, or initial diagnosis
5. History of chronic renal disease or currently on hemodialysis
6. History of adrenal insufficiency
7. Hypothyroidism that is not adequately treated in the opinion of the investigator
8. Use of oral or injectable steroids within the last 8 weeks
9. Known, ongoing adhesive intolerance
10. Plans to receive blood transfusions or erythropoietin injections during the course of the study
11. A condition, which in the opinion of the investigator or designee, would put the participant or study at risk
12. Participation in another pharmaceutical or device trial at the time of enrollment or during the study
13. Having immediate family members employed by Tandem Diabetes Care, Inc. or Dexcom, Inc., or having a direct supervisor at place of employment who is also directly involved in conducting the clinical trial (as a study investigator, coordinator, etc.); or having a first-degree relative who is directly involved in conducting the clinical trial

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
AI Advisor-driven at-home closed loop system initiation and parameter adaptation	AI-based Advisor system	In this single-arm intervention trial, all participants will use the study system (t:slim X2 with Control-IQ Technology and Dexcom Continuous Glucose Monitor) in closed-loop mode for 8 weeks at home with periodic parameter adjustment driven by an AI-based Advisor system.

Primary Outcome Measures

Name	Time	Method
Hierarchical Efficacy Endpoints (tested for superiority compared with baseline) CGM Measured	8 weeks	% Time \<54 mg/dL
Percentage below 54 mg/dL	8 weeks	Alternative Hypothesis: The difference in mean CGM-measured % below 54 mg/dL between the 8 weeks follow-up and baseline is less than +0.5%.
Percentage above 250 mg/dL	8 weeks	Alternative Hypothesis: The difference in mean CGM-measured % above 250 mg/dL between the 8 weeks follow-up and baseline is less than +3%.

Secondary Outcome Measures

Name	Time	Method
Total daily insulin	8 weeks	Total daily insulin (units/kg)
Binary outcome 1	8 weeks	% Time in range 70-180 mg/dL improvement from baseline to 8 weeks ≥5%
Binary outcome 2	8 weeks	% Time in range 70-180 mg/dL improvement from baseline to 8 weeks ≥10%
CGM Measured Time in Range	8 weeks	The percent of time spent within range, 70 mg/dL-140 mg/dL.
Basal Insulin	8 weeks	Percentage of total insulin delivered via basal administration.
CGM Measured	8 weeks	Weekly hypoglycemic event rate
Binary outcome 3	8 weeks	% Time in range 70-180 mg/dL \>70% and % time \<70 mg/dL \<4%

Trial Locations

Locations (3)

Barbara Davis Center, University of Colorado; 🇺🇸 Aurora, Colorado, United States

Stanford University; 🇺🇸 Stanford, California, United States

University of Virginia; 🇺🇸 Charlottesville, Virginia, United States