Early Feasibility Study 2 of Outpatient Control-to-Range - Testing System Efficacy

This study has been completed.
Sponsor:
Collaborators:
Juvenile Diabetes Research Foundation
Sansum Diabetes Research Institute
University of Padova
University Hospital, Montpellier
Information provided by (Responsible Party):
Boris Kovatchev, PhD, University of Virginia
ClinicalTrials.gov Identifier:
NCT01714505
First received: October 23, 2012
Last updated: September 2, 2013
Last verified: September 2013
  Purpose

An unblinded, randomized, cross-over design with each patient participating in two 40-hour outpatient admissions: (a) Experimental involving automated Control-to-Range (CTR) and (b) Control using Continuous Glucose Monitor (CGM)- augmented insulin pump treatment outside of a hospital based clinical research center. The principal goal is to validate a smart phone-based control-to-range (CTR) system for ambulatory use and to estimate the effect of CTR vs. sensor-augmented pump therapy, thereby providing justification for further larger home-based trials of CTR.


Condition Intervention
Diabetes Mellitus, Type 1
Device: Diabetes Assistant (DiAs)

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Early Feasibility Study 2 of Outpatient Control-to-Range - Testing System Efficacy

Resource links provided by NLM:


Further study details as provided by University of Virginia:

Primary Outcome Measures:
  • Estimate the effect size of Control-to-Range (CTR) vs. Continuous Glucose Monitor (CGM)-augmented insulin pump treatment in an outpatient setting. [ Time Frame: 40 hours ] [ Designated as safety issue: Yes ]
    It is expected that compared to CGM-augmented insulin pump treatment, CTR will result in moderate effect size of approximately 0.4, in terms of reduction of the overnight risk for hypoglycemia as measured by the Low Blood Glucose Index computed from retrofitted CGM data. This effect is not expected to be statistically significant with the anticipated sample size but will be used to inform power analysis for the subsequent multi-center trial of CTR at home.


Secondary Outcome Measures:
  • Time spent in target range [ Time Frame: 40 hours ] [ Designated as safety issue: Yes ]
    CTR will improve (non-significantly at the projected sample size of N=5 subjects/site) the time spent within the target range of 80-140 mg/dl overnight (computed from retrofitted CGM data) and will reduce the extent of postprandial glucose excursions during the day. These data will provide justification and design support for a subsequent larger multi-center trial of CTR at home.


Other Outcome Measures:
  • Patient comfort with the Diabetes Assistant (DiAs) user interface [ Time Frame: 40 hours ] [ Designated as safety issue: No ]
  • Reliability of DiAs remote monitoring [ Time Frame: 40 hours ] [ Designated as safety issue: No ]
    Assess the DiAs remote monitoring by medical personnel/technicians to confirm appropriate functioning outside of the hospital setting

  • Reliability of inter-device connections between DiAs and the CGM and between DiAs and the insulin pump. [ Time Frame: 40 hours ] [ Designated as safety issue: Yes ]
    Assess the functioning of the connections between DiAs, the continuous glucose sensor, and the insulin pump.


Enrollment: 9
Study Start Date: October 2012
Study Completion Date: January 2013
Primary Completion Date: January 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Experimental Involving Automated CTR
Closed-Loop Control: Insulin delivery will be controlled by the Diabetes Assistant (DiAs) system running in Control to Range (CTR) or in Safety Only mode. The subject will interact with the system through its Graphic User Interface (GUI). Subjects will not be allowed to administer correction boluses between meals and snacks as the DiAs will automatically be adjusting insulin to correct for hyperglycemia. The total doses recommended by the DiAs prior to meals and snacks includes the correction dose and Insulin on Board (IOB) calculated by the system.
Device: Diabetes Assistant (DiAs)
A medical platform that uses a smart-phone to connect to a continuous glucose sensor to insulin pump and run closed-loop control. The cell phone runs the Control to Range and is connected to work with the insulin pump and continuous glucose monitor to help keep the blood sugar in a desired range (80-180 mg/dL during the day) and help avoid hypoglycemia during the night.
No Intervention: CGM-Augmented Insulin Pump Treatment
Open Loop Control: Insulin delivery will be controlled by the Diabetes Assistant (DiAs) system running in open-loop mode. The subject will interact with the system through its Graphic User Interface (GUI). Subjects will be permitted to administer correction boluses at any time during the Control Admission, whether or not they are eating a scheduled meal or snack. DiAs will be initialized with the subject's typical insulin pump settings. The subject will be reminded that all treatment decisions should be based on fingerstick values and not on continuous glucose monitor (CGM) values.

