Wireless Innovation for Seniors With Diabetes Mellitus

Type 1 Diabetes Mellitus Clinical Trial

— WISDM  

Official title:

Wireless Innovation for Seniors With Diabetes Mellitus (WISDM)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03240432
• Other study ID #: WISDM
• Status: Completed
• Phase: N/A
• Start date: September 26, 2017
• Est. completion date: September 10, 2019

Study information

• Verified date: September 2019
• Source: Jaeb Center for Health Research
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The primary objective of the study is to determine if CGM can reduce hypoglycemia and improve quality of life in older adults with T1D.

Description:

Reducing hypoglycemia is an important aspect of management of T1D in older adults, many of whom have hypoglycemic unawareness, cognitive impairment, or both. CGM offers the opportunity to reduce hypoglycemia and its related complications such as fractures from falls and hospitalizations and improve quality of life including reducing hypoglycemic fear and diabetes distress. Despite these potential benefits, CGM is used by only a small proportion of older adults with T1D. Previous studies assessing CGM efficacy have included only a small number of adults ≥ 60 years of age, excluded patients most prone to severe hypoglycemia, focused on improving HbA1c rather than hypoglycemia, and used older generation CGM sensors. These studies are not generalizable to the population of older adults with T1D. The potential benefit of CGM in reducing hypoglycemia in the older adult population has not been well studied. The goal of this study is to assess the potential benefits and risks of CGM in older adults with T1D.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 200
• Est. completion date: September 10, 2019
• Est. primary completion date: June 6, 2019
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 60 Years and older

Eligibility

Inclusion Criteria:

To be eligible for the study, all participants must meet the following criteria:

1. Clinical diagnosis of insulin dependent presumed autoimmune type 1 diabetes by the investigator and meeting at least one of the following criteria:

i. Age > 6 months and < 10 years old at diagnosis OR ii. Positive pancreatic autoantibodies at any time (GAD-65, IA-2, ICA or ZnT8) or positive anti-insulin autoantibody at diagnosis only (within 10 days of starting insulin) OR iii. Presence of 2 or more of the following clinical indicators suggestive of type 1 diabetes:

1. Age at diagnosis < 40 years

2. Non-obese at diagnosis according to BMI (< 95th percentile pediatric and < 30 kg/m2 adult)

3. Diabetic ketoacidosis (DKA) at any time,

4. Plasma C-peptide level < 0.8 ng/ml (with blood glucose > 80 mg/dL if available) at any time

5. Family history of type 1 diabetes in a first degree relative (parent, sibling, or child).

2. Age =60 years

3. HbA1c <10.0% at screening or within 30 days prior to screening visit (the upper limit was selected as a surrogate measure of likelihood of adherence to the protocol with the belief that those with higher HbA1c levels are generally noncompliant with diabetes management and thus not good candidates for the trial)

4. Insulin regimen involves either use of an insulin pump (a minimum of 40% of study population) or multiple daily injections of insulin (minimum of 40% of study population).

5. Participant is able to manage his/her diabetes with respect to insulin administration and glucose monitoring (which may include assistance from spouse or other caregiver)

6. Participant understands the study protocol and agrees to comply with it

7. Participant comprehends written and spoken English

8. At least 240 hours (10 out of 14 days) of sensor glucose data with appropriate number of calibrations from the blinded CGM pre-randomization phase

Exclusion Criteria:

Individuals meeting any of the following exclusion criteria at baseline will be excluded from study participation.

1. Use of unblinded CGM, outside of a research study, as part of real-time diabetes management in the last 3 months

2. At least 10% of time spent with sensor glucose levels < 54 mg/dl during the blinded CGM screening period AND a severe hypoglycemic event in the past 6 months (a severe hypoglycemic event that required assistance of another person due to altered consciousness, and required another person to actively administer carbohydrate, glucagon, or other resuscitative actions (see section 8.1).

