Artificial Pancreas Technology to Reduce Glycemic Variability and Improve Cardiovascular Health in Type 1 Diabetes

Prior treatment

• Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment
• Diagnosis of diabetic ketoacidosis in the 12 months prior to enrollment
• Prior diagnosis of cardiac disease (e.g., myocardial infarction, congestive heart failure)
• Cerebrovascular accident in the 12 months prior to enrollment
• Current use of oral/inhaled glucocorticoids or other medications, which in the judgment of the investigator would be a contraindication to participation in the study
• History of hypersensitivity or prior adverse reaction (e.g., anaphylaxis or angioedema) to IV regular insulin infusion
• History of hypersensitivity or prior adverse reaction to Definity microbubble infusion

Other illness

• Uncontrolled resting arterial hypertension
• Conditions that would make use of a CGM difficult (e.g., blindness, severe arthritis, immobility)
• Hemophilia or any other bleeding disorder
• Currently being treated for a seizure disorder
• A medical condition or medication, which in the opinion of the investigator or designee, would put the participant or study at risk
• Screening Electrocardiogram (ECG) findings indicative of arrhythmia, sinus node disease, or ischemic heart disease

Lab values

• Concurrent use of any non-insulin glucose-lowering agent (including metformin, GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors, and/or sulfonylureas)
• Any woman with hemoglobin (Hgb) \<11 g/dL or any man with Hgb \<12 g/dL on screening laboratory evaluation (i.e., complete blood count)
• Diagnosis of peripheral neuropathy (assessed by monofilament examination), macroalbuminuria (urine albumin:creatinine \>300 mg per g), or retinopathy beyond mild, nonproliferative retinopathy
• Unstable (i.e., dose adjustment less than 4 weeks prior to study enrollment) doses of vasoactive medications (e.g., calcium channel blockers, statins, nitrates, alpha-blockers, beta-blockers, ACE inhibitors, etc.)

Age

• Current smokers or those who have quit smoking \<2 years ago

Other

• Current enrollment in another clinical trial, unless approved by the investigator of both studies or if clinical trial is a non-interventional registry trial

• Clinical diagnosis, based on World Health Organization criteria, of type 1 diabetes for at least one year
• Currently using insulin for at least six months
• Ages 18-≤40 years
• Hemoglobin A1c \<10.5%
• Body mass index 18-30 kg/m2
• Blood pressure \<140/90 mmHg
• For females, not currently known to be pregnant or breastfeeding
• If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all females of childbearing potential. Participants who become pregnant will be discontinued from the study. Also, participants who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued
• Both pump and MDI users will use insulin parameters such as carbohydrate ratio and correction factors consistently in order to dose insulin for meals or corrections; pump users will have history of entering this information into their pump
• Willingness to suspend use of any personal CGM for the duration of the clinical trial once the study CGM is in use
• Access to internet and willingness to upload data during the study as needed, including data generated prior to the start of the study
• Current use of a glucometer that is downloadable; or willingness to use a study glucometer
• Investigator has confidence that the participant can successfully operate all study devices and is capable of adhering to the protocol
• Willingness to use personal lispro (Humalog) or aspart (Novolog) and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study
• Total daily insulin dose (TDD) at least 10 U/day.
• Willingness not to start any new non-insulin glucose-lowering agent during the trial