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Adapting Diabetes Treatment Expert Systems to Patient in Type 1 Diabetes (DSS-2)

Primary Purpose

Diabetes Mellitus, Type 1

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Personalized Feedback
Decision Support System
Sensor Augmented Mode
Sponsored by
University of Virginia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Diabetes Mellitus, Type 1 focused on measuring Behavior, Continuous Glucose Monitor (CGM), Insulin Pump, Decision Support System (DSS), Personalized Feedback (PF), Sensor Augmented Pump therapy (SAP), Multiple Daily Injections (MDI), Sensor Augmented Mode (SAM), Continuous Subcutaneous Insulin Infusion (CSII)

Eligibility Criteria

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

Inclusion Criteria:

  • Age 18 years and older
  • Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least one year
  • HbA1c 6.0-11.0%, inclusive
  • Demonstration of proper mental status and cognition for the study
  • If on a non-insulin hyperglycemic therapy, stability on that therapy for the prior 3 months and willingness not to alter the therapy for the study duration.
  • For females, not currently known to be pregnant
  • If female and sexually active, must agree to use a highly effective form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all premenopausal women who are not surgically sterile. Subjects who become pregnant will be discontinued from the study. Also, subjects who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued.
  • Subjects must have Internet access and a computer system that meets the requirements for uploading the study equipment and ability to participate in video conferencing.
  • Investigator has confidence that the subject can successfully operate all study devices and is capable of adhering to the protocol

Exclusion Criteria:

  • NPH (neutral protamine hagedorn) insulin
  • Use of any medication that at the discretion of the investigator is deemed to interfere with the trial.
  • Current treatment of a primary seizure disorder
  • Coronary artery disease or heart failure, unless written clearance is received from a cardiologist.
  • Hemophilia or any other bleeding disorder
  • A known medical condition, which in the opinion of the investigator or designee, would put the participant or study at risk 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 >3 times the upper limit of normal)
    • Abnormal renal function test results (calculated GFR <60 mL/min/1.73m2).
    • Active gastroparesis requiring medical therapy
    • Uncontrolled thyroid disease (TSH undetectable or >10 mlU/L).
    • Abuse of alcohol or recreational drugs
    • Infectious process not anticipated to be resolved prior to study procedures (e.g. meningitis, pneumonia, osteomyelitis, deep tissue infection).
    • Uncontrolled arterial hypertension (Resting diastolic blood pressure >100 mmHg and/or systolic blood pressure >180 mmHg).
    • Uncontrolled microvascular complications such as current active proliferative diabetic retinopathy defined as proliferative retinopathy requiring treatment (e.g. laser therapy or VEGF inhibitor injections) in the past 12 months.
  • A recent injury to body or limb, muscular disorder, use of any medication, any carcinogenic disease, or other significant medical disorder if that injury, medication or disease in the judgment of the investigator will affect the completion of the protocol.
  • Not familiar with smart phone technology
  • Current use of the following drugs and supplements:

    • Oral steroids
    • Any other medication that the investigator believes is a contraindication to the subject's participation
  • Participation in another pharmaceutical or device trial at the time of enrollment or during the study.

Sites / Locations

  • University of Virginia Center for Diabetes TechnologyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

De-escalation

Escalation

Arm Description

Subjects randomized to this arm will proceed from DSS to PF to SAM

Subjects randomized to this arm will proceed from SAM to PF to DSS

Outcomes

Primary Outcome Measures

Glycemic Outcomes
Glucose Variability (GV) as measured by CGM-based Coefficient of Variation (CV), as recommended by the International Consensus on Use of Continuous Glucose Monitoring.

