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An Outpatient Study of Automated Blood Glucose Control With an Insulin-Only Bionic Pancreas

Primary Purpose

Diabetes Mellitus, Type 1

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Fixed set point
Variable set point
Sponsored by
Bruce A. Buckingham
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional device feasibility trial for Diabetes Mellitus, Type 1 focused on measuring bionic pancreas, closed-loop control, artificial pancreas

Eligibility Criteria

18 Years - 44 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Type 1 diabetes for at least 1 year
  • insulin pump for ≥ 6 months
  • Prescription medication regimen stable for > 1 month
  • Subject comprehends written English
  • Female patients who are sexually active must be on acceptable method of contraception e.g. oral contraceptive pill, diaphragm, IUD (Intrauterine Device)
  • Female patients must have a negative urine pregnancy test
  • Informed Consent Form signed by the subject
  • Lives and works within a 60 minute drive-time radius of Stanford University
  • Willing to remain within a 60 minute drive-time radius of Stanford University during all 3 of the 7-day study arms (21 days)
  • Have someone over 18 years of age who lives with them,

Exclusion Criteria:

  • Current alcohol abuse (intake averaging > 3 drinks daily in last 30 days), use of marijuana within 1 month of enrollment, or other substance abuse (use within the last 6 months of controlled substances other than marijuana without a prescription)
  • Subject has a history of diagnosed medical eating disorder
  • 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, Neutral Protamine Hagedorn, 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
  • Unwilling or unable to refrain from drinking more than 2 drinks in an hour or more than 4 drinks in a day or use of marijuana during the trial
  • Subject has active Graves' disease
  • Subjects with inadequately treated thyroid disease or celiac disease
  • History of liver disease Renal failure on dialysis
  • Personal history of cystic fibrosis, pancreatitis, pancreatic tumor, or any other pancreatic disease besides type 1 diabetes
  • Any known history of coronary artery disease
  • Abnormal EKG (electrocardiogram) consistent with coronary artery disease or increased risk of malignant arrhythmia
  • Congestive heart failure (established history of congestive heart failure , lower extremity edema, paroxysmal nocturnal dyspnea, or orthopnea)
  • History of transient ischemic attack (TIA) or stroke
  • Seizure disorder, history of any non-hypoglycemic seizure within the last two years, or ongoing treatment with anticonvulsants
  • History of hypoglycemic seizures (grand-mal) or coma in the last year
  • History of pheochromocytoma:
  • episodic or treatment refractory (requiring 4 or more medications to achieve normotension) hypertension
  • paroxysms of tachycardia, pallor, or headache
  • personal or family history of MEN 2A (multiple endocrine neoplasia), MEN 2B, neurofibromatosis, or von Hippel-Lindau disease
  • History of adrenal disease or tumor
  • Hypertension with systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 despite treatment
  • Untreated or inadequately treated mental illness
  • Electrically powered implants (e.g. cochlear implants, neurostimulators) that might be susceptible to RF interference
  • Unable to completely avoid acetaminophen for duration of study
  • Established history of allergy or severe reaction to adhesive or tape that must be used in the study
  • History of eating disorder within the last 2 years, such as anorexia, bulimia, or diabulemia or omission of insulin to manipulate weight
  • History of intentional, inappropriate administration of insulin leading to severe hypoglycemia requiring treatment
  • Lives in or frequents areas with poor Verizon wireless network coverage (which would prevent remote monitoring)
  • Any factors that, in the opinion of the site principal investigator or overall principal investigator, would interfere with the safe completion of the study

Sites / Locations

  • Stanford University School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

No Intervention

Experimental

Experimental

Arm Label

Blinded Sensor

Fixed set point

Variable Set Point

Arm Description

Subjects will wear a blinded Dexcom G4P (Generation 4 Platinum) AP (Artificial Pancreas) glucose sensor for a week

