Back to resultsEvaluation of Accu-Chek DiaPort, a Port System for Continuous Intraperitoneal Insulin Infusion, in Patients With Type I Diabetes
Primary Purpose
Diabetes Mellitus, Type 1
Status
Completed
Phase
Not Applicable
Locations
Germany
Study Type
Interventional
Intervention
Accu-Chek DiaPort
Sponsored by
About this trial
This is an interventional diagnostic trial for Diabetes Mellitus, Type 1
Eligibility Criteria
Inclusion Criteria:
- Adult patients, >= 18 years of age at the time of the screening visit
- Type 1 diabetes mellitus
- On CSII therapy for at least 6 months prior to the screening visit
- Has been unsuccessfully treated with standard subcutaneous insulin therapy including CSII therapy, as defined by frequent (defined as handicapping in daily life) or severe (needing help from a third party) hypoglycemia and/or HbA1c above 8.5%, and/or other medical indication for CIPII therapy
- Presence of at least one of the following indications for CIPII therapy: - Frequent (defined as handicapping daily life) hypoglycemia during CSII therapy - Severe hypoglycemia (needing help from a third party) during CSII therapy - HbA1c above 8.5% during CSII therapy - Hypoglycemia unawareness during CSII therapy - Real subcutaneous insulin resistance - Insulin-induced lipoatrophy - Insulin-associated lipohypertrophy not controlled by site rotation - Other skin disorders interfering with the subcutaneous route of administration - Marked fluctuations of glucose levels and insulin requirements during CSII therapy- History of allergies to materials required for subcutaneous insulin therapy
- Performs usually self-management of blood glucose at least 4 times per day
- Willing to adhere to the study visit schedule and motivated to undergo the therapy
Exclusion Criteria:
- Presence of marked peritoneal adhesions or scarring after abdominal surgery
- Disorders of the gastrointestinal tract, respectively the digestive system potentially interfering with the intraperitoneal route of administration (e.g. presence of marked peritoneal adhesions, or colonic disease)
- Known high levels of anti-insulin antibodies
- History of allergy to materials used for the Accu-Chek DiaPort (titanium, polyethylene)
- Severely impaired immune response
- Uses systemic oral or inhaled steroids for > 14 days within the last 3 months
- Pregnant or lactating women, or women currently planning a pregnancy
- Previous history of severe chronic liver disease defined as signs of portal hypertension and/or Quick's value below 50% in spite of vitamin K administration
- Subject is treated for malignancy (chemotherapy, radiation or other treatment) (self-reported)
- Positive for HIV infection
- Is under CAPD treatment
- Suffers from severe eating disorders like bulimia or anorexia
- Alcohol or drug abuse
- Serious psychological disorders like schizophrenia, depression, Münchhausen's syndrome etc.
- Presence of known or suspected infections, bacteremia, septicemia or peritonitis
- Participation in a clinical trial (medicinal, medical device) within the last 30 days prior to screening
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Single Arm
Arm Description
Participants were implanted with Accu-Chek DiaPort with Infusion Set connected to an Accu-Chek Insulin Pump to perform continuous intraperitoneal insulin delivery.
Outcomes
Primary Outcome Measures
Suitability of the Device - Overall Suitability Score
Suitability of the device was assessed by the investigator using a questionnaire that determined the following: 1) condition of the tissue around the port: tight connection between port and skin (mechanical stability, dislocation of port, signs of redness/swelling, infection, or pain), 2) peritoneal reactions (persistent dull pain due to catheter, signs of infection/allergic reaction) and ability to deliver insulin intraperitonally at every visit after implantation. Suitability score was determined using participant's responses to a questionnaire where 1 equals (=) no problem, 2=minor/negligible problems, 3=some/noticeable problems, 4=major/cumbersome and 5=severe/almost unbearable problems. Each question was scored and an average across the questions was determined as an overall score. The scores ranged from 1 (not at all suitable) to 5 (completely suitable).
