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Context Aware Data Gathering Study

Primary Purpose

Type 1 Diabetes

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Exercise
Sponsored by
Oregon Health and Science University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Type 1 Diabetes focused on measuring automated insulin delivery systems, Context patterns

Eligibility Criteria

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

Inclusion Criteria:

  • Diagnosis of type 1 diabetes mellitus for at least 1 year.
  • Male or female subjects 18 to 65 years of age.
  • Physically willing and able to perform 30 min of exercise (as determined by the investigator after reviewing the subject's activity level).
  • Current use of an insulin pump for at least 3 months.
  • A1C <10.5% at the time of screening.
  • Willingness to follow all study procedures, including attending all clinic visits.
  • Willingness to sign informed consent and HIPAA documents.

Exclusion Criteria:

  • Female of childbearing potential who is pregnant or intending to become pregnant or breast-feeding, or is not using adequate contraceptive methods. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence.
  • Any cardiovascular disease, defined as a clinically significant EKG abnormality at the time of screening or any history of: stroke, heart failure, myocardial infarction, angina pectoris, or coronary arterial bypass graft or angioplasty. Diagnosis of 2nd or 3rd degree heart block or any non-physiological arrhythmia judged by the investigator to be exclusionary.
  • Renal insufficiency (GFR < 60 ml/min, using the MDRD equation as reported by the OHSU laboratory).
  • Liver failure, cirrhosis, or any other liver disease that compromises liver function as determined by the investigator.
  • Hematocrit of less than 36% for men, less than 32% for women.
  • History of severe hypoglycemia during the past 12 months prior to screening visit or hypoglycemia unawareness as judged by the investigator. Subjects will complete a hypoglycemia awareness questionnaire. Subjects will be excluded for four or more R responses.
  • Adrenal insufficiency.
  • Any active infection.
  • Known or suspected abuse of alcohol, narcotics, or illicit drugs.
  • Seizure disorder.
  • Active foot ulceration.
  • Peripheral arterial disease.
  • Major surgical operation within 30 days prior to screening.
  • Use of an investigational drug within 30 days prior to screening.
  • Chronic usage of any immunosuppressive medication (such as cyclosporine, azathioprine, sirolimus, or tacrolimus).
  • Bleeding disorder or platelet count below 50,000.
  • Current administration of oral or parenteral corticosteroids.
  • Any life threatening disease, including malignant neoplasms and medical history of malignant neoplasms within the past 5 years prior to screening (except basal and squamous cell skin cancer).
  • Beta blockers or non-dihydropyridine calcium channel blockers.
  • Current use of any medication intended to lower glucose other than insulin (ex. use of liraglutide).
  • A positive response to any of the questions from the Physical Activity Readiness Questionnaire with one exception: subject will not be excluded if he/she takes a single blood pressure medication that doesn't impact heart rate and blood pressure is controlled on the medication (blood pressure is less than 140/90 mmHg).
  • Any chest discomfort with physical activity, including pain or pressure, or other types of discomfort.
  • Any clinically significant disease or disorder which in the opinion of the Investigator may jeopardize the subject's safety or compliance with the protocol.

Sites / Locations

  • Oregon Health and Science University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Aerobic exercise

