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Early Feasibility Study of Zone-MPC and HMS With DiAs in the Outpatient Setting

Primary Purpose

Diabetes Mellitus, Type 1

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
CGM and Insulin Pump
Closed-Loop Control System
Sponsored by
Sansum Diabetes Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 1 focused on measuring Artificial Pancreas, Diabetes Mellitus, Type 1, Autoimmune Diseases, Diabetes Mellitus, Endocrine System Diseases, Glucose Metabolism Disorders, Immune System Diseases, Metabolic Diseases

Eligibility Criteria

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

Inclusion Criteria:

  • Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least 1 year and an insulin pump for at least 6 months
  • Willing to wear the study CGM device for the duration of the study
  • Age ≥21 to <65 years
  • HbA1c <10.0%; if HbA1c <6.0% then total daily insulin must be ≥0.5 U/kg
  • For females, not currently known to be pregnant If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative urine pregnancy test will be required for all premenopausal women who are not surgically sterile. Subjects who become pregnant will be discontinued from the study.
  • Demonstration of proper mental status and cognition for the study
  • Currently using insulin-to-carbohydrate ratio to calculate meal bolus sizes
  • Hypoglycemia awareness as demonstrated by a Clarke Hypoglycemia Unawareness score of 2 or lower
  • Access to internet and cell phone service at home, and a computer for downloading device data
  • Availability of care partner committed to participating in training activities, knowledgeable at all times of the participant's location, and being present and available to provide assistance when system is being used at night
  • Commitment to maintaining uninterrupted availability via cell phone and avoiding any overnight travel for the duration the period using the closed-loop system
  • An understanding of and willingness to follow the protocol and sign the informed consent

Exclusion Criteria:

  • Admission for diabetic ketoacidosis in the 12 months prior to enrollment
  • Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment
  • History of a seizure disorder (except hypoglycemic seizure), unless written clearance is received from a neurologist
  • Coronary artery disease or heart failure, unless written clearance is received from a cardiologist
  • History of cardiac arrhythmia (except for benign premature atrial contractions and benign premature ventricular contractions which are permitted)
  • Cystic fibrosis
  • 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 function test results (Transaminase >2 times the upper limit of normal); testing required for subjects taking medications known to affect liver function or with diseases known to affect liver function
    • Abnormal renal function test results (calculated GFR <60 mL/min/1.73m2); testing required for subjects with diabetes duration of greater than 5 years post onset of puberty
    • 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 (TSH undetectable or >10 mlU/L); testing required within three months prior to admission for subjects with a goiter or who are on thyroid hormone replacement, and within one year otherwise
    • Abuse of alcohol or recreational drugs
    • Infectious process not anticipated to resolve prior to study procedures (e.g. meningitis, pneumonia, osteomyelitis)
  • 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 protocol
  • Current use of the following drugs and supplements:

    • Acetaminophen
    • Any medication being taken to lower blood glucose, such as Pramlintide, Metformin,GLP-1 Analogs such as Liraglutide, and nutraceuticals intended to lower blood glucose
    • Beta blockers
    • Oral or injectable glucocorticoids
    • Any other medication that the investigator believes is a contraindication to the subject's participation

Sites / Locations

  • William Sansum Diabetes Center
  • Mayo Clinic
  • University of Virginia

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Sensor-Augmented Pump Open-Loop Care (Week 1)

Closed-Loop Control System with Zone MPC and HMS

Arm Description

The subjects Sensor-Augmented Pump Open-Loop Care for the first week of the study before any adjustments to pump settings.

The artificial pancreas system will be allowed to employ its Model Predictive Control algorithm to make decisions about insulin delivery based on measured glucose levels. The Health Monitoring System algorithm uses the same CGM data as the MPC control algorithm but utilizes a separate algorithm for trending and predictions of future glucose values. Using a redundant and independent algorithm is an important safety feature of the overall AP device.

Outcomes

Primary Outcome Measures

Safety and efficacy of the system, as assessed by the composite outcome of time in range for glucose levels of 70-180 mg/dL and time < 70 mg/dL.
The primary endpoint for this pilot study will be to determine the safety and efficacy of the system, as assessed by the composite outcome of time in range for glucose levels of 70-180 mg/dL and time < 70 mg/dL, comparing between sensor-augmented pump use (open loop care) (week 1) to closed-loop care (final week), so as to determine the feasibility of eventual long-term use of the system.

