Evaluating the Safety and Effectiveness of the Omnipod Horizon™ Automated Glucose Control System in Patients With Type 1 Diabetes
Phase: NA
Conditions: Type 1 Diabetes Mellitus
Sponsor: Insulet Corporation

 
 
Omnipod 
Horizon™ Pivotal Study Protocol V5.0 
Confidential 
Page | 1 
 
 
Evaluating the Safety and Effectiveness of the Omnipod 
Horizon™ Automated Glucose Control System in Patients with 
Type 1 Diabetes 
 
 
IDE G190270 
Version 5.0 
November 12, 2020 
 
 
Insulet Corporation 
100 Nagog Park 
Acton, MA 01720 
 
 
 
 
Confidentiality Statement: 
The information in this document contains trade secrets and commercial information that are 
privileged or confidential and may not be disclosed unless such disclosure is required by 
applicable law or regulations. In any event, persons to whom the information is disclosed must 
be informed that the information is privileged or confidential and may not be further disclosed by 
them. These restrictions on the disclosure shall apply equally to all future information supplied to 
you, which is indicated as privileged or confidential. 
 
 

 
 
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PROTOCOL APPROVAL 
 
Evaluating the Safety and Effectiveness of the Omnipod 
Horizon™ Automated Glucose Control System in Patients with 
Type 1 Diabetes 
 
IDE G190270 
Version 5.0 
November 12, 2020 
 
 
 
______________________________________ 
Trang Ly MBBS FRACP PhD - SVP, Clinical and  
Medical Director, Insulet Corporation 
 
 
 
 
        _____________________ 
        Date 
 
 
______________________________________ 
Bonnie Dumais, RN – Senior Director, Clinical Affairs, 
Insulet Corporation 
 
 
 
        _____________________ 
        Date 
 
 
 
______________________________________ 
Julie Perkins - Senior Director, Quality and Regulatory,  
Insulet Corporation 
 
 
 
 
        _____________________ 
        Date 
 
 

 
 
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INVESTIGATOR STATEMENT 
 
Evaluating the Safety and Effectiveness of the Omnipod 
Horizon™ Automated Glucose Control System in Patients with 
Type 1 Diabetes 
IDE G190270 
November 12, 2020 
Version 5 
I agree to conduct the above referenced clinical study protocol in accordance with the 
design and specific provisions as designated in this protocol, the signed agreement with 
the Sponsor, applicable FDA regulations, and any conditions of approval imposed by an 
Institutional Review Board (IRB) or Food and Drug Administration (FDA). Modifications 
to the study protocol are acceptable only in the form of a protocol amendment, except 
when necessary to protect the safety, rights, or welfare of subjects. I agree to await 
Institutional Review Board (IRB) and Insulet approval for the protocol, informed consent 
and documentation to be presented to subjects before initiating the study pursuant to 21 
CFR Part 56, to obtain informed consent from subjects prior to their enrollment into the 
study pursuant to 21 CFR Part 50, to collect and record data as required by this 
protocol and case report forms, to report non serious and serious adverse events that 
may occur for any subject participating in this study under my care, to report product 
complaints for any of the devices utilized in this protocol, and to maintain study related 
documentation (regulatory documentation) for the period of time required. I agree to 
supervise all utilization of investigational study devices and to ensure their usage is only 
in connection with the Study. I agree to provide a Financial Disclosure Statement to 
Sponsor and will also notify Sponsor if my disclosed financial information changes 
during the Study and up to one year following the closure of the Study. I have read and 
understand the contents of this protocol. I agree to follow and abide by the requirements 
set forth in this document. 
I understand the information in this document contains trade secrets and commercial 
information that are privileged or confidential and may not be disclosed unless such 
disclosure is required by applicable law or regulations. In any event, persons whom the 
information is disclosed must be informed that the information is privileged or 
confidential and may not be further disclosed by them. These restrictions on disclosure 
will apply equally to all future information supplied to me, which is indicated as 
privileged or confidential. 
___________________________________  
Clinical Site Investigator Name (print) 
 
___________________________________  
 
__________________ 
Clinical Site Investigator Signature 
 
 
 
 
Date 

 
 
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PRINCIPAL CONTACTS 
 
Sponsor Contacts:  
Trang Ly, MBBS FRACP PhD 
SVP, Clinical and Medical Director 
Insulet Corporation 
100 Nagog Park 
Acton, MA 01720 
Office: 978-600-7628 
E-mail: tly@insulet.com 
 
Julie Perkins 
Senior Director, Quality and Regulatory 
Insulet Corporation 
100 Nagog Park 
Acton, MA 01720 
Office: 978-600-7951 
E-mail: jperkins@insulet.com  
 
Protocol Chairs: 
 
Bruce Buckingham, MD 
 
 
 
 
Professor, Pediatrics 
Division of Endocrinology and Diabetes 
 
Stanford School of Medicine 
 
 
 
 
780 Welch Road 
Palo Alto, CA 94305 
 
E-mail: bbendo@stanford.edu  
 
Sue Brown, MD 
Associate Professor of Medicine 
Division of Endocrinology 
University of Virginia 
Centers for Diabetes Technology 
560 Ray C. Hunt Drive, 3rd Floor 
Charlottesville, VA  22908 
Email: sab2f@virginia.edu 
 
 
 
 
 

 
 
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TABLE OF CONTENTS 
TITLE PAGE ......................................................…........................................................................1 
PROTOCOL APPROVAL ............................................................................................................... 2 
INVESTIGATOR STATEMENT ...................................................................................................... 3 
PRINCIPAL CONTACTS ................................................................................................................ 4 
TABLE OF CONTENTS ................................................................................................................. 5 
PROTOCOL SUMMARY ................................................................................................................ 8 
GLOSSARY OF ACRONYMS ...................................................................................................... 13 
1 
INTRODUCTION ................................................................................................................. 15 
2 
OMNIPOD HORIZON™ SYSTEM STUDY DEVICE OVERVIEW ...................................... 16 
2.1 
Device Description of the Omnipod Horizon™ System ................................. 16 
3 
HORIZON™ DATA PORTAL ............................................................................................... 20 
4 
RESULTS FROM FEASIBILITY STUDIES .......................................................................... 20 
5 
STUDY SUMMARY ............................................................................................................. 20 
5.1 
Study Purpose .............................................................................................. 20 
5.2 
Study Design ................................................................................................ 20 
6 
OBJECTIVES AND ENDPOINTS ........................................................................................ 28 
6.1 
Primary Safety Objective .............................................................................. 28 
6.1.1 
Primary Safety Endpoints .......................................................................... 28 
6.2 
Primary Effectiveness Objective.................................................................... 28 
6.2.1 
Primary Effectiveness Endpoints ............................................................... 28 
6.3 
Secondary Objective ..................................................................................... 28 
6.3.1 
Secondary Endpoints ................................................................................ 28 
6.4 
Exploratory Endpoints ................................................................................... 29 
6.5 
Patient Reported Outcomes .......................................................................... 30 
7 
SCREENING AND ELIGIBILITY .......................................................................................... 31 
7.1 
Visit 1 ............................................................................................................ 31 
8 
STANDARD THERAPY - PHASE 1 ..................................................................................... 34 
8.1 
Visit 2 ............................................................................................................ 36 
8.2 
Visit 3 ............................................................................................................ 37 
9 
HYBRID CLOSED-LOOP - PHASE 2 .................................................................................. 38 
9.1 
Challenge Visits ............................................................................................ 39 
9.2 
Visit 4 ............................................................................................................ 41 
9.3 
Visit 5 ............................................................................................................ 42 
9.4 
Visit 6 ............................................................................................................ 43 
9.5 
Visit 7 ............................................................................................................ 43 
9.6 
Visit 8 ............................................................................................................ 43 
9.7 
Visit 9 ............................................................................................................ 43 
9.8 
Visits 10, 11 and 12 ...................................................................................... 44 
9.9 
Visit 13 (End of Phase 2) .............................................................................. 44 
9.10 
Unscheduled Visits (Phase 2) ....................................................................... 45 

 
 
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9.11 
Recommencing After a Pause ...................................................................... 46 
9.12 
Early Withdrawal (Phase 2) ........................................................................... 47 
10 
HYBRID CLOSED-LOOP – PHASE 3 ................................................................................. 48 
10.1 
Visit 14 .......................................................................................................... 49 
10.2 
Visit 15 .......................................................................................................... 49 
10.3 
Visit 16 .......................................................................................................... 49 
10.4 
Visits 17 and 18 ............................................................................................ 50 
10.5 
Visit 19 .......................................................................................................... 50 
10.6 
Visit 20 .......................................................................................................... 50 
10.7 
Visit 21 .......................................................................................................... 50 
10.8 
Visit 22 .......................................................................................................... 51 
10.9 
Visits 23 (end of study) ................................................................................. 51 
10.10 
Unscheduled Visits (Phase 3) ................................................................... 51 
10.11 
Early Withdrawal (Phase 3) ....................................................................... 52 
10.12 
Lost to Follow-up ....................................................................................... 52 
11 
SPONSOR REPRESENTATIVES ....................................................................................... 52 
12 
SAFETY ............................................................................................................................... 53 
12.1 
Types of Known Risks and Benefits .............................................................. 53 
12.2 
Hypoglycemia/Hyperglycemia ....................................................................... 54 
12.3 
Adverse Events ............................................................................................. 54 
12.3.1 
Definitions ............................................................................................. 54 
12.3.2 
Reportable Adverse Events ................................................................... 56 
12.3.3 
Hypoglycemic Events ............................................................................ 57 
12.3.4 
Hyperglycemic/Ketotic Events ............................................................... 57 
12.3.5 
Relationship of Adverse Event to Investigational Device ....................... 58 
12.3.6 
Severity (Intensity) of Adverse Events ................................................... 58 
12.3.7 
Outcome of Adverse Events .................................................................. 59 
12.4 
Reportable Device Issues ............................................................................. 59 
12.5 
Timing of Event Reporting............................................................................. 60 
12.6 
Safety Oversight ........................................................................................... 61 
12.7 
Stopping Criteria ........................................................................................... 61 
12.7.1 
Participant Discontinuation of Study Participation .................................. 61 
12.7.2 
Criteria for Suspending or Stopping Overall Study ................................ 62 
12.8 
Data Safety Monitoring Board (DSMB).......................................................... 62 
12.9 
Medical Monitor ............................................................................................ 63 
13 
STATISTICAL CONSIDERATIONS ..................................................................................... 64 
13.1 
Definition of Phase 2 and Phase 2 Participation ............................................ 64 
13.2 
Objectives and Endpoints ............................................................................. 64 
13.2.1 
Primary Safety Objective ....................................................................... 64 
13.2.2 
Primary Effectiveness Objective ............................................................ 65 
13.2.3 
Secondary Objective ............................................................................. 66 
13.2.4 
Secondary Endpoints ............................................................................ 66 
13.3 
Sample Size ................................................................................................. 68 
13.3.1 
Primary Endpoint of A1C After at Least 6 Weeks of Continuous Phase 2 
Participation Compared to Baseline ...................................................................... 69 
13.3.2 
Primary Endpoint of Percentage of Time in Range 70-180 mg/dL During 
Phase 2 of Hybrid Closed-Loop Compared to Phase 1 ......................................... 69 
13.4 
Analysis Sets ................................................................................................ 70 

 
 
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13.4.1 
ITT (Intention to Treat) Analysis Set ...................................................... 70 
13.4.2 
mITT (modified Intention to Treat) Analysis Set ..................................... 70 
13.4.3 
PP (Per-Protocol) Analysis Set .............................................................. 70 
13.5 
Analysis of Primary and Secondary Endpoints .............................................. 70 
13.5.1 
Time in Range Endpoints ...................................................................... 71 
13.6 
Additional Data Analyses .............................................................................. 71 
13.7 
Safety Analyses ............................................................................................ 72 
13.7.1 
Evaluation of Adverse Events ................................................................ 72 
13.7.2 
Evaluation of Device Deficiencies ......................................................... 72 
13.8 
Baseline Characteristics ............................................................................... 72 
13.9 
General Statistical Methods .......................................................................... 72 
13.10 
Missing Data ............................................................................................. 73 
13.11 
Statistical Software ................................................................................... 73 
14 
DATA HANDLING AND QUALITY ASSURANCE ............................................................... 73 
14.1 
Electronic Case Report Forms (eCRFs) ........................................................ 73 
14.2 
Electronic Device Outputs ............................................................................. 73 
14.2.1 
PDM Data ............................................................................................. 73 
14.2.2 
CGM Data ............................................................................................. 74 
14.2.3 
BG and Ketone Meter Data ................................................................... 74 
14.3 
Subject Identifiers ......................................................................................... 74 
14.4 
Monitoring Responsibilities ........................................................................... 74 
14.5 
Inspection of Records ................................................................................... 74 
14.6 
Study Record Retention ................................................................................ 75 
14.7 
Device Accountability .................................................................................... 75 
15 
STUDY ETHICS AND CONDUCT ....................................................................................... 75 
15.1 
Role of the Sponsor ...................................................................................... 75 
15.2 
Ethical Conduct of the Study ......................................................................... 75 
15.3 
Institutional Review Board (IRB) ................................................................... 75 
15.4 
Informed Consent ......................................................................................... 76 
15.5 
Confidentiality ............................................................................................... 76 
15.6 
Modification of the Protocol ........................................................................... 77 
15.7 
Protocol Deviations ....................................................................................... 77 
15.8 
Study Reporting Requirements ..................................................................... 78 
15.9 
Selection of Investigators .............................................................................. 78 
15.9.1 
Financial Disclosure .............................................................................. 78 
15.9.2 
Investigator Documentation ................................................................... 78 
15.10 
Clinical Site Training ................................................................................. 79 
15.11 
Device Use ............................................................................................... 79 
15.12 
Device Returns ......................................................................................... 79 
15.13 
Policy for Publication and Presentation of Data ......................................... 79 
15.14 
Sponsor or Regulatory Agency Termination of the Study .......................... 80 
REFERENCES ............................................................................................................................. 81 
APPENDIX A ................................................................................................................................ 84 
 
 

 
 
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PROTOCOL SUMMARY 
Protocol title 
Evaluating the safety and effectiveness of the Omnipod Horizon™ Automated 
Glucose Control System in patients with type 1 diabetes 
Protocol ID 
G190270 
Purpose 
To evaluate the safety and effectiveness of the Omnipod Horizon™ Automated 
Glucose Control System in patients with type 1 diabetes.  
Design 
This study is a single-arm, multi-center, prospective clinical study  
Enrollment 
A total of up to 240 subjects will be enrolled in the study in order to obtain a 
minimum of 200 evaluable subjects.   
 
The study will consist of three phases:  
 
1) 14-day standard therapy outpatient phase (Phase 1) 
2) 13-week outpatient hybrid closed-loop phase (Phase 2) 
• 
Phase 2 excludes periods due to a study pause 
3) 12-month hybrid-closed-loop extension phase (Phase 3) 
 
Subjects will be enrolled across 12-20 clinical study sites. The 200 evaluable 
subjects will be comprised of two age cohorts of 100 subjects each as follows: 
 
• 
100 subjects aged 6-13.9 years 
• 
100 subjects aged 14-70 years 
Indication 
The Omnipod Horizon™ Automated Glucose Control System is a single 
hormone insulin delivery system intended for the management of diabetes in 
persons requiring insulin. Continuous subcutaneous insulin infusion may be 
delivered by user-defined settings (manual mode) or automatically adjusted in 
response to feedback from a continuous glucose monitor (CGM).  
 
The Omnipod Horizon™ System can automatically increase insulin delivery 
based on CGM sensor glucose values and can decrease or suspend delivery of 
insulin when the glucose value falls below or is predicted to fall below 
predefined threshold values. The Omnipod HORIZON™ System is 
interoperable with compatible iCGMs and ACE pumps. 
 
The Omnipod Horizon™ System is designed to assist patients with diabetes in 
achieving glycemic targets set by their health care providers.  
Study duration 
The study is expected to be completed within 30-months which includes clinical 
site initiation to completion of Phase 3 and all data entry and monitoring 
procedures. The sponsor intends to submit results from Phase 2 for marketing 
clearance after data collection for Phase 2 is complete. The results from Phase 
3 will be submitted separately.   
Investigational 
devices 
The Omnipod Horizon™ Automated Glucose Control System is comprised of 
the following components: 
• 
Omnipod Horizon™ tubeless, insulin delivery alternate controller enabled 
(ACE) pump (Pod) with the Horizon™ algorithm 

 
 
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• 
Omnipod Horizon™ Personal Diabetes Manager (PDM) which is a 
Samsung J3 locked down Android device that operates the Omnipod 
Horizon™ App.  
• 
Dexcom G6 - Continuous Glucose Monitoring (CGM) system  
Non-
investigational, 
commercially 
available devices 
• 
Contour® Next One blood glucose meter (Ascensia Diabetes Care, 5 Wood 
Hollow Road, Parsippany, NJ 07054 USA) 
• 
Precision Xtra ketone meter (Abbott Diabetes Care Inc., 1360 South Loop 
Road, Alameda, CA 94502 USA) 
Primary safety 
objective 
To evaluate the safety of the Omnipod Horizon™ Automated Glucose Control 
System in patients with type 1 diabetes   
Primary safety 
endpoints 
The primary safety objective will be evaluated by summarizing the following 
events during Phase 2, and separately during Phase 3:  
 
• 
Incidence rate of severe hypoglycemia (events per person months) 
• 
Incidence rate of diabetic ketoacidosis (DKA) (events per person months)  
Primary 
effectiveness 
objective 
To evaluate the effectiveness of the Omnipod Horizon™ Automated Glucose 
Control System. 
Primary 
effectiveness 
endpoints 
• 
A1C after at least 6 weeks of continuous Phase 2 participation compared to 
baseline 
• 
A1C at Visit 16, 19, 21, and 23 compared to baseline 
• 
Percentage of time in range (70-180 mg/dL) during Phase 2 and separately 
during Phase 3 of the hybrid closed-loop phase compared to Phase 1 
(standard therapy) 
Secondary 
objective 
To evaluate additional glycemic measures of effectiveness of the Omnipod 
Horizon™ Automated Glucose Control System  
Secondary 
endpoints 
The secondary objective will be evaluated using the following per subject 
endpoints with prespecified hypotheses: 
 
• 
Glucose metrics from system CGM during the hybrid closed-loop phase 
for Phase 2 will be compared to Phase 1 overall: 
• 
% of time > 180 mg/dL 
• 
% of time < 70 mg/dL 
 
Additional per subject secondary endpoints without prespecified hypotheses 
used to evaluate the secondary objective include: 
 
• 
A1C: 
• 
A1C after at least 8 weeks of continuous Phase 2 participation at 
the end of Phase 2 (Visit 13), at 6 months (Visit 16), and at the end 
of Phase 3 (Visit 23; approximately 15 months) 
• 
Change from baseline in A1C after at least 6 weeks of continuous 
Phase 2 participation, after at least 8 weeks of continuous Phase 2 
participation at the end of Phase 2 (Visit 13), at 6 months (Visit 16), 
and at the end of Phase 3 (Visit 23; approximately 15 months)  
• 
Proportion of subjects demonstrating an improvement from 
baseline in A1C after at least 6 weeks of continuous Phase 2 
participation, after at least 8 weeks of continuous Phase 2 

 
 
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participation at the end of Phase 2 (Visit 13), at 6 months (Visit 16), 
and at the end of Phase 3 (Visit 23; approximately 15 months) 
 
• 
Glucose metrics from system CGM during the hybrid closed-loop phase 
during Phase 2, and separately during Phase 3, will be compared to 
Phase 1 during the day, overnight and overall: 
 
• 
Mean glucose 
• 
% of time in range 70-180 mg/dL 
• 
% of time in range 70-140 mg/dL 
• 
% of time > 180 mg/dL 
• 
% of time ≥ 250 mg/dL 
• 
% of time ≥ 300 mg/dL 
• 
% of time < 70 mg/dL 
• 
% of time < 54 mg/dL 
• 
Standard deviation 
• 
Coefficient of variation 
 
• 
Percentage of time in hybrid closed-loop as proportion of overall device 
usage time during Phase 2, and separately during Phase 3 
• 
Glucose management indicator (GMI) based on overall mean glucose 
during Phase 2, and separately during Phase 3 will be compared to 
Phase 1 
• 
Insulin requirements during Phase 2, and separately during Phase 3 
will be compared to Phase 1: 
 
• 
Total daily insulin (TDI) (units, units/kg) 
• 
Total daily basal insulin (units, units/kg) 
• 
Total daily bolus insulin (units, units/kg) 
 
• 
Change from baseline in BMI (kg/m2) at end of Phase 2, and at end of 
Phase 3,   
 
Patient Reported 
Outcomes 
Various subject- and caregiver-completed questionnaires will be used to 
evaluate general and disease-specific quality of life, and device usability. 
Eligibility criteria 
Inclusion Criteria 
Subjects must meet all of the following criteria to be included in the study: 
1. Age at time of consent/assent 6-70 years 
2. Subjects aged < 18 years must be living with parent/legal guardian 
3. Diagnosed with type 1 diabetes for at least 6 months. Diagnosis is based on 
investigator’s clinical judgment 
4. Deemed appropriate for pump therapy per investigator’s assessment taking 
into account previous history of severe hypoglycemic and hyperglycemic 
events, and other comorbidities 
5. Investigator has confidence that the subject can successfully operate all 
study devices and is capable of adhering to the protocol 
6. Willing to use only the following types of insulin during the study: Humalog, 
Novolog, Admelog or Apidra during the study  
7. Must be willing to travel to and participate in meal and exercise 
challenges during 5-days of the hybrid closed-loop phase 
8. Willing to wear the system continuously throughout the study 
9. A1C <10% at screening visit 
10. Must be willing to use the Dexcom App on the Omnipod Horizon™ PDM as 

 
 
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the sole source of Dexcom data (with the exception of the Dexcom Follow 
App) during the hybrid closed-loop phase 
11. Subjects scoring ≥ 4 on the Clarke Questionnaire must agree to have an 
overnight companion, defined as someone who resides in the same home 
or building as the study subject and who can be available overnight 
12. Able to read and speak English fluently 
13. Willing and able to sign the Informed Consent Form (ICF) and/or has a 
parent/guardian willing and able to sign the ICF. Assent will be obtained 
from pediatric and adolescent subjects aged < 18 years per State 
requirements. 
 
