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Exercise-Induced Hypoglycemia Prevention in Adults With Type 1 Diabetes Using an Artificial Pancreas

Primary Purpose

Type 1 Diabetes Mellitus, Hypoglycemia

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
EnMPC (Ensemble Model Predictive Control) AP Controller
rMPC (Naïve Model Predictive Control) AP Controller
Sponsored by
Marc Breton
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes Mellitus focused on measuring Artificial Pancreas, Continuous Glucose Monitor, Exercise, Exercise-Induced Hypoglycemia

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥18 and ≤65 years
  • Clinical diagnosis of Type 1 Diabetes for at least one year
  • Currently using an insulin pump for at least 6 months
  • Uses insulin parameters such as carbohydrate ratio and correction factors consistently on their insulin pump in order to dose insulin for meals or corrections
  • Access to internet and willingness to upload data during the study
  • Willingness to be physically active for at least 30 minutes per day at least 4 times per week
  • Willingness to perform the required exercise regimen during Data Collection Period
  • Willingness to not perform regular exercise outside of the study-regimented exercise window
  • For females, not currently pregnant or breastfeeding. If a female is of child-bearing potential and sexually active, she must agree to use a form of contraception to prevent pregnancy while participating in the study.
  • An understanding and willingness to follow the protocol and sign informed consent.

Exclusion Criteria:

  • History of diabetic ketoacidosis (DKA) in the 12 months prior to enrollment.
  • Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment.
  • Pregnancy or intent to become pregnant during the trial.
  • Currently being treated for a seizure disorder
  • Coronary artery disease or heart failure, unless written clearance is received from a cardiologist or primary care provider and documentation of a negative stress test within the year
  • History of cardiac arrhythmia (except for benign premature atrial contractions and benign premature ventricular contractions which are permitted)
  • Clinically significant electrocardiogram (ECG) at time of Screening, as interpreted by the study medical physician.
  • Use of non-insulin glucose-lowering agent (including GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors, biguanides, sulfonylureas and naturaceuticals) with the exception of participants who have been on a stable dose of Metformin for at least 3 months.
  • 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
  • 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
  • Uncontrolled thyroid disease
  • Use of an automated insulin delivery mechanism that is not FDA approved during the data collection phase
  • Use of an automated insulin delivery mechanism that is not downloadable by the subject or study team
  • Inability to be physically active for at least 30 minutes per day for at least 4 times per week
  • Current enrollment in another clinical trial, unless approved by the investigators of both studies or if clinical trial is a non-interventional registry trial.

Sites / Locations

  • University of Virginia

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Control - Experimental Admissions

Experimental - Control Admissions

Arm Description

Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2.

Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2.

Outcomes

Primary Outcome Measures

Number of hypoglycemic occurrences in relation to exercise activity
Number of hypoglycemic occurrences immediately before, during, and immediately after exercise (~5-7pm) as defined by more than one consecutive CGM values below 70 mg/dL or hypoglycemic treatment per glycemic guidelines.

Secondary Outcome Measures

Percent CGM below 50 mg/dL
Percent CGM below 50 mg/dL
Percent CGM below 54 mg/dL
Percent CGM below 54 mg/dL
Percent CGM below 60 mg/dL
Percent CGM below 60 mg/dL
Percent CGM below 70 mg/dL
Percent CGM below 70 mg/dL
Percent CGM between 70 and 180 mg/dL
Percent CGM between 70 and 180 mg/dL
Percent CGM above 180 mg/dL
Percent CGM above 180 mg/dL
Percent CGM above 250 mg/dL
Percent CGM above 250 mg/dL
Percent CGM above 300 mg/dL
Percent CGM above 300 mg/dL
Average CGM
Average CGM
CGM Coefficient of Variation
Coefficient of Variation of the CGM Values
CGM-based Low Blood Glucose Index
CGM-based Low Blood Glucose Index
CGM-based High Blood Glucose Index
CGM-based High Blood Glucose Index

Full Information

First Posted
February 27, 2019
Last Updated
January 15, 2020
Sponsor
Marc Breton
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1. Study Identification