Secondary Outcome Measures

percent time in clinical hypoglycemia
percent time spent below 54mg/dL as per CGM
percent time below recommended threshold
percent time spent below 70mg/dL as per CGM
percent time in target range
percent time spent between 70mg/dL and 180mg/dL as per CGM
percent time above range
percent time spent above 180mg/dL as per CGM
percent time above 250 mg/dL
percent time spent above 250mg/dL as per CGM
average glycemia
average of CGM values
Low Blood Glucose Index
average of hypoglycemia risk value per Kovatchev et al 1998 as per CGM
High Blood Glucose Index
average of hyperglycemia risk value per Kovatchev et al 1998 as per CGM

Full Information

First Posted
June 20, 2020
Last Updated
May 3, 2023
Sponsor
University of Virginia
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT04443153
Brief Title
Adapting Diabetes Treatment Expert Systems to Patient in Type 1 Diabetes
Acronym
DSS-2
Official Title
Adapting Diabetes Treatment Expert Systems to Patient's Expectations and Psychobehavioral Characteristics in Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 4, 2020 (Actual)
Primary Completion Date
July 31, 2024 (Anticipated)
Study Completion Date
July 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Virginia
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

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 study is evaluate the superior efficacy of a Continuous Glucose Monitor (CGM)-based advisory system in Type 1 Diabetes Mellitus (T1DM), as compared to Sensor Augmented Mode (SAM) therapy, and with characterizing the impact of psycho-behavioral factors on system performance, which will enable system individualization and lead to automated adaptation of advice delivery to optimize glycemic control and reduce the system's psychological impact.
Detailed Description
Four cohorts of about 25 participants each (expected retention 20 per cohort). Each cohort will continue for ~7 months. Following recruitment, screening, and a run-in period of SAM, participants will be randomized into one of two groups: escalation vs. de-escalation of devices and function. Each treatment modality (SAM - Sensor-Augmented Mode, PF - Personalized Feedback, DSS - Decision Support Systems) will continue for about 8 weeks, with the last 4 weeks used to assess glucose variability (GV) from CGM data.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1
Keywords
Behavior, Continuous Glucose Monitor (CGM), Insulin Pump, Decision Support System (DSS), Personalized Feedback (PF), Sensor Augmented Pump therapy (SAP), Multiple Daily Injections (MDI), Sensor Augmented Mode (SAM), Continuous Subcutaneous Insulin Infusion (CSII)

