Hybrid Closed Loop Effectiveness Trial in Adults With Type 1 Diabetes

NCT ID: NCT06236607

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-27

Study Completion Date

2028-09-30

Brief Summary

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Minoritized individuals with type 1 diabetes (T1D) have approximately 2% higher average A1c levels and twice the rate of hospitalizations, complications, and mortality as their white counterparts. However, the efficacy trials establishing the benefits of hybrid closed loop (HCL) pump therapy in T1D have been in more socially advantaged and predominantly non-Hispanic white patients. Use of this technology by individuals with T1D from underserved communities remains very low.

The investigators plan to conduct a randomized effectiveness trial - with broader eligibility criteria (including markedly elevated A1c) and longer follow up than the previous HCL efficacy trials - to evaluate the benefits, safety risks and treatment complications of HCL use in underserved adults with T1D. A comprehensive mixed-methods approach will be implemented to capture information about the user experience.

Participants will be randomized (3:1 ratio) to one of three FDA-approved HCL systems or continuous glucose monitoring and multiple daily injection therapy. Subjects will be followed for 9 months to collect data on effectiveness (glucose % time-in-range 70-180 mg/dL and % time \< 70 mg/dL), safety (diabetic ketoacidosis and severe hypoglycemia events) and patient experience using the systems (including benefits and burdens, the impact of life stressors on HCL use, and how the match between HCL system functionality and the individual's needs and expectations impacts on user experience).

Detailed Description

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Conditions

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Diabetes Mellitus, Type 1 Diabetes Complications

Keywords

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Hybrid closed loop (HCL) HCL pump therapy Multiple daily injections (MDI) Continuous glucose monitoring (CGM) Glucose time-in-range (TIR) Glucose management indicator (GMI) Diabetic ketoacidosis Patient reported outcomes (PRO) Ecological momentary assessment (EMA)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The trial will have a four-arm, parallel group design, with 9-month intervention phase. Adults with T1D on MDI therapy will be randomized in a 1:1:1:1 ratio to receive either: 1) BetaBionics iLet HCL system; 2) Insulet OP 5 HCL system; 3) Tandem Control IQ HCL system, or 4) Continued MDI. All trial participants will use CGM, Block randomization, within strata defined by A1c (\> vs ≤ 9%), using blocks of sizes 4 and 6, randomly permuted will be done. The groups are expected to have \>20% participants screening A1c \>9%.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Multiple daily injections

Participants randomized into this arm will use multiple daily injections of insulin.

Group Type ACTIVE_COMPARATOR

Study clinician/educator visit

Intervention Type OTHER

Participants will receive insulin dose and other diabetes management guidance.

BetaBionics iLet HCL system

Participants randomized into this arm will use the BetaBionics iLet HCL system.

Group Type EXPERIMENTAL

Device specific training

Intervention Type DEVICE

Device-specific training materials from the manufactures will be used. The study clinician/pump trainer will use a pump readiness check-list to evaluate the training needs.

Insulet OP 5 HCL system

Participants randomized into this arm will use the Insulet OP 5 HCL system.

Group Type EXPERIMENTAL

Device specific training

Intervention Type DEVICE

Device-specific training materials from the manufactures will be used. The study clinician/pump trainer will use a pump readiness check-list to evaluate the training needs.

Tandem Control IQ HCL system

Participants randomized into this arm will use the Tandem Control IQ HCL system.

Group Type EXPERIMENTAL

Device specific training

Intervention Type DEVICE

Device-specific training materials from the manufactures will be used. The study clinician/pump trainer will use a pump readiness check-list to evaluate the training needs.

Interventions

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Device specific training

Device-specific training materials from the manufactures will be used. The study clinician/pump trainer will use a pump readiness check-list to evaluate the training needs.

Intervention Type DEVICE

Study clinician/educator visit

Participants will receive insulin dose and other diabetes management guidance.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Clinical diagnosis of T1D for at least 12 months, on MDI for at least 6 months;
* A1c \>7.5% with no upper limit at screening (The investigator will consider the participant A1c level, compliance with current diabetes management, and prior acute diabetic complications. For this reason, there is no upper limit on A1c specified for eligibility);
* Able to understand, speak and read English (Given the language limitations in currently available pump interfaces, subjects who are not able to understand written English will not be eligible);
* Willingness to use either lispro or aspart insulin and no other insulin or new non-insulin diabetes pharmacotherapy during the study;
* Total daily dose of insulin of at least 10 units/day;
* Investigator believes that the participant will be able to successfully adhere to the study protocol.

Exclusion Criteria

* Current use of insulin pump or closed loop insulin pump system;
* Unable to provide informed consent;
* Currently taking hydroxyurea or have medical condition that may necessitate use of hydroxyurea;
* Current use of SGLT-2 inhibitors or sulfonylureas (If using GLP-1RA, pramlintide or metformin, must be on a stable dose for 3 months prior to enrollment);
* Tape allergy or skin condition precluding use of pump or CGM;
* Females who are pregnant or intending to become pregnant (since automated algorithm adaption for some of the HCL systems used in the trial cannot be configured to adjust to changing insulin demands of pregnancy);
* Current renal dialysis or plan to begin renal dialysis during study. Most recent eGFR \<30 ml/min is exclusionary (within last 2 years is acceptable);
* Active cancer treatment;
* Extreme visual or hearing impairment that would impair ability to use CGM and pump;
* Cognitive concerns;
* Significant psychiatric diagnosis or substance abuse disorder that in the investigator's opinion impairs ability of the individual to participate.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

Boston Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Howard Wolpert, MD

Role: PRINCIPAL_INVESTIGATOR

Boston Medical Center

Locations

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Boston Medical Center

Boston, Massachusetts, United States

Site Status RECRUITING

Montefiore Medical Center

The Bronx, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Howard Wolpert, MD

Role: CONTACT

Phone: 617-285-9096

Email: [email protected]

Astrid Atakov Castillo, BA

Role: CONTACT

Phone: 617-638-5906

Email: [email protected]

Facility Contacts

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Howard Wolpert, MD

Role: primary

Stefanie Juell

Role: primary

Other Identifiers

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H-44351

Identifier Type: -

Identifier Source: org_study_id

1R01DK138309-01

Identifier Type: NIH

Identifier Source: secondary_id

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