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Phase 3CompletedNCT06346366

PANORAMA — bihormonal artificial pancreas after total pancreatectomy

What this study tests

A randomized crossover study of Inreda’s insulin-and-glucagon system after total pancreatectomy. The ADA 2026 primary abstract reports 34 randomized participants and 20 who completed both three-month periods for the primary analysis. Time in range improved, but the findings concern pancreatic diabetes after surgery, not autoimmune T1D.

Editorial review: .

Registry checked: 2026-09-17. Registry’s own update: 2024-04-04.

Most recent recorded citation date: 2026-06-07. Only explicit date metadata is included; an undated citation may be newer. This does not mean every claim was reviewed on that date.

Trial status, labels and access can change between reviews. How we review the evidence · How to read the evidence

Full sources ↓Full discussion ↓Report an issue →

Evidence at a glance

Who can enter the study?
Adults aged 18–75 with insulin-dependent diabetes at least three months after total pancreatectomy (removal of the whole pancreas), already using flash or continuous glucose monitoring and treated with an insulin pump or injections. Key exclusions: BMI over 35, HbA1c above 11.0%, current chemotherapy, oral glucose-lowering drugs, and daily paracetamol (acetaminophen) use. People who took part in the earlier APPEL 5+ trial were allowed to enroll. Registered eligibility ↗Enrollment criteria describe who may enter. They do not establish who was analyzed or the denominator for a reported result.
Reported benefit and results
The ADA 2026 abstract reports 34 randomized and 20 in the predefined complete-period analysis. Time in range was 81% versus 57%, a 24-percentage-point difference (95% CI 16–32). HbA1c was 56 versus 64 mmol/mol. Time below 70 mg/dL was 0.9% versus 1.2%; its difference was not statistically significant (95% CI −0.8 to 0.3 percentage points). These conference results replace the previous secondary-blog figures.Read the result sources and their limitations →
Important harms
Read the reported results, safety discussion and original sources. A separate harms summary is not available; this does not establish safety.
Research access and approval
Study regions: European Union. A trial listing does not establish product approval or current recruitment at a particular site. Check the study’s current entry requirements.
What remains uncertain?
Read the full discussion and original sources for study limitations. Planned endpoints and completion dates are not results.

Research status alone does not establish approval, clinical benefit or local availability. This record cites company or conference reports. Those sources may describe interim findings; their source type is shown in the source list.

Registry status: Recruitment status unconfirmed. The displayed trial status also reflects the cited study evidence.

Primary endpoints

  • Percentage of time in range (glucose 70–180 mg/dL, i.e. 3.9–10.0 mmol/L) over each 3-month treatment period

The full picture

Population and design

PANORAMA studies adults after their entire pancreas has been removed. This is pancreatic diabetes, a different population from autoimmune T1D. Participants used the Inreda insulin-and-glucagon system and their usual diabetes care for three months each, with a washout between periods. Published protocol.

Results and limitations

The primary ADA abstract reports 34 randomized participants, with 20 completing both periods and entering the predefined primary analysis. Time in range improved; HbA1c was lower on the bihormonal system in the reported point values (56 versus 64 mmol/mol). The time-below-range confidence interval included no difference, so a reduction in hypoglycemia was not established.

Earlier text incorrectly gave 25 analyzed participants and 1.5% time below range on control. It also attributed seven discontinuations to particular device problems using a secondary blog. The primary abstract does not corroborate those details, so they have been removed. Attrition from 34 randomized to 20 analyzed remains an important limitation; a full report is needed to explain it and assess harms.

The registry remains unconfirmed, with no posted results and an outdated April 2024 estimated completion date. We distinguish that registry state from the completed crossover study described in the conference abstract. Registry.

Sources

  1. [1]
  2. [2]
    PANORAMA randomized crossover trial: study protocol · Peer-reviewed study · 2026-01-20
  3. [3]
    NCT06346366: study record · Trial registry — Current status, study design and eligibility checked 16 September 2026; this does not imply posted outcomes.