Automated Insulin Delivery (AID) for Basal Insulin Titration in Type 2 Diabetes

The study will involve 20 people with Type 2 Diabetes who are 18 years or older. The study will be performed at the University of Virginia (UVA), with screening procedures taking place either virtually or at the Clinical Research Unit (CRU) at UVA. All participants will undergo a 10-day run-in phase with a blinded Dexcom Generation 6 Continuous Glucose Monitor (CGM). Participants will be randomized (1:1) to either the Control (CTR) Group or the Experimental (EXP) Group. In the EXP Group, participants will use an Automated Insulin Device (AID) for 10 days in the Basal Insulin Titration (BIT) Phase then return to their original therapy (basal insulin using pen) using the new setting in the Maintenance Phase (MP). The total daily insulin (TDI) requirement during the BIT Phase will be translated to a basal insulin dose. During the same 10 days, in the CTR group, participants will use an unblinded CGM and will be contacted by a study physician as per standard care to adjust their insulin doses if needed. Both groups will then go into a 10-days maintenance period using a blinded CGM. Outcomes will be measured in the last 7 days of the BIT and Maintenance Phases.

Inclusion criteria

• Age ≥18.0 years old at time of consent.
• Clinical diagnosis, based on investigator assessment, of type 2 diabetes for at least one year.
• HbA1c ≥ 7.5%.
• Currently using an approved long-acting insulin for at least two months (e.g., insulin glargine, insulin degludec)
• If using a CGM, willingness to wear an additional study CGM during the duration of the study.
• Access to the internet and willingness to upload data during the study as needed.
• 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 who self-report that they are 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.
• Willingness to remain on same dose of non-insulin glucose-lowering agent during the trial (including metformin/biguanides, GLP-1 receptor agonists, pramlintide, DPP-4 inhibitors, sulfonylureas and naturaceuticals).

Exclusion criteria

• Currently using an approved intermediate (e.g., insulin NPH) or rapid insulin for at least six months (e.g., insulin aspart, insulin lispro, insulin regular).
• Currently being treated for a seizure disorder.
• A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol, such as but not limited to, the following examples:

• Inpatient psychiatric treatment in the past 6 months
• Presence of a known adrenal disorder
• Uncontrolled thyroid disease
• Currently pregnant or intent to become pregnant during the trial.
• Currently breastfeeding.
• Anticipated surgical, interventional procedures or prolonged periods of fasting during this study.
• History of hypoglycemia unawareness.
• On a non-stable dose of non-insulin glucose-lowering agent prior to the trial (including metformin/biguanides, GLP-1 receptor agonists, pramlintide, DPP-4 inhibitors, sulfonylureas and naturaceuticals) as defined by study physician.