Exclusion Criteria 
Subjects who meet any of the following criteria will be excluded from the study: 
1. A medical condition, which in the opinion of the investigator, would put the 
subject at an unacceptable safety risk 
2. History of severe hypoglycemia in the past 6 months 
3. History of DKA in the past 6 months, unrelated to an intercurrent illness, 
infusion set failure or initial diagnosis 
4. Diagnosed with sickle cell disease 
5. Diagnosed with hemophilia or any other bleeding disorders 
6. Plans to receive blood transfusion over the course of the study 
7. Currently diagnosed with anorexia nervosa or bulimia 
8. Acute or chronic kidney disease (e.g. estimated GFR < 45) or currently on 
hemodialysis 
9. History of adrenal insufficiency 
10. Has taken oral or injectable steroids within the past 8-weeks or plans to 
take oral or injectable steroids during the course of the study 
11. Unable to tolerate adhesive tape or has any unresolved skin condition in the 
area of sensor or pump placement 
12. Plans to use insulin other than U-100 insulin intended for use in the study 
device during the course of the study 
13. Use of non-insulin anti-diabetic medication other than metformin (e.g. GLP1 
agonist, SGLT2 inhibitor, DPP-4 inhibitor, pramlintide) 
14. Current or known history of coronary artery disease that is not stable with 
medical management, including unstable angina, or angina that prevents 
moderate exercise despite medical management, or a history of myocardial 
infarction, percutaneous coronary intervention, or coronary artery bypass 
grafting within the previous 12-months.  
15. For subjects >50 years old or with diabetes duration >20 years, abnormal 
electrocardiogram consistent with increased risk of arrhythmia, ischemia, or 
prolonged QTc interval (> 450 ms)  
16. Thyroid Stimulating Hormone (TSH) is outside of normal range with 
clinical signs of hypothyroidism or hyperthyroidism 
17. Pregnant or lactating, or is a woman of childbearing potential and not on 
acceptable form of birth control (acceptable includes abstinence, condoms, 
oral/injectable contraceptives, IUD or implant) 
18. Participation in another clinical study using an investigational drug or device 
other than the Omnipod Horizon™ Automated Glucose Control System 
within the preceding 30-days or intends to participate during the study 
period  
19. Unable to follow clinical protocol for the duration of the study or is otherwise 
deemed unacceptable to participate in the study per the investigator’s 
clinical judgment 

 
 
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Study schedule 
overview 
The study schedule consists of the following three phases: 
 
1) 14-day outpatient standard therapy phase (Phase 1) 
2) 13-week outpatient hybrid closed-loop phase (Phase 2) 
o 
A subset of subjects will participate in 5-days of supervised 
challenges 
o 
Phase 2 excludes periods due to a study pause 
3) 12-month hybrid closed-loop extension phase (Phase 3) 
 
Following subject screening, enrollment, and device training, subjects will 
commence the outpatient standard therapy phase of the study.  
 
Current Dexcom G6 CGM users may provide data from a 14-day period within 
the last 30 days. The CGM data meeting the minimum criteria must be the most 
recent data from the last 30-days. For non-G6 users, subjects will wear a study 
CGM, in blinded mode, to record glucose measurements over 14-days while 
subjects manage their diabetes at home per their usual routine and remaining 
on their current MDI or pump therapy, and sensor, if applicable, for 14-days.  
 
After completion of the standard therapy phase, subjects will be trained on the 
system and transition to the hybrid closed-loop phase initiating treatment with 
the Omnipod Horizon™ System. Subjects in each cohort will participate in 
prescribed challenges during any consecutive 5-day period during Phase 2 of 
the hybrid closed-loop phase. Subjects who complete Phase 2 can commence 
their participation in the extension phase (Phase 3). 
 
Note: Subjects having completed the prepivotal study may participate in this 
pivotal study and begin at Visit 5 of Phase 2 (hybrid closed-loop) since Phase 1 
(standard therapy) was completed as part of the prepivotal study and is not 
required to be repeated.   
 
 
 

 
 
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GLOSSARY OF ACRONYMS 
ACE 
Alternate Controller Enabled 
ADA 
American Diabetes Association 
ADE 
Adverse Device Effect 
AE 
Adverse Event 
AID 
Automated Insulin Delivery 
AWS 
Amazon Web Services  
BG 
Blood Glucose 
BLE 
Bluetooth Low Energy 
CFR 
Code of Federal Regulations 
CGM 
Continuous Glucose Monitoring 
CRA 
Clinical Research Associate 
CRO 
Contract Research Organization 
CV 
Curricula Vitae 
DD 
Device Deficiency 
DKA 
Diabetic Ketoacidosis 
DSMB 
Data Safety Monitoring Board 
DTSQ 
Diabetes Treatment Satisfaction Questionnaire 
dL 
Deciliter 
eCRF 
Electronic Case Report Form 
EDC 
Electronic Data Capture 
EGV 
Estimated Glucose Value 
FDA 
Food and Drug Administration 
GMI 
Glucose Management Indicator 
HABS 
Hypoglycemic Attitudes and Behavior Scale 
HCL 
Hybrid Closed Loop 
HDP 
Horizon Data Portal 
HF 
Human Factors 
HIPAA 
Health Insurance Portability and Accountability Act 
ICF 
Informed Consent Form 
iCGM 
Interoperable Continuous Glucose Monitoring 
IDSS 
Insulin Delivery Satisfaction Survey 
IOB 
Insulin on Board 
IRB 
Institutional Review Board 
ITT 
Intention to Treat 
MD 
Doctor of Medicine 
MDI 
Multiple Daily Injections 
mg 
Milligram 
mITT 
Modified Intention to Treat 
mmol 
Millimole 

 
 
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MPC 
Model Predictive Control 
NGSP 
National Glycohemoglobin Standardization Program 
PAID 
Problem Areas In Diabetes 
PDM 
Personal Diabetes Manager 
PHI 
Protected Health Information 
POC 
Point of Care 
pMPC 
Personalized Model Predictive Control 
PP 
Per Protocol 
PSQI 
Pittsburgh Sleep Quality Index 
PTOF 
Pump Therapy Order Form 
SADE 
Serious Adverse Device Effect 
SAE 
Serious Adverse Event 
SMP 
Safety Management Plan 
SUS 
System Usability Scale 
T1DDS 
Type 1 Diabetes Distress Scale 
TSH 
Thyroid Stimulating Hormone 
TDI 
Total Daily Insulin 
UADE 
Unanticipated Adverse Device Effect 

 
 
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1 
INTRODUCTION 
Diabetes is a disorder affecting the normal homeostatic regulation of blood glucose. In 
type 1 diabetes, insulin insufficiency occurs due to autoimmune destruction of the beta 
cells in the pancreas resulting in persistently elevated glucose. The long-term effects of 
elevated blood glucose or hyperglycemia may result in a range of microvascular 
complications including retinopathy, nephropathy, and neuropathy. Diabetes is the 
leading cause of blindness, kidney disease, and amputation in the United States.1 
The risk for long-term complications of diabetes can be reduced, however, by 
minimizing patient exposure to hyperglycemia and maximizing the time in euglycemia. 
The landmark Diabetes Control and Complications Trial published in 1993 found that 
maintenance of near normal glucose levels reduced the risk of long-term microvascular 
complications. In 2005, the publication of the Epidemiology of Diabetes Interventions 
and Complications study found that despite the multifactorial etiology of heart disease, 
intensive insulin therapy in patients with type 1 diabetes was shown to reduce the 
incidence of nonfatal myocardial infarction, stroke, and death from cardiovascular 
disease.2 
Unfortunately, efforts to minimize hyperglycemia and maximize euglycemia are 
invariably accompanied by episodes of hypoglycemia. Indeed, the justifiable fear of 
hypoglycemia is often described as the single most significant barrier to improved 
glucose control in patients with diabetes.3 A paper by Weinstock et. al. reported on data 
collected by the T1D Exchange and found an annual incidence of 11.8% of one or more 
severe hypoglycemic events defined as a seizure or loss of consciousness. The annual 
incidence of severe hypoglycemic events increased to 18.6% in patients with diabetes 
duration greater than 40 years.4 
Two other recent papers have highlighted the effect of acute and chronic complications 
on the longevity of patients with diabetes. Livingstone et. al. found premature death in a 
Scottish registry of patients with diabetes of 11 years in males and 13 years in females.5 
Lind et. al. found a twofold increase in mortality in a Swedish registry compared with 
age-matched non-diabetic cohorts even in patients with recommended levels of 
glycemic control (A1C < 7.0%).6 The most recent treatment guidelines from the 
American Diabetes Association now recommend that adults with type 1 diabetes should 
aim for target A1C levels of 7.0% and that children and adolescents should aim for 
target A1C levels of 7.5%.7 These recommendations are equivalent to a mean blood 
glucose of 154 mg/dL in adults and 169 mg/dL in children and adolescents compared 
with mean blood glucose in patients without diabetes of 100 mg/dL or less.8 
The last 20 years have seen a number of significant improvements in diabetes care, 
most notably the advent of faster analog insulins, the widespread use of insulin pumps 
and the introduction of continuous glucose monitoring systems. Despite these 
advances, diabetes data registries continue to show that the majority of patients are 
unable to meet recommended glycemic targets with available medication and 
technology. In the 2012 report from the T1D Exchange Registry, Beck et. al. found the 
average A1C across all ages greater than 8.0% or, equivalently, greater than 183 
mg/dL and only 30% of patients met the ADA target A1C of 7.0% (adults) and 7.5% 
(children).9 A more recent paper from the T1D Exchange Registry by Foster et. al. 
comparing the 2016-2018 cohort with 2010-2012 cohort indicated that among the 9,657 

 
 
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participants that had data in both cohorts and at least 3 years of diabetes duration in 
2010-2012, mean HbA1c was higher in the 2016-2018 cohort. The increase in HbA1c 
over time was predominately seen in adolescents and young adults. The American 
Diabetes Association (ADA) HbA1c target as of 2018 of < 7.5% for children and 
adolescents was achieved by only a small percentage of youth < 18 years of age (17%); 
only 21% of adults achieved the ADA treatment goal of < 7.0%.10 
The current dilemma of persistent poor diabetes outcomes despite significant 
improvements in diabetes technology such as modern blood glucose meters, insulin 
pumps and continuous glucose monitoring systems is summarized in the FDA 
Guidance Document on Artificial Pancreas Device Systems: “Even with the aid of these 
devices, maintaining blood glucose concentrations within a suggested optimal range is 
a daily struggle for people living with diabetes mellitus and the risk of hypoglycemia 
associated with attempts at improved glycemic control remains an ever-present 
danger”.11 
Insulet has developed the Omnipod Horizon™ Automated Glucose Control System 
(hereafter named Omnipod Horizon™ System or Omnipod Horizon™) which is similar 
in function to the systems described in the FDA guidance document dated November 9, 
2012. The system provides automated glucose control at all times, but for optimum 
performance, requires user input for meal boluses. The commercial system will consist 
of an Omnipod® tubeless, insulin delivery ACE pump, a Personal Diabetes Manager 
(PDM), and the Dexcom G6 CGM. The control algorithm will reside on the Pod.  
This pivotal study is designed to evaluate the safety and effectiveness of Omnipod 
Horizon™ System. Maximum stressors to the system, by way of prescribed exercise 
and meal challenges, will be assessed during 5 days of the hybrid closed-loop phase 
with a subset of the enrolled subjects. The challenges will consist of prolonged periods 
of moderate to high intensity exercise as well as meal challenges. Challenges will be 
conducted in an environment closely monitored by clinical staff. 
 
2 
OMNIPOD HORIZON™ SYSTEM STUDY DEVICE OVERVIEW 
This study will evaluate the safety and effectiveness of the Omnipod Horizon™ System. 
The Omnipod Horizon™ System is a hybrid closed-loop automated insulin delivery 
(AID) system developed by Insulet. 
2.1 Device Description of the Omnipod Horizon™ System 
The Omnipod Horizon™ System intended for commercialization is composed of three 
primary components as shown in Figure 1: 
 
• 
Omnipod Horizon™ Controller – Horizon App (PDM) and Algorithm 
• 
Omnipod Horizon™ ACE Pump – Pod  
• 
iCGM – Dexcom G6 
The Omnipod Horizon™ System will provide automated insulin delivery when 
connected to CGM. The system is expected to reduce hypoglycemia without incurring 
an unacceptable increase in hyperglycemia and mean glucose. The system is also 

 
 
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expected to reduce the extent and magnitude of hyperglycemia associated with meals. 
Optimal post-prandial control requires the user to deliver meal boluses as in current 
open-loop therapy, but the normal operation of the control algorithm will be expected to 
compensate for mismatched meal boluses and prevent prolonged hyperglycemia. The 
system uses a control-to-target strategy that attempts to achieve and maintain a set 
target glucose level. 
Figure 1:  System components of the Omnipod Horizon™ System  
2.1.1. Omnipod Horizon™ Controller (App and Algorithm) 
 
The Omnipod Horizon™ Controller is composed of two parts: the Horizon application 
(“app”) and the model predictive control (MPC) algorithm on the Pod. The MPC 
algorithm provides insulin micro-boluses once every 5 minutes based upon the 
predicted glucose over a 60-minute prediction horizon. Optimal post-prandial control will 
require the user to give meal boluses in the same manner as current pump therapy, but 
normal operation of the MPC algorithm will compensate for missed meal boluses and 
mitigate prolonged hyperglycemia. The MPC algorithm uses a control-to-target strategy 
that attempts to achieve and maintain a set target glucose value, thereby reducing the 
duration of prolonged hyperglycemia and hypoglycemia. The MPC algorithm resides on 
the Pod (Pump) component of the Omnipod Horizon™ System (similar to the DASH 
ACE pump cleared in K191679), as described further below). 
 
The Omnipod Horizon™ app will be the primary user interface and will be used to start 
and stop a Pod, program basal and bolus calculator settings for Manual Mode as well 
as program settings specific for Automated Mode (hybrid closed-loop).  
 
 
Manual Mode 
 
In Manual Mode, the Horizon™ System will function equivalently to the Omnipod® 
DASH System, which was first cleared under K180045, most recently under K191679. 

 
 
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This includes delivering insulin at programmed basal rates and bolus amounts with the 
option to set temporary basal profiles. The Omnipod Horizon™ Controller will also have 
the ability to function as a sensor augmented pump in Manual Mode, using sensor 
glucose data provided by the iCGM to populate the bolus calculator. 
 
Automated Mode 
 
In Automated Mode, the system will support the use of multiple target glucose values, 
currently intended to be 110-150 mg/dL at commercialization, in 10 mg/dL increments. 
The experience for the user will reflect current setup flows whereby the health care 
provider assists the user to program basal rates, glucose targets and bolus calculator 
settings. These in turn will inform the MPC algorithm for insulin dosing parameters. The 
insulin dosing parameters will be adapted over time based on the total daily insulin 
(TDI) delivered during each Pod use. A temporary hypoglycemia protection mode (Hypo 
Protect) may be implemented by the user for various time durations during Automated 
Mode. With Hypo Protect, the algorithm reduces insulin delivery and is intended for use 
over temporary durations when insulin sensitivity is expected to be higher, such as 
during exercise. 
 
The Omnipod Horizon™ System will include two apps on a locked-down smartphone 
(the Samsung J3), referred to as Personal Diabetes Manager (PDM): the Horizon App 
and the Dexcom App. The Horizon App, which will have a similar interface to the 
cleared Omnipod® DASH System (K191679), will allow the use of large text, graphics, 
and on-screen instructions to prompt the user through set-up processes. It will also be 
used to program the user’s custom basal insulin delivery profile, check the Pod status, 
initiate bolus doses of insulin, make changes to a patient’s insulin delivery profile, 
handle system alerts and alarms, and enter Automated Mode.  
 
The Dexcom App interface is identical to the current app of the interoperable Dexcom 
G6 Continuous Glucose Monitoring System (K191450) and will provide CGM data, 
alerts, and alarms to the user.  
 
The Horizon App and Dexcom App will not directly communicate with one another. 
Instead, the iCGM transmitter will communicate EGV (estimated glucose values) 
directly to the Pod. The Dexcom transmitter number must be entered into the Horizon 
App, and this information is sent to the Pod to allow transmission of EGV. The Pod will 
pair directly to the transmitter to receive EGV for the algorithm and also sends the EGV 
back to the Horizon App as shown in Figure 1. 
 
The Omnipod Horizon™ Controller provides the ability to calculate a suggested bolus 
dose through the use of the bolus calculator. The bolus calculator will have the option 
for user selected population of the EGV, which is communicated to the app via the Pod. 
This suggested bolus calculation feature is provided as a convenience to the user to aid 
in determining the suggested bolus dose based on ingested carbohydrates, most recent 
sensor glucose reading (or blood glucose reading if using fingerstick), programmable 
correction factor, insulin to carbohydrate ratio, target glucose value and insulin on board 
(IOB). IOB is calculated by the algorithm taking into account any manual bolus and 
insulin delivered by the algorithm. 
 
As with the cleared Omnipod® DASH System, Insulet will utilize a proprietary encrypted 
security stack embedded within the Bluetooth Low Energy (BLE) communication 

 
 
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between the Horizon app and Pod. The communication to the iCGM will use Dexcom’s 
communication protocol. The proprietary security stack increases the resilience of the 
device and improves the ability of the system to be protected in the event of future 
identification of vulnerabilities in standard communication protocols. 
 
2.1.2. Omnipod Horizon™ ACE Pump 
The Pod component of the Omnipod Horizon™ System is similar to the Omnipod® 
DASH ACE Pump cleared under K191679.  Compared to the DASH ACE Pump 
(K191679), the Horizon™ ACE Pump (Pod) has additional software to optimize 
communication to accept inputs from the iCGM (initially the Dexcom G6) and the 
Horizon™ Controller.  The insulin delivery mechanism and the patient and fluid 
contacting components are identical to the DASH Pod. 
 
The Pod is a lightweight, self-adhesive device that the user fills with U-100 rapid-acting 
insulin and wears directly on their body. The Pod delivers insulin into the user’s body 
through a small flexible tube, called a cannula, based on the commands from the 
compatible controller. In the Omnipod Horizon™ System, the Pod will house the MPC 
algorithm and communicate directly with the iCGM and the Horizon App. The algorithm 
commands the Pod’s insulin delivery in the form of micro-boluses based on predicted 
glucose values. As with the cleared Omnipod® DASH System, the Pod of the Omnipod 
Horizon™ System will come pre-packaged in a sterile container with a fill needle and a 
fill syringe. Figure 2 below is a representation of the Pod.  
 
