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Inpatient Evaluation of an Automated Closed-Loop Control-to-Range System (CTR)

Primary Purpose

Type 1 Diabetes

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Control-to-Range Automated Insulin Management System
Sponsored by
Jaeb Center for Health Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes

Eligibility Criteria

12 Years - 65 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Clinical diagnosis of type 1 diabetes for at least one year and using an insulin pump for at least 6 months The diagnosis of type 1 diabetes is based on the investigator's judgment; C peptide level and antibody determinations are not needed.
  • Age 12 to 65 years
  • Hemoglobin A1c (HbA1c) between 5.0% and 10.5%, as measured with DCA2000 or equivalent device
  • For females, not currently known to be pregnant
  • Demonstration of proper mental status and cognition for the study
  • An understanding of and willingness to follow the protocol and sign the informed consent or assent

Exclusion Criteria:

  • Diabetic ketoacidosis in the past 6 months
  • Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment
  • History of a seizure disorder (except hypoglycemic seizure). Subjects with a history of seizures may be included in the study if they receive written clearance from their neurologist treatment for a seizure disorder
  • Coronary artery disease or heart failure. Subjects with a history of coronary artery disease may be included in the study if they receive written clearance from their cardiologist
  • Cystic fibrosis
  • Active infection
  • A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol such as the following examples:

    • Inpatient psychiatric treatment in the past 6 months for either the subject or the subject's primary care giver (i.e., parent or guardian)
    • Presence of a known adrenal disorder
    • Abnormal liver or renal function (Transaminase >2 times the upper limit of normal, Creatinine > 1.5 mg/dL)
    • Active gastroparesis
    • 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
    • Uncontrolled thyroid disease
    • Abuse of alcohol Note: Adequately treated thyroid disease and celiac disease do not exclude subjects from enrollment
  • A recent injury to body or limb, muscular disorder, use of any medication, any carcinogenic disease, or other significant medical disorder if that injury, medication or disease in the judgment of the investigator will affect the completion of the exercise protocol
  • Current use of a beta blocker medication
  • Hematocrit <30% (labs drawn at screening visit or within one month prior to screening for other purposes will suffice for enrollment purposes related to hematocrit)
  • Use of pseudoephedrine 48 hours prior to Clinical Research Center (CRC) admission

Sites / Locations

  • Sansum Diabetes Research Institute
  • Stanford University
  • University of Colorado Health Sciences Center- Barbara Davis
  • University of Virginia
  • Montpellier University Hospital
  • Schneider Children's Medical Center of Israel
  • University of Padova

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Closed-Loop Control

Arm Description

The Control to Range algorithm will be used in conjunction with continuous glucose monitoring and insulin pump delivery to manage the subject's blood glucose.

Outcomes

Primary Outcome Measures

Percent of glucose values 71-180 mg/dL of combined day and night readings during the first admission visit
Group success criterion defined as a mean blood glucose >50%, lower end of one-sided 95% confidence interval >40% and individual criterion of no individual <30%.
Percent of subjects with blood glucose reading of 71-180 mg/dL 4 hours following the breakfast with a missed meal bolus
Success is defined as >=40% subjects with a blood glucose in the 71-180 mg/dL range.
Percent of subjects with blood glucose reading of 71-180 mg/dL 5 hours following the breakfast with a meal bolus 30% more than the recommended bolus amount
Success is defined as >=50% subjects with a blood glucose in the 71-180 mg/dL range.
Percent of subjects with a blood glucose nadir <=60 mg/dL following exercise
Success is defined as less than 25% of subjects with a blood glucose nadir <=60 mg/dL.
Overall frequency of hypoglycemia
Success defined as no subjects with severe hypoglycemia with a low blood glucose resulting in seizure, unconsciousness or the inability to treat oneself.
Overall frequency of hyperglycemia
Success defined as no subjects with diabetic ketoacidosis (DKA).

