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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT05481034
Other study ID # SMASH
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date January 11, 2023
Est. completion date September 29, 2023

Study information

Verified date October 2023
Source Insel Gruppe AG, University Hospital Bern
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of the study is to examine whether a simplified meal approach (as compared to exact carbohydrate counting) can alleviate the need of carbohydrate counting without worsening postprandial control in youth and young adults with type 1 diabetes using hybrid closed-loop insulin delivery with the Cambridge Artificial Pancreas FX System (CamAPS FX system).


Description:

Optimal glycaemic control is the aim of diabetes care and critical in the prevention of diabetes-related complications. Despite advances in diabetes technologies and medications, many current youth and young adults (YYA) with type 1 diabetes (T1D) are not meeting desired glycaemic targets, representing a missed opportunity for improving lifetime outcomes. A variety of factors including peer group influences, importance of body image, less parental oversight, greater risk-taking, and performance pressure challenge daily self-management in YYA with T1D. Disengagement from care and barriers for optimal glycaemic management in YYA have been mainly shown to be substantially influenced by perceived burden of daily tasks. Although the recently introduced closed-loop systems, which link insulin delivery to sensor glucose levels, offer promising opportunities to improve glucose control in YYA with T1D, they still require the user to estimate carbohydrates. The perceived burden of exact carbohydrate counting (ECC), the limited evidence supporting its glycaemic benefit and corrective potential of algorithm-driven background insulin titration question its necessity during hybrid-closed loop insulin treatment. Instead, a simplified meal approach (SMA), which only requires the user to select the meal carbohydrate category (small/medium/large), has the potential to alleviate the burden of ECC during hybrid closed-loop insulin therapy whilst resulting in similar glycaemic benefits. The investigators therefore hypothesize that a simplified meal approach (SMA) using the CamAPS FX system would achieve comparable glucose control compared with the use of the CamAPS FX system with ECC in YYA with T1D.


Recruitment information / eligibility

Status Completed
Enrollment 46
Est. completion date September 29, 2023
Est. primary completion date September 29, 2023
Accepts healthy volunteers No
Gender All
Age group 12 Years to 20 Years
Eligibility Inclusion Criteria: - Written informed consent - Type 1 diabetes as defined by the World Health Organization for at least 6 months - Age between 12 and 20 years (inclusive) - Proficient use of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) for at least 5 days in the past - Glycated hemoglobin A1c (HbA1c) =12% - The participant is willing to wear closed-loop devices - The participant is willing to follow study specific instructions - Negative urine-pregnancy test in sexually active female participants of childbearing potential at screening-visit Exclusion Criteria: - Any physical or psychological disease or condition likely to interfere with the normal conduct of the study and interpretation of the study results - Known or suspected allergy against insulin - Participant is pregnant or breast feeding or planning pregnancy within next 6.5 months - Severe visual impairment - Severe hearing impairment - Lack of reliable telephone facility for contact - Concomitant participation in another trial that interferes with the normal conduct of the study and interpretation of the study results - Participant not proficient in German

Study Design


Intervention

Device:
SMA bolus option
SMA comprises the selection of predefined carbohydrate quantities for meal insulin dosing. Meal carbohydrate contents will be set on an individual basis at the baseline visit.
Exactly estimated carbohydrate content bolus option
The carbohydrate content of meals is estimated in grams of carbohydrates prior to a meal bolus

Locations

Country Name City State
Switzerland Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland Bern
Switzerland Department of Paediatric Endocrinology and Diabetes, University Children's Hospital Zurich Zürich

Sponsors (2)

