The Insulin-Only Bionic Pancreas Pivotal Trial
Study Details
Study Description
Brief Summary
This multi-center randomized control trial (RCT) will compare efficacy and safety endpoints using the insulin-only configuration of the iLet Bionic Pancreas (BP) System versus Usual Care (UC) during a 13-week study period. Participants may be enrolled initially into a screening protocol and then transfer into the RCT protocol, or they may enter directly into the RCT protocol. The RCT will be followed by an Extension Phase in which the RCT Usual Care (UC) Group will use the insulin-only configuration of the iLet Bionic Pancreas System for 3 months. At the completion of use of the BP system in the RCT only, participants will enter a 2-4 day Transition Phase and be randomly assigned to either transition back to their usual mode of therapy (MDI or pump therapy) based on therapeutic guidance from the iLet BP System or transition back to their usual mode of therapy based on what their own insulin regimens were prior to enrolling in the RCT.
There is an optional ancillary study to assess the safety of utilizing blood glucose measurements instead of CGM measurements as input into the iLet for ~48-60 hours. The Study is intended to mirror a real-world situation where CGM may not be available for an extended period of time (eg, user runs out of sensors and is awaiting new shipment).
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Primary Objective
• To compare the efficacy and safety of the insulin-only configuration of the iLet BP System (using insulin lispro, insulin aspart, and Fiasp [adults only]) in maintaining near-normal glycemia relative to usual care in a home-use study in adults and children with T1D.
Secondary Objectives • To assess the impact of the insulin-only configuration of the iLet BP System on quality of life and treatment satisfaction.
The study has four major parts: (1) the Test-Run Phase, (2) the RCT Period, (3) the Extension Phase for the UC Arm, and (4) the Transition Phase. These four parts are described below, and detailed in the main part of the protocol.
A Test-Run Phase will be conducted to (1) test the functionality of all aspects of the iLet BP System, (2) train the clinical staff on the execution of the clinical protocol, and (3) provide hands-on training with the device prior to initiating the RCT Period. The initial test run will be conducted at one site (MGH) with ~5 participants using the iLet BP system for 4-7 days. If there are no safety or consequential device issues, a test run will be conducted at each of the other 15 sites, with ~2 participants per site using the iLet BP system for 4-7 days. The iLet BP system will use insulin lispro or insulin aspart. Results of this Test-Run Phase will be evaluated for safety prior to beginning the RCT Period as described in section 3.3.
The 13-week, parallel-group, multi-center RCT Period is designed to compare the insulin-only iLet BP Group using insulin lispro, insulin aspart, or Fiasp (adults only); and a control group following usual care (UC Group). Upon completion of the RCT Period, the BP Group will enter the 2-4 day Transition Phase and the UC Group will enter the Extension Phase.
The UC Group Extension Phase will immediately follow the RCT Period. Participants from the UC Group who complete the primary outcome visit, miss no more than 3 of the maximum possible number of the weekly questionnaires, attend all clinic visits, and follow study procedures for collecting CGM data during the RCT Period, will be given the option to use the iLet BP system for 13 weeks. The visit schedule and procedures for the Extension Phase will be similar to that of the BP Group in the RCT Period.
A 2-4 day Transition Phase will be conducted for all participants who complete BP use at the end of the RCT Period (BP Group). Participants will be randomly assigned (1:1) to either transition back to their usual mode of therapy (MDI or pump therapy) based on therapeutic guidance from the iLet BP system or transition back to their usual mode of therapy based on what their own insulin regimens were prior to enrolling in the RCT Period. For those randomized to using their pre-study regimens, the dosing can be adjusted by the investigator to mitigate safety issues but should follow pre-study regimen as closely as possible.
An optional ancillary study will be offered to participants who are using the iLet at the time of the 13-week randomized trial visit. This will will assess the safety of utilizing blood glucose measurements instead of CGM measurements as input into the iLet for ~48-60 hours. It will be completed at the end of the RCT for those in the BP Group prior to the Transition Phase.