Subjects will be in a hotel and use a fixed set point for glucose control for two days initialized at 130 mg/dl. The setpoint will be adjusted, if necessary, over the two days in the hotel before they are sent home for 5 days

Subjects will begin using a "variable" setpoint which will make adjustments based on their past glucose control over the previous day

Outcomes

Primary Outcome Measures

Mean glucose
Dexcom G4P AP mean glucose

Secondary Outcome Measures

% time <50 mg/dl
Fraction of Dexcom G4P AP readings <60 mg/dl
% time <70 mg/dl
Fraction of Dexcom G4P AP readings <70 mg/dl
% time 70-120 mg/dl
Fraction of Dexcom G4P AP readings 70-120 mg/dl
% time 70-180 mg/dl
Fraction of Dexcom G4P AP readings 70-180 mg/dl
% time >180 mg/dl
Fraction of Dexcom G4P AP readings >180 mg/dl
% time >250 mg/dl
Fraction of Dexcom G4P AP readings >250 mg/dl
% time < 60 mg/dl
Fraction of Dexcom G4AP readings < 60 mg/dl

Full Information

First Posted
July 18, 2015
Last Updated
June 19, 2018
Sponsor
Bruce A. Buckingham
Collaborators
Boston University, Massachusetts General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02536950
Brief Title
An Outpatient Study of Automated Blood Glucose Control With an Insulin-Only Bionic Pancreas
Official Title
An Outpatient Study of Automated Blood Glucose Control With an Insulin-Only Bionic Pancreas
Study Type
Interventional

2. Study Status

Record Verification Date
June 2018
Overall Recruitment Status
Completed
Study Start Date
August 2015 (undefined)
Primary Completion Date
July 2016 (Actual)
Study Completion Date
July 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Bruce A. Buckingham
Collaborators
Boston University, Massachusetts General Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an open-label, non-randomized, pilot study to determine the safety and feasibility of the insulin-only bionic pancreas.
Detailed Description
A total of 16 subjects, ages 18-45, will be enrolled in this crossover study. The study will consist of three 7-day study arms in the following order, one usual care arm, one bionic pancreas insulin only arm with a static glucose target, and one bionic pancreas insulin only arm with at dynamic glucose target.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1
Keywords
bionic pancreas, closed-loop control, artificial pancreas

