Integration of Continuous Glucose Monitoring Into a BiHormonal Closed-Loop Artificial Pancreas (CL2)

October 13, 2017 updated by: Edward R. Damiano, Boston University Charles River Campus

Integration of Continuous Glucose Monitoring Into a Bi-Hormonal Closed-Loop Artificial Pancreas for Automated Management of Type 1 Diabetes

The investigators hypothesize that our closed-loop glucose-control system can provide BG control in subjects with type 1 diabetes using the estimated BG signal from a CGM as the input signal to the controller.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

To test the safety and efficacy of our control system in the bi-hormonal configuration in regulating BG in adults (18 years of age or older) and in children (12-17 years of age) with type 1 diabetes based on interstitial-fluid (ISF) glucose data from a CGM. Experiments will be 51 hours in length incorporating 6 meals and two (night) sleep periods. In order to evaluate the effect of exercise on BG control, the last 48 hours of the experiment will be divided into two 24 hour blocks, the second of which will contain a period of structured exercise near the beginning of the block.

Study Type

Interventional

Enrollment (Actual)

24

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Massachusetts
      • Boston, Massachusetts, United States, 02114
        • Massachusetts General Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

12 years and older (ADULT, OLDER_ADULT, CHILD)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age 12 years or older with clinical type 1 diabetes for at least one year
  • Weight > 41 kg
  • Otherwise healthy (mild chronic disease allowed if well controlled)
  • Diabetes managed using an insulin infusion pump and rapid- or very-rapid-acting insulins
  • Body mass index (BMI) between 20 and 35 for subjects >18 years of age or BMI between the 5th and 95th percentile for age for subjects < 18 years of age
  • Total daily dose (TDD) of insulin that is < 1 U/kg
  • Stimulated C-peptide < 0.1 nmol/L at 90 minutes after liquid mixed meal by DCCT protocol
  • Hemoglobin A1c <= 9%
  • Prescription medication regimen stable for 1 month

Exclusion Criteria:

  • Unable to provide informed consent for subjects > 18 years of age or unable to provide assent if < 18 years of age
  • Unable to comply with study procedures
  • Current participation in another diabetes-related clinical trial other than one that is primarily observational in nature. Potential subjects enrolled in trials of passive monitoring equipment are not excluded.
  • Anemia (HCT less than normal for age and sex)
  • Alanine aminotransferase > 3 fold above upper limit of normal
  • Untreated or inadequately treated hyperthyroidism or hypothyroidism
  • Pregnancy
  • Renal insufficiency (creatinine clearance ≤ 50 ml/min)
  • Any known history of coronary artery disease
  • Abnormal EKG including, but not limited to evidence of active ischemia, prior myocardial infarction, proximal LAD critical stenosis (Wellen's sign), arrhythmia, tachycardia, and prolonged QT interval (> 440 ms)
  • Congestive heart failure
  • History of TIA or stroke
  • Acute illness or exacerbation of chronic illness
  • History of seizures
  • History of pheochromocytoma (fractionated metanephrines will be tested in patients with history suggestive of pheochromocytoma)
  • History of adrenal disease or tumor
  • History of pancreatic tumor, including insulinoma
  • History of impaired gastric motility or gastroparesis requiring pharmacological or surgical treatment
  • Current alcohol abuse (intake averaging > 3 drinks daily in last 30 days) or substance abuse (any use within the last 6 months of controlled substances without a prescription)
  • Untreated or inadequately treated mental illness (indicators would include symptoms such as psychosis, hallucinations, mania, and any psychiatric hospitalization in the last year)
  • Impaired cognition or altered mental status.
  • Hypertension (blood pressure > 140/90 or > 95% for age, height and weight in subjects < 18 years of age) at the time of screening
  • Use of medications that reduce gastric motility (e.g. narcotics, anti-spasmodics, anticholinergics).
  • Electrically powered implants (e.g. cochlear implants, neurostimulators) that might be susceptible to RF interference
  • Use non-insulin, injectable anti-diabetic medications
  • History of adverse reaction to glucagon (including allergy) besides nausea and vomiting.
  • Established history of latex, adhesive, or tape allergy
  • Inadequate venous access
  • History of allergy to aspirin or any history of aspirin intolerance, including Reye syndrome, or gastric ulcer or bleeding associated with salicylates
  • Blood dyscrasia or bleeding diathesis, such as hemophilia, Von Willebrands disorder, and idiopathic thrombocytopenic purpura (ITP)
  • Peptic ulcer
  • Unable to perform 30 minutes of moderate exercise on a treadmill or exercise bicycle
  • Unable or unwilling to discontinue dietary supplements for at least 2 weeks prior to each CRC admission
  • History of celiac disease

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Bi-hormonal with meal-priming bolus
The first meal-priming bolus was solely based on weight (0.05 U/kg), after which meal-priming boluses were automatically adapted by the control system online targeting 75% of the anticipated insulin needed in the first four hours after the start of the meal
Device: Bi-hormonal (insulin and glucagon) artificial pancreas
Subjects wore a bionic pancreas consisting of a continuous glucose monitor, an insulin pump and a glucagon pump
EXPERIMENTAL: Bi-hormonal without meal-priming bolus
The insulin controller was entirely reactive to CGMG; there were no meal priming boluses and no meal announcements
Device: Bi-hormonal (insulin and glucagon) artificial pancreas
Subjects wore a bionic pancreas consisting of a continuous glucose monitor, an insulin pump and a glucagon pump

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Mean Plasma Blood Glucose Achieved by the Bionic Pancreas (mg/dl)
Time Frame: 48 hours
48 hours

Secondary Outcome Measures

Outcome Measure
Time Frame
Percentage of Time Spent With Blood Glucose < 60 mg/dl
Time Frame: 48 hours
48 hours
Percentage of Time Spent With Blood Glucose <70 mg/dl
Time Frame: 48 hours
48 hours
Percentage of Time Spent With Blood Glucose 70-180 mg/dl
Time Frame: 48 hours
48 hours
Insulin Total Daily Dose
Time Frame: 48 hours
48 hours
Number of Carbohydrate Interventions for Hypoglycemia
Time Frame: 48 hours
48 hours
Number of Blood Glucose Events < 70 mg/dl
Time Frame: 48 hours
48 hours
Nadir Blood Glucose in Each Arm
Time Frame: 48 hours
48 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Boston University Charles River Campus

Collaborators

Massachusetts General Hospital
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Juvenile Diabetes Research Foundation
The Leona M. and Harry B. Helmsley Charitable Trust

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2010

Primary Completion (ACTUAL)

December 1, 2012

Study Completion (ACTUAL)

June 1, 2013

Study Registration Dates

First Submitted

July 12, 2010

First Submitted That Met QC Criteria

July 13, 2010

First Posted (ESTIMATE)

July 14, 2010

Study Record Updates

Last Update Posted (ACTUAL)

November 14, 2017

Last Update Submitted That Met QC Criteria

October 13, 2017

Last Verified

October 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • H-29293
  • 1R01DK085633-01 (NIH)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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