Test-Run Visit and Phone Contact Schedule
- Screening Visit - Eligibility assessed, informed consent, point-of-care/local HbA1c, testing and procedures similar to the RCT Screening Visit including psychosocial questionnaires; if eligible, BP system started.
o For participants who completed the separate screening protocol, eligibility will be reassessed. Point-of-care/local HbA1c will be obtained if more than 28 days have elapsed. Participants will not need to repeat the psychosocial questionnaires.
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Phone contact after 1-2 days
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Shut-down visit at the end of the study period 4-7 days
RCT Period Visit and Phone Contact Schedule
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Screening Visit (which may be completed as part of a separate screening protocol)
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Eligibility assessed, informed consent signed, point-of-care/local HbA1c, psychosocial questionnaires completed, blinded Dexcom G6 CGM sensor placed for non Dexcom G6 users.
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For baseline data collection, participants using a personal Dexcom G6 who have at least 85% of possible glucose data in last 14 days can skip the blinded CGM wear
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Participants using a personal Dexcom G6 with <85% of data will use their personal Dexcom G6.
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For participants who completed the separate screening protocol, eligibility will be reassessed. Point-of-care/local HbA1c will be obtained if more than 28 days have elapsed. Participants will not need to repeat the psychosocial questionnaires or blinded CGM wear.
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If the separate screening protocol or Test Run Phase of this protocol was completed or blinded CGM wear is not needed, randomization can proceed immediately. If blinded CGM wear was performed as part of this protocol, randomization visit will occur14-21 days after screening.
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Prior to randomization, eligibility will be reassessed and blood drawn for central lab HbA1c
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BP study start/UC study start on day of Randomization Visit
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Phone contacts after 1-2 days and 7 (±2) days
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Visits at 2 weeks (±4 days), 6 weeks (±4 days), 10 weeks (±4 days), and ~13 weeks (91-98 days from randomization):
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Participants in the UC Group will wear a blinded Dexcom G6 sensor throughout the entire study unless they are current users of the Dexcom G6 CGM, in which case they will continue to use their own Dexcom G6 CGM.
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At the 6-week and 13-week visits, central lab HbA1c determination and psychosocial questionnaires
UC Group Extension Phase Visit and Phone Contact Schedule
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BP initiation at 13-week visit
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Phone contacts after 13 weeks plus 1-2 days and 14 weeks (±2 days)
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Visits at 15 weeks (± 4 days), 19 (±4 days), 23 (±4 days), and ~26 weeks (182-189 days):
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At the 19-week and 26-week visits, central lab HbA1c determination and psychosocial questionnaires
Transition Phase Visit Schedule
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Randomization and transition to UC regimen at 13-week visit for RCT BP Group for a period of 2-4 days in duration.
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Visit ≤4 days later for end of study
Ancillary Study Day 1 (13-week visit of the RCT) - stop CGM, start blinded CGM, start SMBG at least every 2 hours during waking hours and at least once during each overnight for the next 48-60hrs.
Day 2: Phone call for safety
Day 3: stop iLet, stop blinded CGM, restart unblinded CGM, enter Transition Phase.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Bionic Pancreas (BP) Adults (RCT and Extension) and peds (RCT) will use the Bionic Pancreas (BP) with lispro or aspart for 13 weeks |
Device: Bionic Pancreas
iLet Bionic Pancreas System, which consists of an integrated infusion pump, touchscreen display, Bluetooth radio, and insulin dosing algorithms, that automatically controls insulin delivery based on glucose values obtained by communicating with a Dexcom G6 sensor.
