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MMPPC Outpatient Clinical Protocol 2016 (MMPPC)

Primary Purpose

Type 1 Diabetes

Status
Completed
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
MMPPC algorithm artificial pancreas
Sponsored by
Rensselaer Polytechnic Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring artificial pancreas

Eligibility Criteria

15 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

3.1 Eligibility Criteria

1. Clinical diagnosis of type 1 diabetes for at least 12 months 2. Daily insulin therapy for at least 12 months 3. Age between 15.0 to 55.0 years of age 4. Use of an insulin pump for at least 3 months 5. Current use of continuous glucose monitoring with Dexcom sensor 6. Subject comprehends English 7. Females of childbearing potential must use an adequate method of contraception and have a negative pregnancy test 8. Total daily insulin requirement ≥ 0.3 units/kg/day 9. A1C between 7.0 and 10% 3.2 Exclusion Criteria

  1. Diabetic ketoacidosis in the past 6 months
  2. Hypoglycemic seizure or loss of consciousness in the past 6 months
  3. Hypoglycemia unawareness as defined by no recognition of hypoglycemia until the glucose is <60 mg/dL and no adrenergic symptoms at glucose of 60 mg/dL (shakiness, palpitations, diaphoresis). Subjects will also be administered the Clark questionnaire for hypoglycemia unawareness. If they have a score ≥ 4, they are excluded from the study
  4. Subjects requiring an intermediate or long-acting insulin (such as NPH, detemir or glargine)
  5. Subjects using other anti-diabetic medications other than insulin (oral or injectable) at the time of enrollment. Any prior use of other anti-diabetic medications must be washed out for at least 8 weeks prior to enrollment.
  6. Current use of other medications, which in the judgment of the investigator would be a contraindication to participation in the study
  7. Subject has a medical disorder that in the judgment of the investigator will affect completion of any aspect of the protocol
  8. Subject is currently participating in another investigational device or drug study within 30 days or 5-half lives of the drug.
  9. Subject has a history of any cardiac or vascular disorder including, but not limited to, myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, arrhythmia or thromboembolic disease
  10. An EKG will be obtained on subjects who are ≥ 45 years of age, or who have had a 20 year history of diabetes and are ≥ 30 years of age. Subjects will be excluded if they have an abnormal EKG consistent with coronary artery disease or increased risk of malignant arrhythmia including, but not limited to, evidence of active ischemia, prior myocardial infarction, proximal LAD critical stenosis (Wellen's sign), prolonged QT interval (> 440 ms). Non-specific ST segment and T wave changes are not grounds for exclusion in the absence of symptoms or history of heart disease.
  11. Subject has a history of hepatic disease
  12. Subject has renal failure on dialysis
  13. Systolic blood pressure > 160 mmHg on screening visit
  14. Diastolic blood pressure > 90 mmHg on screening visit
  15. Subjects with inadequately treated thyroid disease or celiac disease
  16. Subject has a neurologic disorder that in the judgment of the investigator will affect completion of the protocol
  17. Subject has received inpatient psychiatric treatment in the past 6 months
  18. Subject consumes more than an average of 4 standard alcoholic drinks/day in the last 30 days
  19. Subject has an active skin condition that would affect sensor placement
  20. Subject is unable to avoid acetaminophen for the duration of the study
  21. Subject consuming less than 100g of carbohydrates daily

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    MMPPC arm

    Arm Description

    Subjects in this arm will wear the experimental MMPPC algorithm artificial pancreas for 72 hours in a hotel/house setting. The study period will involve unannounced meals and exercise

    Outcomes

    Primary Outcome Measures

    Mean CGM glucose value
    Average CGm glucose value during the experimental trial
    CGM percent time < 60 mg/dl
    Percent of time the CGM was reading <60 mg/dl

    Secondary Outcome Measures

    CGM percent time < 50 mg/dl
    Percent of time the CGM was reading <50 mg/dl
    CGM percent time < 70 mg/dl
    Percent of time the CGM was reading <70 mg/dl
    % 70-140 mg/dl
    Percent of time CGM glucose levels were between 70-140 mg/dl
    % 70-180 mg/dl
    Percent of time CGM glucose levels were between 70-180 mg/dl
    % CGM >180 mg/dl
    Percent of time CGM glucose levels were >180 mg/dl
    % CGM >250 mg/dl
    Percent of time CGM glucose levels were >250 mg/dl
    number of SMBG <70 mg/dl
    Number of self monitored blood glucose levels less than 70 mg/dl
    number of SMBG <60 mg/dl
    Number of self monitored blood glucose levels less than 60 mg/dl
    number of SMBG <50 mg/dl
    Number of self monitored blood glucose levels less than 50 mg/dl
    Grams of carbs for hypoglycemia
    Number of carbohydrates consumed for treatment of hypoglycemia
    Total daily dose of insulin
    Total daily dose of insulin
    % time CGM used
    Percent of time CGM was used
    % time in closed loop
    Percent of time in closed loop
    % of subjects with mean CGM <169 (eHbA1C < 7.5%)
    Percentage of subjects with mean CGM value < 169 for the 72 hour period. This corresponds to an estimated hemoglobin A1c of <7.5%.