Percentage of Participants With Problems Involving the Tight Connection Between Port and Skin
Mechanical stability of the device was determined by the stability of the ingrowth surrounding the port as determined by the physician. The ingrowth problems are categorized as follows: Category 1= complete stable Ingrowth, 2= Ingrowth working with negligible problems, 3= Ingrowth working with some problems, 4= Ingrowth working with major problems and 5= Ingrowth resulting in almost non-functional port. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Dislocation of Port
Position of the port was determined by the physician and was categorized as follows: Category 1= No dislocation; 2= Minimal dislocation; 3= Clearly visible dislocation, with minimal impairment of function; 4= Dislocation impairs functions; 5= Dislocation results in disabling functions. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Redness/Swelling in the Tissue Around the Port
Signs of Redness/Swelling was determined by the physician and was categorized as follows: Category 1= None; 2= Minor, negligible; 3= Some, noticeable; 4= Major; 5= Severe. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Infection in the Tissue Around the Port
Signs of infection were determined by the physician and categorized as follows : Category 1= None; 2= Minor, negligible; 3= Some, noticeable 4= Major; 5= Severe. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Pain in the Tissue Around the Port
Signs of pain was determined from the participant questionnaire which was categorized as follows: category 1= No pain; 2= Minor, negligible; 3= Some, noticeable; 4= Major, cumbersome; 5=Severe, almost unbearable. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Persistent Dull Pain Due to Catheter
Pain due to catheter was determined by a participant questionnaire and categorized as follows: Category 1= No pain; 2= Minor, negligible; 3= Some, noticeable; 4= Major, cumbersome; 5= Severe, almost unbearable. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Infection/Allergic Reaction at the Site of Implant
Signs of infection/allergic reaction at the site of implant was determined by the physician and categorized as follows: 1= No problems; 2= Minor problems; 3= Some problems; 4= Major problems and/or replacement of catheter necessary; 5= Severe problems and/or explanation of port necessary. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants Categorized by Ability of the Port to Deliver Insulin Intraperitonally
Problems in ability to deliver insulin intraperitoneally was determined by the physician and categorized as follows: 1= No problems; 2= Minor problems; 3= Some problems; 4= Major problems and/or replacement of catheter necessary; 5= Severe problems and/or explanation of port necessary. The percentage of participants in each category for the specified time point is presented.
Secondary Outcome Measures
Insulin Doses Dispensed From Insulin Pump
Total insulin dose (in international units per milliliter [IU/mL]) from pump was measured per day as mean per day measured over 7 days.
Hemoglobin A1c Levels
Glycated hemoglobin (HbA1c) is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. HbA1c levels are a measure of glycemic control.
Self Monitored Blood Glucose Levels
Participants monitored glucose levels on a daily basis and recorded for evaluation. Glucose levels are measured as milligrams per deciliter (mg/dL)
Continuous Glucose Measurement (CGM) - Glucose Levels
CGM measurements were performed using a diurnal CGM sensor and group means were calculated over 10 minute periods of the CGM measurements.
Glycemic Variability: Percent Coefficient of Variation in Blood Glucose
Both self monitored (SMBG) and continuous (CGM) glucose measurements were used to determine the coefficient of variation in blood glucose. CGM data are only evaluated for a 1 week time period and are no direct comparison to the SMBG that reflect the full time frame between visits.
Percentage of Participants Achieving Target Glucose Levels
Target glucose values were 70-180 mg/dL. Participants with glucose levels below 70 mg/dL were considered to be under target and those above 180 mg/dL were considered over target. The mean of Glucose-Measurements at the visit date was calculated as follows: a variable was created for each category ("within target [70-180 mg]", "below target" and "above target") that tells if the value lies within this category. Then the percentage per participant and visit was calculated. The mean represents the mean of these percentages per participant at the visit.