Other Names:
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Experimental: Bionic Pancreas with Fiasp (BPFiasp) Adults will use the Bionic Pancreas (BP) with Fiasp for 13 weeks during RCT Peds will use the Bionic Pancreas (BP) with Fiasp for 13 weeks during Extension |
Device: Bionic Pancreas
iLet Bionic Pancreas System, which consists of an integrated infusion pump, touchscreen display, Bluetooth radio, and insulin dosing algorithms, that automatically controls insulin delivery based on glucose values obtained by communicating with a Dexcom G6 sensor.
Other Names:
|
No Intervention: Usual Care (UC) Adults and peds will use their own diabetes regimen |
Outcome Measures
Primary Outcome Measures
- HbA1c [HbA1c will be taken at baseline, 6 weeks and 13 weeks]
Superiority for HbA1c at 13 weeks will be considered the primary endpoint.
Secondary Outcome Measures
- Non-inferiority for CGM-measured time <54 mg/dL (key secondary endpoint) [13 weeks]
based on sensor glucose ata
- Secondary Efficacy Endpoint: Mean glucose [13 weeks]
Based on sensor glucose data
- Secondary Efficacy Endpoint: Time 70-180 mg/dL [13 weeks]
based on sensor glucose
- Secondary Efficacy Endpoint: Time >180 mg/dL [13 weeks]
based on sensor glucose data
- Secondary Efficacy Endpoint: Time >250 mg/dL [13 weeks]
based on sensor glucose
- Secondary Efficacy Endpoint: Glucose standard deviation [13 weeks]
based on sensor glucose data
- Secondary Efficacy Endpoint: Time <70 mg/dL [13 weeks]
based on sensor glucose data
- Secondary Efficacy Endpoint: Superiority for CGM-measured time <54 mg/dL [13 weeks]
based on sensor glucose data
- Secondary Efficacy Endpoint: Glucose coefficient of variation [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: HbA1c <7.0% [13 weeks]
HbA1c central lab
- Other Secondary Efficacy Endpoint: HbA1c <7.0% in participants with baseline HbA1c >7.5% [13 weeks]
HbA1c central lab
- Other Secondary Efficacy Endpoint: HbA1c <7.5% [13 weeks]
HbA1c central lab
- Other Secondary Efficacy Endpoint: HbA1c <8.0% [13 weeks]
HbA1c central lab
- Other Secondary Efficacy Endpoint: HbA1c >9.0% [13 weeks]
HbA1c central lab
- Other Secondary Efficacy Endpoint: HbA1c improvement >0.5% [13 weeks]
HbA1c central lab at baseline and 13 weeks
- Other Secondary Efficacy Endpoint: HbA1c improvement >1.0% [13 weeks]
HbA1c central lab at baseline and 13 weeks
- Other Secondary Efficacy Endpoint: HbA1c relative improvement >10% [13 weeks]
HbA1c central lab at baseline and 13 weeks
- Other Secondary Efficacy Endpoint: HbA1c improvement >1.0% or HbA1c <7.0% at 13 Weeks [13 weeks]
HbA1c central lab at baseline and 13 weeks
- Other Secondary Efficacy Endpoint: Time in range 70-140 mg/dL [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time in range 70-120 mg/dL [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time <60 mg/dL [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Area over the curve (70 mg/dL) [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Low blood glucose index (LBGI) [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: CGM-measured hypoglycemic events [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: CGM-measured hyperglycemic events [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time >300 mg/dL [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Area under the curve (180 mg/dL) [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: High blood glucose index (HBGI) [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Mean of daily difference in mean glucose [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time in range 70-180 mg/dL >70% [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time in range 70-180 mg/dL improvement from baseline to 13 weeks ≥5% [13 weeks]
based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time in range 70-180 mg/dL improvement from baseline to 13 weeks ≥10% [13 weeks]
Based on sensor glucose data.
- Other Secondary Efficacy Endpoint: Time <70 mg/dL <4% [13 weeks]
Based on sensor glucose data.