Secondary Outcome Measures

Time in range for glucose 80-140 mg/dL
Time in range for glucose 80-140 mg/dL at all times unless described otherwise.
Time in range for glucose during the nocturnal period
Time in range for glucose 70-180 mg/dL during the nocturnal period.
Time in Range Postprandial
Time in range for glucose 70-180 mg/dL postprandial, for 5 hours following all meals
Markers of hypo- and hyperglycemia
Markers of hypo- and hyperglycemia.
Insulin Doses Given
Change in insulin doses given between the open and closed-loop phases of the study.
Treatments for hypoglycemia
Treatments for hypoglycemia between the open and closed-loop phases of the study.
Number of alerts given by the HMS to prevent hypoglycemia
Number of alerts given by the HMS to prevent hypoglycemia during closed-Loop control.
Outside interventions needed
Outside interventions needed to aid with treatment during closed-Loop control.
Failure analysis of the devices/connectivity issues that may occur.
Failure analysis of the devices/connectivity issues that may occur during closed-Loop control.

Full Information

First Posted
May 28, 2015
Last Updated
April 7, 2016
Sponsor
Sansum Diabetes Research Institute
Collaborators
University of California, Santa Barbara, Mayo Clinic, University of Virginia, University of Padova
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1. Study Identification

Unique Protocol Identification Number
NCT02463682
Brief Title
Early Feasibility Study of Zone-MPC and HMS With DiAs in the Outpatient Setting
Official Title
Early Feasibility Study of a Zone-Model Predictive Control (MPC) Controller and a Health Monitoring System (HMS) With the Diabetes Assistant (DiAS) in the Outpatient Setting
Study Type
Interventional

2. Study Status

Record Verification Date
April 2016
Overall Recruitment Status
Completed
Study Start Date
May 2015 (undefined)
Primary Completion Date
October 2015 (Actual)
Study Completion Date
October 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sansum Diabetes Research Institute
Collaborators
University of California, Santa Barbara, Mayo Clinic, University of Virginia, University of Padova

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a feasibility study of an artificial pancreas (AP) system with our previously validated Zone-MPC and Health Monitoring System (HMS) algorithms (ClinicalTraisl.gov: NCT01929798) integrated into the Diabetes Assistant (DiAs) system.
Detailed Description
This is a feasibility study of an artificial pancreas (AP) system with our previously validated Zone-MPC and Health Monitoring System (HMS) algorithms (ClinicalTraisl.gov: NCT01929798) integrated into the Diabetes Assistant (DiAs) system. The system will be evaluated on 2-3 subjects per site (n=6-9 subjects) for 2 weeks at 3 different sites (William Sansum Diabetes Center, University of Virginia, and Mayo Clinic, Rochester, MN). Basal rates will be adjusted in a run-to-run manner by study physicians prior to the closed-loop phase for a maximum of 3 weeks. Subjects will then complete 2 weeks at home use of the Zone-MPC/HMS system using the DIAs platform for a closed-loop feasibility trial. The purpose of this pilot study is to establish that safe day-and-night use of the Zone-MPC/HMS system integrated into the DiAs is achievable in the home environment, to analyze and learn to improve upon the run-to- run optimization process, and to collect efficacy data to inform a future larger study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1
Keywords
Artificial Pancreas, Diabetes Mellitus, Type 1, Autoimmune Diseases, Diabetes Mellitus, Endocrine System Diseases, Glucose Metabolism Disorders, Immune System Diseases, Metabolic Diseases

