2866-LB: Semaglutide Use Along with Neural Network Fully Closed-Loop Systems Improves Time in Range (TIR) to 87% in Adults with Type 1 diabetes: In Silico Study

Introduction and Objective: Prandial action of GLP-1 RA alleviates the shortcomings of automated insulin delivery (AID) around meals. This in-silico study tested the effect of adding semaglutide to both hybrid (HCL) and FCL AID systems. Methods: The ADJUST-T1D trial (NCT05537233) randomized 72 people with T1D using a commercial hybrid closed loop (HCL) system to receive semaglutide up to 1 mg/week or placebo (mean age 40 yrs, 58% F, 87% non-Hispanic White, BMI of 35 kg/m2 and A1c of 7.8%). The trial was reproduced in silico and then extended to test the performance of a new experimental neural-network FCL system (AIDANET) without vs. with semaglutide. Results: There was significant improvement in TIR with semaglutide compared to placebo with HCL (59% to 67%) and AIDANET (73% to 87%) [Table 1]. Significant improvements in glycemia were achieved without any meal announcement with reduced total insulin dose used per day and did not increase in time below range [Table1]. Conclusion: When added to an AIDANET FCL system, semaglutide up to 1 mg achieved mean TIR of >85%, which is much higher than any commercial AID system. Clinical trials in human using GLP-1RA and AIDANET are required. Disclosure D. Lv: Research Support; Ended; Novo Nordisk. Research Support; Current; Dexcom, Inc. A. El Fathi: Research Support; Current; Tandem Diabetes Care, Inc. Research Support; Ended; Novo Nordisk A/S. B. Kovatchev: Research Support; Current; Dexcom, Inc. Other - Patent royalties handled by the UVA Licensing and Ventures Group; Current; Dexcom, Inc. Research Support; Current; Tandem Diabetes Care, Inc. Other - Patent royalties handled by the UVA Licensing and Ventures Group; Current; Tandem Diabetes Care, Inc. Research Support; Ended; Novo Nordisk. Other - Patent royalties handled by the UVA Licensing and Ventures Group; Ended; Novo Nordisk, Sanofi. V. Shah: Advisory Panel; Current; Abbott Diabetes, Dexcom, Inc. Advisory Panel; Ended; Medtronic. Advisory Panel; Current; Novo Nordisk, Eli Lilly and Company. Consultant; Current; Insulet Corporation, T1D Exchange. Advisory Panel; Current; Sanofi, Tandem Diabetes Care, Inc. Consultant; Ended; DreaMed Diabetes, Ltd. Funding Breakthrough T1D Grant (3-SRA-2022-1278-M-B)