 
Figure 2:  The Pod of the Omnipod Horizon™ ACE pump 
 
 
2.1.3. iCGM 
The third component of the Omnipod Horizon™ System is the iCGM. The Omnipod 
Horizon™ System will be interoperable with a compatible iCGM, currently the Dexcom 
G6 Continuous Glucose Monitoring System (K191450). The Omnipod Horizon™ Pod 
will communicate with the Dexcom G6 via Bluetooth Low Energy (BLE). Glucose values 

 
 
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from the Dexcom transmitter will be sent to the MPC algorithm residing on the Pod and 
used in insulin dosing adjustments. The glucose values from the Dexcom transmitter 
will be sent independently to the Dexcom App on the controller.  
3 
HORIZON™ DATA PORTAL 
Data are securely uploaded from the PDM to Insulet Cloud by cellular connection.  Data 
are then transferred from Insulet Cloud to the Horizon Data Portal (HDP), which is a 
platform for data review and management. The HDP runs on an Amazon-based web 
server. The HDP will provide insights including but not limited to: time in range, time at 
each target BG, automated/manual mode comparisons, and time spent in each mode. 
 
Investigators will have access to all uploaded data and be able to view historical trends.  
The HDP will function as the data management review platform for this study.  
 
4 
RESULTS FROM FEASIBILITY STUDIES 
The Omnipod Horizon™ System has been tested in 194 subjects across IDE G160169, 
G170012, G170143 yielding approximately 13,000 subject hours of hybrid closed-loop 
control. The study results were presented in part at ATTD 2017, 2018, ADA 2017, 2018, 
and 2019, and have also been published in Diabetes Technology and Therapeutics 13, 14, 
15, 16, 17, 18, 19, 20, 21, 22, 23, 29. 
5 
STUDY SUMMARY 
5.1 Study Purpose 
The purpose of this study is to assess the safety and effectiveness of the 
Omnipod Horizon™ System in patients with type 1 diabetes.     
5.2 Study Design 
This is a single-arm, multi-center, prospective clinical study. A total of up to 240 
subjects aged 6-70 years with type 1 diabetes will be enrolled in the study in order 
to obtain a minimum of 200 evaluable subjects, 100 evaluable subjects in each 
age cohort (Table 1:  Cohorts). Subjects will be considered evaluable if they have 
at least 8 weeks of data during Phase 2. 
Subjects will be enrolled across 12-20 clinical study sites. Subjects who have 
previously participated during the feasibility studies may be enrolled in the pivotal 
study and will be assigned a new subject identification number. Subjects who 
have participated in the prepivotal study may participate in the pivotal study if it 
has been deemed safe for their continuation in the study and will retain their 
prepivotal subject identification number.  
 

 
 
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The study schedule consists of the following three phases: 
1) 14-day outpatient standard therapy phase (Phase 1) 
2) 13-week outpatient hybrid closed-loop phase (Phase 2) 
▪ 
A subset of subjects will participate in 5-days of supervised challenges 
▪ 
Phase 2 excludes periods due to a study pause 
3) 12-month hybrid closed-loop extension phase (Phase 3) 
 
Note: Subjects having completed the prepivotal study may participate in this pivotal study 
and begin at Phase 2 since Phase 1 was completed as part of the prepivotal study and is 
not required to be repeated.     
 
Figure 2:  Study Schedule Timeline 
 
 
14-Days 
Standard 
Therapy 
 
13-Weeks 
Hybrid Closed-loop 
12-Month Extension 
 
 
 
Cohorts are defined as shown in Table 1: 
Table 1:  Cohorts 
Cohort (Name) 
Age Range 
N (minimum evaluable 
for primary endpoint) 
Adults 
14-70 years 
100 
Children 
6-13.9 years 
100 
 
Following subject screening, enrollment, and device training, subjects will commence 
the standard therapy phase of the study.  
Current Dexcom G6 CGM users may provide data from a 14-day period within the last 
30-days. The CGM data meeting the minimum criteria must be the most recent data 
from the last 30-days. For non-G6 users, subjects will wear a study CGM, in blinded 
mode, to record glucose measurements over 14-days while subjects manage their 
diabetes at home per their usual routine while wearing a study CGM while remaining on 
their current MDI or pump therapy, and sensor, if applicable, for 14-days.   
After completion of Phase 1 (the standard therapy phase), subjects will be trained on 
the system and transition to Phase 2 (13-week hybrid closed-loop phase) initiating 

 
 
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treatment with the Omnipod Horizon™ System.  Subjects in each cohort will participate 
in prescribed challenges during any consecutive 5-days of the 13-week hybrid closed-
loop phase. Phase 2 will be followed by a 12-month hybrid closed-loop phase (Phase 
3). 
Tables 2 and 4 outline the schedule of assessments for each phase of the study. 

 
 
 
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Table 2:  Schedule of Assessments for Phase 1 and Phase 2 
Assessment Schedule 
Screening 
ST1 
ST2 
Hybrid Closed-Loop (HCL) 
EWa 
  
Phase 1e 
Phase 2c 
  
Visit Number 
1 
2 
3 
4 
5 e 
6 
7 
8 
9 
10 
11 
12 
13 
UVb 
  
Study Day/Visit Windowl 
-30 to -14d  
HCL start 
-14d to 
HCL 
start 
-1d to 
HCL 
start 
1 
2 
±1d 
3 
±1d 
10 
±3d 
24 
±3d 
38 
±3d 
52 
±3d 
66 
±3d 
80 
±3d 
94 
±3d 
N/A 
  
Telephone (T) or Office (O) Visit 
O 
O 
O 
O 
T/O 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
O 
Laboratory Assessments 
A1c 
X 
  
  
  
  
  
  
  
  
  
  
  
X 
  
X 
TSH 
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Creatinine Level 
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Pregnancy Test 
X 
  
  
X 
  
  
X 
  
X 
  
  
  
 X 
  
  
Clinical Assessments 
Informed Consent 
X 
  
  
 
Xg  
  
  
  
  
  
  
  
  
  
  
Medical History (including 
demographics) 
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Confirm Eligibility 
X 
  
  
 
Xg  
  
  
  
  
  
  
  
  
  
  
Concomitant medications 
X 
Xh 
  
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Average total daily insulin (~ 7 
days) 
 
X 
  
X 
  
  
  
  
  
  
  
  
  
  
  
Average total basal insulin (~ 7 
days) 
 
X 
  
X 
  
  
  
  
  
  
  
  
  
  
  
Average total bolus insulin (~ 7 
days) 
 
X 
  
X 
  
  
  
  
  
  
  
  
  
  
  
Pump settings/MDI dosing 
  
X 
  
X 
  
  
  
  
  
  
  
  
  
  
  
Height 
X 
  
  
  
  
  
  
  
  
  
  
X 
  
X 
Weight 
X 
  
  
 
  
  
  
  
  
  
  
  
X 
  
X 
Vital signs 
X 
  
  
 
  
  
X 
  
X 
  
  
  
X 
 
X 
Electrocardiogramd (if 
applicable) 
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
Adverse events 
  
 X 
X  
X 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 

 
 
 
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Assessment Schedule 
Screening 
ST1 
ST2 
Hybrid Closed-Loop (HCL) 
EWa 
  
Phase 1e 
Phase 2c 
  
Visit Number 
1 
2 
3 
4 
5 e 
6 
7 
8 
9 
10 
11 
12 
13 
UVb 
  
Study Day/Visit Windowl 
-30 to -14d  
HCL start 
-14d to 
HCL 
start 
-1d to 
HCL 
start 
1 
2 
±1d 
3 
±1d 
10 
±3d 
24 
±3d 
38 
±3d 
52 
±3d 
66 
±3d 
80 
±3d 
94 
±3d 
N/A 
  
Telephone (T) or Office (O) Visit 
O 
O 
O 
O 
T/O 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
O 
Questionnaires 
See Table 4 for specific 
questionnaires 
X 
X 
  
  
  
  
 
  
 
  
  
  
X 
 
X 
Study Devices 
Training on Glucagon 
administration and information 
on treatment of 
hypo/hyperglycemia 
  
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
Horizon Data Portal 
initiation/discontinuation 
 
 
 
X 
 
 
 
 
 
 
 
 
X 
 
X 
Study device training 
  
Xi 
  
Xj 
  
  
  
  
  
  
  
  
  
  
  
Dispense/Return 
BG/Ketone meter, and CGM 
  
X 
  
  
  
  
  
  
  
  
  
  
X 
  
X 
QC testing of BG/Ketone meter 
by site 
  
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
CGM sensor placement (as 
needed throughout) 
  
X 
  
  
  
  
  
  
  
  
  
  
  
  
  
Assess CGM usage and data 
criteria has been met 
  
Xk  
X 
  
  
  
  
  
  
  
  
  
  
  
  
Dispense/Return Horizon System 
  
  
  
X 
  
  
  
  
  
  
  
  
X 
  
X 
Complaints/device deficiencies 
  
  
  
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Device uploads  
  
  
  
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
 
X 
Data review 
 
 
 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
 
 
 

 
 
 
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Table 3:  Schedule of Assessments for Phase 3 
Assessment Schedule 
Hybrid Closed-Loop (HCL) 
  
  
Phase 3 
  
  
Visit Number 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
UV 
EW 
Study Day/Visit Window 
120 
± 5d 
150 
± 5d 
180 
± 5d 
210 
± 5d 
240 
± 5d 
270 
± 5d 
315 
± 5d 
360 
± 5d 
405 
± 5d 
450 
± 5d 
  
  
Telephone (T) or Office (O) 
Visit 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
T/Of 
O 
T/Of  
O  
Laboratory Assessments 
A1C 
  
  
X 
  
  
X 
 
X 
 
X 
  
X 
Pregnancy Test 
 
  
Xf 
  
  
Xf  
 
 
 
 
  
  
Clinical Assessments 
Informed Consent 
 
 
 
 
 
Xm 
 
 
 
 
 
 
Concomitant Medications 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Height 
  
  
  
  
  
 
 
 
 
X 
  
X 
Weight 
  
  
  
  
  
 
 
 
 
X 
  
X 
Adverse Events 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Study Devices 
Return Horizon System 
  
  
  
  
  
 
 
 
 
X 
  
X 
Complaints/Device 
Deficiencies 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Xh 
Device Uploads (BG/Ketone 
Meter) 
Xf 
Xf 
Xf 
Xf 
Xf 
Xf 
Xf 
Xf 
Xf 
X 
 
X 
Data Review 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
Xn 
 
Abbreviations:  S=Screening; ST1=Standard Therapy Day One; HCL=Hybrid Closed-loop; EW=Early Withdrawal; QC=Quality Control Testing;  UV=Unscheduled 
Visit 
aEarly withdrawal visit will only be conducted for any subjects that started but did not complete the full study to include standard therapy and the hybrid 
closed-loop phase.   
bUnscheduled visits will serve as extra study visits, if needed.  For unscheduled visits pertaining to a study pause and recommencement, sites should follow the 
assessments as defined in section 9.10. 

 
 
 
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cChallenges can occur during any consecutive 5-days during Phase 2 of the hybrid closed-loop phase.  A follow up telephone visit will occur the following day 
after the conclusion of the challenge period. 
dElectrocardiogram required for subjects >50 years old or with diabetes duration >20 years 
eSubjects extending into the pivotal study from the prepivotal study will initiate their participation at Visit 5 of pivotal Phase 2.   
fVisits identified as "T/O" can either be conducted in person at the clinical site or over the telephone.  Visits identified as "O" can only be conducted in person at 
the clinical site.  Vital signs, device uploads/data review from the BG and Ketone meter, and pregnancy tests are not required at any visit conducted via 
telephone. 
gPrepivotal subjects extending into pivotal will be required to reconsent.  If original prepivotal screening is within 45 days prior to the start of Phase 2 in the 
pivotal study, subjects will not require rescreening.  All subjects must reconsent prior to commencing the extension phase (Phase 3) on or before Visit 13.   
hDocumentation only applicable if there are changes from previous assessment 
iStudy device training for the CGM, blood glucose and ketone meters 
jStudy device training for the Omnipod Horizon™ System 
kSubjects deemed exempt from wearing the study CGM for 14-days will be eligible to immediately commence the hybrid closed-loop phase at Visit 4 and may 
skip Visit 3/ST2 (in which case, Visit 1, Visit 2/ST1 and Visit 4 may all occur on the same day)  
lIn the event of overlapping visit windows, no visits occurring during Phase 2 are to occur on the same date, except for challenge visit days.  It is acceptable for a 
challenge visit to occur on the same date as a Phase 2 visit 
mSubjects continuing in the study are to be consented for both the first 6-month and the second 6-month interval of Phase 3.  Consent for each interval must 
occur on or any time before commencing that study interval (e.g. consent for first 6-months of Phase 3 must occur on or before Visit 13, consent for second 6-
months of Phase 3 must occur on or before Visit 19).  
nData review for Horizon Automated Mode to occur at all visits 
 
 

 
 
 
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Table 4:  Questionnaires 
Visit    
Age Groups* 
Adult 
(ages 18-70) 
Teen 
(ages 12-17.9) 
Caregiver of Teen 
(ages 12-17.9) 
Pediatric 
(ages 6-11.9) 
Caregiver of Pediatric 
(ages 6-11.9) 
Screening  
Clarke 
Clarke 
n/a 
n/a 
Clarke 
Visit 2 (Phase 1) 
WHO-5 
EQ-5D-5L 
T1DDS 
DTSQs 
 
Hypoglycemia 
Confidence Scale 
HABS 
PSQI 
IDSS (T1) 
SUS 
WHO-5 
EQ-5D-5L 
 
 
PAID-Teen 
Hypoglycemia 
Confidence Scale 
 
PSQI 
 
SUS 
WHO-5 
 
 
DTSQs 
P-PAID-Teen 
Hypoglycemia 
Confidence Scale 
 
PSQI 
IDSS (T1) 
 
EQ-5D-Y 
 
 
PAID-Child 
WHO-5 
 
 
DTSQs 
P-PAID-Child 
Hypoglycemia 
Confidence Scale 
 
PSQI 
IDSS (T1) 
SUS 
End of Phase 2 
(~13 weeks) or 
Early 
Withdrawal 
WHO-5 
EQ-5D-5L 
T1DDS 
DTSQc 
 
Hypoglycemia 
Confidence Scale 
HABS 
PSQI 
IDSS (T1) 
SUS 
INSPIRE-Adult 
Clarke 
Human Factors 
WHO-5 
EQ-5D-5L 
 
 
PAID-Teen 
Hypoglycemia 
Confidence Scale 
 
PSQI 
 
SUS 
INSPIRE-Youth 
Clarke 
Human Factors 
WHO-5 
 
 
DTSQc 
P-PAID-Teen 
Hypoglycemia 
Confidence Scale  
 
PSQI 
IDSS (T1) 
 
INSPIRE-Parent 
EQ-5D-Y 
 
 
 
PAID-Child 
 
 
 
 
 
 
INSPIRE-Youth 
WHO-5 
 
 
DTSQc 
P-PAID-Child 
Hypoglycemia 
Confidence Scale 
 
PSQI 
IDSS (T1) 
SUS 
INSPIRE-Parent 
Clarke 
Human Factors  
*Some questionnaires require completion by both the subject and the caregiver. Caregivers completing questionnaires must be the 
caregiver that provided consent for study participation, or subsequently signed a consent form.  It is preferable that the caregiver 
completing a questionnaire at screening or Visit 2 is the same caregiver completing questionnaires at the End of Phase 2 (~13 weeks 
of hybrid closed-loop participation) or at the time of withdrawal from the study. No questionnaires will be completed during or at the 
conclusion of Phase 3.  
 

 
 
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6 
OBJECTIVES AND ENDPOINTS 
6.1 Primary Safety Objective 
The primary safety objective of this study is to evaluate the safety of the Omnipod 
Horizon™ System.  
 
6.1.1 Primary Safety Endpoints 
The primary safety objective will be evaluated by summarizing the following 
events during Phase 2, and separately during Phase 3:  
 
• 
Incidence rate of severe hypoglycemia (events per person months) 
• 
Incidence rate of diabetic ketoacidosis (DKA) (events per person months)  
6.2 Primary Effectiveness Objective 
The primary effectiveness objective of this study is to evaluate the effectiveness of 
the Omnipod Horizon™ System. 
 
6.2.1 Primary Effectiveness Endpoints 
There are two primary effectiveness endpoints.  
 
• 
A1C after at least 6 weeks of continuous Phase 2 participation compared 
to baseline 
• 
A1C at Visit 16, 19, 21, and 23 compared to baseline 
• 
Percentage of time in range (70-180 mg/dL) during Phase 2 and 
separately during Phase 3 of the hybrid closed-loop phase as compared to 
Phase 1 (standard therapy) 
6.3 Secondary Objective 
The secondary objective of this study is to evaluate additional glycemic measures 
of effectiveness of the Omnipod Horizon™ System.  
6.3.1 Secondary Endpoints 
The secondary objective will be evaluated using the following per subject 
endpoints with prespecified hypotheses:   
• 
Glucose metrics from system CGM during the hybrid closed-loop phase for 
Phase 2 will be compared to Phase 1 overall: 
• 
% of time > 180 mg/dL 
• 
% of time < 70 mg/dL 
 
Additional per subject secondary endpoints without prespecified hypotheses 
used to evaluate the secondary objective include:  
 

 
 
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• 
A1C: 
o A1C after at least 8 weeks of continuous Phase 2 participation at 
the end of Phase 2 (Visit 13), at 6 months (Visit 16), and at the 
end of Phase 3 (Visit 23; approximately 15 months) 
o Change from baseline in A1C after at least 6 weeks of continuous 
Phase 2 participation, after at least 8 weeks of continuous Phase 
2 participation at the end of Phase 2 (Visit 13), at 6 months (Visit 
16), and at the end of Phase 3 (Visit 23; approximately 15 
months)   
o Proportion of subjects demonstrating an improvement from 
baseline in A1C after at least 6 weeks of continuous Phase 2 
participation, after at least 8 weeks of continuous Phase 2 
participation at the end of Phase 2 (Visit 13), at 6 months (Visit 
16), and at the end of Phase 3 (Visit 23; approximately 15 
months) 
  
• 
Glucose metrics from system CGM during the hybrid closed-loop phase 
during Phase 2, and separately during Phase 3, will be compared to Phase 1 
during the day, overnight, and overall: 
 
• 
Mean glucose 
• 
% of time in range 70-180 mg/dL 
• 
% of time in range 70-140 mg/dL 
• 
% of time > 180 mg/dL 
• 
% of time ≥ 250 mg/dL 
• 
% of time ≥ 300 mg/dL 
• 
% of time < 70 mg/dL 
• 
% of time < 54 mg/dL 
• 
Standard deviation 
• 
Coefficient of variation  
 
• 
Percentage of time in hybrid closed-loop as proportion of overall device 
usage time during Phase 2, and separately during Phase 3 
• 
Glucose management indicator (GMI) based on overall mean glucose during 
Phase 2, and separately during Phase 3 will be compared to Phase 1 
• 
Insulin requirements during Phase 2, and separately during Phase 3 will be 
compared to Phase 1: 
 
• 
Total daily insulin (TDI) (units, units/kg) 
• 
Total daily basal insulin (units, units/kg) 
• 
Total daily bolus insulin (units, units/kg) 
 
• 
Change from baseline in BMI (kg/m2) at end of Phase 2, and at end of 
Phase 3. 
6.4 Exploratory Endpoints 
Analysis of the following exploratory endpoints will be considered. The analyses 
may be used for internal research purposes and/or scientific presentations and/or 
manuscripts and may not all be provided in a regulatory submission:   

 
 
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• 
Number of hypoglycemic and hyperglycemic events as measured by the 
system CGM during the hybrid closed-loop phase will be compared to the 
standard therapy phase 
• 
Glucose metrics from the system CGM during the hybrid closed-loop phase 
stratified by device mode 
• 
Change from baseline in A1C and BMI at the last follow-up visit given at 
least 6-weeks of participation during Phase 2 
• 
Change from baseline in A1C after at least 6 weeks of continuous Phase 2 
participation, stratified by baseline A1C (e.g. A1C ≥7.5%, ≥9.0%) 
• 
Proportion of subjects with A1C <7.0% at baseline and after at least 6 weeks 
of continuous Phase 2 participation; similar analyses using A1C cutoffs of 
<7.5%, <8.0% and <9.0% 
• 
Proportion of subjects with change from baseline in A1C after at least 6 
weeks of continuous Phase 2 participation of >0.5% and >1.0% 
• 
Proportion of subjects who either had an improvement from baseline of 
>1.0% in A1C or A1C <7.0% after at least 6 weeks of continuous Phase 2 
participation 
• 
Percentage of time the CGM was used during the hybrid closed-loop phase 
• 
Number of meal and correction boluses 
• 
Compare glycemic outcomes (e.g., time in range <70 mg/dL, time in range 
>180 mg/dL) by bolus frequency per day  
• 
Compare glycemic outcomes (e.g., time in range <70 mg/dL, time in range 
>180 mg/dL) by use of CGM informed bolus calculator (i.e., days with CGM 
informed bolus calculator used at least once and days without CGM 
informed bolus calculator use)   
• 
Post-prandial glucose response including time to peak glucose, peak 
glucose concentration, peak glucose excursion, to meals with bolus 
(challenge days 1 and 3) vs no bolus (challenge days 2 and 4) 
• 
Glycemic outcomes and other measures based on evaluable subjects (i.e., 
those subjects with at least 8-weeks of data during the hybrid closed-loop 
phase) 
6.5 Patient Reported Outcomes 
Various subject- and caregiver-completed questionnaires will be used to evaluate 
general and disease-specific quality of life, and device usability. These include, 
but are not limited to:   
• 
WHO-5 
• 
EQ-5D 
• 
PAID 
• 
T1DDS 
• 
DSTQ 
• 
Hypoglycemia Confidence 
• 
HABS 
• 
PSQI 
• 
IDSS (T1) 
• 
SUS 
• 
INSPIRE 

 
 
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• 
Human Factors Questionnaire 
• 
Clarke Questionnaire 
 
7 
SCREENING AND ELIGIBILITY 
Potential subjects for this study will include individuals who have been diagnosed with 
type 1 diabetes for at least 6 months and are appropriate for pump therapy per 
investigator’s assessment. Potential subjects will be selected at each clinical study site 
and screened accordingly. Clinical study sites will be advised to: 
 
• 
Recruit subjects using insulin aspart, lispro, and glulisine also known as 
Humalog, Novolog, Admelog, and Apidra 
• 
Recruit at least 20% of subjects using MDI 
 
Every effort will be made to establish eligibility of the patient prior to enrollment. Only 
patients who appear to meet all eligibility criteria will be enrolled in the study. Subject 
eligibility will be confirmed by study staff during a screening visit at the clinical site. 
Blood draws will be collected as required to demonstrate study eligibility as noted 
below. Laboratory results within the last 6 months, with the exception of A1C, may also 
be used if available. 
 
