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Hybrid Closed Loop Pivotal Trial in Type 1 Diabetes

Primary Purpose

Type 1 Diabetes

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Insulin Pump
Sponsored by
Medtronic Diabetes
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes

Eligibility Criteria

14 Years - 75 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Is age 14 - 75 years at time of screening
  2. Has a clinical diagnosis of type 1 diabetes for 2 years or more as determined via medical record or source documentation by an individual qualified to make a medical diagnosis
  3. Is willing to participate in a hotel study for the specified duration of hotel stay.
  4. Must have companion who will sleep in the same dwelling place every night during the study period and should also be able to call the subject daily in the event the subject is traveling.
  5. Is willing to perform ≥ 4 finger stick blood glucose measurements daily
  6. Is willing to perform required sensor calibrations
  7. Is willing to wear the system continuously throughout the study
  8. Has a Glycosylated hemoglobin (A1C) value less than 10.0% (as processed by Central Lab) at time of screening visit
  9. Has TSH in the normal range OR if the TSH is out of normal reference range the Free T3 is below or within the lab's reference range and Free T4 is within the normal reference range.
  10. Pump therapy for greater than 6 months prior to screening (with or without CGM experience)
  11. Is willing to upload data from the study pump, must have Internet access and a computer system that meets the requirements for uploading the study pump
  12. If subject has celiac disease, it has been adequately treated as determined by the investigator
  13. Is willing to take one of the following insulins and can financially support the use of either of the 2 insulin preparations throughout the course of the study (i.e. co-payments for insulin with insurance or able to pay full amount)

    • Humalog® (insulin lispro injection)
    • NovoLog® (insulin aspart)
  14. With history of cardiovascular event 1 year or more from the time of screening must have an EKG within 6 months prior to screening or during screening. If subject has an abnormal EKG, participation is allowed if there is clearance from a cardiologist
  15. With 3 or more cardiovascular risk factors listed below must have an EKG within 6 months prior to screening or during screening. If subject has an abnormal EKG, participation is allowed if there is clearance from a cardiologist

    Cardiovascular risk factors include:

    • Age >35 years
    • Type 1 diabetes of >15 years' duration
    • Presence of any additional risk factor for coronary artery disease
    • Presence of microvascular disease (proliferative retinopathy or nephropathy, including microalbuminuria)
    • Presence of peripheral vascular disease
    • Presence of autonomic neuropathy
  16. With history of cardiovascular event 1 year or more from the time of screening must have a stress test within 6 months prior to screening or during run in period. If subject fails stress test, participation is allowed if there is clearance from a cardiologist
  17. Must be able to speak and be literate in English

Exclusion Criteria:

  1. Has a history of 2 or more episodes of severe hypoglycemia, which resulted in any the following during the 6 months prior to screening:

    • Medical assistance (i.e. Paramedics, Emergency Room ( ER) or Hospitalization)
    • Coma
    • Seizures
  2. Is unable to tolerate tape adhesive in the area of sensor placement
  3. Has any unresolved adverse skin condition in the area of sensor placement (e.g., psoriasis, dermatitis herpetiformis, rash, Staphylococcus infection)
  4. Females who are sexually active and able to conceive will be excluded if they are not using an effective method of contraception and do not agree to continue using an effective method of contraception for the duration of the study as determined by investigator.
  5. Has had any of the following cardiovascular events within 1 year of screening: myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, ventricular rhythm disturbances or thromboembolic disease
  6. Is being treated for hyperthyroidism at time of screening
  7. Has diagnosis of adrenal insufficiency
  8. Has had DKA in the 6 months prior to screening visit.
  9. Has taken any oral, injectable, or intravenous (IV) steroids within 8 weeks from time of screening visit, or plans to take any oral, injectable, or IV steroids during the course of the study
  10. Actively participating in an investigational study (drug or device) wherein he/she has received treatment from an investigational study drug or investigational study device in the last 2 weeks
  11. Has been hospitalized or has visited the ER in the 6 months prior to screening resulting in a primary diagnosis of uncontrolled diabetes
  12. Currently abusing illicit drugs
  13. Currently abusing marijuana.
  14. Currently abusing prescription drugs
  15. Currently abusing alcohol
  16. Using pramlintide (Symlin), DPP-4 inhibitor, liraglutide (Victoza or other GLP-1 agonists), metformin, canagliflozin (Invokana or other SGLT2 inhibitors) at time of screening
  17. Has a history of visual impairment which would not allow subject to participate in the study and perform all study procedures safely, as determined by the investigator
  18. Has elective surgery planned that requires general anesthesia during the course of the study
  19. Has a sickle cell disease, hemoglobinopathy; or has received red blood cell transfusion or erythropoietin within 3 months prior to time of screening
  20. Plans to receive red blood cell transfusion or erythropoietin over the course of study participation
  21. Diagnosed with current eating disorder such as anorexia or bulimia
  22. Diagnosed with chronic kidney disease that results in chronic anemia
  23. Hematocrit that is below the normal reference range of lab used.
  24. On dialysis
  25. Serum creatinine of >2 mg/dL.