3. Extreme visual or hearing impairment that would impair ability to use real-time CGM assessed at screening visit

4. Known adhesive allergy or skin reaction during the blinded CGM pre-randomization phase that would preclude participation in the randomized trial

5. Plans to begin non-insulin medication for blood glucose lowering during the course of the study

6. Stage 4 or 5 renal disease or most recent GFR < 30 ml/min/m2 from local lab within the past 6 months

7. The presence of a significant medical or psychiatric condition or use of a medication that in the judgment of the investigator may affect completion of any aspect of the protocol, or is likely to be associated with life expectancy of <1 year.

8. Clinical diagnosis of dementia (cognitive impairment that is mild and not considered sufficient for diagnosis of dementia is acceptable)

9. Need for use of acetaminophen or acetaminophen-containing products on a regular basis during the 6 months of the trial (unless stipulation no longer required with use of newer generation sensors)

10. Inpatient psychiatric treatment in the past 6 months

11. Participation in an intervention study (including psychological studies) in past 6 weeks.

12. Expectation that participant will be moving out of the area of the clinical center during the next 6 months, unless the move will be to an area served by another study center.

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 1
• Type 1 Diabetes Mellitus

Intervention

Device:
• Dexcom CGM
CGM group will be instructed on how to utilize the CGM data for diabetes management. Participants will be encouraged to use CGM values for making diabetes management decisions and will be provided guidelines for when to confirm with a study BGM fingerstick.

Locations

Country	Name	City	State
United States	University of Michigan	Ann Arbor	Michigan
United States	Atlanta Diabetes Associates	Atlanta	Georgia
United States	University of Colorado - Barbara Davis Center	Aurora	Colorado
United States	University of Southern California	Beverly Hills	California
United States	University of North Carolina	Chapel Hill	North Carolina
United States	Northwestern University	Chicago	Illinois
United States	University of Chicago	Chicago	Illinois
United States	Henry Ford Health System	Detroit	Michigan
United States	Scripps Whittier Diabetes Institute	La Jolla	California
United States	University of Miami	Miami	Florida
United States	International Diabetes Center	Minneapolis	Minnesota
United States	Columbia University - Naomi Berrie Diabetes Center	New York	New York
United States	Icahn School of Medicine at Mount Sinai	New York	New York
United States	Florida Hospital Diabetes Institute	Orlando	Florida
United States	University of Pennsylvania	Philadelphia	Pennsylvania
United States	Oregon Health & Science University	Portland	Oregon
United States	Mayo Clinic	Rochester	Minnesota
United States	Washington University	Saint Louis	Missouri
United States	University of Washington Diabetes Care Center	Seattle	Washington
United States	SUNY Upstate Medical University	Syracuse	New York
United States	Iowa Diabetes and Endocrinology Research Center	West Des Moines	Iowa
United States	University of Massachusetts	Worcester	Massachusetts

Sponsors (3)

Lead Sponsor	Collaborator
Jaeb Center for Health Research	Juvenile Diabetes Research Foundation, The Leona M. and Harry B. Helmsley Charitable Trust