Subjects that have participated in the prepivotal study may be eligible to extend their 
participation into the pivotal study. The prepivotal study will be conducted in parallel to 
the pivotal study and will include a minimum of 36-subjects between the ages of 6-70 
years participating in a standard therapy phase followed by the hybrid closed-loop 
phase. The prepivotal study will be conducted at up to 8 clinical study sites. The 
prepivotal study outpatient hybrid closed-loop phase includes 14-days of hybrid closed-
loop. Prepivotal study subjects that are eligible to extend their participation into the 
pivotal study do not require rescreening if their original screening is within 45-days prior 
to Visit 5, which is their start of Phase 2 in the pivotal study. Prepivotal subjects do not 
need to participate in the standard therapy phase of the pivotal study since this phase 
was completed as part of the prepivotal study and is not required to be repeated.  
7.1 Visit 1 
Visit 1 will be conducted in person at the clinical study site. This visit will assess 
eligibility and will include: 
 
• 
Signing of informed consent/assent 
• 
Review of inclusion/exclusion criteria 
• 
Screening assessments performed following Table 2:  Schedule of 
Assessments for Phase 1 and Phase 2 
 
Informed Consent/Assent 
Subjects who appear to meet the eligibility criteria will be asked to sign an 
Informed Consent Form (ICF) approved by each respective Institutional Review 
Board (IRB) for participation in the study. A parent/guardian must sign the ICF for 
subjects <18 years of age. Assent will also be obtained from subjects aged <18 

 
 
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years per State requirements. Failure to provide informed consent/assent will 
render the subject ineligible for the study. 
Subjects must also have a signed HIPAA (Health Insurance Portability and 
Accountability Act) release of protected health information (PHI). The release may 
be a stand-alone document or part of the informed consent. 
After informed consent/assent is obtained, a subject identification number will be 
issued to uniquely identify each subject. The unique identifier will be used to 
identify the subject throughout the study and will be used for all source documents 
and electronic Case Report Forms (eCRFs). 
Inclusion Criteria 
Subjects must meet all of the following criteria in order to be enrolled in the study: 
1. Age at time of consent 6-70 years 
2. Subjects aged < 18 years must be living with parent/legal guardian 
3. Diagnosed with type 1 diabetes for at least 6 months. Diagnosis is based 
on investigator’s clinical judgment 
4. Deemed appropriate for pump therapy per investigators assessment taking 
into account previous history of severe hypoglycemic and hyperglycemic 
events, and other comorbidities 
5. Investigator has confidence that the subject can successfully operate all 
study devices and is capable of adhering to the protocol 
6. Willing to use only the following types of insulin during the study: Humalog, 
Novolog, Admelog or Apidra during the study 
7. Must be willing to travel to and participate in meal and exercise challenges 
during 5-days of the hybrid closed-loop phase 
8. Willing to wear the system continuously throughout the study 
9. A1C <10% at screening visit  
10. Must be willing to use the Dexcom App on the Omnipod Horizon™ PDM as 
the sole source of Dexcom data (with the exception of the Dexcom Follow 
App) during the hybrid closed-loop phase 
11. Subjects scoring ≥ 4 on the Clarke Questionnaire must agree to have an 
overnight companion, defined as someone who resides in the same home 
or building as the study subject and who can be available overnight 
12. Able to read and speak English fluently 
13. Willing and able to sign the Informed Consent Form (ICF) and/or has a 
parent/guardian willing and able to sign the ICF. Assent will be obtained 
from pediatric and adolescent subjects aged < 18 years per State 
requirements. 
 
Exclusion Criteria 
Subjects who meet any of the following criteria will be excluded from the study: 
1. A medical condition, which in the opinion of the investigator, would put the 
subject at an unacceptable safety risk 
2. History of severe hypoglycemia (as defined in Section 12.3.3) in the past 6 
months 

 
 
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3. History of DKA (as defined in Section 12.3.4) in the past 6 months, 
unrelated to an intercurrent illness, infusion set failure or initial diagnosis 
4. Diagnosed with sickle cell disease 
5. Diagnosed with hemophilia or any other bleeding disorders 
6. Plans to receive blood transfusion over the course of the study 
7. Currently diagnosed with anorexia nervosa or bulimia 
8. Acute or chronic kidney disease (e.g. estimated GFR < 45) or currently on 
hemodialysis 
9. History of adrenal insufficiency 
10. Has taken oral or injectable steroids within the past 8-weeks or plans to 
take oral or injectable steroids during the course of the study 
11. Unable to tolerate adhesive tape or has any unresolved skin condition in 
the area of sensor or pump placement 
12. Plans to use insulin other than U-100 insulin intended for use in the study 
device during the course of the study  
13. Use of non-insulin anti-diabetic medication other than metformin (e.g. 
GLP1 agonist, SGLT2 inhibitor, DPP-4 inhibitor, pramlintide) 
14. Current or known history of coronary artery disease that is not stable with 
medical management, including unstable angina, or angina that prevents 
moderate exercise despite medical management, or a history of 
myocardial infarction, percutaneous coronary intervention, or coronary 
artery bypass grafting within the previous 12-months.  
15. For subjects > 50 years old or with diabetes duration > 20 years, abnormal 
electrocardiogram consistent with increased risk of arrhythmia, ischemia, 
or prolonged QTc interval (> 450 ms)  
16. Thyroid Stimulating Hormone (TSH) is outside of normal range with 
clinical signs of hypothyroidism or hyperthyroidism 
17. Pregnant or lactating, or is a woman of childbearing potential and not on 
acceptable form of birth control (acceptable includes abstinence, condoms, 
oral/injectable contraceptives, IUD or implant) 
18. Participation in another clinical study using an investigational drug or 
device other than the Omnipod Horizon™ Automated Glucose Control 
System within the preceding 30-days or intends to participate during the 
study period   
19. Unable to follow clinical protocol for the duration of the study or is 
otherwise deemed unacceptable to participate in the study per the 
investigator’s clinical judgment 
Screening Assessments 
 
Subjects who have signed the informed consent and appear to meet the eligibility 
criteria will continue to the screening assessments which will be performed at the 
clinical study site.   
Screening assessments must be completed within 30-days prior to the start date 
of the hybrid closed-loop phase (assessments do not need to be completed on the 
same day) and include the following: 
• 
Medical history (including prior and current medical conditions and surgical 
history) 
• 
Demographics (age, gender, race) 

 
 
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• 
A1C* 
• 
Thyroid Stimulating Hormone (TSH) level (local laboratory) 
• 
Creatinine level (local laboratory) 
• 
Pregnancy test for women of childbearing potential 
• 
Review of concomitant medications 
• 
Height 
• 
Weight 
• 
Assessment of vital signs 
• 
Electrocardiogram (if applicable, see exclusion criteria 15) 
• 
Questionnaire (Table 4:  Questionnaires) 
o Clarke 
▪ 
Used to assess impaired awareness of hypoglycemia 
• 
For Dexcom G6 users, assessment of whether subjects have met the 
CGM usage and data criteria to participate in an abbreviated standard 
therapy phase (Visit 2 only) per Table 2:  Schedule of Assessments for 
Phase 1 and Phase 2 
o At least 80% CGM use (11.2-days) during any consecutive 14-days in 
the past 30-days and 
o ≥ 2,016 CGM values during the 14-days 
 
*Clinical sites will send the blood specimens for A1C to a NGSP (National 
Glycohemoglobin Standardization Program) certified central laboratory.  A point of 
care (POC) A1C may be used to determine eligibility.   
The Clarke Questionnaire will be administered during the screening visit.  Subjects 
scoring ≥ 4 on the Clarke Questionnaire will require an overnight companion 
during the hybrid closed-loop phase.  A companion is defined as someone who 
resides in the same home or building as the study subject and who can be 
available overnight. 
Enrollment 
 
Subjects who meet all eligibility criteria and have completed all screening 
assessments will continue to enrollment. A subject is enrolled in the study upon 
placement of the first study CGM. Subjects that do not meet the eligibility criteria 
will not continue in the study and will be considered screen failures.  
 
If for any reason a subject is no longer eligible for the study after the standard 
therapy phase has commenced but prior to the commencement of the hybrid 
closed-loop phase, the subject will not continue in the pivotal study. No additional 
study assessments will be required. The reason for study exit will be clearly 
documented. 
 
8 
STANDARD THERAPY - PHASE 1 
The standard therapy phase will commence after all standard therapy assessments are 
completed per Visit 2 – see Table 2:  Schedule of Assessments for Phase 1 and Phase 
2.  

 
 
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During the standard therapy phase, subjects will be asked to perform the following: 
 
• 
Manage their diabetes at home per their usual routine 
• 
Administer meal boluses per their usual dosing routine 
• 
Change their sensor if a sensor fails, or as needed 
• 
Calibrate their CGM, if required, per the manufacturer’s instructions   
• 
Monitor their capillary blood glucose (BG) per usual routine 
• 
Give meal boluses. The timing of the bolus delivery will be per each subject’s 
typical dosing routine. 
 
Extending standard therapy past 14-days will not constitute a protocol deviation unless 
standard therapy extends past 30-days. If subjects extend beyond the 14-days, the 
most recent 14-days of data will be used in the endpoint analysis if the data meets the 
criteria defined for CGM use and data availability. 
 
The standard therapy phase will be customized depending on the following subject 
profile: 
 
• 
Current Dexcom G6 users 
• 
Non-G6 users 
• 
Pump Naïve users 
 
Current Dexcom G6 Users 
 
Current Dexcom G6 users will be required to participate in the assessments required as 
part of standard therapy (ST1/Visit 2) but may be exempt from wearing the study CGM 
for 14-days if the following criteria are met: 
 
• 
Willing to provide 14-days of CGM data from the past 30-days 
• 
Meet the success criteria of 80% CGM use during any consecutive 14-days in the 
past 30-days 
• 
Must have ≥ 2,016 CGM values during the 14-days 
 
If exemption criteria are not met, subjects may choose to continue to collect data until 
they meet the criteria or will be required to participate in the entire 14-day standard 
therapy phase consistent with the requirements for non-G6 users. 
 
Subjects deemed exempt from wearing the study CGM for 14-days will be immediately 
eligible to commence the hybrid closed-loop phase starting at Visit 4.   
 
Non-G6 Users 
 
All non-G6 users will be required to participate in the entire 14-day standard therapy 
phase.  At the commencement of the standard therapy phase, subjects will be 
dispensed a CGM receiver that will be blinded and all user settable CGM alerts will be 
turned off.  The device will record continuous glucose information over the 14-day 
period. 
Pump Naïve Users 

 
 
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Subjects who are naïve to pump therapy will have the opportunity to participate in a 
saline trial during the standard therapy phase.  A saline trial consists of wearing a 
cleared Omnipod® DASH System with the Pod filled with saline to simulate pump 
therapy. This would enable subjects to familiarize themselves with the basic concepts of 
basal and bolus insulin delivery as well as provide the experience of wearing an on-
body device prior to their participation in the hybrid closed-loop phase, if they choose to 
do so.  This is optional and not required. If a pump naïve subject is also a current G6 
user that meets the criteria as stated above, the subject will complete the saline trial 
prior to enrollment in the study.  
8.1 Visit 2 
Visit 2 represents the commencement of the standard therapy phase.  All 
scheduled assessments will be performed according to Table 2:  Schedule of 
Assessments for Phase 1 and Phase 2.  This visit will include: 
 
• 
Review of concomitant medications 
• 
Average total daily insulin (approximately over the past 7 days) 
• 
Average total daily basal insulin (approximately over the past 7 days) 
• 
Average total daily bolus insulin (approximately over the past 7 days) 
• 
Review of pump settings/MDI dosing 
• 
Assessment of AEs 
• 
Completion of questionnaires (see Table 4:  Questionnaires for specific 
requirements by age group): 
• 
WHO-5 
o Used to measure current mental well-being 
• 
EQ-5D 
o Used to measure quality of life 
• 
T1DDS 
o Used to measure four critical dimensions of distress 
• 
DTSQs 
o Used to measure satisfaction with diabetes treatment regimens 
• 
Hypoglycemia Confidence Scale 
o Used to measure hypoglycemia unawareness, hypoglycemia 
frequency, severity and impact 
• 
HABS 
o Used to measure critical dimensions of hypoglycemia related 
concerns and confidence 
• 
PSQI 
o Used to measure sleep disturbance and usual sleep habits 
• 
IDSS (T1) 
o Used to measure patient satisfaction with their devices and impact 
on quality of life 
• 
SUS 
o Used to measure usability of a system 
• 
PAID-(Teen, Child) 
o Measures diabetes-related burden 
• 
Training on Glucagon administration and information on treatment of 
hypo/hyperglycemia   

 
 
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• 
All subjects are required to have access to glucagon and receive 
training on how to deliver the medication 
• 
Study device training per manufacturer’s instructions (CGM - blinded, BG, 
and ketone meters) 
• 
Dispensing of CGM (blinded for non-G6 users), BG, and ketone meter 
• 
QC testing of BG and ketone meter 
• 
Must pass as least one level of quality control testing prior to 
dispensing 
• 
CGM sensor placement (Enrollment)   
• 
Approved anatomical locations for CGM sensor placement will be 
reinforced as well as the importance of using approved locations 
 
During this visit, subjects will be dispensed the following supplies: 
• 
Dexcom transmitter 
• 
Dexcom receiver 
• 
Dexcom sensors 
• 
Contour® Next One blood glucose meter 
• 
Contour® Next One blood glucose meter test strips 
• 
Contour® Next One blood glucose meter control solution 
• 
Lancets 
• 
Precision Xtra blood ketone meter 
• 
Precision Xtra blood ketone meter test strips 
• 
Precision Xtra blood ketone meter control solution 
 
Subjects will be provided, by the site, information regarding treatment of hypoglycemia 
and hyperglycemia including sick day management and emergency management of 
severe hypoglycemia and diabetic ketoacidosis.  Subjects will be given contact 
information for study personnel and product support. 
If a subject is on MDI, the investigator will advise the subject on the treatment regimen 
to reduce insulin depending on the insulin action profile of injected doses prior to the 
commencement of the hybrid closed-loop phase. MDI subjects will be required to keep 
a log to record daily doses of insulin during the standard therapy phase.   
8.2 Visit 3 
Visit 3 will be conducted in person at the clinical study site up to one (1) day prior 
to the start of the hybrid closed-loop phase.  All scheduled assessments will be 
performed according to Table 2:  Schedule of Assessments for Phase 1 and 
Phase 2.  This visit will include: 
 
• 
Assessment of AEs 
• 
Assessment of whether subjects have met the CGM usage and data 
criteria 
 
Prior to the commencement of the hybrid closed-loop phase, subjects must meet 
the following criteria: 
 

 
 
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o At least 80% CGM use (11.2-days) during any consecutive 14-days in the 
past 30-days and 
o ≥ 2,016 CGM values during the 14-days 
If the CGM criteria is not met, the standard therapy phase may be extended up to 
30-days, per investigator discretion, or the subject may be withdrawn from the 
study.   
At the conclusion of the standard therapy phase, if the investigator determines that 
there have been no safety concerns, the subject will continue to the hybrid closed-loop 
phase. If the investigator determines that it is unsafe for the subject to continue into the 
hybrid closed-loop phase, the subject will not be allowed to continue in the second 
phase of the study, and the reason for study exit will be documented.  
9 
HYBRID CLOSED-LOOP - PHASE 2 
The hybrid closed-loop phase will commence at Visit 4 upon the conclusion of the 
standard therapy phase and after all assessments are performed according to the Table 
2:  Schedule of Assessments for Phase 1 and Phase 2.  
During the hybrid-closed loop phase, subjects will be asked to do the following: 
 
• 
Adjust pump and CGM parameters to optimize their insulin therapy in 
collaboration with the recommendations from the clinical study staff 
• 
Follow their pre-exercise management such as insulin reduction for meal 
boluses, consumption of snacks, or adjusting their insulin delivery settings 
• 
Treat themselves per their usual routine if they become hypoglycemic or 
hyperglycemic or have symptoms of either at any time during the study 
• 
Consume meals and snacks of their own choosing. Subjects will be encouraged 
to estimate the grams of carbohydrates for each meal or snack per their usual 
routine. The estimate should be entered into the meal bolus calculator. 
• 
Administer meal boluses per their usual dosing routine 
• 
Participate in challenge visits as specified 
• 
Change their CGM per manufacturer’s instructions or sooner if necessary 
• 
Change the Pod at least once every 72 hours 
• 
Complete questionnaires (Table 4:  Questionnaires) 
Subjects will have scheduled follow-up visits according to Table 2:  Schedule of 
Assessments for Phase 1 and Phase 2 and complete questionnaires according to Table 
4:  Questionnaires. Visits will be conducted either in person at the clinical study site or 
over the telephone or videoconference.  Subjects may also choose to use email or text 
as a substitute for their scheduled telephone visit. In the event of overlapping visit 
windows, no visits occurring during Phase 2 are to occur on the same date, with the 
exception of challenge visit days.   
The duration of the hybrid closed-loop phase for Phase 2 will last ~13-weeks (the 13 
weeks may not be continuous). 

