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Artificial Pancreas Technology to Reduce Glycemic Variability and Improve Cardiovascular Health in Type 1 Diabetes (WBH002)

Primary Purpose

Type 1 Diabetes

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Tandem t:slim X2 with Control-IQ Technology
Sensor augmented pump (SAP) therapy
Sponsored by
University of Virginia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring Glycemic Variability, Inflammation, Oxidative Stress, Endothelial Function, Myocardial Perfusion, Aortic Stiffness, Flow-Mediated Dilation

Eligibility Criteria

18 Years - 40 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Clinical diagnosis, based on World Health Organization criteria, of type 1 diabetes for at least one year Currently using insulin for at least six months Ages 18-≤40 years Hemoglobin A1c <10.5% Body mass index 18-30 kg/m2 Blood pressure <140/90 mmHg For females, not currently known to be pregnant or breastfeeding If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all females of childbearing potential. Participants who become pregnant will be discontinued from the study. Also, participants who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued Both pump and MDI users will use insulin parameters such as carbohydrate ratio and correction factors consistently in order to dose insulin for meals or corrections; pump users will have history of entering this information into their pump Willingness to suspend use of any personal CGM for the duration of the clinical trial once the study CGM is in use Access to internet and willingness to upload data during the study as needed, including data generated prior to the start of the study Current use of a glucometer that is downloadable; or willingness to use a study glucometer Investigator has confidence that the participant can successfully operate all study devices and is capable of adhering to the protocol Willingness to use personal lispro (Humalog) or aspart (Novolog) and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study Total daily insulin dose (TDD) at least 10 U/day. Willingness not to start any new non-insulin glucose-lowering agent during the trial Exclusion Criteria: Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment Diagnosis of diabetic ketoacidosis in the 12 months prior to enrollment Prior diagnosis of cardiac disease (e.g., myocardial infarction, congestive heart failure) Cerebrovascular accident in the 12 months prior to enrollment Uncontrolled resting arterial hypertension Conditions that would make use of a CGM difficult (e.g., blindness, severe arthritis, immobility) 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 Concurrent use of any non-insulin glucose-lowering agent (including metformin, GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors, and/or sulfonylureas) Hemophilia or any other bleeding disorder Currently being treated for a seizure disorder A medical condition or medication, which in the opinion of the investigator or designee, would put the participant or study at risk Any woman with hemoglobin (Hgb) <11 g/dL or any man with Hgb <12 g/dL on screening laboratory evaluation (i.e., complete blood count) Current smokers or those who have quit smoking <2 years ago Screening Electrocardiogram (ECG) findings indicative of arrhythmia, sinus node disease, or ischemic heart disease Diagnosis of peripheral neuropathy (assessed by monofilament examination), macroalbuminuria (urine albumin:creatinine >300 mg per g), or retinopathy beyond mild, nonproliferative retinopathy Unstable (i.e., dose adjustment less than 4 weeks prior to study enrollment) doses of vasoactive medications (e.g., calcium channel blockers, statins, nitrates, alpha-blockers, beta-blockers, ACE inhibitors, etc.) History of hypersensitivity or prior adverse reaction (e.g., anaphylaxis or angioedema) to regular insulin infusion Current enrollment in another clinical trial, unless approved by the investigator of both studies or if clinical trial is a non-interventional registry trial History of hypersensitivity or prior adverse reaction to Definity microbubble infusion

Sites / Locations

  • University of Virginia Health SystemRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Closed-loop artificial pancreas (AP)

Sensor Augmented Pump (SAP) therapy

Arm Description

FDA approved Tandem t:slim insulin pump with Control-IQ Technology and the Dexcom G6 CGM

Sensor augmented pump (SAP) therapy that includes the use of a study CGM and the participant's current insulin therapy (i.e., either insulin pump or multiple daily injections)

Outcomes

Primary Outcome Measures

Glucose Time-in-Range
Time-in-range will measured by continuous glucose monitor device

Secondary Outcome Measures

High-sensitivity C-reactive protein (hs-CRP)
Inflammatory Biomarker
TNF-alpha
Inflammatory Biomarker
Interleukin-6 (IL-6)
Inflammatory Biomarker
E-selectin
Biomarker of endothelial dysfunction
Intracellular adhesion molecule 1 (ICAM-1)
Biomarker of endothelial dysfunction
Malondialdehyde (MDA)
Biomarker of Oxidative Stress
Asymmetric Dimethylarginine (ADMA)
Biomarker of Endothelial Cell Oxidative Stress