Lead Sponsor Collaborator
Lia Bally University of Zurich

Country where clinical trial is conducted

Switzerland, 

Outcome

Type Measure Description Time frame Safety issue
Other Total daily basal insulin dose Mean total daily basal insulin dose infused From the first day of the respective study period to 3 months thereafter
Other Total daily bolus insulin dose Mean total daily bolus insulin dose infused From the first day of the respective study period to 3 months thereafter
Other Percentage of time of closed-loop operation including engagement with specific functionalities Utility evaluation From the first day of the respective study period to 3 months thereafter
Other Diabetes Distress Scale Measurement of distress associated with the use of closed-loop insulin delivery using the Diabetes Distress questionnaire At the predefined study visit 3 months after the start of the respective period.
Other Hypoglycaemia confidence scale HCS is a 9-item self-report scale that examines the degree to which people with diabetes feel able, secure, and comfortable regarding their ability to stay safe from hypoglycemic-related problems At the predefined study visit 3 months after the start of the respective period.
Other Psychosocial factors important to quality of life These factors include anxiety, stress, depressions, etc. At the predefined study visit 3 months after the start of the respective period.
Other Food Frequency Questionnaire to assess dietary intake habits Dietary intake (quantity and quality) At the predefined study visit 3 months after the start of the respective period.
Other Number of severe hypoglycaemia events Hypoglycaemia requiring third-party assistance to administer carbohydrates or other resuscitative action From the first day of the respective study period to 3 months thereafter
Other Diabetic ketoacidosis ADA definition From the first day of the respective study period to 3 months thereafter
Other Significant ketonaemia Value > 3.0 mmol/L From the first day of the respective study period to 3 months thereafter
Other Nature and severity of adverse events AE including SADE and SAE From the first day of the respective study period to 3 months thereafter
Primary Percentage of time with sensor glucose measurements between 3.9 and 10.0 mmol/L The percentage of time with sensor glucose measurements between 3.9 and 10.0 mmol/L will be compared between both intervention arms. Primary analysis will be carried out according to a non-inferiority framework. From the first day of the respective study period to 3 months thereafter
Secondary Time spent with sensor glucose values above target (>10.0 mmol/L) Percentage of time spent with sensor glucose values above target (>10.0 mmol/L) From the first day of the respective study period to 3 months thereafter
Secondary Time spent with sensor glucose values >13.9 mmol/L (%) Percentage of time spent with sensor glucose values >13.9 mmol/L (%) From the first day of the respective study period to 3 months thereafter
Secondary Time spent with sensor glucose measurements < 3.9 mmol/L The percentage of time with sensor glucose measurements < 3.9 mmol/L (%) From the first day of the respective study period to 3 months thereafter
Secondary Time spent with sensor glucose measurements < 3.0 mmol/L The percentage of time with sensor glucose measurements < 3.0 mmol/L (%) From the first day of the respective study period to 3 months thereafter
Secondary Time spent with sensor glucose measurements between < 3.9 mmol/L and 7.8 mmol/L (%) The percentage of time with sensor glucose between < 3.9 mmol/L and 7.8 mmol/L (%) From the first day of the respective study period to 3 months thereafter
Secondary Mean sensor glucose level (mmol/L) Mean of all sensor glucose levels (mmol/L) From the first day of the respective study period to 3 months thereafter
Secondary HbA1c Glycated hemoglobin A1c (%) At baseline and at the predefined study visits (3 months after the start of the respective periods)
Secondary Mean peak postprandial glucose Mean peak postprandial glucose (mmol/L) assessed within 180min following main meals (defined as carbohydrate amounts >25g entered into the CamAPS app by the participants). From the first day of the respective study period to 3 months thereafter
Secondary Coefficient of sensor glucose variation (%) Coefficient of sensor glucose variation (%) From the first day of the respective study period to 3 months thereafter
Secondary Standard deviation of sensor glucose variation (mmol/L) Standard deviation of sensor glucose variation (mmol/L) From the first day of the respective study period to 3 months thereafter
Secondary Glucose Management Indicator (%) Glucose Management Indicator (%) From the first day of the respective study period to 3 months thereafter
Secondary Number of clinically significant hypoglycaemia (number of events with sensor glucose <3.9 mmol/L for at least 15min) Number of events with sensor glucose <3.9 mmol/L for at least 15min From the first day of the respective study period to 3 months thereafter
Secondary Extended hypoglycaemia event rate (number of events with sensor glucose <3.9 mmol/L lasting at least 120min) Number of events with sensor glucose <3.9 mmol/L lasting at least 120min From the first day of the respective study period to 3 months thereafter
Secondary Extended hyperglycaemia event rate (number of events with sensor glucose >13.9 mmol/L lasting at least 120min) Number of events with sensor glucose >13.9 mmol/L lasting at least 120min From the first day of the respective study period to 3 months thereafter
Secondary Proportion of participants with sensor glucose in the target range (3.9 - 10.0 mmol/L for >70% of the time. Proportion of participants with sensor glucose in the target range (3.9 - 10.0 mmol/L for >70% of the time. From the first day of the respective study period to 3 months thereafter
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