Design Validation Participant Questionnaire - Percentage of Participants With a Positive Response
The participant questionnaire consisted of two parts including description of routine operations, followed by 23 questions used to determine the following: percentage of participants needing consultation of instructions for use of fixation disc or infusion set; percentage of participants with pain after implantation, percentage of participants with moderate pain during 4 to 6 days after implantation, moderate pain for 7 days or more; percentage of participants with temporal disconnection from infusion set; percentage of participants with use of handling aid for temporal storage; percentage of participants with a reason for temporal disconnection of infusion set from port either sex, shower, or sport; percentage of participants changing fixation disc ≥3 days or infusion set ≥4 days and the cartridge, and percentage of participants cleaning the skin around the port daily, every second day, or every third to fifth day, either with saline during healing or with alcohol after healing.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01483352
Brief Title
Evaluation of Accu-Chek DiaPort, a Port System for Continuous Intraperitoneal Insulin Infusion, in Patients With Type I Diabetes
Official Title
Evaluation of Accu-Chek DiaPort, a Port System for Continuous Intraperitoneal Insulin Infusion, in Patients With Type I Diabetes
Study Type
Interventional
2. Study Status
Record Verification Date
March 2016
Overall Recruitment Status
Completed
Study Start Date
November 2011 (undefined)
Primary Completion Date
March 2013 (Actual)
Study Completion Date
March 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hoffmann-La Roche
4. Oversight
5. Study Description
Brief Summary
The Accu-Chek DiaPort system enables continuous intraperitoneal insulin infusion (CIPII): that is, infusion of insulin into the peritoneal cavity using an Accu-Chek insulin pump and an infusion set. The Accu-Chek DiaPort consists of a metal body with a catheter that is placed in the abdomen. The opening of the port is raised above the surface of the skin about 5 millimeters, while a flower-shaped plate is placed under the skin, providing stability for the port. The port has been designed for those diabetics who cannot benefit fully from subcutaneous insulin infusion. The primary objective of the study is to assess the suitability of Accu-Chek DiaPort to perform continuous intraperitoneal insulin delivery. The data collection focuses on the condition of tissue around the port after the implantation, possible peritoneal reactions to the port system, and the peritoneal delivery of insulin. Secondary objectives are the assessments of therapeutic performance and successful implementation of design requirements. In total 12 Patients will participate in this open, mono-centre, single-arm, interventional clinical trial. The study lasts 9 months (without run in period of 3 to 1 week) separated in two parts. Phase I last 12 weeks. Phase II last 6 month until the end of the study. During the study, seven visits are planned. The screening visit can take place up to 3 weeks before study start. At the implantation visit which can last up to 5 days the port will be implanted. After the implantation insulin therapy will be adjusted for CIPII and the patients will be trained for handling and daily care of the Accu-Chek DiaPort system. To check the functionality of the system, the first control visit will take place 2 weeks and the second control visit 6 weeks after the implantation. At the week 12 visit, the most important parameters will be collected for the phase I report. The following visits take place 6 and 9 months after the implantation.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1
7. Study Design
Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Single Arm
Arm Type
Experimental
Arm Description
Participants were implanted with Accu-Chek DiaPort with Infusion Set connected to an Accu-Chek Insulin Pump to perform continuous intraperitoneal insulin delivery.
Intervention Type
Device
Intervention Name(s)
Accu-Chek DiaPort
Primary Outcome Measure Information:
Title
Suitability of the Device - Overall Suitability Score
Description
Suitability of the device was assessed by the investigator using a questionnaire that determined the following: 1) condition of the tissue around the port: tight connection between port and skin (mechanical stability, dislocation of port, signs of redness/swelling, infection, or pain), 2) peritoneal reactions (persistent dull pain due to catheter, signs of infection/allergic reaction) and ability to deliver insulin intraperitonally at every visit after implantation. Suitability score was determined using participant's responses to a questionnaire where 1 equals (=) no problem, 2=minor/negligible problems, 3=some/noticeable problems, 4=major/cumbersome and 5=severe/almost unbearable problems. Each question was scored and an average across the questions was determined as an overall score. The scores ranged from 1 (not at all suitable) to 5 (completely suitable).