 
 
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9.1 Challenge Visits 
A subset of subjects will take part in the prescribed supervised challenges per the 
defined sample sizes in Table 5:  Sample Size of Subjects Enrolled in Challenges 
until the minimum number of subjects for each cohort subset has been satisfied. 
Subjects will participate in prescribed challenges during any consecutive 5-days of 
the hybrid closed-loop phase. Subjects should be in Automated Mode during the 
challenges. Every effort will be made to conduct challenges over 5 consecutive 
days however challenges that occur on non-consecutive days will not constitute a 
protocol deviation, nor will performing the challenges out of order as long as all 
prescribed challenges are completed. If challenge visits are not conducted on 
consecutive days, the site will be required to conduct follow-up telephone visits 
12-36 hours after each non-consecutive visit. Challenge visits may occur on the 
same date as any other Phase 2 visit. 
Table 5:  Sample Size of Subjects Enrolled in Challenges 
Cohort (Ages) 
Minimum Number of 
Subjects (N) 
14-70 years 
N=60 
6-13.9 years 
N=100 
Subjects will travel to a central location each day where they will be closely 
monitored by clinical staff throughout the challenges. Alternatively, if subjects are 
self-isolating during the COVID-19 pandemic, they may complete these 
challenges at home if a companion or caregiver is present and communicates 
completion of activities to the site staff by phone or videoconference. Sites can 
supervise glucose levels by monitoring the Horizon Data Portal.     
During the 5-day exercise and meal challenges, subjects will be supervised by 
clinical site staff trained in the assessment and treatment of diabetic emergencies. 
Clinical site staff or companions/caregivers will be equipped with emergency 
supplies including glucose tablets, glucagon, and other supplies used for the 
treatment of diabetic emergencies. Subjects may participate in exercise if their 
CGM value is ≥70 mg/dL with the corresponding CGM trend either steady or 
increasing. Subjects will be discharged from each day of challenges when they 
meet the CGM criteria between 70-300 mg/dL on two consecutive checks for the 
last 30-minutes of their participation given that the CGM trend is not rapidly 
increasing or decreasing at these timepoints.    
Challenges can occur in a group setting with multiple subjects.  
The challenges will include: 

 
 
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Table 6:  Challenges 
Challenges 
Day 
1 
Day 
2 
Day 
3 
Day 
4 
Day 
5 
Day  
6 
High 
Carbohydrate 
Meal  
(≥ 60 grams) 
X 
With Bolus 
Day 1 and 2 
Matched 
Meal 
X 
No Bolus 
Day 1 and 2 
Matched 
Meal 
X 
With Bolus 
Day 3 and 4 
Matched 
Meal 
X 
No Bolus 
Day 3 and 4 
Matched 
Meal 
X 
With Bolus 
 
Exercise to 
include both: 
• 
One-hour 
minimum 
of 
moderate 
or greater 
intensity 
exercise12 
• 
Two-hour 
minimum 
of mild or 
greater 
intensity 
exercise27 
X 
X 
X 
X 
X 
 
Follow-up 
Telephone 
Visit 
(12-36h post 
challenges) 
 
 
 
 
 
X 
 
Moderate intensity exercise is defined using the CDC guidelines12 (Table 7): 
Table 7:  CDC Guidelines12 for Moderate Intensity Exercise 
 
Children and 
Adolescents 
Adults 
Older Adults 
Moderate 
Intensity 
Activities 
Brisk walking 
Bicycling 
Hiking 
Catching/throwing 
Walking/jogging 2.5 
miles per hour 
Bicycling 
Aerobics 
Walking/hiking 
Jogging 
Bicycling 
Aerobics 

 
 
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Low intensity exercise is defined using the US Department of Health and Human 
Services Physical Activity Guidelines for Americans and includes waking non-
sedentary behaviors such as walking at 2.0 miles per hour, cooking activities, or 
light housekeeping. 27 
During the challenge visits, subjects will be encouraged to: 
• 
Follow their pre-exercise management such as insulin reduction for meal 
boluses, consumption of snacks, or adjusting their insulin delivery 
settings.  
• 
Treat themselves per their usual routine if they become hypoglycemic or 
hyperglycemic or have symptoms of either at any time during the exercise 
challenge. 
Subjects will be offered a snack prior to their release from the site upon discharge.  
Inability to complete the 5-days of exercise due to an injury where participation 
may exacerbate the condition will not be considered a protocol deviation. Ability to 
participate will be up to the discretion of the investigator. 
9.2 Visit 4 
Visit 4 represents the commencement of Phase 2 (hybrid closed-loop phase) for 
subjects that did not participate in the prepivotal study and will be conducted in 
person at the clinical site on Study Day 1.  All scheduled assessments will be 
performed according to Table 2:  Schedule of Assessments for Phase 1 and 
Phase 2.  This visit will include: 
• 
Pregnancy test for women of childbearing potential 
• 
Review of concomitant medications 
• 
Average total daily insulin (approximately over the past 7 days) 
• 
Average total daily basal insulin (approximately over the past 7 days) 
• 
Average total daily bolus insulin (approximately over the past 7 days) 
• 
Pump settings/MDI dosing 
• 
Assessment of AEs 
• 
Initiation of Horizon Data Portal monitoring 
 
• 
Omnipod Horizon™ System device training conducted by trained clinical 
site staff 
o Subjects will be trained on operating Omnipod Horizon™ in both 
Manual and Automated Modes.  
o This will include first time device set-up with entry of basal profile, bolus 
calculator settings with insulin:carbohydrate ratio, target glucose and 
correction factor.  
o The Pod will be filled with the subject’s own U-100 rapid-acting insulin 
and placed on body. Subjects will also be trained on use of Dexcom G6 
CGM, regardless of previous experience, setting up low (recommended 
to be 70 mg/dL or higher) and high glucose alerts (recommended to be 
300 mg/dL or lower) and entering transmitter serial number into the 
Horizon App.  

 
 
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o Subjects may choose their desired target BG ranging between 110-150 
mg/dL in increments of 10mg/dL, although the default and 
recommended setpoint is 120 mg/dL.  
o In addition, Omnipod Horizon™ has a novel bolus calculator feature 
that incorporates both the CGM value and trend into the suggested 
bolus amount. In general, if the CGM values are trending up or down, 
the calculator will add or subtract insulin from the suggested bolus 
amount to help keep BGs within target range. 
 
• 
Dispense Omnipod Horizon™ System 
• 
Complaints/device deficiencies for CGM, BG and ketone meter 
• 
Device uploads for CGM, BG and ketone meter 
• 
Data review by clinician 
• 
Removal of the subject’s personal insulin pump (if applicable) 
o Investigators may use the Insulet-provided Patient Therapy Order Form 
(PTOF) as a guide to transition subjects from MDI to pump therapy 
(Appendix A) 
If a subject is a current Dexcom G6 User and Visit 2 and Visit 4 occur on the same 
day, average total daily insulin and pump settings/MDI dosing only needs to be 
collected once.  Further, if Visit 1 and Visit 4 occur on the same day, only one 
pregnancy test is required. 
At the conclusion of the training and completion of assessments, each subject will 
initiate their treatment marking their commencement of the hybrid closed-loop 
phase. 
9.3 Visit 5  
Visit 5 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 2 ± 1-day for subjects commencing the hybrid closed-loop 
phase during Visit 4.  For subjects extending their participation from the prepivotal 
study, the visit may be conducted in person at the clinical study site or over the 
telephone. This visit will include: 
• 
Informed consent for subjects extending their participation from prepivotal 
(Informed Consent may occur at any time during the prepivotal study but 
must occur prior to commencing the pivotal study)   
• 
Establishing eligibility for subjects extending their participation from 
prepivotal 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter for subjects extending their 
participation from prepivotal and the visit was conducted in the office  
• 
Data review of Automated Mode use by clinician 
 

 
 
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9.4 Visit 6 
Visit 6 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 3 ± 1 day. This visit will include: 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Data review of Automated Mode use by clinician 
 
9.5 Visit 7 
Visit 7 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 10 ± 3-days. This visit will include: 
 
• 
A pregnancy test for women of childbearing potential (if visit is conducted 
in person at the clinical study site) 
• 
Review of concomitant medications 
• 
Assessment of vital signs (if visit is conducted in person at the clinical 
study site) 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted in person at 
the clinical study site) 
• 
Data review of Automated Mode use by clinician 
 
9.6 Visit 8 
Visit 8 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 24 ± 3-days. This visit will include: 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Data review of Automated Mode use by clinician 
 
9.7 Visit 9 
Visit 9 will be conducted either over the telephone or in person at the clinical 
study site on study day 38 ± 3-days. This visit will include: 
• 
A pregnancy test for women of childbearing potential (if visit is conducted 
in person at the clinical site).  
• 
Review of concomitant medications 
• 
Assessment of vital signs (if visit is conducted in person at the clinical site) 
• 
Assessment of AEs since last visit 

 
 
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• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted in person at 
the clinical site) 
• 
Data review of Automated Mode use by clinician 
 
9.8 Visits 10, 11 and 12 
Visits 10, 11 and 12 will be conducted either over the telephone or in person at 
the clinical study site on Study Day 52, 66, and 80 ± 3-days. These visits will 
include: 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Data review of Automated Mode use by clinician 
 
9.9 Visit 13 (End of Phase 2) 
Visit 13 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 94 ± 3 days.  This visit will include: 
• 
A1C (blood draw sent to NGSP laboratory) 
• 
Pregnancy test for women of childbearing potential (if visit is conducted in 
person at the clinical site) 
• 
Review of concomitant medications 
• 
Height (if visit is conducted in person at the clinical site) 
• 
Weight (if visit is conducted in person at the clinical site) 
• 
Assessment of vital signs (if visit is conducted in person at the clinical site) 
• 
Assessment of AEs since last visit 
• 
Completion of questionnaires (See Table 4:  Questionnaires for specific 
requirements by age group): 
• 
WHO-5 
• 
EQ-5D 
• 
T1DDS 
• 
DTSQc  
• 
Hypoglycemia Confidence Scale 
• 
HABS 
• 
PSQI 
• 
IDSS (T1) 
• 
SUS 
• 
PAID-(Teen, Child) 
• 
INSPIRE-(Adult, Youth, Parent) 
▪ 
Used to measure a caregiver’s experience of the support they 
receive 
• 
Human Factors (HF) Questionnaire 
▪ 
Measures trust in the Horizon System 

 
 
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• 
Clarke Questionnaire 
• 
Discontinuation of Horizon Data Portal monitoring if not continuing into 
Phase 3 
• 
Return study devices if not continuing into Phase 3 (Omnipod Horizon™ 
System, CGM, BG and ketone meters) 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter 
• 
Data review of Automated Mode use by clinician 
This visit will mark the discontinuation of Phase 2 and mark the end of the study 
for subjects not continuing to Phase 3.        
9.10 Unscheduled Visits (Phase 2) 
Aside from scheduled visits, subjects may require an unscheduled visit either by 
telephone (inclusive of email or text options) or in person at the clinical study site. 
All scheduled assessments will be performed according to Table 2:  Schedule of 
Assessments for Phase 1 and Phase 2. This visit will include, at a minimum: 
 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (recommendation only if visit is 
conducted at the clinical site) 
• 
Data review of Automated Mode use by clinician 
 
During the Phase 2 study pause, subjects that wish to continue to use the 
Omnipod Horizon™ System in Manual Mode or subjects that wish to go back to 
using their own system during the pause will have either telephone or in person 
visits every 4 weeks ± 5 days from their last scheduled or unscheduled visit until 
the study resumes.   
 
Subjects will continue to be provided study supplies during the study pause if they 
wish to continue in the study.  
 
If subjects have been in the pivotal hybrid closed-loop phase for ≥ 35 days prior to 
pausing Automated Mode, subjects may be requested to submit to an A1C lab 
draw as soon as possible after pausing Automated Mode.  The A1C lab draw does 
not have to coincide with a scheduled or an unscheduled visit.    
 
Sites will ensure subjects that are continuing to use the system in Manual Mode 
do not enter Automated Mode during the study pause.   
 
• 
Sites will be asked to check the Horizon Data portal once per week to make 
sure subjects have not entered Automated Mode 
• 
If a subject is found to be in Automated Mode, the subject will be given a 
warning. If the same subject is found to be in Automated Mode a second 

 
 
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time, the subject will be instructed to return the investigational device to the 
site until a software fix is available 
Subjects that do not wish to continue their study participation will be withdrawn 
from the study. 
 
Additional assessments may be warranted at the discretion of the investigator. 
 
Instructions will be given to subjects on how to contact clinical study staff 24 hours per 
day to report any study related problems. Subjects will be encouraged to call the clinical 
study site at any time with any concerns.  
 
9.11 Recommencing After a Pause 
The recommencement visit or visits may be conducted either over the telephone 
or in person at the clinical study site preferably within 5 business days of 
recommencing Phase 2 of the study. The assessments required prior to the 
recommencement of Phase 2 will include: 
 
• 
Informed consent (may be conducted over telephone or email and will 
contain language for the study recommencement and the extension phase) 
• 
Optional A1C (blood draw sent to NGSP laboratory) 
• 
Pregnancy test for women of childbearing potential. If subject is not able to 
attend in person, they may conduct the test at home and report result to 
the site.   
• 
Review of concomitant medications 
• 
Average total daily insulin (approximately over the past 7 days) 
• 
Average total daily basal insulin (approximately over the past 7 days) 
• 
Average total daily bolus insulin (approximately over the past 7 days) 
• 
Assessment of AEs 
• 
Return Horizon System to subject (if applicable) 
• 
Update of PDM software by the study site or provide subject with a new, 
updated PDM  
• 
Resume Phase 2 of hybrid closed-loop including the following (as 
applicable): 
o Entry of Dexcom Transmitter ID into Horizon™ PDM 
o Initiation of Horizon™ Data Portal monitoring  
o Removal of the subject’s personal insulin pump  
• 
Complaints/device deficiencies for study devices 
• 
Device uploads for BG and ketone meter (if visit is conducted in person at 
the clinical site) 
• 
Data review by clinician will include therapy during the pause 
 
All subjects will resume the study where they left off with respect to the visit schedule.  
For example, a subject that started Phase 2 (of hybrid closed-loop) on 01 February 

 
 
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2020, completed Visit 8 on 24 February 2020 and paused participation on 28 February 
2020 has completed 28 days of Phase 2 participation. If the subject resumes Phase 2 
on 01 May 2020, this date is equivalent to Day 29 of Phase 2 participation.  The next 
scheduled study visit would be Visit 9 that should occur on Study Day 38 ± 3 days.  In 
this example, Visit 9 should occur between the 7 May and 13 May 2020, inclusive, with 
the optimal date being 10 May 2020. All subsequent visits will occur as scheduled.    
A total of up to 42 subjects will defer recommencement of Phase 2 to participate in a 
parallel study (G200018) to evaluate the safety and effectiveness of the Omnipod 
Horizon™ CGM-informed bolus calculator.  Once the subset of subjects complete the 
study, they will recommence Phase 2 of the Omnipod Horizon pivotal study (G190270).    
 
9.12 Early Withdrawal (Phase 2) 
Any subject may withdraw early from the study at any time for any reason. Upon 
withdrawal, assessments will be performed following Table 2:  Schedule of 
Assessments for Phase 1 and Phase 2. The investigator may also terminate a 
subject’s participation in the study if it is in the best interest of the subject or if the 
Sponsor or local regulatory agency (e.g., FDA) terminates the study. 
 
The Early Withdrawal visit will include: 
 
• 
A1C (blood draw sent to NGSP laboratory) 
• 
Review of concomitant medications 
• 
Height 
• 
Weight 
• 
Assessment of vital signs 
• 
Assessment of AEs since last visit 
• 
Completion of questionnaires (see Table 4:  Questionnaires for specific 
requirements by age group): 
• 
WHO-5 
• 
EQ-5D 
• 
T1DDS 
• 
DTSQc  
• 
Hypoglycemia Confidence Scale 
• 
HABS 
• 
PSQI 
• 
IDSS (T1) 
• 
SUS 
• 
PAID-(Teen, Child) 
• 
INSPIRE-(Adult, Youth, Parent) 
▪ 
Used to measure a caregiver’s experience of the support they 
receive 
• 
Human Factors (HF) Questionnaire 
▪ 
Measures trust in the Horizon System 
• 
Clarke Questionnaire 
• 
Discontinuation of Horizon Data Portal monitoring 
• 
Return all study devices 

 
 
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• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter 
• 
Data review by clinician 
 
The reason for withdrawal will be recorded, and their participation in the study will 
end. 
In the event of a subject’s death during the study, the subject’s participation will be 
considered terminated and the date of death will be used as the date of study exit. 
10 HYBRID CLOSED-LOOP – PHASE 3 
The hybrid closed-loop Phase 3 extension will commence at Visit 13 upon conclusion 
of hybrid closed-loop Phase 2 and after all assessments are performed according to 
Table 2:  Schedule of Assessments for Phase 1 and Phase 2. Phase 3 assessments 
are to be performed according to Table 3:  Schedule of Assessments for Phase 3. 
For subjects that do not extend their participation into the extension phase, the reason 
for study exit at Visit 13 will be documented. This will not be considered an early 
withdrawal from the study. 
Subjects extending their participation into the extension phase are to be consented for 
both the first 6-month and the second 6-month interval of Phase 3.  Consent for each 
interval must occur on or any time before commencing that study interval (e.g. consent 
for first 6-months of Phase 3 must occur on or before Visit 13, consent for second 6-
months of Phase 3 must occur on or before Visit 19).  
During the hybrid-closed loop extension phase, subjects will continue to perform the 
following: 
 
• 
Adjust pump and CGM parameters to optimize their insulin therapy in 
collaboration with the recommendations from the clinical study staff 
• 
Follow their pre-exercise management such as insulin reduction for meal 
boluses, consumption of snacks, or adjusting their insulin delivery settings 
• 
Treat themselves per their usual routine if they become hypoglycemic or 
hyperglycemic or have symptoms of either at any time during the study 
• 
Consume meals and snacks of their own choosing. Subjects will be encouraged 
to estimate the grams of carbohydrates for each meal or snack per their usual 
routine. The estimate should be entered into the meal bolus calculator. 
• 
Administer meal boluses per their usual dosing routine 
• 
Participate in challenge visits as specified 
• 
Change their CGM per manufacturer’s instructions or sooner if necessary 
• 
Change the Pod at least once every 72 hours 
Subjects will have scheduled follow-up visits. Visits will be conducted either in person at 
the clinical study site or over the telephone.  Subjects may also choose to use email or 
text as a substitute for their scheduled telephone visit.  

 
 
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The duration of the hybrid closed-loop extension phase will last approximately 12-
months. 
Subjects will be encouraged to call the clinical study site at any time with any concerns.  
10.1 Visit 14 
Visit 14 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 120 ± 5 days.  This visit will include: 
• 
Review of concomitant medications 
• 
Assessment of adverse events since previous visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
10.2 Visit 15 
Visit 15 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 150 ±5 days.  This visit will include: 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
10.3 Visit 16 
Visit 16 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 180 ± 5 days.  This visit will include: 
• 
A1C (blood sample sent to NGSP laboratory) 
• 
A pregnancy test for women of childbearing potential (if visit is conducted 
in person at the clinical site) 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
 

 
 
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10.4 Visits 17 and 18 
Visits 17 and 18 will be conducted either over the telephone or in person at the 
clinical study site on Study Day 210 ± 5 days and Study Day 240 ± 5 days, 
respectively.  These visits will include: 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
 
10.5 Visit 19  
Visit 19 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 270 ± 5 days.  This visit will include: 
• 
A1C (blood sample sent to NGSP laboratory) 
• 
Pregnancy test for women of childbearing potential (if visit is conducted in 
person at the clinical site) 
• 
Informed Consent (consent for second 6-month interval of Phase 3 may 
occur on or any time before this visit) 
• 
Review of concomitant medications 
• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter  
• 
Data review of Automated Mode use by clinician 
 
10.6 Visit 20 
Visit 20 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 315 ± 5 days.  This visit will include: 
• 
Review of concomitant medications 
• 
Assessment of AEs since previous visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
10.7 Visit 21 
Visit 21 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 360 ±5 days.  This visit will include: 

 
 
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• 
A1c (blood sample sent to NGSP laboratory) 
• 
Review of concomitant medications 
• 
Assessment of AEs since previous visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
10.8 Visit 22 
Visit 22 will be conducted either over the telephone or in person at the clinical 
study site on Study Day 405 ± 5 days.  This visit will include: 
 
• 
Review of concomitant medications 
• 
Assessment of AEs since previous visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter (if visit is conducted at the clinical 
site) 
• 
Data review of Automated Mode use by clinician 
 
10.9 Visits 23 (end of study) 
Visits 23 will be conducted in person at the clinical study site on Study Day 450 ± 
5 days. This visit will include: 
• 
A1c (blood sample sent to NGSP laboratory) 
• 
Review of concomitant medications 
• 
Height 
• 
Weight 
• 
Assessment of AEs since previous visit  
• 
Return study devices (Omnipod Horizon™ System, CGM, BG and ketone 
meters) 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter  
• 
Data review of Automated Mode use by clinician 
 
10.10 Unscheduled Visits (Phase 3) 
Aside from scheduled visits, subjects may require an unscheduled visit either by 
telephone or in person at the clinical study site. All scheduled assessments will be 
performed according to Table 3:  Schedule of Assessments for Phase 3. This visit 
will include, at a minimum: 
 
• 
Review of concomitant medications 

 
 
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• 
Assessment of AEs since last visit 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Data review of Automated Mode use by clinician 
 
Additional assessments may be warranted at the discretion of the investigator. 
 
10.11 Early Withdrawal (Phase 3) 
Any subject may withdraw early from the study at any time for any reason. Upon 
withdrawal, assessments will be performed following Table 3:  Schedule of 
Assessments for Phase 3. The investigator may also terminate a subject’s 
participation in the study if it is in the best interest of the subject or if the Sponsor 
or local regulatory agency (e.g., FDA) terminates the study. 
 