Full Information

First Posted
December 7, 2022
Last Updated
September 11, 2023
Sponsor
University of Virginia
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1. Study Identification

Unique Protocol Identification Number
NCT05653518
Brief Title
Artificial Pancreas Technology to Reduce Glycemic Variability and Improve Cardiovascular Health in Type 1 Diabetes
Acronym
WBH002
Official Title
Using Closed-Loop Artificial Pancreas Technology to Reduce Glycemic Variability and Subsequently Improve Cardiovascular Health in Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 9, 2023 (Actual)
Primary Completion Date
November 30, 2025 (Anticipated)
Study Completion Date
November 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Virginia

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will examine the potential cardiovascular effect(s) of artificial pancreas (AP) technology in patients with type 1 diabetes. AP technology is a system of devices that closely mimics the glucose-regulating function of a healthy human pancreas. It includes an insulin pump and a continuous glucose monitor (CGM). In this study, the investigators will research whether improvements in blood glucose levels and blood glucose variability will in turn decrease biomarkers of inflammation and endothelial dysfunction while improving cardiovascular function.
Detailed Description
Cardiovascular disease is a type of disease that affects the heart and blood vessels. The current care for cardiovascular disease prevention in people with type 1 diabetes is to manage blood pressure, cholesterol blood levels, or manage blood glucose levels. This study will examine the potential cardiovascular effect(s) of artificial pancreas (AP) technology in patients with type 1 diabetes. AP technology is a system of devices that closely mimics the glucose-regulating function of a healthy human pancreas. It includes an insulin pump and a continuous glucose monitor (CGM). In this study, we will use the Food and Drug Administration (FDA)-approved Tandem t:slim insulin pump with Control-IQ Technology and the FDA approved Dexcom G6 CGM. This study will research whether improvements in blood glucose metrics lead to reductions in some of the cardiovascular biomarkers that represent harmful effects in people with type 1 diabetes. Subjects will be randomly assigned to one of two study groups for 12 weeks---Group 1 will be treated with AP Technology and Group 2 will wear the study CGM and continue to use their current diabetes management strategy (i.e., standard care).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
Glycemic Variability, Inflammation, Oxidative Stress, Endothelial Function, Myocardial Perfusion, Aortic Stiffness, Flow-Mediated Dilation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Closed-loop artificial pancreas (AP)
Arm Type
Experimental
Arm Description
FDA approved Tandem t:slim insulin pump with Control-IQ Technology and the Dexcom G6 CGM
Arm Title
Sensor Augmented Pump (SAP) therapy
Arm Type
Experimental
Arm Description
Sensor augmented pump (SAP) therapy that includes the use of a study CGM and the participant's current insulin therapy (i.e., either insulin pump or multiple daily injections)
Intervention Type
Device
Intervention Name(s)
Tandem t:slim X2 with Control-IQ Technology
Intervention Description
FDA approved Tandem t:slim insulin pump with Control-IQ Technology and the Dexcom G6 CGM
Intervention Type
Device
Intervention Name(s)
Sensor augmented pump (SAP) therapy
Intervention Description
Sensor augmented pump (SAP) therapy that includes the use of a study CGM and the participant's personal insulin pump
Primary Outcome Measure Information:
Title
Glucose Time-in-Range
Description
Time-in-range will measured by continuous glucose monitor device
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
High-sensitivity C-reactive protein (hs-CRP)
Description
Inflammatory Biomarker
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
TNF-alpha
Description
Inflammatory Biomarker
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
Interleukin-6 (IL-6)
Description
Inflammatory Biomarker
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
E-selectin
Description
Biomarker of endothelial dysfunction
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
Intracellular adhesion molecule 1 (ICAM-1)
Description
Biomarker of endothelial dysfunction
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
Malondialdehyde (MDA)
Description
Biomarker of Oxidative Stress
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
Asymmetric Dimethylarginine (ADMA)
Description
Biomarker of Endothelial Cell Oxidative Stress
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Other Pre-specified Outcome Measures:
Title
Myocardial Perfusion (measured by contrast-enhanced ultrasound [CEU])
Description
CEU will be assessed before and during a euglycemic-hyperinsulinemic clamp
Time Frame
At baseline and after 12 weeks of treatment
Title
Carotid Femoral Pulse Wave Velocity (cfPWV)