    Full Information

    First Posted
    May 10, 2016
    Last Updated
    January 26, 2018
    Sponsor
    Rensselaer Polytechnic Institute
    Collaborators
    Stanford University, University of Colorado, Denver, Mount Sinai Hospital, New York
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02769884
    Brief Title
    MMPPC Outpatient Clinical Protocol 2016
    Acronym
    MMPPC
    Official Title
    Multiple Model Probabilistic Predictive Control (MMPPC) Outpatient Clinical Protocol
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2018
    Overall Recruitment Status
    Completed
    Study Start Date
    July 2016 (undefined)
    Primary Completion Date
    December 2016 (Actual)
    Study Completion Date
    December 2016 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Rensselaer Polytechnic Institute
    Collaborators
    Stanford University, University of Colorado, Denver, Mount Sinai Hospital, New York

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    This study trials a prototype artificial pancreas system that consists of a Roche insulin pump, a Dexcom continuous glucose monitor (CGM), and an experiential MMPPC (multiple model probabilistic predictive control) algorithm housed on an android cell phone. The system doses insulin based on CGM sensor glucose levels and the experimental algorithm. The aim of this clinical study is to determine the efficacy of the MMPPC controller in adolescents and adults with type 1 diabetes in a hotel setting.
    Detailed Description
    This study trials a prototype artificial pancreas system that consists of a Roche insulin pump, a Dexcom continuous glucose monitor (CGM), and an experiential MMPPC (multiple model probabilistic predictive control) algorithm housed on an android cell phone. The system doses insulin based on CGM sensor glucose levels and the experimental algorithm. The algorithm runs through a glucose control platform called the DiAs (Diabetes Assistant) The aim of this study is to determine the safety and feasibility of the MMPPC controller in adults and adolescents with type 1 diabetes testing the use of predefined tuning parameters to provide adaptability to patient. We will assess the safety of the system with both unannounced meals, and meals using a meal announcement with a premeal insulin bolus based on the subject's estimated carbohydrate content of the meal

    6. Conditions and Keywords

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

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Model Description
    Use the MMPPC system for 72 hours in a hotel setting
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    10 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    MMPPC arm
    Arm Type
    Experimental
    Arm Description
    Subjects in this arm will wear the experimental MMPPC algorithm artificial pancreas for 72 hours in a hotel/house setting. The study period will involve unannounced meals and exercise
    Intervention Type
    Device
    Intervention Name(s)
    MMPPC algorithm artificial pancreas
    Intervention Description
    An artificial pancreas system using the MMPPC algorithm, Roche insulin pump, and Dexcom CGM
    Primary Outcome Measure Information:
    Title
    Mean CGM glucose value
    Description
    Average CGm glucose value during the experimental trial
    Time Frame
    72 hours
    Title
    CGM percent time < 60 mg/dl
    Description
    Percent of time the CGM was reading <60 mg/dl
    Time Frame
    72 hours
    Secondary Outcome Measure Information:
    Title
    CGM percent time < 50 mg/dl
    Description
    Percent of time the CGM was reading <50 mg/dl
    Time Frame
    72 hours
    Title
    CGM percent time < 70 mg/dl
    Description
    Percent of time the CGM was reading <70 mg/dl
    Time Frame
    72 hours
    Title
    % 70-140 mg/dl
    Description
    Percent of time CGM glucose levels were between 70-140 mg/dl
    Time Frame
    72 hours
    Title
    % 70-180 mg/dl
    Description
    Percent of time CGM glucose levels were between 70-180 mg/dl
    Time Frame
    72 hours
    Title
    % CGM >180 mg/dl
    Description
    Percent of time CGM glucose levels were >180 mg/dl
    Time Frame
    72 hours
    Title
    % CGM >250 mg/dl
    Description
    Percent of time CGM glucose levels were >250 mg/dl
    Time Frame
    72 hours
    Title
    number of SMBG <70 mg/dl
    Description
    Number of self monitored blood glucose levels less than 70 mg/dl
    Time Frame
    72 hours
    Title
    number of SMBG <60 mg/dl
    Description
    Number of self monitored blood glucose levels less than 60 mg/dl
    Time Frame
    72 hours
    Title
    number of SMBG <50 mg/dl
    Description
    Number of self monitored blood glucose levels less than 50 mg/dl
    Time Frame
    72 hours
    Title
    Grams of carbs for hypoglycemia
    Description
    Number of carbohydrates consumed for treatment of hypoglycemia
    Time Frame
    72 hours
    Title
    Total daily dose of insulin
    Description
    Total daily dose of insulin
    Time Frame
    72 hours
    Title
    % time CGM used
    Description
    Percent of time CGM was used
    Time Frame
    72 hours
    Title
    % time in closed loop
    Description
    Percent of time in closed loop
    Time Frame
    72 hours
    Title
    % of subjects with mean CGM <169 (eHbA1C < 7.5%)
    Description
    Percentage of subjects with mean CGM value < 169 for the 72 hour period. This corresponds to an estimated hemoglobin A1c of <7.5%.
    Time Frame
    72 hours
    Other Pre-specified Outcome Measures:
    Title
    Comparison of Announced and Unannounced Meals
    Description
    Glycemic control in the 4 hour period after announced meals will be compared to glycemic control in the 4 hour period after unannounced meals as an exploratory measure
    Time Frame
    72 hours
    Title
    Safety Criteria 1: No more than 3 SMBG values < 50 mg/dL per subject
    Description
    Safety evaluation of system based on SMBG detected severe hypoglycemia
    Time Frame
    72 hours
    Title
    Safety Criteria 2: No more than 2 episodes with SMBG value >300 mg/dL for >1 hour not due to infusion set failure per subject
    Description
    Safety evaluation of system based on SMBG detected hyperglycemia
    Time Frame
    72 hours
    Title
    Safety Criteria 3: No kotonemia >1.0 mmol/L, while the system is functional unless related to an intercurrent illness or infusion set failure for any patient
    Description
    Safety evaluation of system based on ketone detection
    Time Frame
    72 hours
    Title
    Safety Criteria 4: No seizures or loss of consciousness while system is on and functional
    Description
    Safety evaluation of system based on severe hypoglycemic events
    Time Frame
    72 hours