- Other Secondary Efficacy Endpoint: Time <54 mg/dL <1% [13 weeks]
Based on sensor glucose data
- Other Secondary Efficacy Endpoint: Blood Glucose Risk Index (LBGI + HBGI) [13 weeks]
Based on sensor glucose data
- Other Secondary Efficacy Endpoint: Improvement in HbA1c > 0.5% without an increase in time < 54 mg/dl by > 0.5% OR improvement in time < 54 mg/dl by > 0.5% without an increase in HbA1c by > 0.5% [13 weeks]
Based on sensor glucose data and HbA1c from central lab at baseline and 13 weeks
- Other Secondary Efficacy Endpoint: Improvement in time 70-180 mg/dl by >10% without an increase in time < 54 mg/dl by > 0.5% OR improvement in time < 54 mg/dl by > 0.5% without a decrease in time 70-180 mg/dl by > 10% [13 weeks]
Based on sensor glucose data
- Other Secondary Efficacy Endpoint: Mean glucose <154 mg/dL and time <54 mg/dL <1% [13 weeks]
Based on sensor glucose data
- Other Secondary Efficacy Endpoint: Time in range 70-180 mg/dL >70% and time <54 mg/dL <1% [13 weeks]
Based on sensor glucose data
- Other Secondary Efficacy Endpoint: Total daily insulin (units/kg) [13 weeks]
Site-reported insulin data and iLet pump device data
- Other Secondary Efficacy Endpoint: Percentage change in the TDD of insulin over the first two-week period relative to the TDD of insulin in the last two-week period [Weeks 1-2 and weeks 12-13]
Based on iLet pump device data
- Other Secondary Efficacy Endpoint: Body Weight [13 weeks]
Body Weight
- Other Secondary Efficacy Endpoint: Body Mass Index (BMI) [13 weeks]
Height and body weight
- Other Secondary Efficacy Endpoint: Number of hypoglycemic events requiring carbohydrate treatment per 24 hours [13 weeks]
weekly questionnaire
- Other Secondary Efficacy Endpoint: From the weekly questionnaires, grams of carbohydrate taken specifically to prevent or treat hypoglycemic events per 24 hours [13 weeks]
weekly questionnaire
Other Outcome Measures
- Safety Outcome Measure: Severe hypoglycemia events [13 weeks]
event that required assistance from another person to administer carbohydrates or other resuscitative action
- Safety Outcome Measure: Diabetic ketoacidosis events [13 weeks]
DKA adverse event
- Safety Outcome Measure: Other serious adverse events [13 weeks]
Serious Adverse Events
- Safety Outcome Measure: Worsening of HbA1c by >0.5% [13 weeks]
HbA1c central lab
Eligibility Criteria
Criteria
Inclusion Criteria:
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- Clinical diagnosis of T1D for at least one year and using insulin for at least 1 year 2. Diabetes managed using the same regimen (either pump or MDI, with or without CGM) for ≥ 3 months
- Age ≥ 6 years old
- Exception: the initial 5-participant test run will be limited to >18 years old
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Current use of a CGM, or if not a CGM user, at least 3 blood glucose meter tests daily on average over the last 4 weeks (according to judgment of investigator if meter is not available).
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Willingness not to start any new non-insulin glucose-lowering agent during the course of the trial
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For participants <18 years old, living with one or more parent/legal guardian knowledgeable about emergency procedures for severe hypoglycemia.
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For participants >18 years old who live alone, participant has a relative or acquaintance who lives within 30 minutes of participant and is willing to be contacted to check on participant if study staff feel that participant may be experiencing a medical emergency and can't be reached.
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Investigator believes that the participant can safely use the iLet and will follow the protocol
- The investigator will take into account the participant's HbA1c level, compliance with current diabetes management, and prior acute diabetic complications. For this reason, there is no upper limit on HbA1c specified for eligibility.
- If a GLP-1 agonist or pramlintide is being used, participant must be willing to discontinue use while the iLet BP system is being used, including the randomized trial and extension study.