Resistance exercise

High intensity interval exercise

Arm Description

Outcomes

Primary Outcome Measures

Comparison of the Mean Absolute Relative Difference When Including Patterns in Hypoglycemia Prediction.
We used our recently published long short term memory neural network (LSTM) to predict sensor glucose 30-minutes in advance across the entire 4-week study duration when glucose was < 70 mg/dL. We then used the context-aware pattern recognition algorithm to predict when hypoglycemia would occur 30-minutes in the future, and if hypoglycemia was predicted, we included a bias correction that is specific to the hypogylcemia region of glucose measurements. The outcome measure shows the reduction of MARD when the LSTM is corrected using the pattern-based bias correction algorithm. MARD is calculated by subtracting the new sensor glucose - reference value dividing by the reference value. A negative value means that the MARD was reduced. The LSTM is being compared with Dexcom G6 CGM values to determine the MARD. Physiologically relevant thresholds are less than 55 mg/dl, less than 70 mg/dl, above 180 mg/dl and above 250 mg/dl. The Dexcom G6 target range is 70-180 mg/dl.
Comparison of the Mean Relative Difference When Including Patterns in Hypoglycemia Prediction.
We used our recently published long short term memory neural network (LSTM) to predict glucose 30-minutes in advance across the entire 4-week study duration when glucose was < 70 mg/dL. We then used the context-aware pattern recognition algorithm to predict when hypoglycemia would occur 30-minutes in the future, and if hypoglycemia was predicted, we included a bias correction that is specific to the hypogylcemia region of glucose measurements. The outcome measure shows the reduction of mean relative difference (MRD) when the LSTM is corrected using the pattern-based bias correction algorithm. MARD is calculated by subtracting the new sensor glucose - reference value dividing by the reference value. A negative value means that the MARD was reduced. The LSTM is being compared with Dexcom G6 CGM values to determine the MARD. Physiologically relevant thresholds are less than 55 mg/dl, less than 70 mg/dl, above 180 mg/dl and above 250 mg/dl. The Dexcom G6 target range is 70-180 mg/dl.

Secondary Outcome Measures

Full Information

First Posted
November 5, 2019
Last Updated
July 21, 2023
Sponsor
Oregon Health and Science University
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT04154904
Brief Title
Context Aware Data Gathering Study
Official Title
Development of a Context-aware Glucose Prediction Algorithm in Patients With Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Completed
Study Start Date
August 11, 2020 (Actual)
Primary Completion Date
December 23, 2021 (Actual)
Study Completion Date
January 3, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Oregon Health and Science University
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
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Automated Insulin Delivery (AID) systems have now become an important standard-of-care for people with T1D and have demonstrated a reduction, but not elimination, of hypoglycemia during long-term studies. One limitation of current AID systems is that they have no knowledge about the context or environment that a person is currently experiencing. Contextual patterns can potentially improve the performance of an AID by recognizing environments or patterns of living that are related to changes in glucose. The team at OHSU is developing a context-aware glucose prediction algorithm that will capture context data from the patient both indoors and outdoors. This context data will be provided to the algorithm to allow for detecting contextual patterns that might relate to high or low glucose. The goal of this study will be the creation of a data set that will include contextual patterns along with glucose, insulin and physiological data.
Detailed Description
Subjects will be on study for 28 days. Sensor glucose, activity, exercise, insulin, indoor and outdoor contextual patterns and meal data will be collected during this time. Subjects will wear the Dexcom G6 CGM system and a physical activity monitor for the entire 28 days. Subjects will continue to use their own insulin pump. Subjects will be asked to also wear a MotioWear indoor/outdoor context-aware tracking tag and to install the MotioWear beacons within their home. Subjects will be randomized to complete either aerobic, high intensity interval training, or resistance exercise videos twice weekly at home during weeks 1 and 2 and once during weeks 3 and 4. Subjects will also ingest a self-selected meal prior to these prescribed exercise sessions. Subjects will eat a high carbohydrate dinner once each week on the same day at the same approximate time of day (but not on the exercise days). Subjects will use the T1 DEXI mobile app created by OHSU to capture meal and exercise data along with photos of meals the day of exercise and the day after. While at home, subjects will check CBG before and after exercise, for symptoms of hypoglycemia, and for Dexcom G6 alarms for sensor <70 mg/dL and >250 mg/dL.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
automated insulin delivery systems, Context patterns