Description
Measurement of change in central artery stiffness
Time Frame
At baseline and after 12 weeks of treatment
Title
Flow-Mediated Dilation (FMD)
Description
Vascular measure of change in conduit artery stiffness
Time Frame
At baseline and after 12 weeks of treatment
Title
Human CD14+CD16- monocytes
Description
Proinflammatory immune cells associated with atherosclerosis
Time Frame
At baseline (0 weeks), 3 weeks, 6 weeks, 9 weeks, and 12 weeks
Title
Insulin Sensitivity
Description
insulin sensitivity will be assessed by M value during a euglycemic-hyperinsulinemic clamp
Time Frame
At baseline (0 weeks) and after 12 weeks of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis, based on World Health Organization criteria, of type 1 diabetes for at least one year Currently using insulin for at least six months Ages 18-≤40 years Hemoglobin A1c <10.5% Body mass index 18-30 kg/m2 Blood pressure <140/90 mmHg For females, not currently known to be pregnant or breastfeeding If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all females of childbearing potential. Participants who become pregnant will be discontinued from the study. Also, participants who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued Both pump and MDI users will use insulin parameters such as carbohydrate ratio and correction factors consistently in order to dose insulin for meals or corrections; pump users will have history of entering this information into their pump Willingness to suspend use of any personal CGM for the duration of the clinical trial once the study CGM is in use Access to internet and willingness to upload data during the study as needed, including data generated prior to the start of the study Current use of a glucometer that is downloadable; or willingness to use a study glucometer Investigator has confidence that the participant can successfully operate all study devices and is capable of adhering to the protocol Willingness to use personal lispro (Humalog) or aspart (Novolog) and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study Total daily insulin dose (TDD) at least 10 U/day. Willingness not to start any new non-insulin glucose-lowering agent during the trial Exclusion Criteria: Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment Diagnosis of diabetic ketoacidosis in the 12 months prior to enrollment Prior diagnosis of cardiac disease (e.g., myocardial infarction, congestive heart failure) Cerebrovascular accident in the 12 months prior to enrollment Uncontrolled resting arterial hypertension Conditions that would make use of a CGM difficult (e.g., blindness, severe arthritis, immobility) 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 Concurrent use of any non-insulin glucose-lowering agent (including metformin, GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors, and/or sulfonylureas) Hemophilia or any other bleeding disorder Currently being treated for a seizure disorder A medical condition or medication, which in the opinion of the investigator or designee, would put the participant or study at risk Any woman with hemoglobin (Hgb) <11 g/dL or any man with Hgb <12 g/dL on screening laboratory evaluation (i.e., complete blood count) Current smokers or those who have quit smoking <2 years ago Screening Electrocardiogram (ECG) findings indicative of arrhythmia, sinus node disease, or ischemic heart disease Diagnosis of peripheral neuropathy (assessed by monofilament examination), macroalbuminuria (urine albumin:creatinine >300 mg per g), or retinopathy beyond mild, nonproliferative retinopathy Unstable (i.e., dose adjustment less than 4 weeks prior to study enrollment) doses of vasoactive medications (e.g., calcium channel blockers, statins, nitrates, alpha-blockers, beta-blockers, ACE inhibitors, etc.) History of hypersensitivity or prior adverse reaction (e.g., anaphylaxis or angioedema) to regular insulin infusion Current enrollment in another clinical trial, unless approved by the investigator of both studies or if clinical trial is a non-interventional registry trial History of hypersensitivity or prior adverse reaction to Definity microbubble infusion
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
William B Horton, MD
Phone
434-924-1828
Email
WBH2N@uvahealth.org
First Name & Middle Initial & Last Name or Official Title & Degree
Lee Hartline, MEd
Phone
434-924-5247
Email
lmh9d@virginia.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William B Horton, MD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Virginia Health System
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22903
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lee M Hartline
Email
LMH9D@virginia.edu
First Name & Middle Initial & Last Name & Degree
William B Horton, MD

12. IPD Sharing Statement

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Artificial Pancreas Technology to Reduce Glycemic Variability and Improve Cardiovascular Health in Type 1 Diabetes

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