Type 1 diabetes (T1D), is associated with considerable risk of morbidity and mortality due to chronic hyperglycemia. Despite innovations in management, pediatric patients of African ancestry (AA) have been found to have persistently higher mean blood glucose (MBG) than European ancestry (EA) patients. The investigators hypothesize that an intervention using advanced insulin delivery technology together with home management will sustainably improve MBG to levels comparable to EA patients without increasing hypoglycemia.

The investigators will first perform a small "field trial" of the intervention in African American patients having T1D, with 8.5\

Type 1 diabetes (T1D), one of the most prevalent incurable diseases of childhood, is associated with serious risk of morbidity and mortality due to the development of micro- and macrovascular complications. Complications can be prevented by treatment that achieves physiological or near physiological levels of glucose. Despite innovations in management over the past three decades, pediatric patients of African ancestry (AA) have had persistently higher HbA1c than patients of white, European ancestry (EA). Higher HbA1c in AA patients is associated with both higher acute and chronic morbidity and mortality compared to EA patients. Thus, racial disparity in glycemic outcome and the development of complications is a major unresolved challenge of current clinical pediatric diabetes treatment.

Multiple factors contribute to high-risk levels of mean blood glucose (MBG) in pediatric AA patients compared to EA. AA patients have less access to insulin pumps, perform glucose testing less often, have less contact with diabetes management staff, and may have difficulty relating to management staff due to cultural and socioeconomic differences. Greater occurrence of hypoglycemia is another obstacle to achieving optimal glucose control. These considerations have led us to hypothesize that an intervention targeting this group of major management obstacles will sustainably reduce MBG to levels comparable to EA patients without increased hypoglycemia. The investigators propose that an advanced hybrid closed loop (AHCL) pump system combined with frequent enhanced home video management conferencing (TECH) with the study CDE nurse coordinator will facilitate improvement of MBG and HbA1c, increase time in glycemic goal range, have minimal occurrence of hypoglycemia, and improve patient satisfaction with management.

Part 1: The investigators will first pre-test the intervention approach in ten participants using a combination of an advanced hybrid closed loop (AHCL) pump system + home video conferences with the study CDE nurse coordinator to enhance home management. Basic inclusion criterion will be self-identification as African American ethnicity, having T1D, 8.5\

Inclusion Criteria:

• T1D as defined by:

  • Typical clinical presentation at diagnosis
  • Prior documentation of one or more anti-pancreatic antibodies
  • Requiring >0.3 units/kg/d insulin therapy
  • On no oral hypoglycemic agents concurrently
  • Body mass index (BMI) <90% for age and gender

• T1D duration of ≥ 6 months

• Self-identification as of African ancestry (AA)

• Age 10-17 years inclusive

• Pre-recruitment HbA1c 8.6-12%

• Glucose meter MBG ≥ 200 mg/dL

• Have smartphone/tablet/computer for conferencing

• Willingness to download and use the app for conferencing

• Willingness to be randomized to one of the clinical arms of the study (for Randomized intervention trial)

• Willingness and ability to wear pump and sensor, maintain equipment, and upload data from the system

• In stable living environment with a parent or guardian trained and able to recognize and intervene in diabetes emergency such as DKA or hypoglycemia

• Willingness to attend clinic visits during study at 3 and 6 month intervals

Exclusion Criteria:

• Unwillingness or inability to be randomized and/or participate in study procedures
• Pregnancy/plans to become pregnant/immediate post pregnancy and breast feeding
• Smoking, alcohol use, illicit drug use
• Severe psychiatric illness of patient or parent/guardian
• More than one (1) episode of diabetic ketoacidosis (DKA) in the past year
• Inability to wear sensor and/or pump catheter
• Known allergy to medical adhesives
• Less than two (2) clinic visits in the past year
• Absence of anti-pancreatic antibodies at diagnosis
• BMI ≥90%
• Hypoglycemic unawareness associated with severe episodes of hypoglycemia
• Insulin requirement <0.3 units/kg/d
• On hypoglycemic agent besides insulin within prior 6 months or other medication which in the judgment of the investigator may be a contraindication to participation in the study.
• Other chronic illness or condition besides diabetes (exception for hypothyroidism if stable on thyroxine replacement therapy) that would interfere in patient or family's participation in the study, or would influence metabolic control or HbA1c interpretation
• Inability to participate in "run-in" pre-randomization activities for randomized trial