The Early Withdrawal visit will include: 
 
• 
A1C (blood sample sent to NGSP laboratory) 
• 
Review of concomitant medications 
• 
Height 
• 
Weight 
• 
Assessment of AEs since last visit 
• 
Return study devices (Omnipod Horizon™ System, CGM, BG and ketone 
meters) 
• 
Complaints/device deficiencies such as occlusion alarms and system 
hazard alarms since last visit 
• 
Device uploads for BG and ketone meter 
• 
Data review by clinician 
 
The reason for withdrawal will be recorded, and their participation in the study will 
end. 
In the event of a subject’s death during the study, the subject’s participation will be 
considered terminated and the date of death will be used as the date of study exit. 
10.12 Lost to Follow-up 
Every effort will be made to contact a subject in the event of a missed scheduled 
visit. A subject will be considered lost to follow-up if they are inaccessible by two 
or more different methods of contact and fail to show up for two scheduled visits. 
The site will document each attempt made to contact the subject and specify the 
reason for early withdrawal as lost to follow-up.      
 
11 SPONSOR REPRESENTATIVES 
One or more representatives of the Sponsor may be present at the hybrid closed-loop 
clinical study site visits under supervision of the investigator. 

 
 
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12 SAFETY 
12.1 Types of Known Risks and Benefits 
There are known risks and benefits. Most of the risks are not unique to the study 
and are typical for patients using insulin pumps, CGM, and BG meters. 
The known risks are as follows: 
• 
Hypoglycemia and/or hyperglycemia as a result of change in diet, activity, 
diabetes management or insulin regimen during the study. 
• 
Hypoglycemia and/or hyperglycemia as a result of over or under delivery of 
insulin due to a device defect, failure or malfunction of any of the system 
components. 
• 
Hypoglycemia, hyperglycemia, diabetic ketoacidosis, seizure, coma or death 
related to insulin administration, pump use or misuse, or Horizon™ System 
use or misuse. 
• 
Use of the Pod (Omnipod® tubeless, insulin delivery pump) - Because the 
Pod uses only rapid-acting insulin, users are at increased risk for developing 
hyperglycemia if insulin delivery is interrupted. If it is untreated, prolonged 
hyperglycemia can quickly lead to diabetic ketoacidosis (DKA). DKA can 
cause symptoms such as breathing difficulties, shock, coma, or death. 
Further, occlusions can interrupt insulin delivery and lead to hyperglycemia 
or DKA. Other potential risks associated with using the Pod are: 
o Anaphylaxis (allergic shock) 
o Bruising at the Pod site 
o Bleeding at the Pod site 
o Erythema (redness at the Pod site) 
o Excoriation (raw skin at Pod site) 
o Pruritus (itching) 
o Induration (hardening of the skin at the Pod site) 
o Infection (can include heat, redness, swelling, pain, and drainage) 
o Inflammation (redness, swelling) 
o Skin reaction to adhesive at the Pod site 
o Papule (small, solid raised area on the skin similar to a pimple) 
o Pain or discomfort 
o Ulceration (skin sores) 
o Vesicles (blisters) 
• 
Use of the CGM - risk of bruising, infection, pain and/or bleeding at the site 
of insertion, and skin site reaction to adhesive 

 
 
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• 
On rare occasions, the CGM sensor may break and leave a small portion of 
the sensor under the skin that may cause redness, swelling, or pain at the 
insertion site, and may require surgical removal. 
• 
Blood sampling with fingerstick - minor discomfort and risk of infection at site 
of fingerstick 
There are several potential benefits from this study. The Omnipod Horizon™ 
System is designed to provide automated glucose control. The system is expected 
to reduce hypoglycemia without incurring an unacceptable increase in 
hyperglycemia and mean glucose. The system is also expected to reduce the 
extent and magnitude of hyperglycemia associated with meals. The Omnipod 
Horizon™ System uses a control-to-target strategy that attempts to achieve and 
maintain a set target glucose level. 
12.2 Hypoglycemia/Hyperglycemia 
Subjects will be asked to treat per their usual routine if they suspect either 
hypoglycemia or hyperglycemia, either by confirmation of hypoglycemia with a 
fingerstick BG, symptoms, or perceived risk.  
Subjects will be encouraged to manage their hyperglycemia per their usual 
routine.  This includes checking for ketones using the study-approved ketone 
meter and administering a correction bolus if needed.   
In the event of unexplained hyperglycemia, where the CGM is >300mg/dL for 1h 
or >250 mg/dL for 2h, blood glucose (measured with BG meter) and ketones 
should be checked. If BG is ≥300 mg/dL and ketones are >1.0 mmol/L, an 
occlusion or dislodged cannula should be suspected. The Pod should be 
removed, and the subject will be instructed to replace the Pod. Subjects should 
contact the clinical site for further instructions to determine whether an additional 
injection of insulin is required. This prolonged hyperglycemic event, defined as 
meter BG ≥300 mg/dL and ketones >1.0 mmol/L, will be recorded as an adverse 
event and cause may be attributed to suspected occlusion if the cannula is in situ 
or dislodged cannula if it has been pulled out. Pods will be requested to be 
returned to Insulet for analysis.  An Adverse Event form will be completed per the 
Reportable Adverse Events section below. 
12.3 Adverse Events 
12.3.1 Definitions 
Adverse Event (AE): is defined as any untoward medical occurrence, unintended 
disease or injury, or any untoward clinical signs (including an abnormal laboratory 
finding) in subjects, users or other persons, whether or not related to the 
investigational medical device. 
NOTE 1: This includes events related to the investigational medical device or the 
comparator.28 
NOTE 2: This definition includes events related to the procedures involved (any 
procedure in the clinical investigation plan).28 

 
 
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Serious Adverse Event (SAE): Any untoward medical occurrence that: 
o Led to death 
o Led to serious deterioration in the health of the subject, that either 
resulted in: 
▪ 
a life-threatening illness or injury, or 
▪ 
a permanent impairment of a body structure or a body function, or 
▪ 
in-patient or prolonged hospitalization, or 
▪ 
medical or surgical intervention to prevent life-threatening illness 
or injury or permanent impairment to a body structure or a body 
function. 
o Led to fetal distress, fetal death, or a congenital abnormality or birth defect. 
 
NOTE: Planned hospitalization for a pre-existing condition, or a 
procedure required by the clinical investigational plan, without serious 
deterioration in health, is not considered a serious adverse event.28 
Unanticipated Adverse Device Effect (UADE): Any serious adverse effect on 
health or safety or any life-threatening problem or death caused by, or associated 
with, a device, if that effect, problem, or death was not previously identified in 
nature, severity, or degree of incidence in the investigational plan or application 
(including a supplementary plan or application), or any other unanticipated serious 
problem associated with a device that relates to the rights, safety, or welfare of 
participants.28 
Adverse Device Effect (ADE): An adverse device effect (ADE) is an adverse 
event related to the use of an investigational medical device. 28  
NOTE 1: This definition includes any adverse event resulting from insufficient or 
inadequate instructions for use, deployment, implantation, installation, or 
operation, or any malfunction of the investigational medical device.28 
NOTE 2: This definition includes any event resulting from user error or from 
intentional misuse of the investigational medical device.28 
An event that occurs solely due to participant (i.e., user) error in which the device 
functions properly generally will not be considered an ADE unless it is determined 
that the instructions on the screen of the device or user manual (or similar training 
materials) may have contributed to the event (note: the event may still meet 
criteria for reporting as an adverse event). 
Serious Adverse Device Effect (SADE): A serious adverse device effect is 
defined as an adverse device effect that has resulted in any of the consequences 
characteristic of a serious adverse event. 28 
Device Deficiency (DD): A device deficiency is defined as a device related 
complaint or malfunction or any inadequacy of a device with respect to its identity, 
quality, durability, reliability, safety or performance and includes misuse or use 
errors and inadequate labeling. A device deficiency is something that happens to 
a device or is related to device performance, whereas an adverse event happens 
to a participant. A device deficiency may occur independently from an AE, or 

 
 
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along with an AE. An AE may occur without a device deficiency or there may be 
an AE related to a device deficiency. 
Note: for reporting purposes, sites will not be asked to distinguish between device 
complaints and malfunctions.  
For any event where there is suspicion that the study device is involved, the 
Sponsor will request that the investigator return the device for evaluation. 
All device complaints or malfunctions involving any investigational component of 
the Omnipod Horizon™ System used in the study will be reported to the Sponsor 
within 5 business days of knowledge of the deficiency and documented on an 
appropriate eCRF. All study product associated with a reported device deficiency 
(PDM, Pod, and CGM) should be retained at the clinical site and returned to the 
Sponsor or CGM manufacturer for investigation and analysis. 
12.3.2  Reportable Adverse Events 
Adverse events will be assessed on an ongoing basis throughout the study. 
Adverse event reporting will begin at the start time of the standard therapy phase 
(i.e., insertion of the CGM sensor) and continue through the hybrid closed-loop 
phase 2 and 3 until the subject’s participation has ended. All adverse events must 
be followed until resolution, or until the AE has stabilized, or until the study has 
been completed. 
Pre-existing medical conditions or symptoms observed prior to the start time of the 
standard therapy phase will not be recorded as an AE and should be collected in 
the subject’s medical history. In the event there is a change (i.e., worsening) in the 
pre-existing medical condition or symptoms after enrollment meeting the criteria of 
a reportable adverse event, then an AE must be reported. 
For this protocol, a reportable adverse event includes any untoward medical 
occurrence that meets one of the following criteria: 
1. An SAE 
2. An ADE unless excluded from reporting in Hypoglycemic Events and 
Hyperglycemic/Ketotic Events sections below 
3. An AE occurring in association with a study procedure 
4. An AE not related to a study device issue which leads to temporary or 
permanent discontinuation of the study device 
5. An AE that affects the participant’s ability to complete any study 
procedures 
6. An AE for which a visit is made to a hospital emergency department   
7. Hypoglycemic Events as defined below 
8. Hyperglycemia/Ketotic Events as defined 
Skin reactions from sensor or pod placement are only reportable if severe and/or 
required treatment. 

 
 
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For the purpose of this protocol, mild symptoms of hypoglycemia and 
hyperglycemia (i.e., clinically non-significant) or blood glucose values out of the 
normal range (whether or not they resulted in delayed meals or correction 
boluses) will not be reported as AEs unless determined to meet the reportable 
criteria in the Hypoglycemic Events and Hyperglycemic/Ketotic Events sections 
below. 
All reportable AEs—whether volunteered by the participant, discovered by study 
personnel during questioning, or detected through physical examination, 
laboratory test, or other means—will be reported on an AE eCRF.  
12.3.3 Hypoglycemic Events 
Hypoglycemia is only reportable as an adverse event when one of the following 
criteria is met:   
• 
Severe Hypoglycemia: The event required assistance of another person 
due to altered consciousness, and required another person to actively 
administer carbohydrate, glucagon, or other resuscitative actions25. This 
means that the participant was impaired cognitively to the point that he/she 
was unable to treat himself/herself, was unable to verbalize his/her needs, 
was incoherent, disoriented, and/or combative, or experienced seizure or 
loss of consciousness. These episodes may be associated with sufficient 
neuroglycopenia to induce seizure or loss of consciousness.  If plasma 
glucose measurements are not available during such an event, 
neurological recovery attributable to the restoration of plasma glucose to 
normal is considered sufficient evidence that the event was induced by a 
low plasma glucose concentration. 
• 
Hypoglycemia resulting in an SAE that may not otherwise meet the 
definition of Severe Hypoglycemia defined above. 
When a hypoglycemic event meets the above reporting requirements, an Adverse 
Event Form should be completed. A severe hypoglycemia event should be 
considered a serious adverse event and follow the SAE reporting requirements. 
 
12.3.4 Hyperglycemic/Ketotic Events 
Hyperglycemia is only reportable as an adverse event when any of the following 
criteria is met:   
• 
The event involved DKA, as defined by the Diabetes Control and 
Complications Trial (DCCT)24 and described below 
• 
Evaluation or treatment was obtained at a health care provider facility for 
an acute event involving hyperglycemia or ketosis, or the participant 
contacted the site and received guidance on how to manage the 
hyperglycemia/ketosis 
• 
Prolonged hyperglycemia: defined as meter BG ≥300 mg/dL and ketones 
>1.0 mmol/L 
• 
Hyperglycemia resulting in an SAE that may not otherwise meet the above 
criteria 
 
Hyperglycemic events are classified as DKA24 if all of the following are present: 
• 
Symptoms such as polyuria, polydipsia, nausea, or vomiting; 

 
 
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• 
Serum ketones >1.5 mmol/L or large/moderate urine ketones; 
• 
Either arterial blood pH <7.30 or venous pH <7.24 or serum bicarbonate 
<15; and 
• 
Treatment provided in a health care facility 
 
When a hyperglycemia/ketotic event meets the above reporting requirements, 
Adverse Event Form should be completed.  
 
Events meeting DKA criteria should be considered a serious adverse event and 
follow the SAE reporting requirements. Hyperglycemia events not meeting criteria 
for DKA generally will not be considered as serious adverse events unless one of 
the SAE criteria above is met. 
 
12.3.5 Relationship of Adverse Event to Investigational Device 
The investigator will be responsible for making a determination on the causal 
relationship of the AE. Specifically, the investigator will report whether the AE was 
related to study procedures and/or related to the investigational device. 
To ensure consistency of adverse event causality assessments, investigators 
should apply the following general guideline when determining whether an 
adverse event is related. 
The causal relationship to the study procedures and the investigational device for 
each adverse event will be rated as follows:  
• 
Unrelated: The event is not related to the procedures or the investigational 
device.  
• 
Possibly Related: The temporal sequence is such that the relationship is 
not unlikely or there is no contradicting evidence that can reasonably 
explain the subject’s condition. There is a possibility of any relation 
between the event and the procedures or the investigational device.  
• 
Related: The temporal sequence is relevant or the event abates upon 
completion of the procedure/ investigational device, or the event cannot be 
reasonably explained by the subject’s condition or comorbidities. The 
event is related or most likely associated with the procedures or the 
investigational device. 
 
12.3.6 Severity (Intensity) of Adverse Events 
The severity (intensity) of an adverse event will be rated on a three-point scale: (1) 
mild, (2) moderate, or (3) severe. A severity assessment is a clinical determination 
of the intensity of an event. Thus, a severe adverse event is not necessarily 
serious. For example, itching for several days may be rated as severe, but may 
not be clinically serious. 
• 
MILD: Usually transient, requires no special treatment, and does not 
interfere with the participant’s daily activities. 
• 
MODERATE: Usually causes a low level of inconvenience, discomfort or 
concern to the participant and may interfere with daily activities but is 

 
 
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usually ameliorated by simple therapeutic measures and participant is able 
to continue in study. 
• 
SEVERE: Interrupts a participant’s usual daily activities, causes severe 
discomfort, may cause discontinuation of study device, and generally 
requires systemic drug therapy or other treatment. 
 
12.3.7 Outcome of Adverse Events 
The outcome of each reportable adverse event will be classified by the 
investigator as follows: 
• 
RECOVERED/RESOLVED - The participant recovered from the AE/SAE 
without sequelae. Record the AE/SAE stop date. 
• 
RECOVERED/RESOLVED WITH SEQUELAE - The event persisted and 
had stabilized without further anticipated change in the event status. 
Record the AE/SAE stop date. 
• 
FATAL - A fatal outcome is defined as the SAE that resulted in death. Only 
the event that was the cause of death should be reported as fatal.  
AEs/SAEs that were ongoing at the time of death; however, were not the 
cause of death, will be recorded as “resolved” at the time of death. 
• 
NOT RECOVERED/NOT RESOLVED (ONGOING) - An ongoing AE/SAE 
is defined as the event was ongoing with an undetermined outcome. 
• 
An ongoing outcome will require follow-up by the site in order to 
determine the final outcome of the AE/SAE or until participant 
completes the study. 
• 
The outcome of an ongoing event at the time of death that was not the 
cause of death, will be updated and recorded as “resolved” with the 
date of death recorded as the stop date. 
• 
UNKNOWN - An unknown outcome is defined as an inability to access the 
participant or the participant’s records to determine the outcome (for 
example, a participant that was lost to follow-up). 
 
If any UADEs are ongoing when a participant completes the study (or withdraws), 
the subject will continue to be followed until the event resolves or has no prospect 
of improvement or change, even after the participant has completed all applicable 
study visits/contacts, unless that subject has withdrawn their consent. For all other 
reportable adverse events, data collection will end at the time the participant 
completes the study. Note: Participants should continue to receive appropriate 
medical care for an adverse event after their participation in the study ends.  
12.4 Reportable Device Issues 
Device complaints and device malfunctions will be reported except in the following 
circumstances. These occurrences are expected and will not be reported on a 
Device Deficiency Form: 
• 
CGM sensor or Pod lasting fewer days than expected per manufacturer 
• 
CGM tape or Pod adherence issues 
• 
Battery lifespan deficiency due to inadequate charging or extensive wireless 
communication 

 
 
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• 
Intermittent device component disconnections/communication failures not 
requiring system replacement or workaround/resolution not specified in user 
guide/manual. 
• 
Device issues clearly addressed in the user guide manual that do not require 
additional troubleshooting 
12.5 Timing of Event Reporting 
SAEs possibly related or related to a study device or study procedures and 
UADEs must be reported to the Sponsor/CRO within 2 business days of the site 
becoming aware of the event. This can occur via phone or email, or by completion 
of the AE eCRF. If the form is not initially completed, it should be competed as 
soon as possible after there is sufficient information to evaluate the event. All 
other reportable AEs should be submitted by completion of the AE eCRF within 5 
business days of the site becoming aware of the event.  
Each principal investigator is responsible for reporting adverse events required by 
this protocol and abiding by any other reporting requirements specific to his/her 
Institutional Review Board or Ethics Committee.  
Upon receipt of a UADE report, the Sponsor will investigate the UADE and if 
indicated, report the results of the investigation to all participating investigators, 
overseeing IRBs, and the FDA within 10 business days of the Sponsor becoming 
aware of the UADE per 21CFR 812.46(b). Copies of the associated reports and 
correspondence with the investigators, regulatory authorities, and Sponsor must 
be retained with study records. 
The Medical Monitor must notify the DSMB of any UADEs and determine if the 
UADE presents an unreasonable risk to participants. If so, the Sponsor must 
ensure that all investigations, or parts of investigations presenting that risk, are 
terminated as soon as possible but no later than 5 working days after the Medical 
Monitor makes this determination and no later than 15 working days after first 
notice of the UADE. 
Device deficiencies will be handled by the Sponsor or designee as described 
below. In the case of a Dexcom CGM transmitter or sensor device malfunction, 
information will be forwarded to Dexcom by the site personnel, to be handled by 
Dexcom’s complaint management system. 
If the subject is hospitalized because of or during the course of an SAE, then a 
copy of the hospital discharge summary must be requested for inclusion with the 
SAE documentation. In case of death, the investigator must make every effort to 
obtain a copy of the death certificate to submit to the Sponsor. When submitting 
copies of documentation, all subject identifying information must be redacted and 
only the unique subject number will be used to label the forms for identification 
purposes. 
For any event where there is suspicion that the study device is involved, the 
investigator will return the device for evaluation when possible. 

 
 
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12.6 Safety Oversight 
The study Medical Monitor will review all adverse events and adverse device 
events that are reported during the study.  SAEs will typically be reviewed within 
24-hours of reporting.  Other AEs will typically be reviewed approximately weekly.  
A Data and Safety Monitoring Board (DSMB) will be informed of all cases of 
severe hypoglycemia and diabetic ketoacidosis irrespective of device relationship, 
all UADEs during the study and will review compiled safety data at periodic 
intervals. The DSMB also will be informed of any SADEs and ADEs not meeting 
criteria for a UADE if the Medical Monitor requests the DSMB review. The DSMB 
can request modifications to the study protocol or suspension or outright stoppage 
of the study if deemed necessary based on the totality of safety data available. 
Details regarding DSMB review will be documented in a separate DSMB Charter. 
 
