- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03130101
Insulin Management for Exercise in Patients With Type 1 Diabetes
OmniPod®-Type 1 Diabetes Insulin Management for Exercise Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This project focuses on the effectiveness of various basal insulin reductions on the time spent in target range during and after aerobic exercise in adults with type 1 diabetes (T1D) on OmniPod® insulin pump therapy. The OmniPod® is a Health Canada approved tubing-free insulin pump device that uses an insulin delivery 'pod' and a Personal Diabetes Manager (PDM). The PDM is a wireless handheld device that programs the pod, captures diabetes management events (food, exercise, etc.), and acts as a glucose meter.
The primary objective of the protocol is to determine if a moderate basal insulin reduction (-50% of basal), performed 90-minutes before a 75-minute aerobic exercise session (with three 5-minute breaks), improves the time in target range compared to either a more aggressive basal rate reduction (-80%) or complete pump suspension at the onset of exercise in patients with T1D on continuous subcutaneous insulin infusion (CSII) therapy. The time in target will be determined for both the exercise period and during a three-hour window after a standardized meal ingestion performed 30-minutes after the end of exercise.
In all three sessions, aerobic exercise (brisk walking/light jogging) will be performed in the post-absorptive state, ~ four hours after the last meal with their usual bolus insulin given. The exercise will consist of four 15-minute bouts of jogging at 50-60% of the participant's pre-determined aerobic capacity, separated by three 5-minute breaks (to simulate what is typically done in most team and individual workouts and sports). The subjects exercise intensity will be monitored continuously using heart rate and activity monitors.
Each participant will be assigned to a sequence of the three experimental visits through a randomization process. Each exercise session will be separated by at least three days and participants will be expected to complete all sessions within ~ 12 weeks from the time of the baseline/screening visit. Participants will be advised to avoid any vigorous exercise within 24 hours before or after the laboratory-based exercise tests. Subjects will be asked about activity during each clinic visit and phone call to monitor adherence to these recommendations.
Following each exercise session, the participant will rest for 30-minutes and then consume a standardized meal (50 g of carbohydrate, ~17g protein and ~8g of fat, Lean Cuisine). The amount of bolus insulin given at the post-exercise meal will be based on the carbohydrate content of the meal and the patient's own individualized insulin to carbohydrate ratio, and insulin sensitivity index and glycemic targets on their OmniPod® PDM, corrected to 75% of total dose to account for the increase in insulin sensitivity post-exercise. Insulin "corrections" will be given based on the patient's own OmniPod® settings (i.e. usual care). Insulin will be administered 10-minutes before the start of consuming the meal. If hypoglycemia occurs prior to the meal (blood glucose ≤ 3.9 mmol/L), subjects will be treated with 16 grams of fast-acting carbohydrates (Dex4, AMG Medical) prior to meal consumption.
The participant will be monitored for at least three hours after the standardized meal prior to discharge. Continuous glucose monitoring (CGM) low- and high-glucose 'alerts' will be activated. They will also be instructed to perform a standardized basal insulin reduction overnight to help reduce the risk of post-exercise nocturnal hypoglycemia (-20% from bedtime for 6 hours).
CGM sensors will be removed the next day at home and patients will be instructed to perform data upload using the appropriate websites (i.e. Dexcom Share/Clarity). The participant will bring the device to the next visit or an investigator will arrange for pickup.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Ontario
-
Toronto, Ontario, Canada, M3J 1P3
- York University
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Clinical diagnosis of presumed autoimmune type 1 diabetes, receiving daily insulin
- Last A1C ≤ 9.9%
- Age: 18-65 years
- Duration of T1D: ≥ 2 years
- Using CSII via OmniPod® for at least 1 month (~50:50 bolus basal insulin ratio and on at least .25 units of insulin per kilogram body mass per day)
- Body mass index (BMI) < 30 kg/m2
- In good general health with no conditions that could influence the outcome of the trial, and in the judgment of the investigator is a good candidate for the study based on review of available medical history, physical examination and clinical laboratory evaluations
- Willing to adhere to the protocol requirements for the duration of the study
Exclusion Criteria:
- Physician diagnosis of active diabetic retinopathy (proliferative or hemorrhage in past 6 months) that could potentially be worsened by exercise
- Physician diagnosis of peripheral neuropathy with insensate feet
- Physician diagnosis of autonomic neuropathy
- Medications: Beta blockers, agents that affect hepatic glucose production such as beta adrenergic agonists, xanthine derivatives, Pramlinitide, any other hypoglycemic agent
- Participation in other studies involving administration of an investigational drug or device at the time of screening for the current study or planning to participate in another such study during participation in the current study
- Severe hypoglycemic event defined as the individual requiring third party assistance or hospitalization in the last 3 months
Study Plan
How is the study designed?
Design Details
- Primary Purpose: OTHER
- Allocation: RANDOMIZED
- Interventional Model: CROSSOVER
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
OTHER: 80% basal insulin reduction
|
Individual with type 1 diabetes on insulin pump therapy typically lower their basal insulin delivery for exercise.
This study will compare 3 common strategies of basal insulin reductions for 75 minutes of aerobic exercise.
|
OTHER: 50% basal insulin reduction
|
Individual with type 1 diabetes on insulin pump therapy typically lower their basal insulin delivery for exercise.
This study will compare 3 common strategies of basal insulin reductions for 75 minutes of aerobic exercise.
|
OTHER: 100% basal insulin reduction
|
Individual with type 1 diabetes on insulin pump therapy typically lower their basal insulin delivery for exercise.
This study will compare 3 common strategies of basal insulin reductions for 75 minutes of aerobic exercise.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time in interstitial glucose target range (CGM analysis)
Time Frame: Approximately 4-5 hours
|
The primary outcome for this study will be the time spent in target range during the 75-minute exercise session and during the three hours post-meal recovery period using CGM analysis.
For this, interstitial glucose levels will be classified as below target, in target, or above target range.
|
Approximately 4-5 hours
|
Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- e2017 - 073
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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