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
De-escalation
Arm Type
Experimental
Arm Description
Subjects randomized to this arm will proceed from DSS to PF to SAM
Arm Title
Escalation
Arm Type
Experimental
Arm Description
Subjects randomized to this arm will proceed from SAM to PF to DSS
Intervention Type
Device
Intervention Name(s)
Personalized Feedback
Intervention Description
Provides tailored information to the user about what glycemic risk they may be facing as well as how glycemic control and system use looked in the past week. Treatment decision and therapy changes are entirely left to the decision of the user.
Intervention Type
Device
Intervention Name(s)
Decision Support System
Intervention Description
CGM-based system that includes Personalized Feedback (PF) and further assists with treatment recommendations for common metabolic challenges
Intervention Type
Device
Intervention Name(s)
Sensor Augmented Mode
Intervention Description
A mode in Diabetes Assistant (DiAs) that combines Diabetes Assistant, Insulin pump or Multiple Daily Injections, CGM, ketone meters, and glycemic treatment guidelines together to manage diabetes.
Primary Outcome Measure Information:
Title
Glycemic Outcomes
Description
Glucose Variability (GV) as measured by CGM-based Coefficient of Variation (CV), as recommended by the International Consensus on Use of Continuous Glucose Monitoring.
Time Frame
7 Months
Secondary Outcome Measure Information:
Title
percent time in clinical hypoglycemia
Description
percent time spent below 54mg/dL as per CGM
Time Frame
7 months
Title
percent time below recommended threshold
Description
percent time spent below 70mg/dL as per CGM
Time Frame
7 months
Title
percent time in target range
Description
percent time spent between 70mg/dL and 180mg/dL as per CGM
Time Frame
7 months
Title
percent time above range
Description
percent time spent above 180mg/dL as per CGM
Time Frame
7 months
Title
percent time above 250 mg/dL
Description
percent time spent above 250mg/dL as per CGM
Time Frame
7 months
Title
average glycemia
Description
average of CGM values
Time Frame
7 months
Title
Low Blood Glucose Index
Description
average of hypoglycemia risk value per Kovatchev et al 1998 as per CGM
Time Frame
7 months
Title
High Blood Glucose Index
Description
average of hyperglycemia risk value per Kovatchev et al 1998 as per CGM
Time Frame
7 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 years and older Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least one year HbA1c 6.0-11.0%, inclusive Demonstration of proper mental status and cognition for the study If on a non-insulin hyperglycemic therapy, stability on that therapy for the prior 3 months and willingness not to alter the therapy for the study duration. For females, not currently known to be pregnant If female and sexually active, must agree to use a highly effective form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all premenopausal women who are not surgically sterile. Subjects who become pregnant will be discontinued from the study. Also, subjects who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued. Subjects must have Internet access and a computer system that meets the requirements for uploading the study equipment and ability to participate in video conferencing. Investigator has confidence that the subject can successfully operate all study devices and is capable of adhering to the protocol Exclusion Criteria: NPH (neutral protamine hagedorn) insulin Use of any medication that at the discretion of the investigator is deemed to interfere with the trial. Current treatment of a primary seizure disorder Coronary artery disease or heart failure, unless written clearance is received from a cardiologist. Hemophilia or any other bleeding disorder A known medical condition, which in the opinion of the investigator or designee, would put the participant or study at risk 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 >3 times the upper limit of normal) Abnormal renal function test results (calculated GFR <60 mL/min/1.73m2). Active gastroparesis requiring medical therapy Uncontrolled thyroid disease (TSH undetectable or >10 mlU/L). Abuse of alcohol or recreational drugs Infectious process not anticipated to be resolved prior to study procedures (e.g. meningitis, pneumonia, osteomyelitis, deep tissue infection). Uncontrolled arterial hypertension (Resting diastolic blood pressure >100 mmHg and/or systolic blood pressure >180 mmHg). Uncontrolled microvascular complications such as current active proliferative diabetic retinopathy defined as proliferative retinopathy requiring treatment (e.g. laser therapy or VEGF inhibitor injections) in the past 12 months. A recent injury to body or limb, muscular disorder, use of any medication, any carcinogenic disease, or other significant medical disorder if that injury, medication or disease in the judgment of the investigator will affect the completion of the protocol. Not familiar with smart phone technology Current use of the following drugs and supplements: Oral steroids Any other medication that the investigator believes is a contraindication to the subject's participation Participation in another pharmaceutical or device trial at the time of enrollment or during the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Marc Breton, PhD
Phone
434-982-6484
Email
mb6nt@virginia.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Emma Emory, RN
Phone
434-327-0725
Email
ee9m@virginia.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc Breton, PhD
Organizational Affiliation
University of Virginia Center for Diabetes Technology
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Virginia Center for Diabetes Technology
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
Marc Breton, PhD
Phone
434-982-6484
Email
mb6nt@virginia.edu
First Name & Middle Initial & Last Name & Degree
Marc Breton, PhD
First Name & Middle Initial & Last Name & Degree
Ralf Nass, MD
First Name & Middle Initial & Last Name & Degree
Chiara Fabris, PhD
First Name & Middle Initial & Last Name & Degree
Leela Krishna Chaitanya Koravi, PhD
First Name & Middle Initial & Last Name & Degree
Linda Gonder-Fredrick, PhD
First Name & Middle Initial & Last Name & Degree
Mary Clancy-Oliveri, MS
First Name & Middle Initial & Last Name & Degree
Katharine Barnard-Kelly, Ph.D.

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Pending

Learn more about this trial

Adapting Diabetes Treatment Expert Systems to Patient in Type 1 Diabetes

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