Comparison of Two Closed-Loop Strategies for Glucose Control in Type 1 Diabetes The DREMED Trail- 2

Type 1 Diabetes Clinical Trial

Official title:

Comparison of Two Closed-Loop Strategies for Glucose Control in Type 1 Diabetes The DREMED Trail- 2

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02776696
• Other study ID #: rmc082315ctil
• Status: Completed
• Phase: N/A
• Start date: June 2016
• Est. completion date: August 14, 2019

Study information

• Verified date: September 2018
• Source: Rabin Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of the study is to compare two closed-loop strategies in terms of glycemic control in Type 1 Diabetes during a camp setting.

The proposed study is a four-segment feasibility study. One segment is a proof of concept study (with two parts) conducted as in-patient clinic study ,the second segment is two-arms, cross-over, randomized and single-center and the third segment is four-arms, parallel, randomized and single-center, in diabetes camp study in subjects with type 1 diabetes on insulin pump therapy and the forth segment is a single arm feasibility in a diabetes camp setting followed by a 3 weeks period at home.

Segment 1 will be divided into two parts: part 1 is a single arm pilot study aim to asses logistical and safety issues in 12 patients and part 2 is a randomized cross over study aim to evaluate glucose performance using closed-loop control. Part 2-is a randomized cross-over (two arms) in-patient study: A total of 12 patients will participate in this part of the study. Following the run-in period subjects will be randomized to participate in two periods of closed-loop treatment, each period will last 36 hours in hospital setting. During the first period, glycemic control will be controlled by the Hybrid closed-loop system and during the second period by Hybrid Logic closed-loop system. The sequence of treatment first period HCL therapy than AHCL or vice versa will be randomly assigned.

Segment 2 is a randomized cross-over (two arms) Camp Study including up to 30 patients. Following the run-in period subjects will be randomized to participate in two periods of closed-loop treatment, each period will last 2days in a camp setting, the total duration of the camp will be up to 6 days. In one period, glycemic control will be controlled by the Hybrid closed-loop system and another period by Hybrid Logic closed-loop system. The sequence of treatment first period HCL therapy than AHCL or vice versa will be randomly assigned.

Segment 3 is a randomized, parallel (four arm) Camp Study including up to 80 patients. Following the run-in period subjects will be randomized to participate in one of 4 intervention arms of closed-loop treatment in camp settings. The duration of the camp will be 12 days in which glycemic control will be controlled by one of 4 versions of closed-loop system: Hybrid Closed Loop (HCL) or one of 3 versions of Advanced Hybrid Closed Loop (AHCL).

Segment 4 is a single arm, feasibility study in a diabetes camp setting followed by a three week period at home. After the completion of segments 1-3, the AHCL system will be optimized and a new version of the system will be created for use in segment 4. Up to 20 subjects will participate in this part of the study. Following a minimum of 5 days run-in period, subjects will be placed in a camp setting and closed loop will be initiated. Subjects will remain in closed loop for 5 days and will have 3 days of challenges, including missed meal bolus, late meal bolus and moderate-intensity exercise. At the conclusion of the camp, subjects will continue to use the system at home in Auto Mode for a period of 21 days.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 90
• Est. completion date: August 14, 2019
• Est. primary completion date: August 14, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 10 Years to 40 Years

Eligibility

Inclusion Criteria:

• Diabetes duration > 1 year since diagnosis

• Pump therapy for at least 6 months and experience with sensor use

• Age10-40 years: Age 10-30 for segments 1-3, Age 14-40 for segment 4.

• 7>HbA1c <10.0 at time of screening visit for segments 1 and 2, <10.0 at segments 3 and 4.

• Willing to follow study instructions

• Willing to perform = 3 finger stick blood glucose measurements daily

• Willing to perform required sensor calibrations

• Patient capable of reading and understand instructions in English

• Willing to have an adult experienced in the management of diabetes to live with during the outpatient phase of the protocol.

Exclusion Criteria:

• Subject is unable to tolerate tape adhesive in the area of sensor placement

• Subject has any unresolved adverse skin condition in the area of sensor or device placement

• Subject is actively participating in an investigational study (drug or device) wherein they have received treatment from an investigational study (drug or device) in the last 2 weeks

• Subject has a positive pregnancy screening test

• Subject is female, sexually active without the use of contraception, and plans/able to become pregnant during the course of the study and is not using an acceptable method of contraception

• Subject has had a hypoglycemic seizure within the past 6 months prior to screening visit

• Subject has had hypoglycemia resulting in loss of consciousness within the past 6 months prior to screening visit

• Subject has had an episode of diabetic ketoacidosis (DKA) within the past 6 months prior to screening visit

• Subject has a history of a seizure disorder

• Subject has central nervous system or cardiac disorder resulting in syncope

• Subject has a history of myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack (TIA), cerebrovascular accident (CVA), angina, congestive heart failure, ventricular rhythm disturbances or thromboembolic disease

• Subjects with hematocrit lower than the normal reference range per local lab testing

• Subjects with a history or findings on screening electrocardiogram of any cardiac arrhythmia

• Subjects with a history of adrenal insufficiency

• Subjects with history of migraines that have occurred at least 2 times in the last 3 months prior to enrollment

• Any disease or condition that may influence the HbA1c testing

• Subject needs to travel by air during the study duration.

Related Conditions & MeSH terms

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

Intervention

Device:
• Advanced Hybrid Closed Loop System

• Hybrid Closed Loop System

Locations

Country	Name	City	State
Israel	Schneider Children's Medical Center	Petach-Tikva

Sponsors (1)

Lead Sponsor	Collaborator
Rabin Medical Center

Country where clinical trial is conducted

Israel, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentage of glucose sensor readings within 70 to 180 mg/dl		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Area Under the Curve of glucose sensor readings below 70 mg/dl		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Percentage of glucose sensor readings below 70 mg/dl		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Area Under the Curve of glucose sensor readings above 180 mg/dl		Day 21 for segments 1-3 and day 31 for segment 4
Secondary	Percentage of glucose sensor readings above 180 mg/dl		Day 20
Secondary	Average of glucose sensor readings		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Standard Deviation of glucose sensor readings		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Time in glucose range of 70-180 mg/dl during day time (6am-12am)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Time in glucose range of 70-180 mg/dl during night time (12am-6am)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Area Under the Curve of glucose sensor readings above 250 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Area Under the Curve of glucose sensor readings above 300 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Percentage of glucose sensor readings above 250 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Percentage of glucose sensor readings above 300 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Area Under the Curve of glucose sensor readings below 50 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Area Under the Curve of glucose sensor readings below 60 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Percentage of glucose sensor readings below 50 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Percentage of glucose sensor readings below 60 mg/dL		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Percentage of time in Closed Loop		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Sensor mean absolute relative difference (MARD)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Total insulin dose		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Serious Adverse Events (SAE)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Serious Adverse Device Events (SADE)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Unanticipated Adverse Device Effects (UADE)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Incidence of Severe Hypoglycemia		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Incidence of Diabetic Ketoacidosis (DKA)		Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion
Secondary	Closed-loop acceptance questionnaire	The questionnaire contains 5 sections evaluating the user acceptance of the study devise (general satisfaction, comparison to previous treatment, importance of the system, expectations from the system and suggestions for improvement) each section consists of 1-31 questions each, with specific scales for each of the questions. Subscales are not combined to compute a total score.	Day 21 for segments 1-3 , day 5 for segment 4 camp portion and day 31 for segment 4 home portion