Secondary Outcome Measures

Percent of blood glucose values 71-180 mg/dL during the day (9:00AM-11:00PM) of the first admission visit
Group success criterion defined as a mean blood glucose >50%, lower end of one-sided 95% confidence interval >40% and individual criterion of no individual <30%.
Percent of blood glucose values 70-180 mg/dL during the night (11:00PM-8:00AM) of the first admission visit
Group success criterian defined as a mean blood glucose >60%, lower end of one-sided 95% confidence interval >50% and individual criterion of no individual <30%.
Percent of blood glucose values >400 mg/dL during the first admission visit
Individual success is defined as no blood glucose values >400 mg/dL.
Percent of blood glucose values <=60 mg/dL during the first admission visit
No more than 33% of visits with blood glucose <=60 mg/dL
Percent of subjects with a peak blood glucose >400 mg/dL following the breakfast with a missed meal bolus
Success is defined as less than 5% of subjects have a peak blood glucose >400 mg/dL
Percent of subjects with a nadir blood glucose <=60 mg/dL following the breakfast with a missed meal bolus
Success is defined as less than 15% of subjects have a nadir blood glucose <=60 mg/dL
Percent of subjects with a peak blood glucose >400 mg/dL following the breakfast with a meal bolus 30% more than the recommended bolus amount
Success is defined as less than 5% of subjects have a peak blood glucose >400 mg/dL
Percent of subjects with a nadir blood glucose <=60 mg/dL following the breakfast with a meal bolus 30% more than the recommended bolus amount
Success is defined as less than 25% of subjects have a nadir blood glucose <=60 mg/dL

Full Information

First Posted
January 4, 2011
Last Updated
September 7, 2016
Sponsor
Jaeb Center for Health Research
search

1. Study Identification

Unique Protocol Identification Number
NCT01271023
Brief Title
Inpatient Evaluation of an Automated Closed-Loop Control-to-Range System
Acronym
CTR
Official Title
Inpatient Evaluation of an Automated Closed-Loop Control-to-Range System
Study Type
Interventional

2. Study Status

Record Verification Date
September 2016
Overall Recruitment Status
Completed
Study Start Date
March 2011 (undefined)
Primary Completion Date
August 2012 (Actual)
Study Completion Date
August 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Jaeb Center for Health Research

