MMPPC Outpatient Clinical Protocol 2016

Type 1 Diabetes Clinical Trial

— MMPPC  

Official title:

Multiple Model Probabilistic Predictive Control (MMPPC) Outpatient Clinical Protocol

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02769884
• Other study ID #: MMPPC- outpatient-2016
• Status: Completed
• Phase: Phase 2
• First received: May 10, 2016
• Last updated: January 26, 2018
• Start date: July 2016
• Est. completion date: December 2016

Study information

• Verified date: January 2018
• Source: Rensselaer Polytechnic Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study trials a prototype artificial pancreas system that consists of a Roche insulin pump, a Dexcom continuous glucose monitor (CGM), and an experiential MMPPC (multiple model probabilistic predictive control) algorithm housed on an android cell phone. The system doses insulin based on CGM sensor glucose levels and the experimental algorithm.

The aim of this clinical study is to determine the efficacy of the MMPPC controller in adolescents and adults with type 1 diabetes in a hotel setting.

Description:

This study trials a prototype artificial pancreas system that consists of a Roche insulin pump, a Dexcom continuous glucose monitor (CGM), and an experiential MMPPC (multiple model probabilistic predictive control) algorithm housed on an android cell phone. The system doses insulin based on CGM sensor glucose levels and the experimental algorithm. The algorithm runs through a glucose control platform called the DiAs (Diabetes Assistant)

The aim of this study is to determine the safety and feasibility of the MMPPC controller in adults and adolescents with type 1 diabetes testing the use of predefined tuning parameters to provide adaptability to patient. We will assess the safety of the system with both unannounced meals, and meals using a meal announcement with a premeal insulin bolus based on the subject's estimated carbohydrate content of the meal

Recruitment information / eligibility

• Status: Completed
• Enrollment: 10
• Est. completion date: December 2016
• Est. primary completion date: December 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 15 Years to 55 Years

Eligibility

3.1 Eligibility Criteria

1. Clinical diagnosis of type 1 diabetes for at least 12 months 2. Daily insulin therapy for at least 12 months 3. Age between 15.0 to 55.0 years of age 4. Use of an insulin pump for at least 3 months 5. Current use of continuous glucose monitoring with Dexcom sensor 6. Subject comprehends English 7. Females of childbearing potential must use an adequate method of contraception and have a negative pregnancy test 8. Total daily insulin requirement = 0.3 units/kg/day 9. A1C between 7.0 and 10% 3.2 Exclusion Criteria

1. Diabetic ketoacidosis in the past 6 months

2. Hypoglycemic seizure or loss of consciousness in the past 6 months

3. Hypoglycemia unawareness as defined by no recognition of hypoglycemia until the glucose is <60 mg/dL and no adrenergic symptoms at glucose of 60 mg/dL (shakiness, palpitations, diaphoresis). Subjects will also be administered the Clark questionnaire for hypoglycemia unawareness. If they have a score = 4, they are excluded from the study

4. Subjects requiring an intermediate or long-acting insulin (such as NPH, detemir or glargine)

5. Subjects using other anti-diabetic medications other than insulin (oral or injectable) at the time of enrollment. Any prior use of other anti-diabetic medications must be washed out for at least 8 weeks prior to enrollment.

6. Current use of other medications, which in the judgment of the investigator would be a contraindication to participation in the study

7. Subject has a medical disorder that in the judgment of the investigator will affect completion of any aspect of the protocol

8. Subject is currently participating in another investigational device or drug study within 30 days or 5-half lives of the drug.

9. Subject has a history of any cardiac or vascular disorder including, but not limited to, myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, arrhythmia or thromboembolic disease

10. An EKG will be obtained on subjects who are = 45 years of age, or who have had a 20 year history of diabetes and are = 30 years of age. Subjects will be excluded if they have an abnormal EKG consistent with coronary artery disease or increased risk of malignant arrhythmia including, but not limited to, evidence of active ischemia, prior myocardial infarction, proximal LAD critical stenosis (Wellen's sign), prolonged QT interval (> 440 ms). Non-specific ST segment and T wave changes are not grounds for exclusion in the absence of symptoms or history of heart disease.

