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Cited by 286Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

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Multicenter Trial of a Tubeless, On-Body Automated Insulin Delivery System With Customizable Glycemic Targets in Pediatric and Adult Participants With Type 1 Diabetes

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Brown, Sue A., Forlenza, Gregory P., Bode, Bruce W., Pinsker, Jordan E., Levy, Carol J., Criego, Amy B., Hansen, David W., Hirsch, Irl B., Carlson, Anders L., Bergenstal, Richard M., Sherr, Jennifer L., Mehta, Sanjeev N., Laffel, Lori M., Shah, Viral N., Bhargava, Anuj, Weinstock, Ruth S., MacLeish, Sarah A., DeSalvo, Daniel J., Jones, Thomas C., Aleppo, Grazia, Buckingham, Bruce A., Ly, Trang T., Omnipod 5 Research Group, Brown, Sue A., Voelmle, Mary, Emory, Emma, Forlenza, Gregory P., Wadwa, R. Paul, Slover, Robert, Cobry, Erin, Messer, Laurel H., Berget, Cari, McCoy, Susan, Shah, Viral N., Akturk, Halis K., Schneider, Nicole, Joseph, Hal, Joshee, Prakriti, Beatson, Christie, Bode, Bruce W., Narron, Brooke, Lopez, Tricia, Pinsker, Jordan E., Church, Mei Mei, Castorino, Kristin, Piper, Molly, Perez, Jimena, Levy, Carol J., Lam, David W., Levister, Camilla, O’Malley, Grenye, Ogyaadu, Selassie, Arasaratnam, Dushyanthy, Plesser, Mitchell, Nosova, Emily, Bzdick, Suzan, Hansen, David W., Stone, Sheri L., Weinstock, Ruth S., Hirsch, Irl B., Trikudanathan, Subbulaxmi, Sanborn, Nancy, Khakpour, Dori, Carlson, Anders L., Criego, Amy B., Bergenstal, Richard M., Martens, Thomas, Grieme, Aimee, Hyatt, Jamie, Punel, Alina, Whipple, Diane, Sherr, Jennifer L., Van Name, Michelle, Brei, Michelle, Zgorski, Melinda, Steffen, Amy, Carria, Lori, Mehta, Sanjeev N., Laffel, Lori M., Roethke, Lindsay, Fisher, Margaret, Ortiz La Banca, Rebecca, Volkening, Lisa, Ambler-Osborn, Louise, Turcotte, Christine, Freiner, Emily F., Bhargava, Anuj, Borg, Lisa, MacLeish, Sarah A., Wood, Jamie R., Kaminski, Beth A., Casey, Terri L., Campbell, Wendy, DeSalvo, Daniel J., McKay, Siripoom, DeLaO, Mary Kylie, Villegas, Carolina, Jones, Thomas C., Russel Johns, Barry, Gore, Ashwini, Harvill, Leslie, Merritt, Kayla, Stanfield, Jennifer, Sheldon, Jennifer, Hichkad, Lisa, Burnett, Erica, Castelot, Alicia, Bounds, Lindsay, Preston, Kaitlyn, Goldfaden, Rebecca, Aleppo, Grazia, Kravarusic, Jelena, Bansal, Anupam, Buckingham, Bruce A., Ekhlaspour, Laya, Kingman, Ryan, Kivilaid, Kaisa, Kleve, Krista, Ly, Trang T., Dumais, Bonnie, Vienneau, Todd, Huyett, Lauren M., Lee, Joon Bok, O’Connor, Jason, Benjamin, Eric·2021·Diabetes Care
DOI 10.2337/dc21-0172PMC PMC8323171