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Aerobic exercise
Arm Type
Experimental
Arm Title
Resistance exercise
Arm Type
Experimental
Arm Title
High intensity interval exercise
Arm Type
Experimental
Intervention Type
Other
Intervention Name(s)
Exercise
Intervention Description
Subjects will be randomized to complete either aerobic, high intensity interval training, or resistance exercise videos twice weekly at home.
Primary Outcome Measure Information:
Title
Comparison of the Mean Absolute Relative Difference When Including Patterns in Hypoglycemia Prediction.
Description
We used our recently published long short term memory neural network (LSTM) to predict sensor glucose 30-minutes in advance across the entire 4-week study duration when glucose was < 70 mg/dL. We then used the context-aware pattern recognition algorithm to predict when hypoglycemia would occur 30-minutes in the future, and if hypoglycemia was predicted, we included a bias correction that is specific to the hypogylcemia region of glucose measurements. The outcome measure shows the reduction of MARD when the LSTM is corrected using the pattern-based bias correction algorithm. MARD is calculated by subtracting the new sensor glucose - reference value dividing by the reference value. A negative value means that the MARD was reduced. The LSTM is being compared with Dexcom G6 CGM values to determine the MARD. Physiologically relevant thresholds are less than 55 mg/dl, less than 70 mg/dl, above 180 mg/dl and above 250 mg/dl. The Dexcom G6 target range is 70-180 mg/dl.
Time Frame
28 days
Title
Comparison of the Mean Relative Difference When Including Patterns in Hypoglycemia Prediction.
Description
We used our recently published long short term memory neural network (LSTM) to predict glucose 30-minutes in advance across the entire 4-week study duration when glucose was < 70 mg/dL. We then used the context-aware pattern recognition algorithm to predict when hypoglycemia would occur 30-minutes in the future, and if hypoglycemia was predicted, we included a bias correction that is specific to the hypogylcemia region of glucose measurements. The outcome measure shows the reduction of mean relative difference (MRD) when the LSTM is corrected using the pattern-based bias correction algorithm. MARD is calculated by subtracting the new sensor glucose - reference value dividing by the reference value. A negative value means that the MARD was reduced. The LSTM is being compared with Dexcom G6 CGM values to determine the MARD. Physiologically relevant thresholds are less than 55 mg/dl, less than 70 mg/dl, above 180 mg/dl and above 250 mg/dl. The Dexcom G6 target range is 70-180 mg/dl.
Time Frame
28 days

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: Diagnosis of type 1 diabetes mellitus for at least 1 year. Male or female subjects 18 to 65 years of age. Physically willing and able to perform 30 min of exercise (as determined by the investigator after reviewing the subject's activity level). Current use of an insulin pump for at least 3 months. A1C <10.5% at the time of screening. Willingness to follow all study procedures, including attending all clinic visits. Willingness to sign informed consent and HIPAA documents. Exclusion Criteria: Female of childbearing potential who is pregnant or intending to become pregnant or breast-feeding, or is not using adequate contraceptive methods. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence. Any cardiovascular disease, defined as a clinically significant EKG abnormality at the time of screening or any history of: stroke, heart failure, myocardial infarction, angina pectoris, or coronary arterial bypass graft or angioplasty. Diagnosis of 2nd or 3rd degree heart block or any non-physiological arrhythmia judged by the investigator to be exclusionary. Renal insufficiency (GFR < 60 ml/min, using the MDRD equation as reported by the OHSU laboratory). Liver failure, cirrhosis, or any other liver disease that compromises liver function as determined by the investigator. Hematocrit of less than 36% for men, less than 32% for women. History of severe hypoglycemia during the past 12 months prior to screening visit or hypoglycemia unawareness as judged by the investigator. Subjects will complete a hypoglycemia awareness questionnaire. Subjects will be excluded for four or more R responses. Adrenal insufficiency. Any active infection. Known or suspected abuse of alcohol, narcotics, or illicit drugs. Seizure disorder. Active foot ulceration. Peripheral arterial disease. Major surgical operation within 30 days prior to screening. Use of an investigational drug within 30 days prior to screening. Chronic usage of any immunosuppressive medication (such as cyclosporine, azathioprine, sirolimus, or tacrolimus). Bleeding disorder or platelet count below 50,000. Current administration of oral or parenteral corticosteroids. Any life threatening disease, including malignant neoplasms and medical history of malignant neoplasms within the past 5 years prior to screening (except basal and squamous cell skin cancer). Beta blockers or non-dihydropyridine calcium channel blockers. Current use of any medication intended to lower glucose other than insulin (ex. use of liraglutide). A positive response to any of the questions from the Physical Activity Readiness Questionnaire with one exception: subject will not be excluded if he/she takes a single blood pressure medication that doesn't impact heart rate and blood pressure is controlled on the medication (blood pressure is less than 140/90 mmHg). Any chest discomfort with physical activity, including pain or pressure, or other types of discomfort. Any clinically significant disease or disorder which in the opinion of the Investigator may jeopardize the subject's safety or compliance with the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jessica Castle, MD
Organizational Affiliation
Oregon Health and Science University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Oregon Health and Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Context Aware Data Gathering Study

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