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to test an insulin management system ("Control-to-Range (CTR) system") in an inpatient setting to see if the system is safe and effective enough to test in a future at-home study. The system includes (1) a DexCom Seven Plus Continuous Glucose Monitoring (CGM) device that measures the blood sugar, (2) a laptop computer that determines how much insulin is needed, and (3) an Insulet OmniPod insulin pump that delivers the insulin. The study will include two hospital stays consisting of meals and exercise scenarios. Both hospital stays will be for 24+ hours during the day and night. The study will include about 50 individuals at 7 clinical centers in the United States, France, Israel, and Italy.
Detailed Description
Clinical Research Center (CRC) Session Detail (closed-loop control active for all elements) Day 1 (24+ hours): Admission at 7:00 AM Standardized breakfast with normal bolus at 9:00 AM Lunch with normal bolus at 1:00 PM Dinner with normal bolus at 7:00 PM Overnight sleep Breakfast with missed meal bolus followed by user alert and correction bolus Discharge Day 2 (24+ hours): Admission at 7:00 AM Standardized breakfast with normal bolus at 9:00 AM Lunch with normal bolus at 1:00 PM Exercise Dinner with normal bolus at 7:00 PM Overnight sleep Breakfast with overbolus at 7:00 AM Discharge Meal boluses will be semi-automated, with manual meal announcement by the physician/nurse, automated bolus recommendation by the system, and automated delivery of the bolus following confirmation of the recommendation. Between-meal insulin dosing will be fully automated; bolus confirmation by the physician/nurse will be requested by the closed-loop controller only when it determines that carbohydrates may be necessary to avoid hypoglycemia following the bolus.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
57 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Closed-Loop Control
Arm Type
Experimental
Arm Description
The Control to Range algorithm will be used in conjunction with continuous glucose monitoring and insulin pump delivery to manage the subject's blood glucose.
Intervention Type
Device
Intervention Name(s)
Control-to-Range Automated Insulin Management System
Intervention Description
The devices that will be used in the Closed-Loop Control System are standardized across all study sites and include the DexCom Seven Plus Continuous Glucose Monitor (CGM), the OmniPod insulin pump, and the FreeStyle blood glucose meter. The Closed-Loop Control System will be used during all 3 admission visits.
Primary Outcome Measure Information:
Title
Percent of glucose values 71-180 mg/dL of combined day and night readings during the first admission visit
Description
Group success criterion defined as a mean blood glucose >50%, lower end of one-sided 95% confidence interval >40% and individual criterion of no individual <30%.
Time Frame
Admission Visit 1
Title
Percent of subjects with blood glucose reading of 71-180 mg/dL 4 hours following the breakfast with a missed meal bolus
Description
Success is defined as >=40% subjects with a blood glucose in the 71-180 mg/dL range.
Time Frame
4 hours following the breakfast with a missed meal bolus
Title
Percent of subjects with blood glucose reading of 71-180 mg/dL 5 hours following the breakfast with a meal bolus 30% more than the recommended bolus amount
Description
Success is defined as >=50% subjects with a blood glucose in the 71-180 mg/dL range.
Time Frame
5 hours following the breakfast with a meal bolus 30% more than the recommended bolus amount
Title
Percent of subjects with a blood glucose nadir <=60 mg/dL following exercise
Description
Success is defined as less than 25% of subjects with a blood glucose nadir <=60 mg/dL.
Time Frame
Following exercise completion
Title
Overall frequency of hypoglycemia
Description
Success defined as no subjects with severe hypoglycemia with a low blood glucose resulting in seizure, unconsciousness or the inability to treat oneself.
Time Frame
Includes both admission visits
Title
Overall frequency of hyperglycemia
Description
Success defined as no subjects with diabetic ketoacidosis (DKA).
Time Frame
Includes both admission visits
Secondary Outcome Measure Information:
Title
Percent of blood glucose values 71-180 mg/dL during the day (9:00AM-11:00PM) of the first admission visit
Description
Group success criterion defined as a mean blood glucose >50%, lower end of one-sided 95% confidence interval >40% and individual criterion of no individual <30%.
Time Frame
Admission Visit Day 1 (9:00AM-11:00PM)
Title
Percent of blood glucose values 70-180 mg/dL during the night (11:00PM-8:00AM) of the first admission visit
Description
Group success criterian defined as a mean blood glucose >60%, lower end of one-sided 95% confidence interval >50% and individual criterion of no individual <30%.
Time Frame
Admission Visit Night 1 (11:00PM-8:00AM)
Title
Percent of blood glucose values >400 mg/dL during the first admission visit
Description
Individual success is defined as no blood glucose values >400 mg/dL.
Time Frame
Admission Visit 1
Title
Percent of blood glucose values <=60 mg/dL during the first admission visit
Description
No more than 33% of visits with blood glucose <=60 mg/dL
Time Frame
Admission Visit 1
Title
Percent of subjects with a peak blood glucose >400 mg/dL following the breakfast with a missed meal bolus
Description
Success is defined as less than 5% of subjects have a peak blood glucose >400 mg/dL
Time Frame
4 hours following the breakfast with a missed meal bolus
Title
Percent of subjects with a nadir blood glucose <=60 mg/dL following the breakfast with a missed meal bolus
Description
Success is defined as less than 15% of subjects have a nadir blood glucose <=60 mg/dL
Time Frame
4 hours following the breakfast with a missed meal bolus
Title
Percent of subjects with a peak blood glucose >400 mg/dL following the breakfast with a meal bolus 30% more than the recommended bolus amount
Description
Success is defined as less than 5% of subjects have a peak blood glucose >400 mg/dL
Time Frame
following the breakfast with a meal bolus 30% more than the recommended bolus amount
Title
Percent of subjects with a nadir blood glucose <=60 mg/dL following the breakfast with a meal bolus 30% more than the recommended bolus amount
Description
Success is defined as less than 25% of subjects have a nadir blood glucose <=60 mg/dL
Time Frame
following the breakfast with a meal bolus 30% more than the recommended bolus amount