7. Study Design

Primary Purpose
Device Feasibility
Study Phase
Not Applicable
Interventional Study Model
Sequential Assignment
Masking
Participant
Allocation
Non-Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Blinded Sensor
Arm Type
No Intervention
Arm Description
Subjects will wear a blinded Dexcom G4P (Generation 4 Platinum) AP (Artificial Pancreas) glucose sensor for a week
Arm Title
Fixed set point
Arm Type
Experimental
Arm Description
Subjects will be in a hotel and use a fixed set point for glucose control for two days initialized at 130 mg/dl. The setpoint will be adjusted, if necessary, over the two days in the hotel before they are sent home for 5 days
Arm Title
Variable Set Point
Arm Type
Experimental
Arm Description
Subjects will begin using a "variable" setpoint which will make adjustments based on their past glucose control over the previous day
Intervention Type
Device
Intervention Name(s)
Fixed set point
Intervention Description
Fixed set point arm: A fixed setpoint will be used initially. Staff will observe glucose control over 2 days while subjects remain in a hotel environment, and then over 5 more days in the same subjects in an outpatient setting. The clinical staff will adjust this target up or down by 15 mg/dl based on their glycemic control in the hotel setting.
Intervention Type
Device
Intervention Name(s)
Variable set point
Intervention Description
Variable set point arm: The setpoint will be variable over a 30 mg/dl range and glycemic control will be optimized based on the preceding 24-hour window.
Primary Outcome Measure Information:
Title
Mean glucose
Description
Dexcom G4P AP mean glucose
Time Frame
change over 5 days
Secondary Outcome Measure Information:
Title
% time <50 mg/dl
Description
Fraction of Dexcom G4P AP readings <60 mg/dl
Time Frame
change over 5 days
Title
% time <70 mg/dl
Description
Fraction of Dexcom G4P AP readings <70 mg/dl
Time Frame
change over 5 days
Title
% time 70-120 mg/dl
Description
Fraction of Dexcom G4P AP readings 70-120 mg/dl
Time Frame
change over 5 days
Title
% time 70-180 mg/dl
Description
Fraction of Dexcom G4P AP readings 70-180 mg/dl
Time Frame
change over 5 days
Title
% time >180 mg/dl
Description
Fraction of Dexcom G4P AP readings >180 mg/dl
Time Frame
change over 5 days
Title
% time >250 mg/dl
Description
Fraction of Dexcom G4P AP readings >250 mg/dl
Time Frame
change over 5 days
Title
% time < 60 mg/dl
Description
Fraction of Dexcom G4AP readings < 60 mg/dl
Time Frame
Change over 5 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
44 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Type 1 diabetes for at least 1 year insulin pump for ≥ 6 months Prescription medication regimen stable for > 1 month Subject comprehends written English Female patients who are sexually active must be on acceptable method of contraception e.g. oral contraceptive pill, diaphragm, IUD (Intrauterine Device) Female patients must have a negative urine pregnancy test Informed Consent Form signed by the subject Lives and works within a 60 minute drive-time radius of Stanford University Willing to remain within a 60 minute drive-time radius of Stanford University during all 3 of the 7-day study arms (21 days) Have someone over 18 years of age who lives with them, Exclusion Criteria: Current alcohol abuse (intake averaging > 3 drinks daily in last 30 days), use of marijuana within 1 month of enrollment, or other substance abuse (use within the last 6 months of controlled substances other than marijuana without a prescription) Subject has a history of diagnosed medical eating disorder 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, Neutral Protamine Hagedorn, 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 Unwilling or unable to refrain from drinking more than 2 drinks in an hour or more than 4 drinks in a day or use of marijuana during the trial Subject has active Graves' disease Subjects with inadequately treated thyroid disease or celiac disease History of liver disease Renal failure on dialysis Personal history of cystic fibrosis, pancreatitis, pancreatic tumor, or any other pancreatic disease besides type 1 diabetes Any known history of coronary artery disease Abnormal EKG (electrocardiogram) consistent with coronary artery disease or increased risk of malignant arrhythmia Congestive heart failure (established history of congestive heart failure , lower extremity edema, paroxysmal nocturnal dyspnea, or orthopnea) History of transient ischemic attack (TIA) or stroke Seizure disorder, history of any non-hypoglycemic seizure within the last two years, or ongoing treatment with anticonvulsants History of hypoglycemic seizures (grand-mal) or coma in the last year History of pheochromocytoma: episodic or treatment refractory (requiring 4 or more medications to achieve normotension) hypertension paroxysms of tachycardia, pallor, or headache personal or family history of MEN 2A (multiple endocrine neoplasia), MEN 2B, neurofibromatosis, or von Hippel-Lindau disease History of adrenal disease or tumor Hypertension with systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 despite treatment Untreated or inadequately treated mental illness Electrically powered implants (e.g. cochlear implants, neurostimulators) that might be susceptible to RF interference Unable to completely avoid acetaminophen for duration of study Established history of allergy or severe reaction to adhesive or tape that must be used in the study History of eating disorder within the last 2 years, such as anorexia, bulimia, or diabulemia or omission of insulin to manipulate weight History of intentional, inappropriate administration of insulin leading to severe hypoglycemia requiring treatment Lives in or frequents areas with poor Verizon wireless network coverage (which would prevent remote monitoring) Any factors that, in the opinion of the site principal investigator or overall principal investigator, would interfere with the safe completion of the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bruce A Buckingham, MD
Organizational Affiliation
Stanford School of Medicine, Pediatric Endocrinology
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford University School of Medicine
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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An Outpatient Study of Automated Blood Glucose Control With an Insulin-Only Bionic Pancreas

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