Assessing the iLet Bionic Pancreas Deployed in Primary Care and via Telehealth: A Randomized Clinical Trial

The iLet Bionic Pancreas system can improve glycemia in individuals with type 1 diabetes with its simple interface, setup, and maintenance, making it practical for use in the primary care setting and via telehealth (TH). This multisite, random-order crossover trial included 40 adults with type 1 diabetes who received care either from an endocrinology or a primary care clinic and were seen either in person or via TH. Of these 40 participants, 97% achieved an average glucose (AG) <183 mg/dL, and 64% achieved an AG <154 mg/dL. These results suggest that the system can be initiated effectively by primary care providers and via TH, potentially expanding access to this technology to a broad population, including individuals who cannot easily access subspecialty diabetes care. Key Points · The iLet Bionic Pancreas (BP) system was previously studied only in diabetes subspecialty centers, although half of adults with type 1 diabetes receive care from primary care providers (PCPs). · The BP is the first automated insulin delivery system that fully automates dosing and titration, improving diabetes management for people with diabetes and their care providers. · Average glucose levels were significantly lower among individuals using the BP compared with usual care in each subgroup (in-person [IP] primary care, telehealth [TH] primary care, IP endocrinology, and TH endocrinology) (all P <0.05). · PCP–led initiation of the BP, including via TH, can improve equity in diabetes care and expand access to this diabetes technology.