simple initiation of advanced hybrid closed loop system

Conditions: Diabetes type1

Summary: background and aim. the new and advanced hybrid closed loop (ahcl) system minimed 780g automatically adjusts basal insulin delivery in addition to automated bolus corrections, based on continuous glucose monitoring (cgm) readings, to offer protection against both hyperglycemia and hypoglycemia. the objective of this study is to evaluate whether a simplified approach for patients' follow up using preset of pump settings and a simplified meal announcement, followed by minimal interaction can achieve similar glycemic control of ahcl system minimed 780g with guardian sensor 4 than a regular protocol that is currently used in adolescents with type 1 diabetes (t1d). methods. this study is randomized clinical trial, two arm, single-center, clinical investigation in subjects with type 1 diabetes on ahcl insulin pump in a period of 3 months. a total of 34 individuals (age 12-18 years) will be enrolled to reach 30 individuals who will complete the 3 months study. participants will be randomized in two groups: group 1, regular clinical protocol, 17 participants and group 2, simplified clinical protocol, 17 participants. all patients will be recruited during the regular clinic visits to the outpatient endocrine clinics at sidra medicine in doha. patients will be chosen on a first-come first-served basis. inclusion criteria: clinical diagnosis of type 1 diabetes, , age 12-18 years, basal bolus therapy \>8.0 units per day. exclusion criteria: diabetic ketoacidosis (dka) in the 6 months prior to screening visit. the initiation protocol consists of four stages: hcl system compatibility assessment, hcl system training, manual mode start and auto mode start. patients will have 7 visits in a period of 3 months after initiation of insulin pump therapy. pump initiation: group 1, finetune icr, target 100 or 110 mg/dl and ait: 2-3 hour and group 2, carb ratio by formula 360 / tdd, icr 8-10 (tdd 40-60), icr 5-7 (tdd \>60), target 100 mg/dl, ait: 2 hours with fixed meals results. no group difference in time in range (tir) (70-180mg/dl) \> 70% and hba1c \< 7.5% in a period of 3 months after initiation of ahcl. conclusion. conclusions will be drawn on completion of the study and evaluation of the results.

this study is randomized clinical trial, two arm, single-center, clinical investigation in subjects with type 1 diabetes on ahcl insulin pump in a period of 3 months. a total of 34 individuals (age 12-18 years) will be enrolled to reach 30 individuals who will complete the 3 months study. participants will be randomized in two groups: * group 1, regular clinical protocol, 17 participants * group 2, simplified clinical protocol, 17 participants intervention description * intervention in group 2, simplified protocol. * insulin carb ratio (icr) by formula 360 / total daily dose (tdd) * icr 8-10 (tdd 40-60) * icr 5-7 (tdd \>60) * target 100 mg/dl * active insulin time (ait): 2 hours * meals: thee sets of meal set of meals announcement carbs calculated by the following formula: * regular meal: total carbs per day x 0.6 / 3 * large meal: total carbs per day x 0.6 / 3 x 1.5 * small (snack) meal: total carbs per day x 0.6 / 3 x 1.5 \* efficacy the efficacy shall be measured time in ranges (provided by cgm data), for time in range (70-180mg/dl), time below range(\ 180 mg/dl) in the third month of the study.

Eligibility criteria:
inclusion criteria: 1. clinical diagnosis of type 1 diabetes \>0.5 year prior to consent date. diagnosis of type 1 diabetes is based on the investigator's judgment; c peptide level and antibody determinations are not required. 2. age 12-18 years and above at the initiation of the system 3. total daily insulin use of great than 8.0 units per day over a 1-week period 4. willing and able (access to internet from home) 5. clinically able to start the ahcl system exclusion criteria: 1. pregnancy 2. untreated diabetes retinopathy, or other causes that in the investigator's opinion , precludes the individual from participating in the trial. 3. currently in other clinical trial

Keywords: automated insulin delivery time in range intervention