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Assessment of an Automatic Closed-loop Insulin Delivery System

Primary Purpose

Diabetes Mellitus, Type 1

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Automatic closed-loop insulin delivery
Control
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 1 focused on measuring Insulin Infusion Systems, Continuous Glucose Monitors

Eligibility Criteria

14 Years - 40 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Clinical diagnosis of type 1 diabetes

    • The diagnosis of type 1 diabetes is based on the investigator's judgment
    • C peptide levels and antibody determinations are not required
  2. Daily insulin therapy for ≥ 12 months
  3. Insulin pump therapy for ≥ 3 months
  4. Age 14.0 - 40.0 years
  5. Subject comprehends written English
  6. Female subjects who are sexually active must be on acceptable method of contraception e.g. oral contraceptive pill, diaphragm, IUD
  7. Female subjects past menarche must have a negative urine pregnancy test
  8. Informed consent form is signed by the subject and/or parent and assent assigned by the subject if under 18 years of age
  9. For subjects under 18 years, both the subject and parent/guardian understand the study protocol and agree to comply with it. Both parents must sign if possible.

Exclusion Criteria:

  1. Subject has a medical disorder that in the judgment of the investigator will affect the wearing of the devices or the completion of any aspect of the protocol
  2. Diabetic ketoacidosis in the past month
  3. Hypoglycemic seizure or loss of consciousness or an event requiring glucagon or IV glucose in the past 3 months
  4. Subject has a respiratory condition such as asthma, treated with systemic or inhaled corticosteroids in the previous 6 months or cystic fibrosis
  5. Subject has a history of any cardiac or vascular disorder such as myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, arrhythmia or thromboembolic disease
  6. Subject has a history of liver or kidney disease (other than microalbuminuria)
  7. Subject has active Graves' disease
  8. Subjects with inadequately treated thyroid disease or celiac disease
  9. Subject has a neurologic disorder that in the judgment of the investigator will affect completion of the protocol
  10. Subject has a history of diagnosed medical eating disorder
  11. Subject has a history of known illicit drug abuse
  12. Subject has a history of known prescription drug abuse
  13. Subject has a history of current alcohol abuse
  14. Subject has a history of visual impairment which would not allow subject to participate
  15. Subject has an active skin condition that would affect sensor placement
  16. Subject has adhesive allergies
  17. Subjects requiring an intermediate or long-acting insulin (such as NPH, detemir or glargine)
  18. Subjects requiring other anti-diabetic medications other than insulin (oral or injectable)
  19. Current use of oral/inhaled glucocorticoids or other medications, which in the judgment of the investigator would be a contraindication to participation in the study
  20. Subject is currently on beta blocker medication
  21. Subject is currently participating in another investigational study (drug or device)
  22. Subject is deemed by the investigator to be unwilling or unable to follow the protocol
  23. Presence of a febrile illness within 24 hours of enrollment

Sites / Locations

  • Camp Conrad-Chinnock
  • Packard El Camino Hospital
  • Lucile Packard Children's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

automatic closed-loop insulin delivery

Control

Arm Description

The closed-loop arm will consist of participants wearing a sensor and transmitter which transmits sensor glucose data. The algorithm determines insulin delivery rates and this is delivered in microboluses every 5 minutes

The subjects in the control arm will wear the 530G system using Enlite and MiniLink transmitter and threshold suspend.

Outcomes

Primary Outcome Measures

Safety of Automatic Closed Loop Insulin Delivery System in Adolescents and Adults With Type 1 Diabetes
As measured by the number of events of plasma glucose values ≤ 50 mg/dL OR frequency of system alerts preceding a plasma glucose value of ≤ 50 mg/dL in all subjects As measured by the number of events of system alerts of plasma glucose values >300 mg/dL lasting for more than one hour in all subjects. As measured by number of events of serum ketones >3 mmol/L in all subjects As measured by the number of events meeting the criteria for severe hypoglycemia, defined as hypoglycemic seizure, loss of consciousness or coma or an event requiring administration of glucagon or IV glucose in all subjects

Secondary Outcome Measures

Feasibility of Using the Automatic Closed Loop Delivery System in Adolescents and Adults With Type 1 Diabetes
As measured by the system initiating and operating properly for at least 75% of the time for 75% of subjects. As measure by the completion of study enrollment procedures and education on system use within 2 hours for 75% of the subjects.
Efficacy of Hybrid Closed-loop System in Comparison With Control
As measured by overall mean sensor glucose percent time in range 70-180 mg/dL.