Unique Protocol Identification Number
NCT03859401
Brief Title
Exercise-Induced Hypoglycemia Prevention in Adults With Type 1 Diabetes Using an Artificial Pancreas
Official Title
Hypoglycemia Prevention During and After Moderate Exercise in Adults With Type 1 Diabetes Using an Artificial Pancreas With Exercise Behavior Recognition
Study Type
Interventional

2. Study Status

Record Verification Date
January 2020
Overall Recruitment Status
Completed
Study Start Date
April 12, 2019 (Actual)
Primary Completion Date
January 13, 2020 (Actual)
Study Completion Date
January 13, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Marc Breton

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a randomized crossover trial with 1:1 randomization to the admission sequence of using the Control AP system (rMPC - Naïve Model Predictive Control) vs. Experimental AP system (EnMPC - Ensemble Model Predictive Control) over approximately 4 months. Eligible participants will proceed to the Data Collection Phase for approximately 28 days, during which they will participate in regimented exercise activities. If the participant collected adequate data during the Data Collection Phase, they will be randomized and undergo the study admissions in the assigned sequence. Each admission is approximately 36 hours in length and will consist of one afternoon of exercise and one without.
Detailed Description
Exercise remains a challenge to AP systems; more specifically, by the time exercise is detected it is often too late to avoid hypoglycemia without the ingestion of rapid carbohydrates or the use of rescue injections, such as glucagon. To this avail, the investigators propose to add a novel Model Predictive Control module to the proven USS system. This module is designed to compute insulin doses every 5 minutes that are designed to "optimally" maintain glycaemia around a target of 120mg/dL. The optimality is defined mathematically as minimizing deviations from basal rate injections and the distance between current and future (up to 2h) glycaemia from a physiologically feasible trajectory back down (or up) to a pre-specified target. Furthermore, the novel control system, labelled Multi Stage MPC or Ensemble MPC, accounts for a preset number of exercise scenarios during the prediction horizon, these scenarios being derived from the user historical record; this setup allows the control system to anticipate expected exercise bouts up to 2h in advance while maintaining the condition for optimal glycemic control. By adding such module to a well validated system, the investigators expect an improvement in protection against hypoglycemia during and immediately after physical activity without increase in hyperglycemia. To demonstrate the feasibility of this approach, the novel anticipatory system will be compared to a naïve AP system during highly supervised hotel admissions with afternoon exercise. Participants will be asked to exercise regularly in the late afternoon during a month of data collection to generate the patterns to be anticipated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus, Hypoglycemia
Keywords
Artificial Pancreas, Continuous Glucose Monitor, Exercise, Exercise-Induced Hypoglycemia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Control - Experimental Admissions
Arm Type
Experimental
Arm Description
Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2.
Arm Title
Experimental - Control Admissions
Arm Type
Experimental
Arm Description
Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2.
Intervention Type
Device
Intervention Name(s)
EnMPC (Ensemble Model Predictive Control) AP Controller
Intervention Description
This AP controller has the ability to anticipate exercise activity by use of trends seen during the Data Collection Period.
Intervention Type
Device
Intervention Name(s)
rMPC (Naïve Model Predictive Control) AP Controller
Intervention Description
This AP controller does not have the ability to anticipate exercise activity.
Primary Outcome Measure Information:
Title
Number of hypoglycemic occurrences in relation to exercise activity
Description
Number of hypoglycemic occurrences immediately before, during, and immediately after exercise (~5-7pm) as defined by more than one consecutive CGM values below 70 mg/dL or hypoglycemic treatment per glycemic guidelines.
Time Frame
2 Hours
Secondary Outcome Measure Information:
Title
Percent CGM below 50 mg/dL
Description
Percent CGM below 50 mg/dL
Time Frame
36 Hours
Title
Percent CGM below 54 mg/dL
Description
Percent CGM below 54 mg/dL
Time Frame
36 Hours
Title
Percent CGM below 60 mg/dL
Description
Percent CGM below 60 mg/dL
Time Frame
36 Hours
Title
Percent CGM below 70 mg/dL
Description
Percent CGM below 70 mg/dL