Detailed Description:

The overall objective of this project is to sequentially test, validate, obtain regulatory approval for, and deploy at home, a closed-loop Control-to-Range (CTR) system for optimal blood glucose (BG) regulation in people with type 1 diabetes. The CTR system is comprised of two algorithmic layers: a Safety Supervision Module (SSM) and Insulin on Board Tracking and Safety Module (ITSM), and an automated Range Correction Module (RCM). Both modules will receive continuous glucose monitoring (CGM) and insulin delivery data. The SSM and ITSM will monitor the safety of the subject's continuous subcutaneous insulin infusion pump (CSII) to prevent hypoglycemia. The RCM will be responsible for optimizing BG control and mitigating postprandial hyperglycemic excursions through series of insulin boluses. To run CTR, we will use our wearable artificial pancreas platform, known as DiAs (Diabetes Assistant), which consists of a smart phone running CTR and connected to standard insulin delivery and CGM devices.

  Eligibility

Ages Eligible for Study:   21 Years to 64 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. ≥21 and <65 years old.
  2. Clinical diagnosis of type 1 diabetes mellitus. For an individual to be enrolled at least one criterion from each list must be met.

    o Criteria for documented hyperglycemia (at least 1 must be met): i. Fasting glucose ≥126 mg/dL - confirmed ii. Two-hour Oral Glucose Tolerance Test (OGTT) glucose ≥200 mg/dL - confirmed iii. HbA1c ≥6.5% documented - confirmed iv. Random glucose ≥200 mg/dL with symptoms v. No data at diagnosis is available but the participant has a convincing history of hyperglycemia consistent with diabetes

    o Criteria for requiring insulin at diagnosis (1 must be met): i. Participant required insulin at diagnosis and continually thereafter ii. Participant did not start insulin at diagnosis but upon investigator review likely needed insulin (significant hyperglycemia that did not respond to oral agents) and did require insulin eventually and used continually iii. Participant did not start insulin at diagnosis but continued to be hyperglycemic, had positive islet cell antibodies - consistent with latent autoimmune diabetes in adults (LADA) and did require insulin eventually and used continually

  3. Use of an insulin pump to treat his/her diabetes for at least 1 year.
  4. Familiarity with a bolus calculator with the current insulin pump with pre-defined parameters for carbohydrate (CHO) ratio, insulin sensitivity factor (ISF), target glucose and active insulin.
  5. HbA1c <9% as measured with DCA2000 or equivalent device.
  6. Not currently known to be pregnant, breast feeding, or intending to become pregnant (females).
  7. Demonstration of proper mental status and cognition for the study.
  8. Willingness to avoid consumption of acetaminophen-containing products during the study interventions involving CGM use.
  9. If on antihypertensive, thyroid, anti-depressant or lipid lowering medication, have stability on the medication for at least 2 months prior to enrollment in the study.

Exclusion Criteria:

  1. Severe hypoglycemia resulting in seizure, loss of consciousness, or diabetic ketoacidosis within the 12 months prior to enrollment.
  2. Pregnancy; breast feeding, or intention of becoming pregnant.
  3. Uncontrolled arterial hypertension (Resting diastolic blood pressure >90 mmHg and/or systolic blood pressure >160 mmHg).
  4. Conditions which may increase the risks associated with possible hypoglycemia, such as any active cardiac disorder/arrhythmia, uncontrolled coronary artery disease during the previous year (e.g. history of myocardial infarction, acute coronary syndrome, therapeutic coronary intervention, coronary bypass or stenting procedure, stable or unstable angina, episode of chest pain of cardiac etiology with documented EKG changes, or positive stress test or catheterization with coronary blockages >50%), congestive heart failure, history of cerebrovascular event, seizure disorder, syncope, adrenal insufficiency, neurologic disease or atrial fibrillation.
  5. Self-reported hypoglycemia unawareness.
  6. History of a systemic or deep tissue infection with methicillin-resistant staph aureus or Candida albicans.
  7. Use of a device that may pose electromagnetic compatibility issues and/or radiofrequency interference with the CGM (implantable cardioverter-defibrillator, electronic pacemaker, neurostimulator, intrathecal pump, and cochlear implants).
  8. Anticoagulant therapy other than aspirin.
  9. Oral steroids.
  10. Medical condition requiring use of an acetaminophen-containing medication that cannot be withheld for the study admissions.
  11. Psychiatric disorders that would interfere with study tasks (e.g. inpatient psychiatric treatment within 6 months prior to enrollment).
  12. Mental incapacity, unwillingness or language barriers precluding adequate understanding or cooperation.
  13. Known current or recent alcohol or drug abuse.
  14. Medical conditions that would make operating a CGM, the DiAs cell phone or insulin pump difficult (e.g. blindness, severe arthritis, immobility).
  15. Any skin condition that prevents sensor or pump placement on the abdomen or arm (e.g. bad sunburn, pre-existing dermatitis, intertrigo, psoriasis, extensive scarring, cellulitis).
  16. In adherence with the One Touch Ultra 2 User Guide, subjects with hematocrit levels less than 30% and above 55% will be excluded.
  17. Impaired hepatic function measured as alanine aminotransferase or aspartate aminotransferase ≥three times the upper reference limit.
  18. Impaired renal function measured as creatinine >1.2 times above the upper limit of normal.
  19. Uncontrolled microvascular (diabetic) complications, such as current proliferative diabetic retinopathy or macular edema, known diabetic nephropathy (other than microalbuminuria with normal creatinine) or neuropathy requiring treatment.
  20. Active gastroparesis requiring current medical therapy.
  21. If on antihypertensive, thyroid, anti-depressant or lipid lowering medication, lack of stability on the medication for the past 2 months prior to enrollment in the study.
  22. Uncontrolled thyroid disease.
  23. Known bleeding diathesis or dyscrasia.
  24. Known allergy to medical adhesives, components of the insulin pump insertion set or continuous glucose monitor sensor.
  25. Active enrollment in another clinical trial.
  26. Use of anti-diabetic agents other than continuous subcutaneous insulin infusion (CSII) including long-acting insulin, intermediate-acting insulin, metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-IV inhibitors, glucagon-like peptide 1 agonists, and alpha-glucosidase inhibitors
  27. Subjects with basal rates less than 0.01U/hr.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01714505

Locations
United States, California
Sansum Diabetes Research Institute
Santa Barbara, California, United States, 93105
United States, Virginia
University of Virginia
Charlottesville, Virginia, United States, 22908
Sponsors and Collaborators
University of Virginia
Juvenile Diabetes Research Foundation
Sansum Diabetes Research Institute
University of Padova
University Hospital, Montpellier
Investigators
Principal Investigator: Boris P. Kovatchev, Ph.D. University of Virginia
  More Information

No publications provided

Responsible Party: Boris Kovatchev, PhD, Director, UVA Center for Diabetes Technology, University of Virginia
ClinicalTrials.gov Identifier: NCT01714505     History of Changes
Other Study ID Numbers: 16457, JDRF 22-2011-649
Study First Received: October 23, 2012
Last Updated: September 2, 2013
Health Authority: United States: Food and Drug Administration
United States: Institutional Review Board

Keywords provided by University of Virginia:
Diabetes Mellitus, Type 1
Continuous Glucose Monitor
Artificial Pancreas
Insulin Pump
Closed Loop control
Open Loop treatment

Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases
Insulin
Hypoglycemic Agents
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on July 23, 2014