The VRIF Trial: Hypoglycemia Reduction With Automated-Insulin Delivery System

This study will evaluate up to 15 subjects in each age group for a period of 8-10 weeks
performing neurocognitive tests before and after each intervention. The first study phase
will be up to 2 weeks of a training period to allow participants to get acquainted with the
use of the CGM if they are not familiar with the use of the device. This training period will
be followed by a 4-week sensor-augmented pump (SAP) period using a study CGM and the
subject's personal insulin pump. The subjects will return to clinic at the completion of the
SAP period and will be trained on the Tandem t:slim X2 with Control-IQ and G6 CGM. At the
completion of the system training session, subjects will begin 4-weeks of Closed-Loop Control
(CLC). Questionnaires will be completed by the study subject at screening, after completion
of SAP and after completion of CLC. Ecological Momentary Assessments (EMAs) and actigraphy
data will be collected in the last 14 days of the SAP and CLC periods.

A parent/guardian of the enrolled children will also be asked to participate in all
trainings, complete parental Patient-Report Outcomes (PRO) Questionnaires, and collect sleep
patterns while wearing the actigraph watch.

Inclusion Criteria:

- Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least
one year, using insulin for at least 1 year and using an insulin pump for at least 6
months.

- Familiarity and use of a carbohydrate ratio for meal boluses by participants and
families participating.

- Age 6-10 years old or 65 years or older

- Hemoglobin A1c <10%

- For females of child-bearing potential, not currently known to be pregnant:

A negative serum or urine pregnancy test will be required for all females of child-bearing
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.

- For participants <18 years old, living with one or more parent/legal guardian
knowledgeable about emergency procedures for severe hypoglycemia and able to contact
the participant in case of an emergency.

- Willing to disable any automated insulin delivery functionality on a personal insulin
pump during study, such as Medtronic 670G in auto mode. Predictive low blood glucose
suspend, such as Tandem insulin pump with Basal-IQ, will be allowed.

- Investigator has confidence that the participant and family can successfully operate
all study devices and is capable of adhering to the protocol.

- Willingness to switch to lispro (Humalog) or aspart (Novolog) and to use no other
insulin besides lispro (Humalog) or aspart (Novolog) during the study.

- Total daily insulin dose (TDD) at least 10 U/day.

- Willingness not to start any new non-insulin glucose-lowering agent during the course
of the trial

Exclusion Criteria:

- Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months
prior to enrollment.

- Diagnosis of Diabetic Ketoacidosis in the 12 months prior to enrollment.

- Uncontrolled cardiac disease (e.g. recent myocardial infarction, severe congestive
heart failure).

- Cerebrovascular accident in the 12 months prior to enrollment.

- Uncontrolled resting arterial hypertension (>160/90 mm Hg).

- Conditions that would make use of a CGM difficult (e.g., blindness, severe arthritis,
immobility).

- Current use of oral/inhaled glucocorticoids or other medications, which in the
judgment of the investigator would be a contraindication to participation in the
study.

- Concurrent use of any non-insulin glucose-lowering agent other than metformin
(including GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors,
sulfonylureas).

- Hemophilia or any other bleeding disorder

- A condition, which in the opinion of the investigator or designee, would put the
participant or study at risk

- Participation in another pharmaceutical or device trial at the time of enrollment or
during the study

- Employed by, or having immediate family members employed by Tandem Diabetes Care,
Inc., or having a direct supervisor at place of employment who is also directly
involved in conducting the clinical trial (as a study investigator, coordinator,
etc.); or having a first-degree relative who is directly involved in conducting the
clinical trial.