70-OR: Evaluation of the Omnipod 5 Automated Insulin Delivery System in Very Young Children with Type 1 Diabetes (T1D)

Abstract

The Omnipod 5 System is a novel hybrid closed-loop (HCL) system with full on-body operation. A tubeless insulin pump containing a personalized MPC algorithm communicates directly with a Dexcom G6 CGM to automate insulin delivery. Following demonstration of positive safety and efficacy in older children (≥6y) and adults, we evaluated the system in very young children (2-5.9y) with T1D. Preschoolers with T1D often have erratic eating behaviors and may dislike being tethered to devices, and parental concern may lead to permissive hyperglycemia. This HCL system may be ideal for young children, given its customizable glucose targets from 110-150mg/dL, wireless system interaction through a mobile application, and bolus calculator that incorporates CGM trend information. Also, the system has no minimum weight or total daily dose (TDD) requirement. Participants with T1D and A1C<10% used their respective standard therapies (ST) for 14d, and then transitioned to use of the HCL system for 3mo. Primary safety outcomes are the incidence of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA). Primary effectiveness outcomes are change in A1C and percent of time in target range (TIR, 70-180 mg/dL) with the HCL system compared with ST. Baseline characteristics of participants (N=80) were (mean±SD) age 4±1y (range 2-5y), T1D duration 2.2±1.1y, and A1C 7.4±0.9%, with mean (range) TDD 13.7 (5.3-27.1) U/day and weight 20 (12-53) kg. There have been no serious adverse events, including SH and DKA, reported in over 5,254 person-days of HCL use. During the ST phase, TIR was 57.2±15.1%, time <54mg/dL was 0.8±1.7%, <70mg/dL was 3.4±3.9%, >180mg/dL was 39.4±16.5%, and ≥250mg/dL was 14.7±12.0%. The same efficacy analysis is planned for the 3-month HCL phase upon its completion in January 2021. This multi-center pivotal study has, to date, demonstrated safety of the Omnipod 5 System in very young children with T1D. At completion, this will be the largest study of HCL in this age group reported to date. Disclosure J. Sherr: Advisory Panel; Self; Cecelia Health, Insulet Corporation, Medtronic, Consultant; Self; Insulet Corporation, Lexicon Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Research Support; Self; Dexcom, Inc., Insulet Corporation, Medtronic, Speaker’s Bureau; Self; Lilly Diabetes. D. W. Hansen: None. T. T. Ly: Employee; Self; Insulet Corporation. Omnipod 5 in preschoolers study group: n/a. B. W. Bode: Advisory Panel; Self; Eli Lilly and Company, Consultant; Self; Bigfoot Biomedical, Inc., Companion Medical, Lexicon Pharmaceuticals, Inc., Medtronic, Novo Nordisk Inc., Zealand Pharma A/S, Research Support; Self; Abvance Therapeutics, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Dompe, Eli Lilly and Company, Eyenuk, Inc., Insulet Corporation, Jaeb Center for Health Research, Medtronic, Nova Biomedical, Novo Nordisk, Provention Bio, Inc., REMD Biotherapeutics, Sanofi, Senseonics, Viacyte, Inc., vTv Therapeutics, Xeris Pharmaceuticals, Inc., Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk, Sanofi, Stock/Shareholder; Self; AgaMatrix, Aseko, Inc., Glytec, LLC. G. P. Forlenza: Advisory Panel; Self; Medtronic, Consultant; Self; Beta Bionics, Inc., Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Medtronic, Tandem Diabetes Care. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. S. A. Brown: Research Support; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Tolerion, Inc. B. A. Buckingham: Advisory Panel; Self; Medtronic, Tolerion, Inc., Research Support; Self; Beta Bionics, Inc., Insulet Corporation, Medtronic, Tandem Diabetes Care. A. B. Criego: Consultant; Self; Bigfoot Biomedical, Inc., Other Relationship; Self; Sanofi, Research Support; Self; Abbott Diabetes, Eli Lilly and Company, Insulet Corporation, Medtronic. D. Desalvo: Consultant; Self; Insulet Corporation, Research Support; Self; Insulet Corporation, Speaker’s Bureau; Self; Dexcom, Inc. S. A. Macleish: Advisory Panel; Self; Insulet Corporation. Funding Insulet Corporation