Insulin Delivery With Self-Adjusting Closed-Loop and Behavioral Glycemic Control Enhanced by Prediction (INSIGHT)

Insulin Delivery With Self-Adjusting Closed-Loop and Behavioral Glycemic Control Enhanced by Prediction (INSIGHT)

This study is a randomized cross-over trial comparing AIDANET with Anticipation to AIDANET in FCL without Anticipation. Participants will complete 4 weeks of AID data collection which will be used to establish baseline and initialize the control algorithm. Participants will then be randomized to one of two groups: Group A: AIDANET in FCL with Anticipation (AIDANET+ACL), and Group B: AIDANET in FCL without Anticipation (AIDANET+FCL). The study duration of each group is 4 weeks each. The order of these two phases will be dependent upon randomization.

Study Overview

• Status: Recruiting
• Conditions: Type 1 Diabetes (T1D)
• Intervention / Treatment: Device: Automated Insulin Delivery (AID); Device: AIDANET + Fully Closed Loop (FCL); Device: AIDANET + Anticipatory Closed Loop (ACL)

Detailed Description

The UVA AIDANET algorithm is intended for use by patients with T1D to control the subcutaneous infusion of insulin and aid in their T1D self-management. AIDANET automatically adjusts insulin delivery every 5 minutes in response to CGM values. AIDANET can be used with meal announcement (hybrid closed loop, HCL), without meal announcement (full closed loop, FCL), and with meal anticipation (anticipatory closed loop, ACL).

The purpose of this study is to demonstrate superior glycemic control when using anticipation within our latest Automated Insulin Delivery as Adaptive NETwork (AIDANET) in FCL with Anticipation (AIDANET+ACL) vs. AIDANET in FCL without Anticipation.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Andrea Riana, MD; Phone Number: (434) 249-6251; Email: rys6hm@uvahealth.org
• Study Contact Backup: Name: Laura Kollar, RN; Phone Number: (434) 982-6479; Email: llk7m@uvahealth.org

Study Locations

• United States
  • Virginia
    • Charlottesville, Virginia, United States, 22903
      • Recruiting
      • University of Virginia Center for Diabetes Technology
      • Sub-Investigator: Mark DeBoer, MD
      • Sub-Investigator: Samina Afreen, MD
      • Sub-Investigator: Marcela Moscoso-Vasquez, PhD
      • Contact: Sue Brown, MD; Phone Number: 4349820602; Email: sab2f@uvahealth.org
      • Sub-Investigator: Driscoll Kimberly, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Participant Inclusion Criteria

1. Age ≥18.0 years old at time of consent
2. Clinical diagnosis, based on investigator assessment, of T1D for > 1 year.
3. Having used an FDA approved AID system within the last 6 months (can be intermittent use).
4. Currently using insulin for >6 months.
5. Willingness to switch to use an FDA-approved personal insulin for the study pump (e.g., lispro or aspart, or biosimilar FDA-approved products) as directed by the study team.
6. Has one or more supportive companions knowledgeable about emergency procedures for severe hypoglycemia and able to contact emergency services and study staff who either lives with participant or located within approximately 30 minutes of participant and able to locate participant in the event of an emergency.
7. Participant not currently known to be pregnant or breastfeeding.
8. If participant can become pregnant, they 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 participants 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.
9. Willingness to wear a Dexcom CGM during each of the study phases.
10. Willingness to use the study AIDANET system (CGM, pump, and phone) during the relevant study periods.
11. Willingness not to start any new non-insulin glucose-lowering agent during the trial.
12. Willingness to participate in all study procedures including in person training.
13. Access to internet at home and willingness to upload data during the study as needed.
14. Investigator has confidence that the participant can successfully operate all study devices and can adhere to the protocol.
15. Participant is proficient in reading and verbal communication in English.

Participant Exclusion Criteria The participant must not have any exclusion criteria to be eligible to participate in the study.

