Short Term Closed-loop Glucose Control in Adults With Type 1 Diabetes

Overview

The main objective of this study is to determine the feasibility, efficacy and safety of automated closed-loop glucose control in the home setting over a short term period. The data and experienced gained from this study will be utilised in planning future home studies. This is an open-label, three centre, randomised, crossover design, involving two, 8 day (first day in the clinical research facility and seven days at home) study periods during which glucose levels will be controlled either by an automated closed-loop system or by subjects usual insulin pump therapy in random order. A total of up to 24 adults (aiming for 18 completed subjects) aged 18 years and older with T1D on insulin pump therapy will be recruited through diabetes clinics and other established methods in participating centres. Subjects will receive appropriate training in the safe use of closed-loop insulin delivery system. During the 24 hour in-patient stay subjects will be encouraged to mimic their usual day and will be allowed to walk inside hospital premises. Subjects will be advised to discontinue automated closed-loop insulin delivery and follow their usual insulin pump therapy for periods of strenuous exercise during the 7 day home study phase. The primary outcome is time spent in target range between 3.9 and 10.0 mmol/L as recorded by CGM (adjusted for potential over-estimation) during home stay. Secondary outcomes are the time spent with glucose levels above and below target, as recorded by CGM, and other CGM-based metrics, and for the stay at the clinical research facility, time spent in the target range, above and below the target range as measured by plasma glucose.

Full Title of Study: “An Open-label, Three-centre, Randomised, Two-period Crossover Study to Assess the Safety, Efficacy and Utility of Automated Closed-loop Glucose Control in Comparison With Continuous Subcutaneous Insulin Infusion Combined With Continuous Glucose Monitoring in Adults With Type 1 Diabetes – A Combined Clinical Research Facility and Home Study”

Study Type

• Study Type: Interventional
• Study Design
  • Allocation: Randomized
  • Intervention Model: Crossover Assignment
  • Primary Purpose: Treatment
  • Masking: None (Open Label)
• Study Primary Completion Date: November 2013

Interventions

• Device: FlorenceD or similar closed loop glucose control system
  • Subject’s glucose level will be controlled by the FlorenceD or similar automated closed loop glucose control system. The system comprises of FreeStyle Navigator® Continuous Glucose Monitoring (CGM) System (Abbott Diabetes Care, Alameda, CA, USA), Dana R Diabecare subcutaneous insulin infusion pump (Sooil Corp. Seoul, South Korea)or similar insulin pump, and MPC-based glucose control algorithm running on a portable computer.
• Device: CSII with real-time CGM
  • Subject glucose level controlled by usual insulin pump therapy in conjunction with real time continuous glucose monitoring (CGM)

Arms, Groups and Cohorts

• Experimental: Closed Loop Glucose control
  • Subject’s glucose level is controlled by the automated closed loop glucose control system
• Active Comparator: CSII with real-time CGM
  • Subject glucose level controlled by usual insulin pump therapy in conjunction with real time continuous glucose monitoring (CGM)

Clinical Trial Outcome Measures

Primary Measures

• Time spent in the target glucose range from 3.9 to 10.0 mmol/l based on subcutaneous glucose monitoring (CGM) adjusted for sensor error.
  • Time Frame: 7 day home study period

Secondary Measures

• Time spent above and below the target glucose (3.9 to 10.0 mmol/l) based on continuous subcutaneous glucose monitoring (CGM)
  • Time Frame: 7 day home study period
• Average and standard deviation glucose levels based on continuous subcutaneous glucose monitoring
  • Time Frame: 7 day home study period
• The time with glucose levels < 3.5 mmol/l and <2.8 mmol/l based on continuous subcutaneous glucose monitoring
  • Time Frame: 7 Day home study period
• The time with glucose levels in the significant hyperglycaemia, as based on continuous subcutaneous glucose monitoring (glucose levels > 16.7 mmol/l)
  • Time Frame: 7 day home study period
• Low Blood Glucose Index (LBGI) based on continuous subcutaneous glucose monitoring
  • Time Frame: 7 day Home study period
• During 24 hour in-patient stay – Same glucose metrics as during 7 day home stay but calculated based on continuous subcutaneous glucose monitoring (CGM) and plasma glucose measurements.
  • Time Frame: 24 hours
• Number of episodes of hypoglycaemia, severe hypoglycaemia as well as nature and severity of any other adverse events.
  • Time Frame: 8 days

