Feasibility Study of a Modular Control to Range System in Type 1 Diabetes Mellitus - Full Text View

Purpose

In this protocol the investigators plan to demonstrate the feasibility of a modular insulin management system based on continuous glucose monitoring and targeted towards the avoidance of hypoglycemic and prolonged hyperglycemic episodes (i.e. control to range). The protocol is designed to challenge the insulin management system with meals and mild exercise, so as to demonstrate its capacity to avoid large glucose excursion with changing metabolic state. This system is designed to both

monitor the meal boluses of the patient and correct it in case of observed/predicted under insulinization (avoidance of prolonged hyperglycemia), based on a coarse and subjective knowledge of the meal amount, a precise understanding of the subject's day to day insulin treatment, continuous glucose monitoring, and past insulin injections;
predict and avoid hypoglycemic events, based on continuous glucose reading and past insulin injection.

The investigators plan to enroll 12 adult Type 1 Diabetes Mellitus (T1DM) patients (expected retention 10/12) and compare glucose control performances under two treatments: standard vs. the new insulin management system. The protocol will include a total of 6 admissions per subject (4 out-patients and 2 in-patients): screening, effort test, CGM insertion 1, inpatient 1, CGM insertion 2, and inpatient 2. During the 24h inpatient admissions, the patients will be challenged with 30 minutes of mild exercise and 3 meals, insulin coverage of these events will vary depending on the chosen treatment, each subject will be exposed to both studied treatments (repeated measure design).The order of treatment during the inpatient admissions will be randomized.

Condition	Intervention
Type 1 Diabetes Mellitus	Procedure: Closed-Loop System Procedure: Open-Loop System

Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Crossover Assignment Masking: Open Label Primary Purpose: Supportive Care
Official Title:	Feasibility Study of a Modular Control to Range System in T1DM

Resource links provided by NLM:

Genetics Home Reference related topics: type 1 diabetes

MedlinePlus related topics: Diabetes Diabetes Medicines Diabetes Type 1

U.S. FDA Resources

Further study details as provided by University of Virginia:

Primary Outcome Measures:

Number of hypoglycemic events below 70 mg/dL per patient per day [ Time Frame: 24h ] [ Designated as safety issue: Yes ]
Hypoglycemic event is defined as consecutive YSI plasma glucose measurements below 70 or moderate hypoglycemia symptoms

Secondary Outcome Measures:

Percent time in euglycemia [ Time Frame: 24h ] [ Designated as safety issue: No ]
Percent of time the patient plasma glucose as measured by YSI is between 70mg/dl and 180mg/dl
Mean glucose [ Time Frame: 24h ] [ Designated as safety issue: No ]
Average plasma glucose concentration in mg/dl

Enrollment:	9
Study Start Date:	October 2009
Study Completion Date:	December 2010
Primary Completion Date:	December 2010 (Final data collection date for primary outcome measure)

Intervention Details:

In this study, the researchers compared the management of diabetes during physical activity and meals with the closed-loop system developed at the University of Virginia. This Control to Range System uses two DexComTM Seven Continuous Glucose Monitor, a computer containing an investigational control algorithm (well-defined instructions that are expressed in mathematical equations), and an OmniPod Insulin Management System, a portable subcutaneous (under the skin) insulin pump. During the closed-loop admission, the computer used CGM values to make recommendations of insulin treatment based on the algorithms.

This admission was to assess the subjects' level of glucose control and created a base to compare the performance of the closed-loop system. Subjects monitored their own blood glucose values and administer their basal/bolus as they would at home. Subjects use their own pump. Otherwise, the admission remained the same as in the closed-loop admission (i.e. meals, exercise, etc...).

Eligibility

Ages Eligible for Study:	21 Years to 65 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

21 years of age and up to and including 65 years of age.
Have Type 1 Diabetes Mellitus as defined by American Diabetes Association criteria or judgment of physician for at least 2 years (including those who may also be treated with metformin, thiazolidinedione, exenatide, or pramlintide).
Use of an insulin pump
If on antihypertensive, thyroid, anti-depressant or lipid lowering medication, have stability on the medication for at least 2 months prior to enrollment in the study
Willingness to use lispro (Humalog) insulin for the duration of the inpatient study
Demonstration of proper mental status and cognition for the study
Willingness to stop using any dietary supplements for two weeks prior to admission and for the duration of their participation.

Exclusion Criteria:

Age <21or >65
Pregnancy
Hematocrit <36% (females); <38% (males)
HemoglobinA1c > 10.0
Symptomatic coronary artery disease (e.g. history of myocardial infarction, history of acute coronary syndrome, history of therapeutic coronary intervention, history of coronary bypass or stenting procedure, stable or unstable angina, episode of chest pain of cardiac etiology with documented EKG changes, positive stress test or catheterization with coronary blockages >50%).
Use of a medication that significantly lowers heart rate (beta blockers, reserpine, guanethidine, methyldopa, clonidine, cimetidine, digitalis, calcium channel blockers, amiodarone, antiarrythmic drugs, or lithium)
Congestive heart failure
History of a cerebrovascular event
Use of a medication that significantly impacts glucose metabolism (oral steroids)
Atrial fibrillation
Uncontrolled hypertension (resting blood pressure >140/90)
History of a systemic or deep tissue infection with methicillin- resistant staph aureus or Candida albicans
Use of a device that may pose electromagnetic compatibility issues and/or radiofrequency interference with the FreeStyle NavigatorTM CGM (implantable cardioverter-defibrillator, electronic pacemaker, neurostimulator,intrathecal pump, and cochlear implants)
Active enrollment in another clinical trial
Allergy or adverse reaction to lispro insulin
Known adrenal gland problem, pancreatic tumor, or insulinoma
Current alcohol abuse by patient history, substance abuse by patient history, or severe mental illness
Retinopathy and renal failure
Uncontrolled anxiety or panic disorder
Known bleeding diathesis or dyscrasia
Renal insufficiency (creatinine >1.5)
Any comorbid condition affecting glucose metabolism

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01418703

Locations

United States, Virginia
University of Virginia Health System
Charlottesville, Virginia, United States, 22904

Sponsors and Collaborators

University of Virginia

Abbott Diabetes Care

Insulet Corporation

DexCom, Inc.

University of California, Santa Barbara

Investigators

Principal Investigator:

Marc D Breton, Ph.D.

University of Virgnia - School of Medicine, Psychiatry and Neurobehavioral Sciences

More Information

No publications provided

Responsible Party:	Marc Breton, Associate Professor, University of Virginia
ClinicalTrials.gov Identifier:	NCT01418703 History of Changes
Other Study ID Numbers:	14356
Study First Received:	July 8, 2011
Last Updated:	September 14, 2011
Health Authority:	United States: Food and Drug Administration United States: Institutional Review Board

Additional relevant MeSH terms:

Diabetes Mellitus
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases

Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases

ClinicalTrials.gov processed this record on May 16, 2013

Feasibility Study of a Modular Control to Range System in Type 1 Diabetes Mellitus (MDB003)