1. Plans to start a new non-insulin glucose-lowering agent (e.g., GLP-1 receptor agonists, Symlin, DPP-4 inhibitors,). Participants may be on a stable dose of such an agent for at least the past month.
2. Current use of sulfonylurea medications.
3. Uncontrolled microvascular complications such as active proliferative retinopathy not being treated or not responsive to current treatment.
4. Current use of an SGLT-2 or SGLT-1/2 inhibitor due to risk of euglycemic DKA.
5. Hemophilia or any other bleeding disorder.
6. History of severe hypoglycemic events with seizure or loss of consciousness in the last 12 months.
7. History of DKA event in the last 12 months.
8. Currently on peritoneal or hemodialysis.
9. Currently being treated for adrenal insufficiency.
10. Currently being treated for a seizure disorder.
11. Hypothyroidism or hyperthyroidism that is not adequately treated.
12. Use of oral or injectable steroids at the time of enrollment.
13. Known ongoing adhesive intolerance that is not well managed.
14. A condition, which in the opinion of the investigator or designee, would put the participant or study at risk.
15. Participation in another interventional trial at the time of enrollment.
16. Participant with a direct supervisor at work/school who is involved in the conduct of the trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A: AID first followed by AIDANET+ACL then AIDANET+FCL; Participants will first complete 4 weeks of AID data collection which will be used to establish baseline and initialize the control algorithm. Participants will then complete 4 weeks of AIDANET + Anticipatory Closed Loop (ACL) and 4 weeks of AIDANET + Fully Closed-Loop (FCL)	Device: Automated Insulin Delivery (AID); Usual Care; Device: AIDANET + Fully Closed Loop (FCL); All participants will use AIDANET in FCL mode with instructions to avoid announcing meal boluses whenever possible during the four weeks.; Device: AIDANET + Anticipatory Closed Loop (ACL); All insulin will be delivered automatically. The algorithm will review past behaviors to determine the amount of insulin that will be needed for a meal.
Active Comparator: Group B: AID first followed by AIDANET+FCL then AIDANET+ACL; Participants will first complete 4 weeks of AID data collection which will be used to establish baseline and initialize the control algorithm. Participants will then complete 4 weeks of AIDANET + Fully Closed Loop (FCL) and 4 weeks of AIDANET+ Anticipatory Closed Loop (ACL).	Device: Automated Insulin Delivery (AID); Usual Care; Device: AIDANET + Fully Closed Loop (FCL); All participants will use AIDANET in FCL mode with instructions to avoid announcing meal boluses whenever possible during the four weeks.; Device: AIDANET + Anticipatory Closed Loop (ACL); All insulin will be delivered automatically. The algorithm will review past behaviors to determine the amount of insulin that will be needed for a meal.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time in range 70-140 mg/dL as computed by the study CGM	Computed as the number of estimated glucose values ≥70mg/dL and <140mg/dL divided by the number of valid values (defined as a number between 39 and 401)	8 weeks
Time in range 70-140 mg/dL as computed by the study CGM	Outcome is computed if: >4032 values are recorded (availability condition, 2 weeks equivalent); AND there is >70% values between the first recorded EGV of the analysis window and the last (density condition)	8 weeks

Collaborators and Investigators

• Sponsor: Sue Brown
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); DexCom, Inc.; Tandem Diabetes Care, Inc.
• Investigators: Principal Investigator: Sue A Brown, MD, University of Virginia Center for Diabetes Technology

Study record dates

Study Major Dates

• Study Start (Actual): May 14, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: March 27, 2026
• First Submitted That Met QC Criteria: March 27, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): June 22, 2026
• Last Update Submitted That Met QC Criteria: June 17, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Insulin Pump; Hybrid Closed Loop (HCL); Continuous subcutaneous insulin infusion (CSII); Automated insulin delivery as Adaptive Network (AIDANET); Fully automated Closed Loop (FCL); Tandem Mobi system; Anticipatory Closed Loop (ACL)
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Autoimmune Diseases; Immune System Diseases; Glucose Metabolism Disorders; Diabetes Mellitus; Nutritional and Metabolic Diseases; Diabetes Mellitus, Type 1
• Other Study ID Numbers: 302996; 5R01DK129553 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes