Type 1 Diabetes Clinical Trial
Official title:
A Comparison of Two Sensor-Augmented Glycemic Control Systems in Persons With Type 1 Diabetes Mellitus: Subcutaneous (SC) Insulin and Glucagon Delivery vs. SC Insulin Only
This study aims to test an insulin and glucagon delivery algorithm designed to be used in conjunction with a continuous glucose monitoring system. This combined glucose sensing/hormone delivery approach is a step on the way to eventual development of an artificial (or automated) pancreas. The insulin and glucagon delivery algorithm is based on the difference between the current blood glucose and the target glucose (proportional error) and the rate of change in blood glucose (derivative error), both adjusted for the recent glucose history. This algorithm is called the Fading Memory Proportional-Derivative (FMPD) Algorithm. The principal investigator of this study has published previous research regarding the use of this algorithm and found it to be well-suited to control blood glucose in type 1 diabetic animals. The addition of glucagon was helpful; better glycemic control with fewer glucose excursions were observed when small intermittent infusions of subcutaneous glucagon were given during times of impending low blood sugar (Ward et al. 2008).
The objective of the current human study is to compare glycemic control in persons with Type
1 Diabetes using the FMPD Insulin plus Glucagon Delivery Algorithm vs. the FMPD
Insulin-Alone Algorithm. Subjects will undergo two 28-hour sensor-augmented glycemic control
studies. Each subject will be fitted with two short term continuous glucose monitoring
systems and two subcutaneous (SC) infusion catheters. These catheters will allow for SC
delivery of insulin and glucagon (or insulin plus a glucagon placebo). The accuracy of the
wire sensors will be verified every 10 minutes with a venous blood glucose test. For the
first 4 hours, the insulin and glucagon delivery will be controlled by venous blood in order
to assess and compare the accuracy of the two sensors, after which the more accurate sensor
(if it remains accurate) will control the FMPD algorithm. The main outcomes of our study are
time spent in the target range (70 - 180 mg/dl) and the percentage of studies requiring
intervention due to hypoglycemia (glucose < 70 mg/dl). The accuracy of the sensors over the
life of the study will also be evaluated.
The specific system used in this study of frequent blood testing and the use of two separate
infusion pumps is not feasible for every day use for individuals with diabetes. However, if
the glucose control algorithm (with or without the use of glucagon) provides effective blood
glucose management over long time periods the calculation program may be integrated into a
continuous blood glucose monitoring system with an insulin and glucagon pump.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment
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