Full Information

First Posted
June 26, 2014
Last Updated
February 9, 2017
Sponsor
Stanford University
Collaborators
Medtronic
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1. Study Identification

Unique Protocol Identification Number
NCT02366767
Brief Title
Assessment of an Automatic Closed-loop Insulin Delivery System
Official Title
Assessment of an Automatic Closed-loop Insulin Delivery System
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
June 2014 (undefined)
Primary Completion Date
September 2014 (Actual)
Study Completion Date
September 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University
Collaborators
Medtronic

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The overall aim of this research proposal is to determine the safety, feasibility and efficacy of an automatic closed-loop insulin delivery system.
Detailed Description
This study will be completed in two parts. The initial part of this study will be an inpatient evaluation of the system with the primary goal of assessing safety and feasibility. This will involve 8 subjects with type 1 diabetes, aged 14 - 40 years, admitted for up to 60 hour. Plasma glucose levels will be collected hourly and tested by YSI (YSI 2300, Yellow Springs Instrument). These studies will be performed at Stanford University and will include group sporting activities to mimic the diabetes camp environment. Capillary blood glucose testing will be performed every 2-3 hours before meals, snacks, exercise, and prebed by subjects with research staff supervision during the day and at 00:00, 03:00 and 07:00 by research staff. These data will be reviewed by the DSMB before proceeding to camp studies. The second part of this study will be to test the efficacy of the system during diabetes summer camps. We will test the system in subjects with type 1 diabetes, aged 14-40 years, attending diabetes camp. There will be 20 subjects recruited, with 10 subjects randomized to the control arm Medtronic 530G system with threshold suspend (control group) and 10 subjects randomized to the automatic closed-loop insulin delivery (intervention group). Capillary blood glucose testing will be performed every 2-3 hours before meals, snacks, exercise and prebed by subjects with research staff supervision and at 00:00, 03:00 and 07:00 by research staff. The primary aim of this study is to generate preliminary data of system safety and efficacy in a closely supervised environment that challenges glucose control.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1
Keywords
Insulin Infusion Systems, Continuous Glucose Monitors