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Rate of episodes of severe hypoglycemia	A hypoglycemic event will be defined as severe low blood sugar requiring assistance of another person due to altered or loss of consciousness. The rate of episodes will be tabulated and assessed using a regression model adjusted for baseline number of events.	baseline to 6 months (26 weeks)
Other	Rate of episodes of diabetic ketoacidosis events	A diabetic ketoacidosis event will be defined as hyperglycemia meeting all of the following criteria: Symptoms such as polyuria, polydipsia, nausea, or vomiting; Serum ketones >1.5 mmol/L or large/moderate urine ketones; Either arterial blood pH <7.30 or venous pH <7.24 or serum bicarbonate <15; and; Treatment provided in a health care facility; The rate of episodes of diabetic ketoacidosis will be tabulated and assessed using a regression model adjusted for baseline number of events.	baseline to 6 months (26 weeks)
Other	Number of falls	The number of falls and any resulting injuries will be tabulated and compared between treatment groups using a Fisher's exact test.	baseline to 6 months (26 weeks)
Other	Number of ER visits	The number of ER visits will be tabulated and compared between treatment groups using a Fisher's exact test.	baseline to 6 months (26 weeks)
Other	Number of hospitalizations	The number of hospitalizations will be tabulated and compared between treatment groups using a Fishers's exact test.	baseline to 6 months (26 weeks)
Other	Number of device-related adverse events	The study investigator will determine if an adverse event (severe hypoglycemic events, diabetic ketoacidosis events, falls, hospitalizations, ER visits, etc.) may have been caused by the study intervention (CGM) by any of the following: Component disconnections; CGM sensors lasting fewer than 7 days; CGM tape adherence issues; Battery lifespan deficiency due to inadequate charging or extensive wireless communication; Intermittent device component disconnections/communication failures not leading to system replacement; Device issues clearly addressed in the user guide manual that do not require additional troubleshooting; Skin reactions from CGM sensor placement that don't meet criteria for AE reporting; The number of device-related adverse events will be tabulated and compared between treatment groups using a Fisher's exact test.	baseline to 6 months (26 weeks)
Other	Hyperglycemia: time >180 mg/dL	Time spent >180 mg/dL will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Hyperglycemia: time >250 mg/dL	Time spent >250 mg/dL will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Hyperglycemia: time >300mg/dL	Time spent >300mg/dL will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Hyperglycemia: area under the curve 180 mg/dL	The area under the curve for 180 mg/dL will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Hyperglycemia: high blood glucose index	High blood glucose index will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Time in range 70-180 mg/dL	The time in range (70-180 mg/dL) will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Mean glucose	Mean glucose will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Other	Glycemic variability (coefficient of variation)	Glycemic variability will be compared between groups using the methods described above for the primary objective.	6 months (26 weeks) from baseline
Primary	Time spent with glucose level <70 mg/dL	The primary outcome will be a treatment group comparison of the percentage of sensor values in the hypoglycemic range (<70 mg/dL), adjusted for the baseline values and factors used to stratify randomization in a regression model. Residual values will be examined for an approximate normal distribution. If values are highly skewed, then a transformation or non-parametric methods will be used instead. The BGM Group will be wearing a blinded CGM for one week at 3 time points in the study (in addition to baseline). For analysis, sensor data from the CGM Group will be used from these same time periods to match up with the blinded CGM placed for the BGM Group. The CGM data will be pooled across each time point of CGM data collection for the primary analysis.	6 months (26 weeks) from baseline
Secondary	Change in HbA1c	Mean ± SD values for the change in HbA1c from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be computed for each randomization group and compared in a regression model adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: Preferring Hypoglycemia Scale	Mean ± SD values for the change in total score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: Blood glucose Monitoring Satisfaction Questionnaire	Mean ± SD values for the change in total score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: Hypoglycemia Fear Survey	Mean ± SD values for the change in total score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: Diabetes Distress Questionnaire	Mean ± SD values for the change in total score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: PROMIS Measures for QOL	Mean ± SD values for the change in total score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: NIH Cognitive Toolbox	Mean ± SD values for the change in total score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Change in QOL: NIH Emotions Toolbox	Mean ± SD values for the change in total and composite score from baseline to 26-weeks with 95% confidence intervals or percentiles appropriate to the distribution will be reported for each randomization group, and compared in linear regression models adjusted for baseline level and factors used to stratify randomization.	6 months (26 weeks) from baseline
Secondary	Time spent with glucose level <60 mg/dL	Analyses will be similar to the primary objective.	6 months (26 weeks) from baseline
Secondary	Time spent with glucose level <54 mg/dL	Analyses will be similar to the primary objective.	6 months (26 weeks) from baseline