Participating in This Clinical Trial

Inclusion Criteria

1. The subject has type 1 diabetes as defined by WHO 2. The subject is 18 years of age or older 3. The subject will have been on an insulin pump for at least 3 months currently using insulin Aspart, with good knowledge of insulin self-adjustment including carbohydrate counting 4. HbA1c ≤ 10 % based on analysis from local laboratory 5. The subject is willing to perform regular finger-prick blood glucose monitoring, with at least 6 measurements per day during the 7 day home phase of the study 6. The subject is willing to wear closed-loop system at home and at work place 7. The subject is willing to follow study specific instructions 8. The subject is literate in English 9. Female subjects of child bearing age should be on effective contraception and must have a negative urine-HCG pregnancy test at screening. In addition in Germany, women of childbearing potential must use a highly effective method of birth control, which is defined as those which result in a low failure rate (i.e. less than 1% per year) and must use two independent methods of contraception, e.g. diaphragm and spermicide-coated condom. Exclusion Criteria:

1. Non-type 1 diabetes mellitus 2. Any other physical or psychological disease or condition likely to interfere with the normal conduct of the study and interpretation of the study results 3. Current treatment with drugs known to have significant interference with glucose metabolism, such as systemic corticosteroids, as judged by the investigator 4. Known or suspected allergy against insulin 5. Subjects with clinically significant nephropathy, neuropathy or proliferative retinopathy as judged by the investigator 6. Significantly reduced hypoglycaemia awareness as judged by the investigator 7. Total daily insulin dose more than 2 IU/kg/day 8. Subject is pregnant or breast feeding or planning pregnancy in near future (within next 3 months) 9. Severe visual impairment 10. Severe hearing impairment 11. Subjects using implanted internal pacemaker 12. Lack of reliable telephone facility for contact Additional exclusion criteria specific for Austria and Germany 1. Positive results on urine drug screen (amphetamines/metamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, opiates). 2. Positive alcohol breath test. Additional exclusion criteria specific for Germany only Positive reaction to any of the following tests: hepatitis B surface (HBs) antigen, anti-hepatitis C virus (anti-HCV) antibodies, anti-human immunodeficiency virus (HIV) 1 antibodies, anti-HIV2 antibodies -

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

• Lead Sponsor
  • University of Cambridge
• Collaborator
  • Cambridge University Hospitals NHS Foundation Trust
• Provider of Information About this Clinical Study
  • Principal Investigator: Dr Roman Hovorka, Principal Research Associate – University of Cambridge
• Overall Official(s)
  • Mark Evans, FRCP (UK) MD, Principal Investigator, University of Cambridge
  • Sabine Arnolds, MD, Principal Investigator, Profil Institut für Stoffwechselforschung GmbH
  • Thomas Pieber, MD, Principal Investigator, Medical University of Graz
  • Roman Hovorka, PhD, Study Director, University of Cambridge

References

Hovorka R, Allen JM, Elleri D, Chassin LJ, Harris J, Xing D, Kollman C, Hovorka T, Larsen AM, Nodale M, De Palma A, Wilinska ME, Acerini CL, Dunger DB. Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomised crossover trial. Lancet. 2010 Feb 27;375(9716):743-51. doi: 10.1016/S0140-6736(09)61998-X. Epub 2010 Feb 4.

Hovorka R, Kumareswaran K, Harris J, Allen JM, Elleri D, Xing D, Kollman C, Nodale M, Murphy HR, Dunger DB, Amiel SA, Heller SR, Wilinska ME, Evans ML. Overnight closed loop insulin delivery (artificial pancreas) in adults with type 1 diabetes: crossover randomised controlled studies. BMJ. 2011 Apr 13;342:d1855. doi: 10.1136/bmj.d1855.