What question did this study set out to answer?

This study aims to evaluate the effectiveness of two automated insulin delivery algorithms in managing blood glucose levels after unannounced meals in adolescents with type 1 diabetes.

July 12, 2026Endocrine0 citationsOpen Access

The CRUMB study: closed-loop response to unannounced mixed and carbohydrates-rich breakfasts. A randomized controlled crossover pilot-study in a cohort of adolescents with type 1 diabetes

DPDonatella Lo PrestiUniversity of Catania SCSalvatore Scirè CalabrisottoUniversity of Catania LTL. TomaselliUniversity of Padua

Key Points

This study aims to evaluate the effectiveness of two automated insulin delivery algorithms in managing blood glucose levels after unannounced meals in adolescents with type 1 diabetes.
Randomized crossover study design involving 20 adolescents aged 11 to 18 years.
Assessment of two insulin delivery algorithms: Medtronic MiniMed 780G's PID and Tandem t: slim X2's MPC.
Endpoints included blood glucose differences at 2 and 4 hours, glucose peak, and time spent in glucose ranges after carbohydrate and mixed meals.
In announced meals, significant higher 2-hour blood glucose difference observed with AM versus UM; 4-hour differences not significant.
In unannounced meals, PID algorithm showed lower 2-hour blood glucose difference than MPC with reduced peaks and improved time in range.
Both algorithms effectively returned glucose levels to baseline within 4 hours without safety concerns.

Abstract

Abstract Purpose Unannounced meals pose a major challenge to type 1 diabetes patients. This study compared the performance of two automated insulin delivery (AID) algorithms, the Medtronic MiniMed 780G’s proportional-integral-derivative (PID) and the Tandem t: slim X2’s model predictive control (MPC), following unannounced breakfasts (ClinicalTrials.gov identifier: NCT07455643, retrospectively registered the 3rd of February 2026). Methods In a randomized crossover study, we enrolled 20 children between 11 and 18 years using the MiniMed 780G or the Tandem t: slim X2 AID system. Endpoints included 2-hour and 4-hour blood glucose difference (ΔBG), glucose peak, time to peak, and time spent above (TAR), below (TBS), in range (TIR), and in tight range (TITR). Two meals were tested: a carbohydrate (CHO) meal and a mixed one, both containing 30 g of carbohydrates, and additional 15 g proteins for the mixed meal. Announced (AM) and unannounced (UM) meals were analyzed. Results AM, compared to UM, showed significant higher 2-hourΔBG; conversely 4-hourΔBG did not differ significantly. In CHO AM, algorithms were comparable. In mixed AM, PID gained lower peaks and TAR, with higher TIR and TITR. In UM, PID obtained lower 2-hourΔBG than MPC, with reduced peak, TAR, and improved TIR and TITR. Differences in 4-hourΔBG and time-at-peak were not significant. Conclusion Both AID algorithms mitigated postprandial glycemia and returned glucose to baseline levels within 4 h without safety concerns. The PID demonstrated higher reactivity to unannounced meals, while performances were comparable when meal boluses were properly announced. ClinicalTrials.gov identifier NCT07455643.

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