11. Subject has a history of hepatic disease

12. Subject has renal failure on dialysis

13. Systolic blood pressure > 160 mmHg on screening visit

14. Diastolic blood pressure > 90 mmHg on screening visit

15. Subjects with inadequately treated thyroid disease or celiac disease

16. Subject has a neurologic disorder that in the judgment of the investigator will affect completion of the protocol

17. Subject has received inpatient psychiatric treatment in the past 6 months

18. Subject consumes more than an average of 4 standard alcoholic drinks/day in the last 30 days

19. Subject has an active skin condition that would affect sensor placement

20. Subject is unable to avoid acetaminophen for the duration of the study

21. Subject consuming less than 100g of carbohydrates daily

Related Conditions & MeSH terms

• Diabetes Mellitus, Type 1
• Type 1 Diabetes

Intervention

Device:
• MMPPC algorithm artificial pancreas
An artificial pancreas system using the MMPPC algorithm, Roche insulin pump, and Dexcom CGM

Locations

Country	Name	City	State
n/a

Sponsors (4)

Lead Sponsor	Collaborator
Rensselaer Polytechnic Institute	Mount Sinai Hospital, New York, Stanford University, University of Colorado, Denver

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Comparison of Announced and Unannounced Meals	Glycemic control in the 4 hour period after announced meals will be compared to glycemic control in the 4 hour period after unannounced meals as an exploratory measure	72 hours
Other	Safety Criteria 1: No more than 3 SMBG values < 50 mg/dL per subject	Safety evaluation of system based on SMBG detected severe hypoglycemia	72 hours
Other	Safety Criteria 2: No more than 2 episodes with SMBG value >300 mg/dL for >1 hour not due to infusion set failure per subject	Safety evaluation of system based on SMBG detected hyperglycemia	72 hours
Other	Safety Criteria 3: No kotonemia >1.0 mmol/L, while the system is functional unless related to an intercurrent illness or infusion set failure for any patient	Safety evaluation of system based on ketone detection	72 hours
Other	Safety Criteria 4: No seizures or loss of consciousness while system is on and functional	Safety evaluation of system based on severe hypoglycemic events	72 hours
Primary	Mean CGM glucose value	Average CGm glucose value during the experimental trial	72 hours
Primary	CGM percent time < 60 mg/dl	Percent of time the CGM was reading <60 mg/dl	72 hours
Secondary	CGM percent time < 50 mg/dl	Percent of time the CGM was reading <50 mg/dl	72 hours
Secondary	CGM percent time < 70 mg/dl	Percent of time the CGM was reading <70 mg/dl	72 hours
Secondary	% 70-140 mg/dl	Percent of time CGM glucose levels were between 70-140 mg/dl	72 hours
Secondary	% 70-180 mg/dl	Percent of time CGM glucose levels were between 70-180 mg/dl	72 hours
Secondary	% CGM >180 mg/dl	Percent of time CGM glucose levels were >180 mg/dl	72 hours
Secondary	% CGM >250 mg/dl	Percent of time CGM glucose levels were >250 mg/dl	72 hours
Secondary	number of SMBG <70 mg/dl	Number of self monitored blood glucose levels less than 70 mg/dl	72 hours
Secondary	number of SMBG <60 mg/dl	Number of self monitored blood glucose levels less than 60 mg/dl	72 hours
Secondary	number of SMBG <50 mg/dl	Number of self monitored blood glucose levels less than 50 mg/dl	72 hours
Secondary	Grams of carbs for hypoglycemia	Number of carbohydrates consumed for treatment of hypoglycemia	72 hours
Secondary	Total daily dose of insulin	Total daily dose of insulin	72 hours
Secondary	% time CGM used	Percent of time CGM was used	72 hours
Secondary	% time in closed loop	Percent of time in closed loop	72 hours
Secondary	% of subjects with mean CGM <169 (eHbA1C < 7.5%)	Percentage of subjects with mean CGM value < 169 for the 72 hour period. This corresponds to an estimated hemoglobin A1c of <7.5%.	72 hours