Exclusion Criteria:
- Eligibility may be assessed initially in a separate screening protocol or at a screening visit in the RCT protocol. To be eligible for all phases of the study, a participant must meet all of the following inclusion criteria and none of the exclusion criteria:
Exclusion
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Unable to provide informed consent (e.g. impaired cognition or judgment)
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Unable to safely comply with study procedures and reporting requirements (e.g. impairment of vision or dexterity that prevents safe operation of the bionic pancreas, impaired memory)
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Unable to speak and read English
• For pediatric participants, both caregivers and participants must be able to speak and read English
- Plan to change usual diabetes regimen in the next 3 months
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This would include changing from MDI to pump. pump to MDI, change in insulin automation delivery system, starting a CGM if not previously used, changes in drug therapy specifically for glucose control except for changes in one insulin analog to another.
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Changes in insulin dose, carb ratio, sensitivity factor and basal rate profile are allowed.
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Current use of non-FDA approved closed-loop or hybrid closed-loop insulin delivery system
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Use of Apidra as the pre-study rapid-acting insulin analog and unwilling to switch to lispro or aspart for the duration of the study
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Known hemoglobinopathy (sickle cell trait is not an exclusion)
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Current participation in another diabetes-related clinical trial
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History of cystic fibrosis, pancreatitis, or other pancreatic disease, including pancreatic tumor or insulinoma, or history of complete pancreatectomy
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Electrically powered implants (e.g. cochlear implants, neurostimulators) that might be susceptible to RF interference
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Established history of allergy or severe reaction to adhesive or tape that must be used in the study
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Current use of SGLT2 inhibitors or a sulfonylurea drug (use more than 3 months prior to enrollment is acceptable)
• If using GLP1 agonist, pramlintide, or metformin drugs must be on a stable dose for 3 months prior to enrollment (and as per inclusion criterion #8, must be willing to discontinue use of GLP-1 agonist or pramlintide while using the iLet BP system during the RCT and the extension phase).
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Pregnant (positive urine hCG), breast feeding, plan to become pregnant in the next 3 months, or sexually active without use of contraception
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For adults >18 years old, most recent (must be within the last 2 years) eGFR <30 ml/min OR currently in renal failure on dialysis
• If no eGFR is available for an adult participant during the last 2 years, one must be obtained to confirm eligibility
- Presence of a medical condition or use of a medication that, in the judgment of the investigator, clinical protocol chair, or medical monitor, could compromise the results of the study or the safety of the participant. Conditions to be considered by the investigator may include the following:
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Alcohol or drug abuse
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Use of prescription drugs that may dull the sensorium, reduce sensitivity to symptoms of hypoglycemia, or hinder decision making during the period of participation in the study
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Coronary artery disease that is not stable with medical management, including unstable angina, angina that prevents moderate exercise (e.g. climbing a flight of stairs) despite medical management, or within the last 12 months before screening a history of myocardial infarction, percutaneous coronary intervention, enzymatic lysis of a presumed coronary occlusion, or coronary artery bypass grafting
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Congestive heart failure with New York Heart Association (NYHA) Functional Classification III or IV
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History of TIA or stroke in the last 12 months