Time Frame
36 Hours
Title
Percent CGM between 70 and 180 mg/dL
Description
Percent CGM between 70 and 180 mg/dL
Time Frame
36 Hours
Title
Percent CGM above 180 mg/dL
Description
Percent CGM above 180 mg/dL
Time Frame
36 Hours
Title
Percent CGM above 250 mg/dL
Description
Percent CGM above 250 mg/dL
Time Frame
36 Hours
Title
Percent CGM above 300 mg/dL
Description
Percent CGM above 300 mg/dL
Time Frame
36 Hours
Title
Average CGM
Description
Average CGM
Time Frame
36 Hours
Title
CGM Coefficient of Variation
Description
Coefficient of Variation of the CGM Values
Time Frame
36 Hours
Title
CGM-based Low Blood Glucose Index
Description
CGM-based Low Blood Glucose Index
Time Frame
36 Hours
Title
CGM-based High Blood Glucose Index
Description
CGM-based High Blood Glucose Index
Time Frame
36 Hours
Other Pre-specified Outcome Measures:
Title
Total Amount of Insulin Used
Description
Total Amount of Insulin Used
Time Frame
36 Hours
Title
Number of Hypoglycemic Episodes
Description
Number of Hypoglycemic Episodes as defined by contiguous CGM below 70 mg/dL
Time Frame
36 Hours
Title
Number of Rescue Carbohydrates Administrations
Description
Number of Rescue Carbohydrates Administrations
Time Frame
36 Hours
Title
Total Amount of Rescue Carbohydrates
Description
Total Amount of Rescue Carbohydrates
Time Frame
36 Hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥18 and ≤65 years Clinical diagnosis of Type 1 Diabetes for at least one year Currently using an insulin pump for at least 6 months Uses insulin parameters such as carbohydrate ratio and correction factors consistently on their insulin pump in order to dose insulin for meals or corrections Access to internet and willingness to upload data during the study Willingness to be physically active for at least 30 minutes per day at least 4 times per week Willingness to perform the required exercise regimen during Data Collection Period Willingness to not perform regular exercise outside of the study-regimented exercise window For females, not currently pregnant or breastfeeding. If a female is of child-bearing potential and sexually active, she must agree to use a form of contraception to prevent pregnancy while participating in the study. An understanding and willingness to follow the protocol and sign informed consent. Exclusion Criteria: History of diabetic ketoacidosis (DKA) in the 12 months prior to enrollment. Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment. Pregnancy or intent to become pregnant during the trial. Currently being treated for a seizure disorder Coronary artery disease or heart failure, unless written clearance is received from a cardiologist or primary care provider and documentation of a negative stress test within the year History of cardiac arrhythmia (except for benign premature atrial contractions and benign premature ventricular contractions which are permitted) Clinically significant electrocardiogram (ECG) at time of Screening, as interpreted by the study medical physician. Use of non-insulin glucose-lowering agent (including GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors, biguanides, sulfonylureas and naturaceuticals) with the exception of participants who have been on a stable dose of Metformin for at least 3 months. 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 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 Uncontrolled thyroid disease Use of an automated insulin delivery mechanism that is not FDA approved during the data collection phase Use of an automated insulin delivery mechanism that is not downloadable by the subject or study team Inability to be physically active for at least 30 minutes per day for at least 4 times per week Current enrollment in another clinical trial, unless approved by the investigators of both studies or if clinical trial is a non-interventional registry trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc Breton, PhD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
There are no current plans to share IPD for this study at this time.
Citations:
PubMed Identifier
33270531
Citation
Garcia-Tirado J, Brown SA, Laichuthai N, Colmegna P, Koravi CLK, Ozaslan B, Corbett JP, Barnett CL, Pajewski M, Oliveri MC, Myers H, Breton MD. Anticipation of Historical Exercise Patterns by a Novel Artificial Pancreas System Reduces Hypoglycemia During and After Moderate-Intensity Physical Activity in People with Type 1 Diabetes. Diabetes Technol Ther. 2021 Apr;23(4):277-285. doi: 10.1089/dia.2020.0516. Epub 2020 Dec 1.
Results Reference
derived

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Exercise-Induced Hypoglycemia Prevention in Adults With Type 1 Diabetes Using an Artificial Pancreas

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