{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T12:40:43Z","timestamp":1792327243896,"version":"4.4.0"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      The iLet\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Bionic Pancreas replaces carbohydrate counting and manual bolus calculations with simplified qualitative meal announcements. Its performance among diverse patients with high baseline glycated hemoglobin (HbA1c) is not well characterized.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Retrospective, single-center cohort study of 71 patients aged 6\u201321 years with type 1 diabetes (T1D) who initiated the iLet Bionic Pancreas (2023\u20132025). Primary outcomes were changes in HbA1c and time in range (TIR; 70\u2013180 mg\/dL [3.9\u201310.0 mmol\/L]) from baseline to 3 months. Secondary outcomes included glycemic metrics through 12 months, hypoglycemia, and meal-announcement behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean age was 13.2 \u00b1 3.5 years; 40.8% Black and 38.0% Medicaid-insured. Baseline HbA1c was 9.4 \u00b1 2.1% (79 \u00b1 23 mmol\/mol) and TIR was 30.1 \u00b1 19.0%. At 3 months, HbA1c decreased by 1.8 \u00b1 1.7% (\u221220 \u00b1 19 mmol\/mol) and TIR increased by 22.4 \u00b1 22.5 percentage points (both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001) without increased hypoglycemia. Improvements were greatest among participants with baseline HbA1c \u2265 9.5% (\u226580 mmol\/mol) (\u0394HbA1c = \u22123.0% [\u221232 mmol\/mol]; \u0394TIR = +31.2 percentage points). Among participants with paired 12-month data, HbA1c decreased from 9.6%\u20137.6% and TIR increased from 27.7 to 55.8% (both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). Mean meal announcements were 2.9\/d at 3 months and 2.1\/d at 12 months (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.722) and were not associated with HbA1c or TIR at 3 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this real-world pediatric cohort, iLet initiation was associated with substantial glycemic improvement without increased hypoglycemia, particularly among participants with high baseline HbA1c. Favorable outcomes were observed among participants contributing paired 12-month data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15209156261496625","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:47:10Z","timestamp":1792043230000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Clinical Outcomes Following Initiation of the iLet\u00ae Bionic Pancreas in Youth with Type 1 Diabetes"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6643-0066","authenticated-orcid":false,"given":"Elizabeth R.","family":"Sullivan-Ingram","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham and Children\u2019s of Alabama, Birmingham, Alabama, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0144-882X","authenticated-orcid":false,"given":"Ortal","family":"Resnick","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham and Children\u2019s of Alabama, Birmingham, Alabama, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Margaret","family":"Barr","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham and Children\u2019s of Alabama, Birmingham, Alabama, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0692-6624","authenticated-orcid":false,"given":"Ambika P.","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham and Children\u2019s of Alabama, Birmingham, Alabama, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_3_5_2_1","volume-title":"Diabetes in America","author":"National Institute of Diabetes and Digestive and Kidney Diseases","year":"2023","unstructured":"1.National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes in America, 3rd ed. National Institutes of Health: Bethesda, MD; 2023.","edition":"3"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.11165"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0384"},{"key":"e_1_3_5_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1706291"},{"key":"e_1_3_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2009.05.025"},{"key":"e_1_3_5_7_1","first-page":"48","article-title":"Standards of care in diabetes","author":"American Diabetes Association","year":"2025","unstructured":"6.American Diabetes Association. Standards of care in diabetes. 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