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Untreated or inadequately treated mental illness
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History of eating disorder within the last 2 years, such as anorexia, bulimia, or diabulemia or omission of insulin to manipulate weight
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History of intentional, inappropriate administration of insulin leading to severe hypoglycemia requiring treatment
- Employed by, or having immediate family members employed by Beta Bionics, or being directly involved in conducting the clinical trial, or having a direct supervisor at place of employment who is also directly involved in conducting the clinical trial (as a study investigator, coordinator, etc.); or having a first-degree relative who is directly involved in conducting the clinical trial
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Children's Hospital of Orange County (Pediatrics) | Orange | California | United States | 92868 |
2 | University of California - San Diego (Adults) | San Diego | California | United States | 92037 |
3 | Stanford University (Pediatrics and Adults) | Stanford | California | United States | 94305 |
4 | Barbara Davis Center for Diabetes (Pediatrics and Adults) | Aurora | Colorado | United States | 80045 |
5 | Children's National Health System (Pediatrics) | Washington | District of Columbia | United States | 20010 |
6 | Nemours Children's Clinic (Pediatrics) | Jacksonville | Florida | United States | 32207 |
7 | Emory University (Pediatrics) | Atlanta | Georgia | United States | 30322 |
8 | Massachusetts General Hospital - Diabetes Research Center (Peds and Adults) | Boston | Massachusetts | United States | 02114 |
9 | Henry Ford Health System (Adults) | Detroit | Michigan | United States | 48202 |
10 | Washington University (Adults) | Saint Louis | Missouri | United States | 63110 |
11 | Naomi Berrie Diabetes Center at Columbia University (Pediatrics) | New York | New York | United States | 10032 |
12 | University of Noth Carolina- Chapel Hill (Adults) | Chapel Hill | North Carolina | United States | 27517 |
13 | Cleveland Clinic (Adults) | Cleveland | Ohio | United States | 44195 |
14 | University of Texas- Southwestern (Pediatrics and Adults) | Dallas | Texas | United States | 75390 |
15 | University of Texas Health Science Center (Pediatrics) | San Antonio | Texas | United States | 78229 |
16 | University of Washington (Adults) | Seattle | Washington | United States | 98109 |
Sponsors and Collaborators
- Jaeb Center for Health Research
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- Beta Bionics, Inc.
- Boston University
- Massachusetts General Hospital
Investigators
- Principal Investigator: R. Paul Wadwa, MD, University of Colorado, Denver
- Principal Investigator: Mark Daniels, MD, Children's Hospital of Orange County
- Principal Investigator: Fran Cogen, MD, Children's National Health System
- Principal Investigator: Keren Zhou, MD, The Cleveland Clinic
- Principal Investigator: Andrew Muir, MD, Emory University
- Principal Investigator: Davida Kruger, NP, Henry Ford Health System
- Principal Investigator: Steven J Russell, MD, Massachusetts General Hospital
- Principal Investigator: Robin Goland, MD, Naomi Berrie Center - Columbia University
- Principal Investigator: Nelly Mauras, MD, Nemours Children's Health System
- Principal Investigator: Bruce Buckingham, MD, Stanford University
- Principal Investigator: Jeremy Pettus, MD, UC-San Diego
- Principal Investigator: John Buse, MD, University of North Carolina, Chapel Hill
- Principal Investigator: Irl Hirsch, MD, University of Washington
- Principal Investigator: Jane Lynch, MD, UT Health Science Center - San Antonio
- Principal Investigator: Perrin White, MD, University of Texas, Southwestern Medical Center at Dallas
- Principal Investigator: Janet McGill, MD, Washington University School of Medicine
- Principal Investigator: Jill Weissberg-Benchell, PhD, Lurie Children's Hospital
- Study Director: Roy Beck, MD, PhD, Jaeb Center for Health Research
- Study Director: Katrina Ruedy, MSPH, Jaeb Center for Health Research
- Principal Investigator: Philip Raskin, MD, UT Southwestern
Study Documents (Full-Text)
- Informed Consent Form: RCT ICF - Jan 28, 2021
- Informed Consent Form: RCT Assent - Sep 18, 2020
- Informed Consent Form: BG Run iLet Ancillary Study ICF - May 13, 2021
- Informed Consent Form: BG Run iLet Ancillary Study Assent - May 13, 2021
- Informed Consent Form: Screening ICF and Assent - Mar 13, 2020
- Informed Consent Form: Test Run ICF and Assent - Oct 6, 2020
More Information
Publications
None provided.- IOBPPT
- 1UC4DK108612-01