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    15 Years
    Maximum Age & Unit of Time
    55 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    3.1 Eligibility Criteria 1. Clinical diagnosis of type 1 diabetes for at least 12 months 2. Daily insulin therapy for at least 12 months 3. Age between 15.0 to 55.0 years of age 4. Use of an insulin pump for at least 3 months 5. Current use of continuous glucose monitoring with Dexcom sensor 6. Subject comprehends English 7. Females of childbearing potential must use an adequate method of contraception and have a negative pregnancy test 8. Total daily insulin requirement ≥ 0.3 units/kg/day 9. A1C between 7.0 and 10% 3.2 Exclusion Criteria Diabetic ketoacidosis in the past 6 months Hypoglycemic seizure or loss of consciousness in the past 6 months Hypoglycemia unawareness as defined by no recognition of hypoglycemia until the glucose is <60 mg/dL and no adrenergic symptoms at glucose of 60 mg/dL (shakiness, palpitations, diaphoresis). Subjects will also be administered the Clark questionnaire for hypoglycemia unawareness. If they have a score ≥ 4, they are excluded from the study Subjects requiring an intermediate or long-acting insulin (such as NPH, detemir or glargine) Subjects using other anti-diabetic medications other than insulin (oral or injectable) at the time of enrollment. Any prior use of other anti-diabetic medications must be washed out for at least 8 weeks prior to enrollment. Current use of other medications, which in the judgment of the investigator would be a contraindication to participation in the study Subject has a medical disorder that in the judgment of the investigator will affect completion of any aspect of the protocol Subject is currently participating in another investigational device or drug study within 30 days or 5-half lives of the drug. Subject has a history of any cardiac or vascular disorder including, but not limited to, myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, arrhythmia or thromboembolic disease An EKG will be obtained on subjects who are ≥ 45 years of age, or who have had a 20 year history of diabetes and are ≥ 30 years of age. Subjects will be excluded if they have an abnormal EKG consistent with coronary artery disease or increased risk of malignant arrhythmia including, but not limited to, evidence of active ischemia, prior myocardial infarction, proximal LAD critical stenosis (Wellen's sign), prolonged QT interval (> 440 ms). Non-specific ST segment and T wave changes are not grounds for exclusion in the absence of symptoms or history of heart disease. Subject has a history of hepatic disease Subject has renal failure on dialysis Systolic blood pressure > 160 mmHg on screening visit Diastolic blood pressure > 90 mmHg on screening visit 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 received inpatient psychiatric treatment in the past 6 months Subject consumes more than an average of 4 standard alcoholic drinks/day in the last 30 days Subject has an active skin condition that would affect sensor placement Subject is unable to avoid acetaminophen for the duration of the study Subject consuming less than 100g of carbohydrates daily

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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