Time Frame
Week 12
Title
Percentage of Participants With Problems Involving the Tight Connection Between Port and Skin
Description
Mechanical stability of the device was determined by the stability of the ingrowth surrounding the port as determined by the physician. The ingrowth problems are categorized as follows: Category 1= complete stable Ingrowth, 2= Ingrowth working with negligible problems, 3= Ingrowth working with some problems, 4= Ingrowth working with major problems and 5= Ingrowth resulting in almost non-functional port. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants With Dislocation of Port
Description
Position of the port was determined by the physician and was categorized as follows: Category 1= No dislocation; 2= Minimal dislocation; 3= Clearly visible dislocation, with minimal impairment of function; 4= Dislocation impairs functions; 5= Dislocation results in disabling functions. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants With Signs of Redness/Swelling in the Tissue Around the Port
Description
Signs of Redness/Swelling was determined by the physician and was categorized as follows: Category 1= None; 2= Minor, negligible; 3= Some, noticeable; 4= Major; 5= Severe. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants With Signs of Infection in the Tissue Around the Port
Description
Signs of infection were determined by the physician and categorized as follows : Category 1= None; 2= Minor, negligible; 3= Some, noticeable 4= Major; 5= Severe. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants With Signs of Pain in the Tissue Around the Port
Description
Signs of pain was determined from the participant questionnaire which was categorized as follows: category 1= No pain; 2= Minor, negligible; 3= Some, noticeable; 4= Major, cumbersome; 5=Severe, almost unbearable. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants With Persistent Dull Pain Due to Catheter
Description
Pain due to catheter was determined by a participant questionnaire and categorized as follows: Category 1= No pain; 2= Minor, negligible; 3= Some, noticeable; 4= Major, cumbersome; 5= Severe, almost unbearable. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants With Signs of Infection/Allergic Reaction at the Site of Implant
Description
Signs of infection/allergic reaction at the site of implant was determined by the physician and categorized as follows: 1= No problems; 2= Minor problems; 3= Some problems; 4= Major problems and/or replacement of catheter necessary; 5= Severe problems and/or explanation of port necessary. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Title
Percentage of Participants Categorized by Ability of the Port to Deliver Insulin Intraperitonally
Description
Problems in ability to deliver insulin intraperitoneally was determined by the physician and categorized as follows: 1= No problems; 2= Minor problems; 3= Some problems; 4= Major problems and/or replacement of catheter necessary; 5= Severe problems and/or explanation of port necessary. The percentage of participants in each category for the specified time point is presented.
Time Frame
Weeks 2 and 12 and Months 6, 9, 12 and 15
Secondary Outcome Measure Information:
Title
Insulin Doses Dispensed From Insulin Pump
Description
Total insulin dose (in international units per milliliter [IU/mL]) from pump was measured per day as mean per day measured over 7 days.
Time Frame
Screening, Week 12 and Months 6, 9 and 12
Title
Hemoglobin A1c Levels
Description
Glycated hemoglobin (HbA1c) is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. HbA1c levels are a measure of glycemic control.
Time Frame
Screening, Week 12 and Months 6, 9 and 12
Title
Self Monitored Blood Glucose Levels
Description
Participants monitored glucose levels on a daily basis and recorded for evaluation. Glucose levels are measured as milligrams per deciliter (mg/dL)
Time Frame
Screening, Week 12 and Months 6, 9 and 12
Title
Continuous Glucose Measurement (CGM) - Glucose Levels
Description
CGM measurements were performed using a diurnal CGM sensor and group means were calculated over 10 minute periods of the CGM measurements.
Time Frame
Screening, Week 12 and 6 Months
Title
Glycemic Variability: Percent Coefficient of Variation in Blood Glucose
Description
Both self monitored (SMBG) and continuous (CGM) glucose measurements were used to determine the coefficient of variation in blood glucose. CGM data are only evaluated for a 1 week time period and are no direct comparison to the SMBG that reflect the full time frame between visits.