12.7 Stopping Criteria 
12.7.1 Participant Discontinuation of Study Participation 
In the case of a UADE, the Medical Monitor will determine if the use of the study 
device will be suspended while the problem is diagnosed. The use of the study 
device may continue if the Medical Monitor believes the event is explainable, 
unlikely to reoccur and that it is safe for the subject to continue using the device. 
Alternately, the Medical Monitor may request the study subject, or all study 
subjects, to stop using the study device or to only use in Manual Mode. Should all 
study subjects be required to stop using the study device or to only use in Manual 
Mode due an UADE, use of the study device or Automated Mode will not be 
restarted until approval is received from the IRB, DSMB and FDA. 
Use of the study device by a participant will be discontinued if any of the following 
occur:  
• 
The investigator believes it is unsafe for the participant to continue on the 
intervention. This could be due to the development of a new medical 
condition or worsening of an existing condition; or participant behavior 
contrary to the indications for use of the device that imposes on the 
participant’s safety. 
• 
The participant requests that the treatment be stopped 
• 
Participant pregnancy 
• 
Two distinct episodes of DKA as defined above 
• 
Two distinct severe hypoglycemia events as defined above 
• 
One episode of DKA and one severe hypoglycemia event as defined 
above 
 
An additional requirement for continued study device use following a single DKA 
or severe hypoglycemia event will be that (1) the site investigator believes that 
the event is explainable, unlikely to recur, and that it is safe for the participant to 
continue to use the system and (2) the Medical Monitor concurs. If the Medical 
Monitor determines that the occurrence of the event indicates that it is not safe 
for the participant to continue to use the system, use will be discontinued, and the 
subject will be withdrawn from the study. 
 

 
 
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12.7.2 Criteria for Suspending or Stopping Overall Study 
Stopping criteria for Phase 2 will be determined by an independent DSMB, who 
will assess the specific event rates for DKA and severe hypoglycemia from the 
study at specific timepoints relative to published rates from large, population-
based datasets. Stopping rules may be modified for the Phase 3 extension.    
 
In consideration of adverse events rates occurring in this proposed study, the 
rates will be assessed relative to published rates from Foster et. al.10 and Miller et. 
al.26 to determine whether severe hypoglycemia or diabetic ketoacidosis are within 
expected rates during this study Table 8:  T1D Exchange Rates of Severe 
Hypoglycemia and Diabetic Ketoacidosis10,26provides a summary of these 
published rates. 
 
Table 8:  T1D Exchange Rates of Severe Hypoglycemia and Diabetic 
Ketoacidosis10,26 
Adverse Event 
Frequency of subjects to experience ≥ 1 
event extrapolated from T1DX registry 
2016-2018, 2013-2014 
Severe hypoglycemia (loss of consciousness or 
seizure) 
4-5% < 18 years  
7% ≥ 18 years 
Diabetic ketoacidosis (overnight hospitalization) 
3-4% < 18 years   
2-3% ≥ 18 years  
 
For unanticipated adverse device effects (UADEs), the DSMB will determine 
whether the study should proceed or not based upon risk of additional serious 
adverse events and the underlying root cause analysis of the UADE.   
 
Study activities could be similarly suspended if the manufacturer of any 
component of the investigational study device requires stoppage of device use for 
safety reasons (e.g. product recall).  
 
The affected study activities may resume if the underlying problem can be 
corrected by a protocol or system modification that will not invalidate the results 
obtained prior to suspension.  
 
The study Medical Monitor will review all adverse events that are reported during 
the study, and the DSMB will review all cases of severe hypoglycemia, DKA and 
UADEs as well as compiled safety data at periodic intervals. The Medical Monitor 
and/or DSMB may recommend suspension of study activities or stoppage of the 
study to the Sponsor if deemed necessary based on the totality of safety data 
available. 
12.8 Data Safety Monitoring Board (DSMB) 
The DSMB will be established prior to the first enrollment and consist, at a 
minimum, of two physicians and one statistician independent from the Sponsor 
and study. The physicians will have relevant therapeutic and medical expertise. 

 
 
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The DSMB will determine the stopping criteria for the study and review Severe 
Hypoglycemia and DKA as well compiled safety data at periodic intervals to 
determine if the stopping rules apply. Stopping rules may be modified for the 
Phase 3 extension.  
 
Compiled safety data may include listings of protocol deviations, device 
deficiencies, subject terminations, and/or subject withdrawals related to device or 
procedure safety. In addition, the DSMB members will be notified upon the 
occurrence of any UADEs to determine whether the study should proceed or not 
based upon risk and may request an ad hoc meeting to discuss. At minimum, the 
DSMB will conduct reviews after 16 subjects from the prepivotal study have 
completed a minimum of 10-days of the hybrid closed-loop phase (and prior to 
commencement of Pivotal Phase 2 for any subjects that did not participate in 
Prepivotal Phase 2), at the conclusion of the prepivotal study, after at least 80 
pivotal subjects have completed study visit 7 (24 ± 3 days of HCL therapy), and 
after the end of Phase 3. Additional reviews may be conducted at any time based 
on the request of the DSMB, Sponsor or Medical Monitor. At the conclusion of 
each meeting, the DSMB will make a recommendation to the Sponsor concerning 
the continuation, modification, and/or termination, of the study and/or a statement 
regarding their overall assessment of device safety and continuation of the pivotal 
study. The final decision regarding the continuation, modification or termination of 
the study will reside with the Sponsor. Responsibilities, qualifications, membership 
and committee procedures, including the final stopping rules, will be outlined in the 
DSMB Charter. 
12.9 Medical Monitor 
An independent Medical Monitor will be responsible for individual and timely 
review of adverse events as defined below. The Medical Monitor will be a 
physician with relevant therapeutic and medical expertise that is not participating 
as an Investigator in the study and does not have a financial, scientific, or other 
conflict of interest with the clinical study. 
 
Specific responsibilities of the Medical Monitor include:  
 
• 
Review of all adverse events reported during the study 
• 
Review all serious study procedure-related and/or investigational device-
related adverse events to determine if the adverse event warrants 
consideration as a UADE and facilitate the reporting of UADEs if applicable  
• 
Adjudicate the following(a) all SAEs; (b) any events of Diabetic Ketoacidosis 
or Severe Hypoglycemia; (c) all AEs reported by the site as related or 
possibly related to the investigational device; and/or (d) any additional 
events as requested by the Sponsor.  
• 
The specified events will be adjudicated to determine: 
o event relatedness to the study procedures and/or the 
investigational device 
o event categorization and assess seriousness and severity 
o whether an adverse event is anticipated or unanticipated 
The adjudication decision of the Medical Monitor will be used for the final 
classification of events, including relatedness to the study procedures and/or the 

 
 
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investigational device, for the determination of safety endpoints and for all 
regulatory reports, product labeling, and publications or presentations. 
 
The Medical Monitor’s roles and responsibilities are described in the Safety 
Management Plan (SMP).  
 
13 STATISTICAL CONSIDERATIONS 
13.1 Definition of Phase 2 and Phase 2 Participation 
For the majority of subjects, Phase 2 of hybrid closed-loop data will include both 
data collected prior to a study pause and data collected after the 
recommencement. Unless otherwise specified, any data that may have been 
collected during a study pause (including but not limited to CGM readings from the 
Horizon system while in Manual Mode), will be excluded from analyses.  
Continuous Phase 2 participation refers to the length of time on the Horizon 
system (either in Automated on Manual Modes) and is calculated as: 
• 
Commencement of Phase 2 until a study pause (for subjects who started 
Phase 2 prior to a study pause) 
• 
Recommencement until discontinuation from the Horizon system or end of 
Phase 2 (for subjects who started Phase 2 prior to a study pause) 
• 
Commencement of Phase 2 until discontinuation from the Horizon system 
or end of Phase 2 (for subjects who started Phase 2 after a study pause) 
If a subject has ≥6 weeks on the Horizon system during Phase 2 prior to a study 
pause and ≥6 weeks on the Horizon system during Phase 2 after the 
recommencement, the longer interval will be used for analysis of A1C. 
Specifically, the A1C associated with the longer interval, if available, will be used 
for the analysis of the A1C endpoints.  
13.2 Objectives and Endpoints 
13.2.1 Primary Safety Objective 
The primary safety objective of the study is to evaluate the safety of the Omnipod 
Horizon™ System in patients with type 1 diabetes. 
 
13.2.1.1 Primary Safety Endpoints 
The primary safety objective will be evaluated by summarizing the following 
events during Phase 2, and separately during Phase 3:  
 
• 
Incidence rate of severe hypoglycemia (events per person months) 
• 
Incidence rate of diabetic ketoacidosis (DKA) (events per person months) 
 

 
 
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13.2.2 Primary Effectiveness Objective 
The primary effectiveness objective of this study is to evaluate the effectiveness of 
the Omnipod Horizon™ System 
 
13.2.2.1 Primary Effectiveness Endpoints 
There are two primary effectiveness endpoints.  
 
• 
A1C after at least 6 weeks of continuous Phase 2 participation compared 
to baseline  
• 
A1C at Visit 16, 19, 21, and 23 compared to baseline 
• 
Percentage of time in range (70-180 mg/dL) during Phase 2 and 
separately during Phase 3 of the hybrid closed-loop phase as compared to 
Phase 1 (standard therapy) 
 
A1C – Phase 2 
 
A1C after at least 6 weeks of continuous Phase 2 participation will be compared to 
baseline A1C as measured by the core laboratory by calculating the change from 
baseline in A1C at the appropriate follow-up visit for each subject. Given the 
nature of this measure, continuous device use is essential for unbiased 
measurement of A1C. Therefore, the follow-up A1C used in the analysis of this 
endpoint will include only data from the subjects with at least 6 weeks of 
continuous Phase 2 participation, either prior to study pause or after 
recommencement, depending on the length of continuous participation and 
availability of the A1C measurements. The A1C collected at the latest follow-up 
visit during Phase 2 will be used, assuming it was collected after at least 6 weeks 
of subject’s participation in Phase 2. 
 
The change in A1C is calculated as A1C at follow-up minus baseline A1C (where 
negative change indicates decrease or improvement in A1C). The null hypothesis 
associated with this endpoint states that the mean change in A1C is greater than 
or equal to zero. Rejection of the null hypothesis indicates that the observed data 
support the alternative hypothesis that the mean change in A1C is less than zero. 
 
The hypotheses associated with the first primary endpoint are defined as: 
H0: µ ≥ 0 
H1: µ < 0 
where µ is the mean of the per subject differences in A1C from baseline to follow-
up.  
 
A1C – Phase 3 
 
A1C at Visit 16 (~6 months total HCL participation) will be compared to baseline 
A1C as measured by the core laboratory by calculating the change from baseline 
in A1C at follow-up visit for each subject.  
 
The change in A1C is calculated as A1C at follow-up minus baseline A1C.  There 
are no hypotheses associated with this endpoint.   
 

 
 
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Percentage of Time in Range 70-180 mg/dL – Phase 2 
 
The percentage of time in range 70-180 mg/dL during Phase 2of the hybrid 
closed-loop phase will be compared to standard therapy by calculating the change 
between the time in range percentages between Phase 2of hybrid closed-loop and 
Phase 1 (standard therapy) for each subject. The change in percentage of time in 
range 70-180 mg/dL is calculated as the percentage of time in range during Phase 
2 minus the percentage of time in range during Phase 1 (where positive change 
indicates increased time in range). The null hypothesis associated with this 
endpoint states that the mean change in percentage of time in range 70-180 
mg/dL is less than or equal to zero. Rejection of the null hypothesis indicates that 
the observed data support the alternative hypothesis that the mean change in 
percentage of time in range 70-180 mg/dL is greater than zero. 
 
The hypotheses associated with the this primary endpoint are defined as: 
H0: µ ≤ 0 
H1: µ > 0 
where µ is the mean of the per subject differences in percentage of time in range 
70-180 mg/dL during Phase 2 of hybrid closed-loop phase compared to Phase 1. 
 
Percentage of Time in Range 70-180 mg/dL – Phase 3 
 
The percentage of time in range 70-180 mg/dL during Phase 3 of the hybrid 
closed-loop phase will be compared to standard therapy by calculating the change 
between the time in range percentages between Phase 3 of hybrid closed-loop 
and Phase 1 (standard therapy) for each subject. The change in percentage of 
time in range 70-180 mg/dL is calculated as the percentage of time in range 
during Phase 3 minus the percentage of time in range during Phase 1. There are 
no hypotheses associated with this endpoint.   
 
13.2.3 
Secondary Objective 
The secondary objective of the study is to evaluate additional glycemic measures 
of effectiveness of the Omnipod Horizon™ System. 
13.2.4 
Secondary Endpoints 
The secondary objective will be evaluated using the following per subject 
endpoints with prespecified hypotheses: 
• 
Glucose metrics from system CGM during the hybrid closed-loop phase for 
Phase 2 will be compared to Phase 1 overall: 
• 
% of time > 180 mg/dL 
• 
% of time < 70 mg/dL 
Additional per subject secondary endpoints without prespecified hypotheses used 
to evaluate the secondary objective include:   
• 
A1C: 

 
 
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o A1C after at least 8 weeks of continuous Phase 2 participation at 
the end of Phase 2 (Visit 13), at 6 months (Visit 16), and at the 
end of Phase 3 (Visit 23; approximately 15 months) 
o Change from baseline in A1C after at least 6 weeks of continuous 
Phase 2 participation, after at least 8 weeks of continuous Phase 
2 participation at the end of Phase 2 (Visit 13), at 6 months (Visit 
16), and at the end of Phase 3 (Visit 23; approximately 15 
months)  
o Proportion of subjects demonstrating an improvement from 
baseline in A1C after at least 6 weeks of continuous Phase 2 
participation, after at least 8 weeks of continuous Phase 2 
participation at the end of Phase 2 (Visit 13), at 6 months (Visit 
16), and at the end of Phase 3 (Visit 23; approximately 15 
months)  
 
• 
Glucose metrics from system CGM during the hybrid closed-loop phase 
during Phase 2, and separately during Phase 3 will be compared to Phase 1 
during the day, overnight, and overall: 
 
• 
Mean glucose 
• 
% of time in range 70-180 mg/dL 
• 
% of time in range 70-140 mg/dL 
• 
% of time > 180 mg/dL 
• 
% of time ≥ 250 mg/dL 
• 
% of time ≥ 300 mg/dL 
• 
% of time < 70 mg/dL 
• 
% of time < 54 mg/dL 
• 
Standard deviation 
• 
Coefficient of variation 
 
• 
Percentage of time in hybrid closed-loop as proportion of overall device 
usage time during Phase 2, and separately during Phase 3 
• 
Glucose management indicator (GMI) based on overall mean glucose during 
Phase 2, and separately during Phase 3 will be compared to Phase 1 
• 
Insulin requirements during Phase 2, and separately during Phase 3 will be 
compared to Phase 1: 
 
• 
Total daily insulin (TDI) (units, units/kg) 
• 
Total daily basal insulin (units, units/kg) 
• 
Total daily bolus insulin (units, units/kg) 
 
• 
Change from baseline in BMI (kg/m2) at end of Phase 2, and at end of Phase 
3 
 
Percentage of Time in Range >180 mg/dL 
 
The percentage of time in range >180 mg/dL during Phase 2 of hybrid closed-loop 
phase will be compared to standard therapy (Phase 1) by calculating the change 
between the time in range percentages between Phase 2 and Phase 1 for each 
subject. The change in percentage of time in range >180 mg/dL is calculated as 

 
 
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the percentage of time in range during Phase 2 minus the percentage of time in 
range during Phase 1. The null hypothesis associated with this endpoint states 
that the mean change in percentage of time in range >180 mg/dL is greater than 
or equal to zero. Rejection of the null hypothesis indicates that the observed data 
support the alternative hypothesis that the mean change in percentage of time in 
range >180 mg/dL is less than zero. 
 
The hypotheses associated with this secondary effectiveness endpoint are defined 
as: 
H0: µ ≥ 0 
H1: µ < 0 
where µ is the mean of the per subject differences in percentage of time in range 
>180 mg/dL during Phase 2 of hybrid closed-loop compared to the standard 
therapy phase (Phase 1). 
 
Percentage of Time in Range <70 mg/dL 
 
The percentage of time in range <70 mg/dL during Phase 2 of hybrid closed-loop 
phase will be compared to standard therapy (Phase 1) by calculating the change 
between the time in range percentages between Phase 2 and Phase 1 for each 
subject. The change in percentage of time in range <70 mg/dL is calculated as the 
percentage of time in range during Phase 2 minus the percentage of time in range 
during Phase 1. The null hypothesis associated with this endpoint states that the 
mean change in percentage of time in range <70 mg/dL is greater than or equal to 
zero. Rejection of the null hypothesis indicates that the observed data support the 
alternative hypothesis that the mean change in percentage of time in range <70 
mg/dL is less than zero. 
 
The hypotheses associated with this secondary effectiveness endpoint are defined 
as: 
H0: µ ≥ 0 
H1: µ < 0 
where µ is the mean of the per subject differences in percentage of time in range 
<70 mg/dL during Phase 2 of hybrid closed-loop compared to the standard 
therapy phase (Phase 1). 
 
13.3 Sample Size 
This is a single-arm, multi-center, prospective study. The sample size and study 
duration were determined to allow for adequate safety profile of the investigational 
device. The study will be claimed successful if rates of Severe Hypoglycemia and 
DKA during Phase 2 are considered acceptable compared to published rates. 
In addition, a statistically powered sample size was determined for the two Phase 
2 primary effectiveness endpoints. Since each of the Phase 2 primary 
effectiveness endpoints will be evaluated separately, the significance level will be 
adjusted so that the overall type I error can be maintained at one-sided 2.5% and 
each endpoint will be tested at one-sided 1.25%. 

 
 
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13.3.1 
Primary Endpoint of A1C After at Least 6 Weeks of Continuous 
Phase 2 Participation Compared to Baseline 
The sample size estimation is based on the following assumptions: 
• 
Mean difference between paired observations of A1C after at least 6 
weeks of continuous Phase 2 participation compared to baseline is -
0.5% 
• 
Standard deviation of the difference between paired observations of A1C 
after at least 6 weeks of continuous Phase 2 participation compared to 
baseline is 0.8% 
• 
Power of 90% and one-sided significance level of 1.25% 
The estimates for the mean difference and standard deviation of the difference 
between the paired observations were obtained from previous Omnipod studies, 
where subjects experienced a mean change in A1C of 0.38% over 3 months 
(standard pump therapy only), from 8.1 to 7.7%, n=85 (data on file). Based on the 
above assumptions, 35 subjects are required to provide evaluable data. 
13.3.2 
Primary Endpoint of Percentage of Time in Range 70-180 mg/dL 
During Phase 2 of Hybrid Closed-Loop Compared to Phase 1 
The sample size estimation is based on the following assumptions: 
• 
Mean difference between paired observations of percentage of time in 
range 70-180 mg/dL during Phase 2 of hybrid closed-loop compared to 
the Phase 1 is 10% 
• 
Standard deviation of the difference between paired observations of 
percentage of time in range 70-180 mg/dL during Phase 2 of hybrid 
closed-loop compared to Phase 1 is 15% 
• 
Power of 90% and one-sided significance level of 1.25% 
The estimates for the mean difference and standard deviation of the difference 
between the paired observations were obtained from recent Omnipod studies, 
G170012 and G170143, where subjects experienced a mean change in 
percentage of time in range 70-180 mg/dL of 10.0 ± 15.1% and 13.8 ± 14.6%, 
respectively. Based on the above assumptions, 31 subjects are required to 
provide evaluable data.  
To gather adequate safety and effectiveness data on the performance of the 
Omnipod Horizon™ System, a total of up to 240 subjects will be enrolled in the 
study in order to obtain a minimum of 200 evaluable subjects.  
Subjects will be enrolled at up to 20 clinical study sites. No single site should 
enroll more than 24 subjects for each age cohort.  

 
 
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A subset of subjects will take part in the prescribed exercise challenges per the 
defined sample sizes until the minimum number of subjects for each cohort subset 
has been satisfied. The enrollment cap for the exercise challenges will follow a 
similar logic as above for total enrollment and will be detailed in the Statistical 
Analysis Plan. 
13.4 Analysis Sets 
The following analysis sets are planned for the study and will apply to the 
endpoints through the end of Phase 2.  There are no prespecified analysis sets for 
Phase 3; all available data will be used to summarize Phase 3 endpoints: 
13.4.1 
ITT (Intention to Treat) Analysis Set 
The ITT analysis set includes all subjects that are enrolled in the study. All safety 
analyses (other than primary analysis of primary safety endpoints) will be based 
on the ITT analysis set. 
13.4.2 
mITT (modified Intention to Treat) Analysis Set 
The modified Intention to Treat (mITT) analysis set is a subset of the ITT analysis 
set. The mITT analysis set will consist of subjects who have entered the hybrid 
closed-loop phase of the study successfully. The mITT analysis set will be used as 
the primary analysis for the primary and secondary endpoints and other clinical 
outcome data. 
13.4.3 
PP (Per-Protocol) Analysis Set 
The Per-Protocol (PP) analysis set is a subset of the mITT analysis set. Subjects 
will be included in the PP analysis set if they have a minimum of 80% system use 
during the hybrid closed-loop phase inclusive of Manual and hybrid closed-loop 
(Automated) modes over a minimum duration of 10 weeks and have completed 
the study without major protocol deviations. The Manual Mode use during study 
pause does not contribute to the minimum system use requirement. The PP 
analysis set will be used as supportive analysis for the endpoints. The following 
will be considered major protocol deviations: 
• 
Major inclusion/exclusion criterion deviation 
• 
Significant protocol non-compliance that may confound the study objective 
data (e.g., use of prohibited medications) 
The list of subjects excluded from the PP analysis set will be determined prior to 
analysis. If the PP analysis set does not differ from the mITT analysis set, 
separate analyses will not be presented. 
13.5 Analysis of Primary and Secondary Endpoints 
Both Phase 2 primary effectiveness endpoints will be tested independently of each 
other for statistical significance using a paired t-test at a one-sided significance 
level of 1.25%.  