Sites / Locations

  • AMCR Institute
  • Stanford University Medical Center
  • Barbara Davis Center for Childhood Diabetes (Adult)
  • Barbara Davis Center for Childhood Diabetes (Pediatric)
  • Yale University School of Medicine
  • Atlanta Diabetes Associates
  • Park Nicollet Clinic-International Diabetes Center - Adult and Pediatric
  • University of Virginia
  • Rainer Clinical Research Center
  • Institute of Endocrinology, Sheba Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Study Arm

Arm Description

All subjects wearing the MMT-670G insulin pump, using it with the closed loop algorithm

Outcomes

Primary Outcome Measures

Change in A1C
There is no statistically powered primary endpoint in this study. However, there will be a descriptive analysis of change in A1C.

Secondary Outcome Measures

Number of Severe Hypoglycemia Events
There is no statistically powered secondary endpoint in this study. However, there will be a descriptive analysis of the number of Severe Hypoglycemia events.
Number of Diabetic Ketoacidosis (DKA) Events
There is no statistically powered secondary endpoint in this study. However, there will be a descriptive analysis on number of Diabetic Ketoacidosis (DKA) Event.

Full Information

First Posted
May 28, 2015
Last Updated
April 11, 2019
Sponsor
Medtronic Diabetes
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1. Study Identification

Unique Protocol Identification Number
NCT02463097
Brief Title
Hybrid Closed Loop Pivotal Trial in Type 1 Diabetes
Official Title
Safety Evaluation of the Hybrid Closed Loop (HCL) System in Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
June 2015 (undefined)
Primary Completion Date
March 2016 (Actual)
Study Completion Date
October 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medtronic Diabetes

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is a single-arm, multi-center, Home and Hotel Clinical Investigation in subjects with type 1 diabetes on insulin pump therapy. The purpose of this study is to demonstrate that the closed loop algorithm that is built into the 670G insulin pump is safe as part of the overall system.
Detailed Description
The study will proceed as follows: Run-in Period: A total of up to 150 subjects (age 14 - 75) will be enrolled at up to 10 investigational centers (9 in the US, 1 in the Europe, Middle East and Africa (EMEA) region) in order to reach 100 subjects who will complete the HCL study. The 2-week run-in period will be used to allow subjects to become familiar with new study devices. During the two week run-in period subjects will be using the Study Pump (670G) with the Sensor Augmented Pump function only activated (i.e. SmartGuard OFF and HCL OFF). Study Period - At Home: Following the two week run-in period using the Study Pump (670G), all subjects will participate in a 3-month study period. Subjects will be required to have a companion with them during the night for the duration of the study period. Companions will need to be under the same roof, but not necessarily in the same bedroom. During the Hotel stay where subjects are monitored closely, the presence of a companion is not necessary. Study Period - Hotel Study Subjects will participate in a Hotel study (6 days, 5 nights), with the remainder of the study period to be spent at home. All subjects will undergo daytime and nighttime Frequent Sample Testing (FST) for approximately 24 hours during the Hotel study with YSI or i-STAT® used as a reference value. With respect to meals, subjects will be allowed to eat as they normally do. Continued Access Program Subjects will be given the opportunity to extend use of their study devices for a period of 3 years. If subjects choose to participate in the continuation period, they will retain the study devices at the end of study period visit or receive them back in the event they have been returned to study staff already. During the continuation period, subjects will come in for office visits every 3 months. At each of the quarterly visits, subjects will be asked about the occurrence of adverse events and device complaints.