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
automatic closed-loop insulin delivery
Arm Type
Experimental
Arm Description
The closed-loop arm will consist of participants wearing a sensor and transmitter which transmits sensor glucose data. The algorithm determines insulin delivery rates and this is delivered in microboluses every 5 minutes
Arm Title
Control
Arm Type
Active Comparator
Arm Description
The subjects in the control arm will wear the 530G system using Enlite and MiniLink transmitter and threshold suspend.
Intervention Type
Device
Intervention Name(s)
Automatic closed-loop insulin delivery
Intervention Description
Sensor transmit glucose data every 5 minutes to the control algorithm which adjusts insulin delivery every 5 minutes.
Intervention Type
Device
Intervention Name(s)
Control
Other Intervention Name(s)
530G Pump
Intervention Description
Threshold suspend
Primary Outcome Measure Information:
Title
Safety of Automatic Closed Loop Insulin Delivery System in Adolescents and Adults With Type 1 Diabetes
Description
As measured by the number of events of plasma glucose values ≤ 50 mg/dL OR frequency of system alerts preceding a plasma glucose value of ≤ 50 mg/dL in all subjects As measured by the number of events of system alerts of plasma glucose values >300 mg/dL lasting for more than one hour in all subjects. As measured by number of events of serum ketones >3 mmol/L in all subjects As measured by the number of events meeting the criteria for severe hypoglycemia, defined as hypoglycemic seizure, loss of consciousness or coma or an event requiring administration of glucagon or IV glucose in all subjects
Time Frame
6 days
Secondary Outcome Measure Information:
Title
Feasibility of Using the Automatic Closed Loop Delivery System in Adolescents and Adults With Type 1 Diabetes
Description
As measured by the system initiating and operating properly for at least 75% of the time for 75% of subjects. As measure by the completion of study enrollment procedures and education on system use within 2 hours for 75% of the subjects.
Time Frame
6 days
Title
Efficacy of Hybrid Closed-loop System in Comparison With Control
Description
As measured by overall mean sensor glucose percent time in range 70-180 mg/dL.
Time Frame
6 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
14 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis of type 1 diabetes The diagnosis of type 1 diabetes is based on the investigator's judgment C peptide levels and antibody determinations are not required Daily insulin therapy for ≥ 12 months Insulin pump therapy for ≥ 3 months Age 14.0 - 40.0 years Subject comprehends written English Female subjects who are sexually active must be on acceptable method of contraception e.g. oral contraceptive pill, diaphragm, IUD Female subjects past menarche must have a negative urine pregnancy test Informed consent form is signed by the subject and/or parent and assent assigned by the subject if under 18 years of age For subjects under 18 years, both the subject and parent/guardian understand the study protocol and agree to comply with it. Both parents must sign if possible. Exclusion Criteria: Subject has a medical disorder that in the judgment of the investigator will affect the wearing of the devices or the completion of any aspect of the protocol Diabetic ketoacidosis in the past month Hypoglycemic seizure or loss of consciousness or an event requiring glucagon or IV glucose in the past 3 months Subject has a respiratory condition such as asthma, treated with systemic or inhaled corticosteroids in the previous 6 months or cystic fibrosis Subject has a history of any cardiac or vascular disorder such as myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, arrhythmia or thromboembolic disease Subject has a history of liver or kidney disease (other than microalbuminuria) Subject has active Graves' disease Subjects with inadequately treated thyroid disease or celiac disease Subject has a neurologic disorder that in the judgment of the investigator will affect completion of the protocol Subject has a history of diagnosed medical eating disorder Subject has a history of known illicit drug abuse Subject has a history of known prescription drug abuse Subject has a history of current alcohol abuse Subject has a history of visual impairment which would not allow subject to participate Subject has an active skin condition that would affect sensor placement Subject has adhesive allergies Subjects requiring an intermediate or long-acting insulin (such as NPH, detemir or glargine) Subjects requiring other anti-diabetic medications other than insulin (oral or injectable) Current use of oral/inhaled glucocorticoids or other medications, which in the judgment of the investigator would be a contraindication to participation in the study Subject is currently on beta blocker medication Subject is currently participating in another investigational study (drug or device) Subject is deemed by the investigator to be unwilling or unable to follow the protocol Presence of a febrile illness within 24 hours of enrollment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bruce Buckingham, MD
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Camp Conrad-Chinnock
City
Angelus Oaks
State/Province
California
ZIP/Postal Code
92305
Country
United States
Facility Name
Packard El Camino Hospital
City
Mountain View
State/Province
California
ZIP/Postal Code
94040
Country
United States
Facility Name
Lucile Packard Children's Hospital
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26049550
Citation
Ly TT, Roy A, Grosman B, Shin J, Campbell A, Monirabbasi S, Liang B, von Eyben R, Shanmugham S, Clinton P, Buckingham BA. Day and Night Closed-Loop Control Using the Integrated Medtronic Hybrid Closed-Loop System in Type 1 Diabetes at Diabetes Camp. Diabetes Care. 2015 Jul;38(7):1205-11. doi: 10.2337/dc14-3073. Epub 2015 Jun 6.
Results Reference
result

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Assessment of an Automatic Closed-loop Insulin Delivery System

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