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Real-time Adaptation to Changes in Insulin Sensitivity

Primary Purpose

Type 1 Diabetes Mellitus

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
The Fading Memory Proportional Derivative/Adaptive Proportional Derivative Algorithm
The Adaptive Proportional Derivative Algorithm
Sponsored by
Legacy Health System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes Mellitus focused on measuring glucose sensors, artificial pancreas, Diabetes Mellitus

Eligibility Criteria

21 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Diagnosis of Type 1 Diabetes Mellitus for at least 1 year
  • Male or Female subjects 21 to 65 years of age
  • Willingness to follow all study procedures, including attending all clinic visits
  • Willingness to sign informed consent and HIPAA documents.

Exclusion Criteria:

  • Pregnancy or Lactation: For women of childbearing potential: there is a requirement for a negative urine pregnancy test and for agreement to use contraception during the study and for at least 1 month after participating in the study. 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.
  • Renal insufficiency (serum creatinine of 2.0 mg/dL or greater).
  • Serum ALT or AST equal to or greater than 3 times the upper limit of normal; hepatic synthetic insufficiency as defined as a serum albumin of less than 3.3 g/dL; or serum bilirubin of over 2.
  • Adrenal insufficiency
  • Hematocrit of less than or equal to 34%.
  • A history of cerebrovascular disease or coronary artery disease regardless of the time since occurrence.
  • Congestive heart failure, NYHA class III or IV.
  • Cardiac rhythm disturbance characterized by: 2nd or 3rd degree heart block, bradycardia of less than 50 bpm (exception of bradycardia in an aerobic athlete), tachycardia of greater than 100 bpm, or any arrhythmia judged by the investigator to be exclusionary.
  • Any active infection.
  • Visual impairment preventing reading of glucose meter values or continuous glucose monitoring device.
  • Physical impairment impeding the ability to use a glucose meter or glucose monitoring device.
  • Active foot ulceration.
  • Severe peripheral arterial disease characterized by ischemic rest pain or severe claudication.
  • Active alcohol abuse, substance abuse, or severe mental illness (as judged by the principal investigator).
  • Active malignancy, except basal cell or squamous cell skin cancers.
  • Major surgical operation within 30 days prior to screening.
  • Seizure disorder.
  • Any concurrent illness, other than diabetes, that is not controlled by a stable therapeutic regimen.
  • Chronic usage of any immunosuppressive medication (such as cyclosporine, azathioprine, sirolimus, or tacrolimus).
  • Current administration of oral or parenteral corticosteroids.
  • Use of an investigational drug within 30 days prior to screening.
  • Bleeding disorder, treatment with warfarin, or platelet count below 50,000.
  • History of major non-compliance.
  • Allergy to aspart insulin.
  • Allergy to glucagon.
  • Past history of pheochromocytoma or a family history of MEN 2, neurofibromatosis, or von Hippel-Lindau disease.
  • Insulin resistance requiring more than 200 units per day.
  • Need for uninterrupted treatment of acetaminophen.
  • Intolerance of mild hypoglycemia (glucose 60-70 mg/dl).
  • Patients using all dietary supplements (except for vitamin supplements, calcium or vitamin D in standard doses).
  • Patients with a history of glaucoma or who have not had an ophthalmologic exam in the previous 2 years (because of the risk of increased intraocular pressure)
  • Patients with a history of psychiatric disease or steroid-induced psychosis.
  • Patients currently on estrogen supplementation (low dose estrogen contraceptives are not exclusionary).
  • Chronic use of dietary supplements that contain adrenal cell extracts, adrenal cortical extracts, or other hormones.
  • The use of dietary supplements (except for vitamin supplements, calcium or vitamin D in standard doses) will be exclusionary (unless the subjects agrees to abstain from taking such supplements for three weeks before beginning the study.
  • Administration of an immunization (such as a flu or travel immunization) or plans to receive such an immunization within one week of beginning of the study.
  • Any reason the principal investigator deems exclusionary.

Sites / Locations

  • Legacy Good Samaritan Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

FMPD/APD intervention

APD only intervention

Arm Description

Type 1 Diabetes Mellitus subjects who fit the inclusion/exclusion criteria will undergo artificial pancreas closed-loop study for 33 hours. For the first 13 hours, the original artificial pancreas algorithm FMPD, will be used to control the subject's blood glucose. After 13 hours, the adaptive component or APD will be used to control the subject's blood glucose for the remaining 20 hours.

Type 1 Diabetes Mellitus subjects who fit the inclusion/exclusion criteria will undergo artificial pancreas closed-loop study for 33 hours. For the entire study, the adaptive component or APD will be used to control the subject's blood glucose.

