RECRUITING

Hybrid Closed Loop Effectiveness Trial in Adults With Type 1 Diabetes

Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

Minoritized individuals with type 1 diabetes (T1D) have approximately 2% higher average A1c levels and twice the rate of hospitalizations, complications, and mortality as their white counterparts. However, the efficacy trials establishing the benefits of hybrid closed loop (HCL) pump therapy in T1D have been in more socially advantaged and predominantly non-Hispanic white patients. Use of this technology by individuals with T1D from underserved communities remains very low. The investigators plan to conduct a randomized effectiveness trial - with broader eligibility criteria (including markedly elevated A1c) and longer follow up than the previous HCL efficacy trials - to evaluate the benefits, safety risks and treatment complications of HCL use in underserved adults with T1D. A comprehensive mixed-methods approach will be implemented to capture information about the user experience. Participants will be randomized (3:1 ratio) to one of three FDA-approved HCL systems or continuous glucose monitoring and multiple daily injection therapy. Subjects will be followed for 9 months to collect data on effectiveness (glucose % time-in-range 70-180 mg/dL and % time \< 70 mg/dL), safety (diabetic ketoacidosis and severe hypoglycemia events) and patient experience using the systems (including benefits and burdens, the impact of life stressors on HCL use, and how the match between HCL system functionality and the individual's needs and expectations impacts on user experience).

Official Title

Hybrid Closed Loop Effectiveness Trial in Adults With Type 1 Diabetes

Quick Facts

Study Start:2025-02-27
Study Completion:2027-06
Study Type:Not specified
Phase:Not Applicable
Enrollment:Not specified
Status:RECRUITING

Study ID

NCT06236607

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years to 75 Years
Sexes Eligible for Study:ALL
Accepts Healthy Volunteers:No
Standard Ages:ADULT, OLDER_ADULT
Inclusion CriteriaExclusion Criteria
  1. * Clinical diagnosis of T1D for at least 12 months, on MDI for at least 6 months;
  2. * A1c \>7.5% with no upper limit at screening (The investigator will consider the participant A1c level, compliance with current diabetes management, and prior acute diabetic complications. For this reason, there is no upper limit on A1c specified for eligibility);
  3. * Able to understand, speak and read English (Given the language limitations in currently available pump interfaces, subjects who are not able to understand written English will not be eligible);
  4. * Willingness to use either lispro or aspart insulin and no other insulin or new non-insulin diabetes pharmacotherapy during the study;
  5. * Total daily dose of insulin of at least 10 units/day;
  6. * Investigator believes that the participant will be able to successfully adhere to the study protocol.
  1. * Current use of insulin pump or closed loop insulin pump system;
  2. * Unable to provide informed consent;
  3. * Currently taking hydroxyurea or have medical condition that may necessitate use of hydroxyurea;
  4. * Current use of SGLT-2 inhibitors or sulfonylureas (If using GLP-1RA, pramlintide or metformin, must be on a stable dose for 3 months prior to enrollment);
  5. * Tape allergy or skin condition precluding use of pump or CGM;
  6. * Females who are pregnant or intending to become pregnant (since automated algorithm adaption for some of the HCL systems used in the trial cannot be configured to adjust to changing insulin demands of pregnancy);
  7. * Current renal dialysis or plan to begin renal dialysis during study. Most recent eGFR \<30 ml/min is exclusionary (within last 2 years is acceptable);
  8. * Active cancer treatment;
  9. * Extreme visual or hearing impairment that would impair ability to use CGM and pump;
  10. * Cognitive concerns;
  11. * Significant psychiatric diagnosis or substance abuse disorder that in the investigator's opinion impairs ability of the individual to participate.

Contacts and Locations

Study Contact

Howard Wolpert, MD
CONTACT
617-285-9096
howard.wolpert@bmc.org
Astrid Atakov Castillo, BA
CONTACT
617-638-5906
Astrid.AtakovCastillo@bmc.org

Principal Investigator

Howard Wolpert, MD
PRINCIPAL_INVESTIGATOR
Boston Medical Center

Study Locations (Sites)

Boston Medical Center
Boston, Massachusetts, 02118
United States
Montefiore Medical Center
Bronx, New York, 10467
United States

Collaborators and Investigators

Sponsor: Boston Medical Center

  • Howard Wolpert, MD, PRINCIPAL_INVESTIGATOR, Boston Medical Center

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2025-02-27
Study Completion Date2027-06

Study Record Updates

Study Start Date2025-02-27
Study Completion Date2027-06

Terms related to this study

Keywords Provided by Researchers

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

Additional Relevant MeSH Terms

  • Diabetes Mellitus, Type 1
  • Diabetes Complications