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Sensor-Augmented Pump Open-Loop Care (Week 1)
Arm Type
Active Comparator
Arm Description
The subjects Sensor-Augmented Pump Open-Loop Care for the first week of the study before any adjustments to pump settings.
Arm Title
Closed-Loop Control System with Zone MPC and HMS
Arm Type
Experimental
Arm Description
The artificial pancreas system will be allowed to employ its Model Predictive Control algorithm to make decisions about insulin delivery based on measured glucose levels. The Health Monitoring System algorithm uses the same CGM data as the MPC control algorithm but utilizes a separate algorithm for trending and predictions of future glucose values. Using a redundant and independent algorithm is an important safety feature of the overall AP device.
Intervention Type
Device
Intervention Name(s)
CGM and Insulin Pump
Intervention Description
Dexcom G4 Platinum CGM with Share AP Receiver Roche Accu-Chek insulin pump
Intervention Type
Device
Intervention Name(s)
Closed-Loop Control System
Intervention Description
The devices that will be used in the Closed-Loop Control System include the following components: DiAs - a smart-phone medical platform; Dexcom Dexcom G4 Platinum connected to DiAs via Bluetooth CGM receiver; Roche Accu-Chek insulin pump connected to DiAs via wireless Bluetooth; Remote Monitoring Server connected to DiAs via 3G or local Wi-Fi network, and Zone-MPC and HMS algorithms running on DiAs (MPC and HMS)
Primary Outcome Measure Information:
Title
Safety and efficacy of the system, as assessed by the composite outcome of time in range for glucose levels of 70-180 mg/dL and time < 70 mg/dL.
Description
The primary endpoint for this pilot study will be to determine the safety and efficacy of the system, as assessed by the composite outcome of time in range for glucose levels of 70-180 mg/dL and time < 70 mg/dL, comparing between sensor-augmented pump use (open loop care) (week 1) to closed-loop care (final week), so as to determine the feasibility of eventual long-term use of the system.
Time Frame
1 Week
Secondary Outcome Measure Information:
Title
Time in range for glucose 80-140 mg/dL
Description
Time in range for glucose 80-140 mg/dL at all times unless described otherwise.
Time Frame
1 Week
Title
Time in range for glucose during the nocturnal period
Description
Time in range for glucose 70-180 mg/dL during the nocturnal period.
Time Frame
1 week
Title
Time in Range Postprandial
Description
Time in range for glucose 70-180 mg/dL postprandial, for 5 hours following all meals
Time Frame
1 Week
Title
Markers of hypo- and hyperglycemia
Description
Markers of hypo- and hyperglycemia.
Time Frame
1 Week
Title
Insulin Doses Given
Description
Change in insulin doses given between the open and closed-loop phases of the study.
Time Frame
1 Week
Title
Treatments for hypoglycemia
Description
Treatments for hypoglycemia between the open and closed-loop phases of the study.
Time Frame
1 week
Title
Number of alerts given by the HMS to prevent hypoglycemia
Description
Number of alerts given by the HMS to prevent hypoglycemia during closed-Loop control.
Time Frame
2 Weeks
Title
Outside interventions needed
Description
Outside interventions needed to aid with treatment during closed-Loop control.
Time Frame
2 Weeks
Title
Failure analysis of the devices/connectivity issues that may occur.
Description
Failure analysis of the devices/connectivity issues that may occur during closed-Loop control.
Time Frame
2 Weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least 1 year and an insulin pump for at least 6 months Willing to wear the study CGM device for the duration of the study Age ≥21 to <65 years HbA1c <10.0%; if HbA1c <6.0% then total daily insulin must be ≥0.5 U/kg For females, not currently known to be pregnant If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative urine pregnancy test will be required for all premenopausal women who are not surgically sterile. Subjects who become pregnant will be discontinued from the study. Demonstration of proper mental status and cognition for the study Currently using insulin-to-carbohydrate ratio to calculate meal bolus sizes Hypoglycemia awareness as demonstrated by a Clarke Hypoglycemia Unawareness score of 2 or lower Access to internet and cell phone service at home, and a computer for downloading device data Availability of care partner committed to participating in training activities, knowledgeable at all times of the participant's location, and being present and available to provide assistance when system is being used at night Commitment to maintaining uninterrupted availability via cell phone and avoiding any overnight travel for the duration the period using the closed-loop system An understanding of and willingness to follow the protocol and sign the informed consent Exclusion Criteria: Admission for diabetic ketoacidosis in the 12 months prior to enrollment Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment History of a seizure disorder (except hypoglycemic seizure), unless written clearance is received from a neurologist Coronary artery disease or heart failure, unless written clearance is received from a cardiologist History of cardiac arrhythmia (except for benign premature atrial contractions and benign premature ventricular contractions which are permitted) Cystic fibrosis 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 function test results (Transaminase >2 times the upper limit of normal); testing required for subjects taking medications known to affect liver function or with diseases known to affect liver function Abnormal renal function test results (calculated GFR <60 mL/min/1.73m2); testing required for subjects with diabetes duration of greater than 5 years post onset of puberty 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 (TSH undetectable or >10 mlU/L); testing required within three months prior to admission for subjects with a goiter or who are on thyroid hormone replacement, and within one year otherwise Abuse of alcohol or recreational drugs Infectious process not anticipated to resolve prior to study procedures (e.g. meningitis, pneumonia, osteomyelitis) 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 protocol Current use of the following drugs and supplements: Acetaminophen Any medication being taken to lower blood glucose, such as Pramlintide, Metformin,GLP-1 Analogs such as Liraglutide, and nutraceuticals intended to lower blood glucose Beta blockers Oral or injectable glucocorticoids Any other medication that the investigator believes is a contraindication to the subject's participation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Francis J Doyle III, PhD
Organizational Affiliation
University of California, Santa Barbara/William Sansum Diabetes Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Eyal Dassau, PhD
Organizational Affiliation
University of California, Santa Barbara/William Sansum Diabetes Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jordan E Pinsker, MD
Organizational Affiliation
Sansum Diabetes Research Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ananda Basu, MD
Organizational Affiliation
Mayo Clinic, Rochester, MN
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Yogish Kudva, MD
Organizational Affiliation
Mayo Clinic, Rochester, MN
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Boris Kovatchev, PhD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Sue Brown, MD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Stephen Patek, PhD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Claudio Cobelli, PhD
Organizational Affiliation
University of Padova
Official's Role
Principal Investigator
Facility Information:
Facility Name
William Sansum Diabetes Center
City
Santa Barbara
State/Province
California
ZIP/Postal Code
93111
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22903
Country
United States

12. IPD Sharing Statement

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Early Feasibility Study of Zone-MPC and HMS With DiAs in the Outpatient Setting

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