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Validation of a Biomathematical Model to Help Identify the Parameters of Flexible Insulin Therapy (ModIF)

Primary Purpose

Type 1 Diabetes

Status
Completed
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Bio-mathematical model
Without bio-mathematical model
Sponsored by
Nantes University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Type 1 Diabetes focused on measuring Type 1 diabetes mellitus, biomathematical model, Flexible insulin therapy

Eligibility Criteria

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

Inclusion Criteria:

  1. Patient with type 1 diabetes for at least two years with an indication for sensor placement,
  2. Patient patient with at least 6 months of external insulin pump therapy and using the Medtronic 640G pump with or without the Enlite® System.
  3. Patient having at least 6 months experience of flexible insulin therapy,
  4. Patient with HbA1c <10% (less than 4 months' duration of testing in a medical laboratory or equivalent),
  5. Patient who has been wearing a Continuous Glucose Monitoring device for at least 3 months,
  6. Adult patient,
  7. Patient affiliated to a Social Security or equivalent,
  8. Patient who has signed Informed Consent Form.

Exclusion Criteria:

  1. Patient with type 2 diabetes or secondary diabetes
  2. Patient with any serious medical condition that may affect participation in the study,
  3. Patient benefiting from a legal protection measure,
  4. Woman who is pregnant or likely to become pregnant during the course of the study, i.e., a lack of effective contraception in women of childbearing age,
  5. Breastfeeding,
  6. Psychological and/or physical condition that may affect the proper monitoring of study procedures,
  7. Severe hypoglycemia leading to convulsions or loss of consciousness within the last 12 months,
  8. Decreased hypoglycemic feelings (as judged by the clinician),
  9. Impaired renal function (creatinine clearance calculated by CKD-EPI < 30mL/min),
  10. Patient who has had a pancreas transplant or pancreatic islets,
  11. Persons with severe uncorrected hearing and/or visual acuity problems,
  12. Insulin resistance defined by daily insulin requirements > 1 U/kg/day in the week prior to inclusion,
  13. Patient treated with oral corticosteroid therapy.

Sites / Locations

  • CHU de Nantes

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Augmented physician

Control

Arm Description

Medical decision assisted by the bio-mathematical model to define the parameters of flexible insulin therapy based on data from a continuous glucose measurement record.

Unassisted medical decision to define the parameters of flexible insulin therapy based on data from a continuous glucose measurement record.

Outcomes

Primary Outcome Measures

percentage of time in glycemic target
percentage of time in glycemic target (70-180 mg/dL) during the four weeks following medical consultation where the parameters of flexible insulin therapy are estimated by the physician, either conventionally or with the help of the bio-mathematical model, and parameterized in the insulin pump.

Secondary Outcome Measures

Coefficient of variation of glucose
Hypoglycemic readings < 0.7 g/L, Time below 0.7 g/L, Time above 1.8 g/L
Frequency of severe hypoglycemia
Frequency of severe hypoglycemia (requiring the intervention of a third party)
Robustness of the model
for each glycemic holter, identification of the model from the first 3 days of recording and comparison during the last 3 days of the predicted results with the observed glucose levels. And comparison, in the "delayed modelling" arm, of the doses estimated by the diabetologist and the doses estimated from the model.
assessment of patient compliance
evaluation of the difference between the theoretical doses recommended following modelling and the actual doses given by the patient
assessment of patient acceptance
Quality of life questionnaire SF36
the average time of medical consultation in each group.
Duration of the consultation
changes in heart rate over time
changes in activity over time

Full Information

First Posted
September 22, 2020
Last Updated
October 20, 2022
Sponsor
Nantes University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04572009
Brief Title
Validation of a Biomathematical Model to Help Identify the Parameters of Flexible Insulin Therapy
Acronym
ModIF
Official Title
Validation of a Biomathematical Model to Help Identify the Parameters of Flexible Insulin Therapy: Monocentric, Controlled, Randomized and Prospective Pilot Clinical Study in Patients With Type 1 Diabetes.
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Completed
Study Start Date
January 12, 2021 (Actual)
Primary Completion Date
October 4, 2022 (Actual)
Study Completion Date
October 4, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nantes University Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Type 1 diabetes is an autoimmune disease that requires daily treatment with insulin. The use of subcutaneous pumps for continuous insulin delivery has been an important advance for diabetic patients. The evolution of technologies through the miniaturization of insulin pumps and the advent of continuous glucose sensors has made it possible to understand the development of the artificial pancreas. Several teams are working on the development of an artificial pancreas with considerable progress in closed-loop insulin delivery, particularly during the night. The Laboratory of Digital Sciences of Nantes has developed a new bio-mathematical model describing the glucose-insulin dynamics, closer to the physiological reality of patients with type 1 diabetes. This model allows firstly to identify the parameters of flexible insulin therapy (basal rate, insulin sensitivity, carbohydrate ratios). The objective of this study is to test the relevance of this bio-mathematical model to help the physician identify the parameters of flexible insulin therapy (basal rate, insulin sensitivity, carbohydrate ratios).
Detailed Description
This is an open randomized pilot clinical study, comparing the effectiveness of medical decision assisted by this bio-mathematical model ("augmented physician") versus unassisted medical decision, to define the parameters of flexible insulin therapy based on data from a continuous glucose measurement record for 7 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
Type 1 diabetes mellitus, biomathematical model, Flexible insulin therapy

