Diabetes Autoimmunity Withdrawn In New Onset and In Established Patients

The SUNRISE study is a prospective, multi-center, double-blind, randomized, placebo-controlled trial in subjects aged 12.0 to \<41.0 years diagnosed with type 1 diabetes (T1D), as defined by American Diabetes Association (ADA) criteria, and within 5 years of diagnosis. Time of diagnosis is defined as the first day of insulin administration. Subjects will be stratified by duration (zero up to 1 year and 1 year up to five years) to ensure balance of disease duration across treatment and placebo groups in each strata. For analytical purposes, all subjects12-\<41 will be considered cohort A, subjects aged 12-\<18 will considered cohort B and subjects aged 18-\<41 will be considered cohort C. For subjects aged 12-\<18 (Cohort B), dosing will be staggered with an initial 6 subjects aged 14-\<18 being enrolled with the last subject a having a minimum of 2 injections with at least 1 week follow-up after the 2nd injection. Safety data from this cohort will be evaluated before opening the study to subjects 12 and older. Subjects should be randomized no sooner than 6 weeks after diagnosis, unless glycemic range is adequately controlled as confirmed by time in glycemic range (70-180 mg/dL) \>55% by continuous glucose monitoring (CGM) recording over 3 or more consecutive or non-consecutive days. Screening assessments will include a physical examination, a fundoscopic photograph, chemistry and hematology safety labs, urinalysis, 24-hour urine protein and creatinine, hemoglobin A1c (HbA1c), presence of T1D antibodies, and a 4-hour mixed meal tolerance test (MMTT). Approximately 99 qualified subjects who meet all selection criteria will be randomized in a 2:1 ratio to treatment with TOL-3021 or placebo and treated for 52 weeks. Study drug treatments will be administered via an intramuscular (IM) injection into a large muscle every week for 52 weeks. CGM will be initiated within 5 days prior to the screening MMTT visit and continued through Week 52. Subjects will agree to diabetes management during the study with the goal of maintaining HbA1c levels of approximately 7.0% without frequent episodes of hypoglycemia.