Time Frame
Screening, Week 12 and Months 6, 9 and 12
Title
Percentage of Participants Achieving Target Glucose Levels
Description
Target glucose values were 70-180 mg/dL. Participants with glucose levels below 70 mg/dL were considered to be under target and those above 180 mg/dL were considered over target. The mean of Glucose-Measurements at the visit date was calculated as follows: a variable was created for each category ("within target [70-180 mg]", "below target" and "above target") that tells if the value lies within this category. Then the percentage per participant and visit was calculated. The mean represents the mean of these percentages per participant at the visit.
Time Frame
Screening, Week 12 and 6 Months
Title
Design Validation Participant Questionnaire - Percentage of Participants With a Positive Response
Description
The participant questionnaire consisted of two parts including description of routine operations, followed by 23 questions used to determine the following: percentage of participants needing consultation of instructions for use of fixation disc or infusion set; percentage of participants with pain after implantation, percentage of participants with moderate pain during 4 to 6 days after implantation, moderate pain for 7 days or more; percentage of participants with temporal disconnection from infusion set; percentage of participants with use of handling aid for temporal storage; percentage of participants with a reason for temporal disconnection of infusion set from port either sex, shower, or sport; percentage of participants changing fixation disc ≥3 days or infusion set ≥4 days and the cartridge, and percentage of participants cleaning the skin around the port daily, every second day, or every third to fifth day, either with saline during healing or with alcohol after healing.
Time Frame
Week 12
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Adult patients, >= 18 years of age at the time of the screening visit
Type 1 diabetes mellitus
On CSII therapy for at least 6 months prior to the screening visit
Has been unsuccessfully treated with standard subcutaneous insulin therapy including CSII therapy, as defined by frequent (defined as handicapping in daily life) or severe (needing help from a third party) hypoglycemia and/or HbA1c above 8.5%, and/or other medical indication for CIPII therapy
Presence of at least one of the following indications for CIPII therapy: - Frequent (defined as handicapping daily life) hypoglycemia during CSII therapy - Severe hypoglycemia (needing help from a third party) during CSII therapy - HbA1c above 8.5% during CSII therapy - Hypoglycemia unawareness during CSII therapy - Real subcutaneous insulin resistance - Insulin-induced lipoatrophy - Insulin-associated lipohypertrophy not controlled by site rotation - Other skin disorders interfering with the subcutaneous route of administration - Marked fluctuations of glucose levels and insulin requirements during CSII therapy- History of allergies to materials required for subcutaneous insulin therapy
Performs usually self-management of blood glucose at least 4 times per day
Willing to adhere to the study visit schedule and motivated to undergo the therapy
Exclusion Criteria:
Presence of marked peritoneal adhesions or scarring after abdominal surgery
Disorders of the gastrointestinal tract, respectively the digestive system potentially interfering with the intraperitoneal route of administration (e.g. presence of marked peritoneal adhesions, or colonic disease)
Known high levels of anti-insulin antibodies
History of allergy to materials used for the Accu-Chek DiaPort (titanium, polyethylene)
Severely impaired immune response
Uses systemic oral or inhaled steroids for > 14 days within the last 3 months
Pregnant or lactating women, or women currently planning a pregnancy
Previous history of severe chronic liver disease defined as signs of portal hypertension and/or Quick's value below 50% in spite of vitamin K administration
Subject is treated for malignancy (chemotherapy, radiation or other treatment) (self-reported)
Positive for HIV infection
Is under CAPD treatment
Suffers from severe eating disorders like bulimia or anorexia
Alcohol or drug abuse
Serious psychological disorders like schizophrenia, depression, Münchhausen's syndrome etc.
Presence of known or suspected infections, bacteremia, septicemia or peritonitis
Participation in a clinical trial (medicinal, medical device) within the last 30 days prior to screening
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Barbara Holzer
Organizational Affiliation
Roche Diabetes Care AG
Official's Role
Study Director
Facility Information:
City
Bad Heilbrunn
ZIP/Postal Code
83670
Country
Germany
12. IPD Sharing Statement
Learn more about this trial
Evaluation of Accu-Chek DiaPort, a Port System for Continuous Intraperitoneal Insulin Infusion, in Patients With Type I Diabetes
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