7. Study Design

Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
37 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Augmented physician
Arm Type
Experimental
Arm Description
Medical decision assisted by the bio-mathematical model to define the parameters of flexible insulin therapy based on data from a continuous glucose measurement record.
Arm Title
Control
Arm Type
Placebo Comparator
Arm Description
Unassisted medical decision to define the parameters of flexible insulin therapy based on data from a continuous glucose measurement record.
Intervention Type
Other
Intervention Name(s)
Bio-mathematical model
Intervention Description
bio-mathematical model to help the physician identify the parameters of flexible insulin therapy (basal rate, insulin sensitivity, carbohydrate ratios)
Intervention Type
Other
Intervention Name(s)
Without bio-mathematical model
Intervention Description
No bio-mathematical model to help the physician identify the parameters of flexible insulin therapy (basal rate, insulin sensitivity, carbohydrate ratios)
Primary Outcome Measure Information:
Title
percentage of time in glycemic target
Description
percentage of time in glycemic target (70-180 mg/dL) during the four weeks following medical consultation where the parameters of flexible insulin therapy are estimated by the physician, either conventionally or with the help of the bio-mathematical model, and parameterized in the insulin pump.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Coefficient of variation of glucose
Description
Hypoglycemic readings < 0.7 g/L, Time below 0.7 g/L, Time above 1.8 g/L
Time Frame
75 days
Title
Frequency of severe hypoglycemia
Description
Frequency of severe hypoglycemia (requiring the intervention of a third party)
Time Frame
75 days
Title
Robustness of the model
Description
for each glycemic holter, identification of the model from the first 3 days of recording and comparison during the last 3 days of the predicted results with the observed glucose levels. And comparison, in the "delayed modelling" arm, of the doses estimated by the diabetologist and the doses estimated from the model.
Time Frame
75 days
Title
assessment of patient compliance
Description
evaluation of the difference between the theoretical doses recommended following modelling and the actual doses given by the patient
Time Frame
75 days
Title
assessment of patient acceptance
Description
Quality of life questionnaire SF36
Time Frame
75 days
Title
the average time of medical consultation in each group.
Description
Duration of the consultation
Time Frame
75 days
Title
changes in heart rate over time
Time Frame
75 days
Title
changes in activity over time
Time Frame
75 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient with type 1 diabetes for at least two years with an indication for sensor placement, Patient patient with at least 6 months of external insulin pump therapy and using the Medtronic 640G pump with or without the Enlite® System. Patient having at least 6 months experience of flexible insulin therapy, Patient with HbA1c <10% (less than 4 months' duration of testing in a medical laboratory or equivalent), Patient who has been wearing a Continuous Glucose Monitoring device for at least 3 months, Adult patient, Patient affiliated to a Social Security or equivalent, Patient who has signed Informed Consent Form. Exclusion Criteria: Patient with type 2 diabetes or secondary diabetes Patient with any serious medical condition that may affect participation in the study, Patient benefiting from a legal protection measure, Woman who is pregnant or likely to become pregnant during the course of the study, i.e., a lack of effective contraception in women of childbearing age, Breastfeeding, Psychological and/or physical condition that may affect the proper monitoring of study procedures, Severe hypoglycemia leading to convulsions or loss of consciousness within the last 12 months, Decreased hypoglycemic feelings (as judged by the clinician), Impaired renal function (creatinine clearance calculated by CKD-EPI < 30mL/min), Patient who has had a pancreas transplant or pancreatic islets, Persons with severe uncorrected hearing and/or visual acuity problems, Insulin resistance defined by daily insulin requirements > 1 U/kg/day in the week prior to inclusion, Patient treated with oral corticosteroid therapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lucy CHAILLOUS, Dr
Organizational Affiliation
Nantes University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
CHU de Nantes
City
Nantes
ZIP/Postal Code
44093
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
35577814
Citation
Scharbarg E, Greck J, Le Carpentier E, Chaillous L, Moog CH. A metamodel-based flexible insulin therapy for type 1 diabetes patients subjected to aerobic physical activity. Sci Rep. 2022 May 16;12(1):8017. doi: 10.1038/s41598-022-11772-x.
Results Reference
derived

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Validation of a Biomathematical Model to Help Identify the Parameters of Flexible Insulin Therapy

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