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Abstract

OBJECTIVE: Advances in diabetes technology have transformed the treatment paradigm for type 1 diabetes, yet the burden of disease is significant. We report on a pivotal safety study of the first tubeless, on-body automated insulin delivery system with customizable glycemic targets. RESEARCH DESIGN AND METHODS: This single-arm, multicenter, prospective study enrolled 112 children (age 6–13.9 years) and 129 adults (age 14–70 years). A 2-week standard therapy phase (usual insulin regimen) was followed by 3 months of automated insulin delivery. Primary safety outcomes were incidence of severe hypoglycemia and diabetic ketoacidosis. Primary effectiveness outcomes were change in HbA1c and percent time in sensor glucose range 70–180 mg/dL (“time in range”). RESULTS: A total of 235 participants (98% of enrolled, including 111 children and 124 adults) completed the study. HbA1c was significantly reduced in children by 0.71% (7.8 mmol/mol) (mean ± SD: 7.67 ± 0.95% to 6.99 ± 0.63% [60 ± 10.4 mmol/mol to 53 ± 6.9 mmol/mol], P < 0.0001) and in adults by 0.38% (4.2 mmol/mol) (7.16 ± 0.86% to 6.78 ± 0.68% [55 ± 9.4 mmol/mol to 51 ± 7.4 mmol/mol], P < 0.0001). Time in range was improved from standard therapy by 15.6 ± 11.5% or 3.7 h/day in children and 9.3 ± 11.8% or 2.2 h/day in adults (both P < 0.0001). This was accomplished with a reduction in time in hypoglycemia <70 mg/dL among adults (median [interquartile range]: 2.00% [0.63, 4.06] to 1.09% [0.46, 1.75], P < 0.0001), while this parameter remained the same in children. There were three severe hypoglycemia events not attributable to automated insulin delivery malfunction and one diabetic ketoacidosis event from an infusion site failure. CONCLUSIONS: This tubeless automated insulin delivery system was safe and allowed participants to significantly improve HbA1c levels and time in target glucose range with a very low occurrence of hypoglycemia.

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Authors
Brown, S. A., Forlenza, G. P., Bode, B. W., Pinsker, J. E., Levy, C. J., Criego, A. B., Hansen, D. W., Hirsch, I. B., Carlson, A. L., Bergenstal, R. M., Sherr, J. L., Mehta, S. N., Laffel, L. M., Shah, V. N., Bhargava, A., Weinstock, R. S., MacLeish, S. A., DeSalvo, D. J., Jones, T. C., Aleppo, G., Buckingham, B. A., Ly, T. T., Omnipod 5 Research Group, Brown, S. A., Voelmle, M., Emory, E., Forlenza, G. P., Wadwa, R. P., Slover, R., Cobry, E., Messer, L. H., Berget, C., McCoy, S., Shah, V. N., Akturk, H. K., Schneider, N., Joseph, H., Joshee, P., Beatson, C., Bode, B. W., Narron, B., Lopez, T., Pinsker, J. E., Church, M. M., Castorino, K., Piper, M., Perez, J., Levy, C. J., Lam, D. W., Levister, C., O’Malley, G., Ogyaadu, S., Arasaratnam, D., Plesser, M., Nosova, E., Bzdick, S., Hansen, D. W., Stone, S. L., Weinstock, R. S., Hirsch, I. B., Trikudanathan, S., Sanborn, N., Khakpour, D., Carlson, A. L., Criego, A. B., Bergenstal, R. M., Martens, T., Grieme, A., Hyatt, J., Punel, A., Whipple, D., Sherr, J. L., Van Name, M., Brei, M., Zgorski, M., Steffen, A., Carria, L., Mehta, S. N., Laffel, L. M., Roethke, L., Fisher, M., Ortiz La Banca, R., Volkening, L., Ambler-Osborn, L., Turcotte, C., Freiner, E. F., Bhargava, A., Borg, L., MacLeish, S. A., Wood, J. R., Kaminski, B. A., Casey, T. L., Campbell, W., DeSalvo, D. J., McKay, S., DeLaO, M. K., Villegas, C., Jones, T. C., Russel Johns, B., Gore, A., Harvill, L., Merritt, K., Stanfield, J., Sheldon, J., Hichkad, L., Burnett, E., Castelot, A., Bounds, L., Preston, K., Goldfaden, R., Aleppo, G., Kravarusic, J., Bansal, A., Buckingham, B. A., Ekhlaspour, L., Kingman, R., Kivilaid, K., Kleve, K., Ly, T. T., Dumais, B., Vienneau, T., Huyett, L. M., Lee, J. B., O’Connor, J., & Benjamin, E.
Affiliations
  • Park Nicollet Health Services (US)
  • Joslin Diabetes Center (US)
  • Yale University (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2021-07-01
Volume
44
Issue
7
Pages
1630-1640
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc21-0172
PMC
PMC8323171
OpenAlex
W3166779635
Cited by
286
References
24
Citations by year
2026: 33 · 2025: 72 · 2024: 53 · 2023: 64 · 2022: 53 · 2021: 11
FWCI
33.78
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Insulet Corporation
  • National Institutes of Health (UL1TR001422, UL1TR001863)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P60DK020541, P30DK036836, P30DK020541, P30DK045735)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes, artificial pancreas, glycemic targets, HbA1c, time in range, hypoglycemia, diabetic ketoacidosis, type 1 diabetes in children, adults with type 1 diabetes, diabetes technology, glycemic control, safety and effectiveness, continuous glucose monitoring
MeSH terms
Adolescent, Adult, Aged, Blood Glucose, Child, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Middle Aged, Prospective Studies, Young Adult

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