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis of type 1 diabetes for at least one year and using an insulin pump for at least 6 months The diagnosis of type 1 diabetes is based on the investigator's judgment; C peptide level and antibody determinations are not needed. Age 12 to 65 years Hemoglobin A1c (HbA1c) between 5.0% and 10.5%, as measured with DCA2000 or equivalent device For females, not currently known to be pregnant Demonstration of proper mental status and cognition for the study An understanding of and willingness to follow the protocol and sign the informed consent or assent Exclusion Criteria: Diabetic ketoacidosis in the past 6 months Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment History of a seizure disorder (except hypoglycemic seizure). Subjects with a history of seizures may be included in the study if they receive written clearance from their neurologist treatment for a seizure disorder Coronary artery disease or heart failure. Subjects with a history of coronary artery disease may be included in the study if they receive written clearance from their cardiologist Cystic fibrosis Active infection A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol such as the following examples: Inpatient psychiatric treatment in the past 6 months for either the subject or the subject's primary care giver (i.e., parent or guardian) Presence of a known adrenal disorder Abnormal liver or renal function (Transaminase >2 times the upper limit of normal, Creatinine > 1.5 mg/dL) Active gastroparesis 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 Uncontrolled thyroid disease Abuse of alcohol Note: Adequately treated thyroid disease and celiac disease do not exclude subjects from enrollment A recent injury to body or limb, muscular disorder, use of any medication, any carcinogenic disease, or other significant medical disorder if that injury, medication or disease in the judgment of the investigator will affect the completion of the exercise protocol Current use of a beta blocker medication Hematocrit <30% (labs drawn at screening visit or within one month prior to screening for other purposes will suffice for enrollment purposes related to hematocrit) Use of pseudoephedrine 48 hours prior to Clinical Research Center (CRC) admission
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roy W Beck, MD, PhD
Organizational Affiliation
Jaeb Center for Health Research
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Howard Zisser, MD
Organizational Affiliation
Sansum Diabetes Research Institute
Official's Role
Study Chair
Facility Information:
Facility Name
Sansum Diabetes Research Institute
City
Santa Barbara
State/Province
California
ZIP/Postal Code
93105
Country
United States
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
University of Colorado Health Sciences Center- Barbara Davis
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
Facility Name
Montpellier University Hospital
City
Montpellier
ZIP/Postal Code
34295
Country
France
Facility Name
Schneider Children's Medical Center of Israel
City
Petah Tikva
ZIP/Postal Code
49202
Country
Israel
Facility Name
University of Padova
City
Padova
ZIP/Postal Code
93106
Country
Italy

12. IPD Sharing Statement

Citations:
PubMed Identifier
25188375
Citation
Chase HP, Doyle FJ 3rd, Zisser H, Renard E, Nimri R, Cobelli C, Buckingham BA, Maahs DM, Anderson S, Magni L, Lum J, Calhoun P, Kollman C, Beck RW; Control to Range Study Group. Multicenter closed-loop/hybrid meal bolus insulin delivery with type 1 diabetes. Diabetes Technol Ther. 2014 Oct;16(10):623-32. doi: 10.1089/dia.2014.0050. Epub 2014 Sep 4.
Results Reference
derived
PubMed Identifier
25003311
Citation
Zisser H, Renard E, Kovatchev B, Cobelli C, Avogaro A, Nimri R, Magni L, Buckingham BA, Chase HP, Doyle FJ 3rd, Lum J, Calhoun P, Kollman C, Dassau E, Farret A, Place J, Breton M, Anderson SM, Dalla Man C, Del Favero S, Bruttomesso D, Filippi A, Scotton R, Phillip M, Atlas E, Muller I, Miller S, Toffanin C, Raimondo DM, De Nicolao G, Beck RW; Control to Range Study Group. Multicenter closed-loop insulin delivery study points to challenges for keeping blood glucose in a safe range by a control algorithm in adults and adolescents with type 1 diabetes from various sites. Diabetes Technol Ther. 2014 Oct;16(10):613-22. doi: 10.1089/dia.2014.0066. Epub 2014 Jul 8. Erratum In: Diabetes Technol Ther. 2015 Jan;17(1):68. Vistenin, Roberto [corrected to Visentin, Roberto].
Results Reference
derived

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Inpatient Evaluation of an Automated Closed-Loop Control-to-Range System

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