 
 
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If at least one of the Phase 2 primary effectiveness endpoints are found to be 
significant, the testing for Phase 2 secondary endpoints can commence. The 
details on how the family-wise error rate will be maintained at the 2.5% 
significance level (one-sided) will be provided in the Statistical Analysis Plan 
(SAP). In addition, the Phase 2 primary effectiveness endpoints may also be 
tested for significance within a smaller cohort of subjects (such as based on age). 
The details of subgroup analyses and testing will also be detailed in the SAP. At a 
minimum, the Phase 2 primary effectiveness endpoints will be presented by 
existing Dexcom G6 use at the time of screening (users and non-users) and by 
participation in the prepivotal study (those who participated in the prepivotal study 
and those who did not). 
There are no hypotheses associated with the other Phase 2 secondary endpoints 
or any of the Phase 3 endpoints. Summary statistics will be presented by age 
cohort for all endpoints, stratified by time points of interest (e.g., day vs. night, 
overall). The Phase 2 primary and secondary endpoints will be summarized for 
modified Intention to Treat (mITT) and Per Protocol (PP) analysis sets. If the PP 
analysis set does not differ from the mITT analysis set, separate analyses will not 
be presented. The data may be stratified by phase of the study, where the data 
collected in the standard therapy phase of the study will be compared to the data 
collected in the hybrid closed-loop phase of the study.  
13.5.1 Time in Range Endpoints 
The primary effectiveness endpoint and the secondary endpoints that summarize 
time in specific glycemic ranges will be calculated from device data outputs as 
follows: 
100 × # 𝑜𝑓 𝐶𝐺𝑀 𝑟𝑒𝑐𝑜𝑟𝑑𝑠 𝑖𝑛 𝑟𝑎𝑛𝑔𝑒 
# 𝑜𝑓 𝑒𝑣𝑎𝑙𝑢𝑎𝑏𝑙𝑒 𝐶𝐺𝑀 𝑟𝑒𝑐𝑜𝑟𝑑𝑠= 𝑇𝐼𝑅% 
13.6 Additional Data Analyses 
Following the upload of controller data into the database, the data will be made 
available to Sponsor representatives for periodic reviews. Reviews of the 
controller data will be conducted to identify any anomalies and to confirm the 
algorithm appears to be functioning as expected. These reviews, including any 
findings, will be documented. Unless potential safety concerns are identified, the 
results of such reviews will not be shared with study sites or subjects and thus, will 
not impact study outcomes. Should a potential safety concern be identified, sites 
may be notified as appropriate to ensure subject safety and measures may be 
taken to address the issue such as, but not limited to, changes to the protocol 
and/or device. Any resulting device deficiencies will be reported, if applicable. A 
brief summary of the controller data reviews will be included in the final clinical 
study report. 

 
 
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13.7 Safety Analyses 
13.7.1 
Evaluation of Adverse Events  
All adverse events reported over the course of the study will be summarized and 
tabulated by study phase, event category, seriousness, severity, and relationship 
to the study procedure and the investigational device. For the purposes of 
summarization, an event will be considered “Related” if the relationship was 
deemed as “Possibly Related” or “Related”. In cases where the same event is 
reported more than once per subject, the event will only be counted once in the 
incidence table(s).  
Adverse events leading to death or to discontinuation from the study will be listed 
separately. A listing of all adverse events will be provided. The primary safety 
endpoints will be presented by existing Dexcom G6 use at the time of screening 
(users and non-users) and by participation in the prepivotal study (those who 
participated in the prepivotal study and those who did not). 
Adverse events that were reported during study pause will be listed separately. 
13.7.2 Evaluation of Device Deficiencies  
Device deficiencies will be tabulated and listed in a manner similar to the methods 
described for adverse events. Any device deficiency leading to an AE or to study 
termination will be listed separately. 
Device deficiencies that were reported during study pause will be listed 
separately. 
13.8 Baseline Characteristics 
The distribution of each baseline characteristic or demographic parameter of 
interest (such as age, gender, medical history, etc.) will be presented. Data on all 
enrolled subjects will be presented. Continuous variables will be summarized 
using count, mean, median, standard deviation, and range. Categorical variables 
will be summarized using counts and percentages. 
13.9 General Statistical Methods 
Standard statistical methods will be employed to analyze all data. Data collected 
in this study will be presented using summary tables and subject data listings. 
Unless otherwise noted, all p-values will be considered significant at a two-sided 
significance level of 5%. Continuous variables will be summarized using 
descriptive statistics, including count, mean, median, standard deviation (SD), 
minimum and maximum. Where appropriate, 95% two-sided confidence intervals 
for the means or medians will be presented. If the observed data are found not to 
follow a normal distribution, appropriate non-parametric methods may be 
employed. Categorical variables will be summarized by frequencies and 
percentages. Unless explicitly stated otherwise, percentages will utilize a 
denominator corresponding to the number of unique subjects. 

 
 
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13.10 Missing Data 
All practical monitoring and follow-up steps will be taken to ensure complete and 
accurate data collection. All analyses will be based on available data only; no 
imputation for missing data is planned. 
13.11 Statistical Software 
The statistical software package SAS® 9.4 or later will be used for all the data 
derivations, summarization, data listings and statistical analyses. Additional 
software such as Splus or R may be used for graphics or validation as 
appropriate. 
Additional details regarding statistical analyses will be provided in the Statistical 
Analysis Plan (SAP) which will be prepared prior to data analysis. If discrepancies 
exist between the protocol and the SAP, the SAP will prevail. Any deviations from 
the finalized SAP will be described in the final study report. 
14 DATA HANDLING AND QUALITY ASSURANCE 
Data in this study will be collected on Electronic Case Report Forms as well as via 
electronic device outputs. 
14.1 Electronic Case Report Forms (eCRFs) 
Study data are collected through a combination of subject electronic CRFs 
(eCRFs) and electronic device data files.  eCRF Data will be recorded in a 21 CFR 
Part 11 compliant database that will reside on a central server accessible via the 
Internet. 
Electronic data files contain the primary source data for study devices.  When data 
are directly collected in the eCRFs, this will be considered source data.  When 
data is not directly collected in the eCRFs, electronic or paper documents 
containing source data that is transcribed into the eCRF are the source. 
The investigator is responsible for the accuracy and completeness of data 
reported on the eCRFs. Each set of subject eCRFs must be reviewed and signed 
by the investigator in the EDC system. The investigator also agrees to maintain 
accurate source documentation supporting the data. When pertinent supportive 
information is available for data entered directly into the eCRFs, this supporting 
documentation will also be maintained. Source documents may include chart 
notes, laboratory reports, images, study specific source worksheets, eCRFs, 
device data files, etc. 
14.2 Electronic Device Outputs 
14.2.1 
PDM Data 
This study will utilize insulin delivery data from the PDM device. All insulin delivery 
data and all CGM readings from the hybrid closed-loop phase will be stored on the 

 
 
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PDM and exported to Insulet Cloud. Data will be saved in a compatible format that 
will be extractable for statistical analysis purposes. Data from the hybrid closed-
loop phase will be uploaded to the database and used for analysis.  
14.2.2 
CGM Data 
This study will utilize CGM measurements from the CGM device. All CGM 
readings from the hybrid closed-loop phase will be stored on the controller. CGM 
data will be saved in a compatible format that will be extractable for statistical 
analysis purposes. CGM data from the standard therapy phase will be uploaded to 
the database and used for comparative analysis.  
14.2.3 
BG and Ketone Meter Data 
This study will also utilize measurements from a BG and ketone meter. BG and 
Ketone meter data, in any format, will be uploaded to the database.  
14.3 Subject Identifiers 
All data used in the analysis and reporting of the study will be without identifiable 
reference to the subject. Only the unique subject number will be used to identify 
subject data submitted to the Sponsor, and only the investigating clinical site will 
be able to link the unique subject ID to the subject’s name. 
14.4 Monitoring Responsibilities 
This study will be monitored for compliance with the protocol and applicable 
regulatory requirements. A study specific monitoring plan will specify the minimum 
frequency, scope, and general conduct of monitoring visits as well as identify any 
relevant study-specific monitoring responsibilities. 
Monitors for this study will be qualified by education, experience and training. The 
monitor will report to the Sponsor any non-compliance with the protocol, 
applicable regulations, or any conditions imposed by the IRB or local regulatory 
authority. If compliance cannot be secured, device shipments to the Investigator 
may be discontinued and the Investigator’s participation in the study terminated. 
Investigators and clinical site coordinators are expected to make source files and 
other records and reports available to the monitors as required. 
14.5 Inspection of Records 
The Sponsor or its designee may perform quality assurance site and study file 
audits. Investigators and institutions involved in the study will permit trial-related 
monitoring, audits, IRB review, and regulatory inspection by providing direct 
access to all study records. In the event of an audit or inspection, the investigator 
agrees to allow the Sponsor, representatives of the Sponsor, the FDA, or other 
regulatory authorities access to all study records. 
The investigator should promptly notify the Sponsor of any study inspections 
scheduled by the regulatory authorities and promptly forward copies of any audit 
reports received to the Sponsor. 

 
 
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14.6 Study Record Retention 
Records and reports must remain on file at the investigational site for a minimum 
of two years after the later of either the completion/termination of the study or the 
date of market approval for the indication being studied. They may be discarded 
only upon approval from the Sponsor. The Principal Investigator must contact the 
Sponsor before destroying any records and reports pertaining to the study to 
ensure that they no longer need to be retained. In addition, the Sponsor must be 
contacted if the investigator plans to leave the investigational site to ensure that 
arrangements for a new investigator or records transfer are made prior to 
investigator departure. 
14.7 Device Accountability 
Investigators will be responsible for investigational device accountability, 
reconciliation and records maintenance throughout the course of the investigation. 
Accountability records will include receipt, use and final disposition of 
investigational product.  
Study devices must be stored according to the conditions set forth for the device 
on the label in a controlled, locked area. All device shipment records (packing 
lists, etc.) must be maintained at the clinical site.  
The study monitor will verify accountability of the study devices during routine 
monitoring visits to the clinical site. 
15 STUDY ETHICS AND CONDUCT 
15.1 Role of the Sponsor 
As the Sponsor of this clinical study, Insulet has the overall responsibility for the 
conduct of the study, including assurance that the study meets the requirements 
of the appropriate regulatory bodies. In this study, the Sponsor will have certain 
direct responsibilities and may delegate certain study tasks to the Contract 
Research Organization (CRO). 
15.2 Ethical Conduct of the Study 
The investigation will be conducted according to the applicable FDA regulations 
(21CFR 812, 56, 54, 50). The investigator will conduct all aspects of this study in 
accordance with all state, and local laws or regulations. 
15.3 Institutional Review Board (IRB) 
Federal regulations (21 CFR 812) require that approval be obtained from an IRB 
prior to participation of subjects in research studies. Prior to subject enrollment, a 
signed copy of the IRB approval letter must be submitted to the Sponsor. In 
addition, the protocol, informed consent, advertisements to be used for subject 
recruitment, and any other written information regarding this study to be provided 
to the subject must be approved by the IRB. Documentation of all IRB approvals 

 
 
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will be maintained by the clinical site and will be available for review by the 
Sponsor or its designee. 
All IRB approvals should be signed by the IRB chairperson or designee and must 
identify the IRB by name and address, the clinical protocol by title and/or protocol 
number, and the date approval was granted. 
The Investigator is responsible for submitting and obtaining initial and continuing 
review of the trial at intervals not exceeding 1 year or as otherwise directed by the 
IRB. The investigator must supply the Sponsor, or its designee written 
documentation of continued review of the study. 
15.4 Informed Consent 
A written informed consent in compliance with 21 CFR 50 shall be obtained from 
each subject prior to participating in the study or performing any unusual or non-
routine procedure that involves risk to the subject. An informed consent form (ICF) 
template will be provided by the Sponsor or designee to investigative clinical sites. 
If any institution-specific modifications to study-related procedures are proposed 
or made by the clinical site, the consent must be reviewed by the Sponsor prior to 
IRB submission. Once reviewed, the consent will be submitted by the investigator 
to their IRB for review and approval prior to the start of the study. 
Before recruitment and enrollment, each prospective subject will be given a full 
explanation of the study and be allowed to read the approved ICF. Once the 
investigator or designee is assured that the subject understands the implications 
of participating in the study, the subject will be asked to give consent to participate 
in the study by signing the ICF. 
The investigator or designee shall provide a copy of the signed ICF to the subject. 
The original form shall be maintained in the subject binder at the clinical site. 
15.5 Confidentiality 
All information and data sent to the Sponsor concerning study subjects or their 
participation in this trial will be considered confidential. Only authorized personnel 
will have access to these confidential files. All records will be kept in secure 
storage areas and on password-protected computers.  
This includes, but is not limited to the following: 
• 
Subjects will be identified on all eCRFs by a unique subject ID 
• 
eCRFs are confidential documents and will only be available to the Sponsor 
(including delegates, such as CRAs), DSMB, Medical Monitor, CRO, the 
investigator and study staff, and if requested, to the IRB or regulatory 
authorities. The investigator will maintain, as part of the investigation file, a 
list identifying all subjects entered into the study. 
All laboratory specimens, evaluation forms, reports, and other records will be 
identified in a manner designed to maintain subject confidentiality. Clinical 

 
 
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information will not be released without the written permission of the subject, 
except as necessary for monitoring and auditing by the Sponsor, its designee, the 
FDA, or the IRB. 
The investigator and all clinical site staff involved in this study may not disclose (or 
use for any purpose other than performance of the study), any data, record, or 
other unpublished confidential information disclosed to those individuals for the 
purpose of the study. Prior written agreement from the Sponsor or its designee 
must be obtained for the disclosure of any said confidential information to other 
parties. 
15.6 Modification of the Protocol 
Any changes in this research activity, except those necessary to remove an 
apparent immediate hazard to the subject, must be reviewed and approved by the 
Sponsor. The protocol amendment(s) must be signed by the investigator and 
approved by the IRB before implementation. The protocol amendment(s) will be 
filed with the appropriate regulatory agency(s) having jurisdiction over the conduct 
of the study. 
Substantial changes will require approval from the Sponsor, FDA, and IRB prior to 
implementation. 
15.7 Protocol Deviations 
The investigator will not deviate from the protocol without prior written approval 
from the Sponsor except in medical emergencies or in unforeseen, isolated 
instances where minor changes are made that will not increase the subject’s risk 
or affect the validity of the trial. In medical emergencies, prior approval for protocol 
deviations will not be required, but the Sponsor must be notified within 2 working 
days of the incident. Periodic monitoring of protocol compliance will be performed 
for each clinical site. The Sponsor has the right to suspend enrollment at clinical 
sites deemed to have excessive protocol compliance issues. 
All deviations related to study inclusion or exclusion criteria, conduct of the study, 
subject management or subject assessment must be appropriately documented 
and reported. Other protocol deviations to be considered include non-adherence 
to the protocol that results in a significant additional risk to the subject, or non-
adherence to FDA regulations.  
The investigator must document and explain any protocol deviation in the 
subject’s source documentation. The IRB should be notified of all protocol 
deviations in a timely manner. Protocol deviations should be reported to the IRB 
periodically, according to their requirements. Deviations will also be reviewed by 
the monitor during clinical site visits and those observations may be discussed 
with the investigator. 
The Sponsor will evaluate circumstances where the investigator deviates from the 
study protocol and will retain the right to remove either the investigator or the 
investigational clinical site from the study. 

 
 
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15.8 Study Reporting Requirements 
By participating in this study, the investigator agrees to submit SAE reports 
according to the timeline and method outlined in this protocol. In addition, the 
investigator agrees to submit annual reports to his/her IRB as appropriate. 
Upon completion or termination of the study, the principal investigator (PI) must 
submit a final written report to the Sponsor and IRB. The report must be submitted 
within 3 months (90 days) of completion or termination of the trial. 
The Sponsor will submit all reports required by the appropriate regulatory 
authorities, including unanticipated adverse device effects, withdrawal of IRB 
approval, list of current investigators, annual progress reports, recall information, 
final reports and protocol deviations. 
15.9 Selection of Investigators 
The Sponsor will select qualified investigators, ship devices only to participating 
investigators, obtain a signed Investigator’s Agreement and provide all 
investigators with the information and training necessary to conduct the study. 
15.9.1 
Financial Disclosure 
Investigators and sub-investigators are required to provide financial disclosure 
information to allow the Sponsor to submit the complete and accurate certification 
or disclosure statements required under 21 CFR 54. In addition, the investigator 
must notify the Sponsor promptly of any relevant changes that occur during the 
course of the study, at the completion of the study, and 1 year following the 
completion of the study. 
15.9.2 
Investigator Documentation 
Prior to beginning the study, the investigator will be asked to comply with 21 CFR 
812 by providing the following essential documents, including but not limited to: 
• 
An investigator-signed Investigator Agreement page of the protocol  
• 
An IRB approved informed consent, samples of clinical site advertisements 
for recruitment for this study, and any other written information regarding this 
study that is to be provided to the subject 
• 
IRB approval of the investigator, protocol, and acknowledgement of the user 
guide 
• 
Curricula vitae (CV) for the PI and each investigator participating in the 
study. Current licensure must be noted on the CV or a copy of the license 
provided. CVs must be signed and dated by the investigators within 1 year of 
study start-up, indicating that they are accurate and current. 
• 
Financial disclosure information (as stated above) and a commitment to 
promptly update this information if any relevant changes occur 

 
 
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• 
Laboratory certifications and normal ranges for any local laboratories used 
by the clinical site. 
15.10 Clinical Site Training 
The training of appropriate clinical site personnel will be the responsibility of the 
Sponsor or its designee. To ensure proper device usage, uniform data 
collection, and protocol compliance, the Sponsor or designee will present formal 
training sessions to relevant clinical study site personnel. Clinical study 
personnel trained by the Sponsor may also train additional clinical study 
personnel at their site. The Sponsor reserves the right to enforce retraining for 
clinical sites who have demonstrated study or procedure compliance issues. 
Protocol-specific training will occur for all research personnel and key ancillary 
staff who will be involved in subject care. 
15.11 Device Use 
The Omnipod Horizon™ System consists of the following primary components: 
an Omnipod Horizon™ Pod, Omnipod Horizon™ Controller, and the iCGM. 
The Pod and PDM are intended for single use only.  The PDMs will be returned 
to the Sponsor after completion of the study. 
The Dexcom G6 CGM sensor (the component of the system that enters the 
skin), the Dexcom G6 CGM transmitter (the component of the system that 
attaches to the sensor to transmit the signal), and the Dexcom G6 CGM receiver 
will all be single use only in this study. The Dexcom G6 receiver will be returned 
to the Sponsor after completion of the study. 
Study blood glucose meters and ketone meters will not be cleaned or reused by 
subjects. A new meter will be used for each subject. 
15.12 Device Returns 
Any unused or damaged investigational devices or investigational devices 
related to a suspected deficiency or adverse event must be returned to the study 
Sponsor. To initiate the return, the clinical site will contact the Sponsor 
representative and provide the following information: 
• 
Part number/Lot number 
• 
Quantities 
• 
Tracking number 
15.13 Policy for Publication and Presentation of Data 
All data and results and all intellectual property rights in the data and results 
derived from the study will be the property of the study Sponsor, Insulet.  

 
 
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15.14 Sponsor or Regulatory Agency Termination of the Study 
Although the Sponsor intends to complete the study, the Sponsor reserves the 
right to stop the study at any time for clinical or administrative reasons, or if 
required by the local regulatory authority, with suitable written notice to the 
investigators and regulatory authorities as appropriate. 
Similarly, investigators may withdraw from the study by providing written 
notification to the Sponsor within 30 days of intent to withdraw. However, the 
Sponsor and investigators will be bound by their obligation to complete the 
follow-up of subjects already enrolled in the trial. Subjects must be followed 
according to the clinical protocol and information obtained during subject follow-
up shall be reported on the eCRF. 
 
 

 
 
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APPENDIX A