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
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
124 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Study Arm
Arm Type
Experimental
Arm Description
All subjects wearing the MMT-670G insulin pump, using it with the closed loop algorithm
Intervention Type
Device
Intervention Name(s)
Insulin Pump
Other Intervention Name(s)
MMT-670G
Intervention Description
Closed Loop Algorithm
Primary Outcome Measure Information:
Title
Change in A1C
Description
There is no statistically powered primary endpoint in this study. However, there will be a descriptive analysis of change in A1C.
Time Frame
Baseline and 3 months
Secondary Outcome Measure Information:
Title
Number of Severe Hypoglycemia Events
Description
There is no statistically powered secondary endpoint in this study. However, there will be a descriptive analysis of the number of Severe Hypoglycemia events.
Time Frame
3 months
Title
Number of Diabetic Ketoacidosis (DKA) Events
Description
There is no statistically powered secondary endpoint in this study. However, there will be a descriptive analysis on number of Diabetic Ketoacidosis (DKA) Event.
Time Frame
3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
14 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is age 14 - 75 years at time of screening Has a clinical diagnosis of type 1 diabetes for 2 years or more as determined via medical record or source documentation by an individual qualified to make a medical diagnosis Is willing to participate in a hotel study for the specified duration of hotel stay. Must have companion who will sleep in the same dwelling place every night during the study period and should also be able to call the subject daily in the event the subject is traveling. Is willing to perform ≥ 4 finger stick blood glucose measurements daily Is willing to perform required sensor calibrations Is willing to wear the system continuously throughout the study Has a Glycosylated hemoglobin (A1C) value less than 10.0% (as processed by Central Lab) at time of screening visit Has TSH in the normal range OR if the TSH is out of normal reference range the Free T3 is below or within the lab's reference range and Free T4 is within the normal reference range. Pump therapy for greater than 6 months prior to screening (with or without CGM experience) Is willing to upload data from the study pump, must have Internet access and a computer system that meets the requirements for uploading the study pump If subject has celiac disease, it has been adequately treated as determined by the investigator Is willing to take one of the following insulins and can financially support the use of either of the 2 insulin preparations throughout the course of the study (i.e. co-payments for insulin with insurance or able to pay full amount) Humalog® (insulin lispro injection) NovoLog® (insulin aspart) With history of cardiovascular event 1 year or more from the time of screening must have an EKG within 6 months prior to screening or during screening. If subject has an abnormal EKG, participation is allowed if there is clearance from a cardiologist With 3 or more cardiovascular risk factors listed below must have an EKG within 6 months prior to screening or during screening. If subject has an abnormal EKG, participation is allowed if there is clearance from a cardiologist Cardiovascular risk factors include: Age >35 years Type 1 diabetes of >15 years' duration Presence of any additional risk factor for coronary artery disease Presence of microvascular disease (proliferative retinopathy or nephropathy, including microalbuminuria) Presence of peripheral vascular disease Presence of autonomic neuropathy With history of cardiovascular event 1 year or more from the time of screening must have a stress test within 6 months prior to screening or during run in period. If subject fails stress test, participation is allowed if there is clearance from a cardiologist Must be able to speak and be literate in English Exclusion Criteria: Has a history of 2 or more episodes of severe hypoglycemia, which resulted in any the following during the 6 months prior to screening: Medical assistance (i.e. Paramedics, Emergency Room ( ER) or Hospitalization) Coma Seizures Is unable to tolerate tape adhesive in the area of sensor placement Has any unresolved adverse skin condition in the area of sensor placement (e.g., psoriasis, dermatitis herpetiformis, rash, Staphylococcus infection) Females who are sexually active and able to conceive will be excluded if they are not using an effective method of contraception and do not agree to continue using an effective method of contraception for the duration of the study as determined by investigator. Has had any of the following cardiovascular events within 1 year of screening: myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, ventricular rhythm disturbances or thromboembolic disease Is being treated for hyperthyroidism at time of screening Has diagnosis of adrenal insufficiency Has had DKA in the 6 months prior to screening visit. Has taken any oral, injectable, or intravenous (IV) steroids within 8 weeks from time of screening visit, or plans to take any oral, injectable, or IV steroids during the course of the study Actively participating in an investigational study (drug or device) wherein he/she has received treatment from an investigational study drug or investigational study device in the last 2 weeks Has been hospitalized or has visited the ER in the 6 months prior to screening resulting in a primary diagnosis of uncontrolled diabetes Currently abusing illicit drugs Currently abusing marijuana. Currently abusing prescription drugs Currently abusing alcohol Using pramlintide (Symlin), DPP-4 inhibitor, liraglutide (Victoza or other GLP-1 agonists), metformin, canagliflozin (Invokana or other SGLT2 inhibitors) at time of screening Has a history of visual impairment which would not allow subject to participate in the study and perform all study procedures safely, as determined by the investigator Has elective surgery planned that requires general anesthesia during the course of the study Has a sickle cell disease, hemoglobinopathy; or has received red blood cell transfusion or erythropoietin within 3 months prior to time of screening Plans to receive red blood cell transfusion or erythropoietin over the course of study participation Diagnosed with current eating disorder such as anorexia or bulimia Diagnosed with chronic kidney disease that results in chronic anemia Hematocrit that is below the normal reference range of lab used. On dialysis Serum creatinine of >2 mg/dL.
Facility Information:
Facility Name
AMCR Institute
City
Escondido
State/Province
California
ZIP/Postal Code
92026
Country
United States
Facility Name
Stanford University Medical Center
City
Palo Alto
State/Province
California
ZIP/Postal Code
94035
Country
United States
Facility Name
Barbara Davis Center for Childhood Diabetes (Adult)
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Barbara Davis Center for Childhood Diabetes (Pediatric)
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Yale University School of Medicine
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06520
Country
United States
Facility Name
Atlanta Diabetes Associates
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30318
Country
United States
Facility Name
Park Nicollet Clinic-International Diabetes Center - Adult and Pediatric
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55416
Country
United States
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22903
Country
United States
Facility Name
Rainer Clinical Research Center
City
Renton
State/Province
Washington
ZIP/Postal Code
98057
Country
United States
Facility Name
Institute of Endocrinology, Sheba Medical Center
City
Tel Aviv
ZIP/Postal Code
52621
Country
Israel

12. IPD Sharing Statement

Citations:
PubMed Identifier
29148821
Citation
Cordero TL, Garg SK, Brazg R, Bailey TS, Shin J, Lee SW, Kaufman FR. The Effect of Prior Continuous Glucose Monitoring Use on Glycemic Outcomes in the Pivotal Trial of the MiniMed 670G Hybrid Closed-Loop System. Diabetes Technol Ther. 2017 Dec;19(12):749-752. doi: 10.1089/dia.2017.0208. Epub 2017 Nov 17.
Results Reference
derived
PubMed Identifier
28134564
Citation
Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Brazg RL, Ilany J, Slover RH, Anderson SM, Bergenstal RM, Grosman B, Roy A, Cordero TL, Shin J, Lee SW, Kaufman FR. Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes. Diabetes Technol Ther. 2017 Mar;19(3):155-163. doi: 10.1089/dia.2016.0421. Epub 2017 Jan 30.
Results Reference
derived

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Hybrid Closed Loop Pivotal Trial in Type 1 Diabetes

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