Outcomes

Primary Outcome Measures

Measurement of the Effectiveness of APD and FMPD/APD Intervention in Adapting to Reduced Insulin Sensitivity
The effectiveness of the APD and FMPD/APD intervention in adapting to reduced insulin sensitivity was analyzed using mean glucose.

Secondary Outcome Measures

Measurement of APD and FMPD/APD Interventions in Controlling Post-prandial Blood Glucose With Reduced Insulin Sensitivity.
Assessment of control of post prandial hyperglycemia with APD and FMPD/APD interventions using mean post-prandial glucose (3 hours after meals).

Full Information

First Posted
December 15, 2010
Last Updated
November 29, 2012
Sponsor
Legacy Health System
Collaborators
Juvenile Diabetes Research Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT01261052
Brief Title
Real-time Adaptation to Changes in Insulin Sensitivity
Official Title
Sensor-Controlled Insulin and Glucagon Delivery in Subjects With Type 1 Diabetes: Real-time Adaptation to Changes in Insulin Sensitivity
Study Type
Interventional

2. Study Status

Record Verification Date
November 2012
Overall Recruitment Status
Completed
Study Start Date
November 2010 (undefined)
Primary Completion Date
April 2011 (Actual)
Study Completion Date
April 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Legacy Health System
Collaborators
Juvenile Diabetes Research Foundation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this research study is to test an automated blood glucose control system that includes a new component designed to adapt to stress. The importance of this component is that when Type 1 Diabetics are stressed (for example, from illness or infection), their body is resistant to the effects of insulin. The investigators will be adjusting their blood glucose using insulin and glucagon and making their body less sensitive to insulin with a steroid, hydrocortisone. Insulin is a hormone that lowers blood glucose. Glucagon raises blood glucose when it is low. Both are natural hormones made by people without diabetes. Hydrocortisone is a steroid that will increase their blood glucose temporarily and will be given every 4 hours. All subjects will participate in two 33 hour experiments. One experiment will use the adaptive version of the sensor-based glucose control system. The other study will use the original version of the control system, without the adaptive component, for the first 13 hours. Then, the adaptive component will be added to the glucose control system for the remaining 20 hours of the study. Our primary goal is to assess the effectiveness of the adaptive component to control glucose levels in the presence of steroid-induced insulin resistance in persons with Type 1 Diabetes Mellitus.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus
Keywords
glucose sensors, artificial pancreas, Diabetes Mellitus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Randomized
Enrollment
14 (Actual)

8. Arms, Groups, and Interventions

Arm Title
FMPD/APD intervention
Arm Type
Active Comparator
Arm Description
Type 1 Diabetes Mellitus subjects who fit the inclusion/exclusion criteria will undergo artificial pancreas closed-loop study for 33 hours. For the first 13 hours, the original artificial pancreas algorithm FMPD, will be used to control the subject's blood glucose. After 13 hours, the adaptive component or APD will be used to control the subject's blood glucose for the remaining 20 hours.
Arm Title
APD only intervention
Arm Type
Active Comparator
Arm Description
Type 1 Diabetes Mellitus subjects who fit the inclusion/exclusion criteria will undergo artificial pancreas closed-loop study for 33 hours. For the entire study, the adaptive component or APD will be used to control the subject's blood glucose.
Intervention Type
Device
Intervention Name(s)
The Fading Memory Proportional Derivative/Adaptive Proportional Derivative Algorithm
Intervention Description
The APD algorithm is based largely on a program that employs the Fading Memory Proportional Derivative (FMPD) insulin and glucagon infusion algorithm. The FMPD algorithm determines insulin and glucagon delivery rates based on proportional error, defined as the difference between the current glucose level and the target level, and the derivative error, defined as the rate of change of the glucose. The "fading memory" designation refers to weighting recent errors more heavily than remote errors. The APD algorithm, like the FMPD algorithm, will determine insulin and glucagon infusion rates based on sensed glucose values and utilizes the derivative and proportional glucose error to determine delivery rates of insulin. However, the APD algorithm has a model predictive element which also leads to frequent measurement of tissue sensitivity to insulin.
Intervention Type
Device
Intervention Name(s)
The Adaptive Proportional Derivative Algorithm
Intervention Description
The APD algorithm is based largely on a program that employs the Fading Memory Proportional Derivative (FMPD) insulin and glucagon infusion algorithm. The FMPD algorithm determines insulin and glucagon delivery rates based on proportional error, defined as the difference between the current glucose level and the target level, and the derivative error, defined as the rate of change of the glucose. The "fading memory" designation refers to weighting recent errors more heavily than remote errors. The APD algorithm, like the FMPD algorithm, will determine insulin and glucagon infusion rates based on sensed glucose values and utilizes the derivative and proportional glucose error to determine delivery rates of insulin. However, the APD algorithm has a model predictive element which also leads to frequent measurement of tissue sensitivity to insulin.
Primary Outcome Measure Information:
Title
Measurement of the Effectiveness of APD and FMPD/APD Intervention in Adapting to Reduced Insulin Sensitivity
Description
The effectiveness of the APD and FMPD/APD intervention in adapting to reduced insulin sensitivity was analyzed using mean glucose.
Time Frame
all 33 hour studies
Secondary Outcome Measure Information:
Title
Measurement of APD and FMPD/APD Interventions in Controlling Post-prandial Blood Glucose With Reduced Insulin Sensitivity.
Description
Assessment of control of post prandial hyperglycemia with APD and FMPD/APD interventions using mean post-prandial glucose (3 hours after meals).
Time Frame
all 33 hour studies

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Diagnosis of Type 1 Diabetes Mellitus for at least 1 year Male or Female subjects 21 to 65 years of age Willingness to follow all study procedures, including attending all clinic visits Willingness to sign informed consent and HIPAA documents. Exclusion Criteria: Pregnancy or Lactation: For women of childbearing potential: there is a requirement for a negative urine pregnancy test and for agreement to use contraception during the study and for at least 1 month after participating in the study. 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. Renal insufficiency (serum creatinine of 2.0 mg/dL or greater). Serum ALT or AST equal to or greater than 3 times the upper limit of normal; hepatic synthetic insufficiency as defined as a serum albumin of less than 3.3 g/dL; or serum bilirubin of over 2. Adrenal insufficiency Hematocrit of less than or equal to 34%. A history of cerebrovascular disease or coronary artery disease regardless of the time since occurrence. Congestive heart failure, NYHA class III or IV. Cardiac rhythm disturbance characterized by: 2nd or 3rd degree heart block, bradycardia of less than 50 bpm (exception of bradycardia in an aerobic athlete), tachycardia of greater than 100 bpm, or any arrhythmia judged by the investigator to be exclusionary. Any active infection. Visual impairment preventing reading of glucose meter values or continuous glucose monitoring device. Physical impairment impeding the ability to use a glucose meter or glucose monitoring device. Active foot ulceration. Severe peripheral arterial disease characterized by ischemic rest pain or severe claudication. Active alcohol abuse, substance abuse, or severe mental illness (as judged by the principal investigator). Active malignancy, except basal cell or squamous cell skin cancers. Major surgical operation within 30 days prior to screening. Seizure disorder. Any concurrent illness, other than diabetes, that is not controlled by a stable therapeutic regimen. Chronic usage of any immunosuppressive medication (such as cyclosporine, azathioprine, sirolimus, or tacrolimus). Current administration of oral or parenteral corticosteroids. Use of an investigational drug within 30 days prior to screening. Bleeding disorder, treatment with warfarin, or platelet count below 50,000. History of major non-compliance. Allergy to aspart insulin. Allergy to glucagon. Past history of pheochromocytoma or a family history of MEN 2, neurofibromatosis, or von Hippel-Lindau disease. Insulin resistance requiring more than 200 units per day. Need for uninterrupted treatment of acetaminophen. Intolerance of mild hypoglycemia (glucose 60-70 mg/dl). Patients using all dietary supplements (except for vitamin supplements, calcium or vitamin D in standard doses). Patients with a history of glaucoma or who have not had an ophthalmologic exam in the previous 2 years (because of the risk of increased intraocular pressure) Patients with a history of psychiatric disease or steroid-induced psychosis. Patients currently on estrogen supplementation (low dose estrogen contraceptives are not exclusionary). Chronic use of dietary supplements that contain adrenal cell extracts, adrenal cortical extracts, or other hormones. The use of dietary supplements (except for vitamin supplements, calcium or vitamin D in standard doses) will be exclusionary (unless the subjects agrees to abstain from taking such supplements for three weeks before beginning the study. Administration of an immunization (such as a flu or travel immunization) or plans to receive such an immunization within one week of beginning of the study. Any reason the principal investigator deems exclusionary.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
W K Ward, MD
Organizational Affiliation
Legacy Health Research
Official's Role
Principal Investigator
Facility Information:
Facility Name
Legacy Good Samaritan Hospital
City
Portland
State/Province
Oregon
ZIP/Postal Code
97210
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20332355
Citation
Castle JR, Engle JM, El Youssef J, Massoud RG, Yuen KC, Kagan R, Ward WK. Novel use of glucagon in a closed-loop system for prevention of hypoglycemia in type 1 diabetes. Diabetes Care. 2010 Jun;33(6):1282-7. doi: 10.2337/dc09-2254. Epub 2010 Mar 23.
Results Reference
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Real-time Adaptation to Changes in Insulin Sensitivity

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