- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04016662
Automated Insulin Delivery in Elderly With Type 1 Diabetes (AIDE T1D) (AIDE T1D)
A Randomized Cross-over Trial Evaluating Automated Insulin Delivery Technologies on Hypoglycemia and Quality of Life in Elderly Adults With Type 1 Diabetes
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Automated insulin delivery (AID) technologies hold the promise of optimizing glycemic control and reducing the burden of diabetes care for patients with Type 1 Diabetes (T1D). However, clinical trials of lower burden AID technologies have not included older adults in sufficient numbers to allow for focused evaluation of efficacy and quality of life (QOL) impacts that may differ from those observed in younger age groups. Most notably, primary endpoints have focused on reducing hyperglycemia, while avoidance of hypoglycemia is of upmost concern for older adults with T1D. T1D Exchange clinic registry data have shown severe hypoglycemia (SH) occurs more commonly in older adults with longstanding T1D than in younger individuals with events occurring just as often with HbA1c levels >8.0% as with HbA1c levels <7.0%. These data do not support the strategy of "raising the HbA1c" as being an effective approach for hypoglycemia prevention in older adults with T1D. In addition to acutely altered mental status, hypoglycemia is associated with an increased risk for falls leading to fractures, car accidents, emergency room (ER) visits, hospitalizations, and mortality resulting in substantial societal costs. The occurrence of hypoglycemia, hypoglycemia unawareness and fear of hypoglycemia have adverse effects on overall QOL of both individuals with T1D and their families.
While continuous glucose monitoring (CGM) technology alone has the potential to be beneficial in reducing hypoglycemia in older patients, our preliminary data from the Wireless Innovations for Seniors with Diabetes Mellitus (WISDM) trial shows a majority of patients still have frequent hypoglycemia even when using CGM. Thus, knowledge of CGM alone may not be sufficient to avoid hypoglycemia in this population. Predictive low-glucose suspend algorithms have particular promise when the primary goal is hypoglycemia avoidance rather than glucose reduction. Whether the added complexity of closed loop systems provides additional glycemic benefit is not known. There is a critical need to determine whether automated insulin delivery can reduce hypoglycemia in the older adult population with T1D.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Kamille Janess
- Phone Number: 8139758690
- Email: kjaness@jaeb.org
Study Contact Backup
- Name: Robert Henderson
- Phone Number: 8139758690
Study Locations
-
-
Florida
-
Orlando, Florida, United States, 32803
- AdventHealth Diabetes Institute
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905
- Mayo Clinic
-
-
New York
-
Syracuse, New York, United States, 13214
- SUNY Upstate
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19104
- University of Pennsylvania
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Clinical diagnosis of type 1 diabetes
- Age ≥ 65 years old
- T1D Duration of at least 1 year
- HbA1c < 10.0% from point of care or local lab within the past 6 months
- Insulin regimen involves basal/bolus insulin via insulin pump or multiple daily injections
- Most recent GFR ≥ 30 ml/min/m^2 from local lab within the past 6 months
- Willingness to use a rapid acting insulin compatible with the Tandem t:slim X2 pump (currently aspart and lispro; other rapid acting insulins likely to be approved for pump use prior to study initiation such as Fiasp)
- Familiarity with and willingness to use a carbohydrate ratio for meal boluses
- Willing to use study devices and automated insulin delivery features
- Ability to download study devices at home or if not able to download at home willing to come into clinic to bring devices for download of data at visits and as needed for safety
- Participant is independently managing his/her diabetes with respect to insulin administration and glucose monitoring (may include assistance from spouse or other caregiver)
- Participant understands the study protocol, agrees to comply with it and is able to successfully pass the consent understanding assessment with no more than 2 attempts
- Participant comprehends written and spoken English
- At least 240 hours of CGM readings available during the end of run-in assessment
- At least 1.5% of time with CGM glucose levels < 70 mg/dL prior to SAP initiation
- Active prescription for glucagon and willing and able to have glucagon available
Exclusion Criteria:
- Use of PLGS technology or HCL insulin delivery in the past 1 month
- History of 1 or more Diabetic Ketoacidosis episodes in the previous 6 months
- Clinical diagnosis by a primary care provider, neurologist or psychiatrist of dementia, in the investigator's opinion a suspected severe cognitive impairment such that it would preclude ability to understand the study or use devices, or a score of 6 or less out of 15 on the 5 min MoCA (5-min T MoCA Version 2.1) (mild cognitive impairment is not an exclusion)
- A condition, which in the opinion of the investigator or designee, would put the participant or study at risk, including severe vision or hearing impairment and any contraindication to the use of any of the study devices per FDA labeling
- Known adhesive allergy or skin reaction during the run-in pre-randomization phase or previous difficulty with pump and CGM insertions that would preclude participation in the randomized trial
- Concurrent use of any non-insulin glucose-lowering agent other than metformin (including GLP-1 agonists, Symlin, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylureas)
- Stage 4 or 5 renal disease
- The presence of a significant medical or psychiatric condition or use of a medication that in the judgment of the investigator may affect completion of any aspect of the protocol, or is likely to be associated with life expectancy of <1 year
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Hybrid Closed Loop Control (HCL)
The HCL intervention arm will utilize the Tandom t:slim X2 with Control-IQ Technology and Dexcom G6 CGM
|
The system components include the t:slim X2 with Control-IQ Technology and the Dexcom CGM G6. The modular control algorithm has a safety supervision module that limits insulin delivery to prevent hypoglycemia at all times. The algorithm gradually decreases hyperglycemia from bedtime to reach a target of 120 mg/dL by waking time. During awake hours, the control algorithm attempts to maintain glucose within a target range (112.5 to 160 mg/dL) with meal time insulin boluses delivered based on usual bolus procedures undertaken by patients on an insulin pump (Hybrid closed loop). The system components include the t:slim X2 with with Basal-IQ Technology and the Dexcom CGM G6. The PLGS System is able to stop and resume basal insulin delivery automatically in response to predicted or low sensor glucose values, thereby reducing the incidence and duration of hypoglycemic episodes. The pump includes the hypoglycemia minimization strategy that will issue insulin delivery commands.
Other Names:
|
Active Comparator: Predictive Low-Glucose Insulin Suspension (PLGS)
The PLGS intervention arm will utilize the Tandom t:slim X2 with Basal-IQ Technology and Dexcom G6 CGM
|
The system components include the t:slim X2 with Control-IQ Technology and the Dexcom CGM G6. The modular control algorithm has a safety supervision module that limits insulin delivery to prevent hypoglycemia at all times. The algorithm gradually decreases hyperglycemia from bedtime to reach a target of 120 mg/dL by waking time. During awake hours, the control algorithm attempts to maintain glucose within a target range (112.5 to 160 mg/dL) with meal time insulin boluses delivered based on usual bolus procedures undertaken by patients on an insulin pump (Hybrid closed loop). The system components include the t:slim X2 with with Basal-IQ Technology and the Dexcom CGM G6. The PLGS System is able to stop and resume basal insulin delivery automatically in response to predicted or low sensor glucose values, thereby reducing the incidence and duration of hypoglycemic episodes. The pump includes the hypoglycemia minimization strategy that will issue insulin delivery commands.
Other Names:
|
No Intervention: Sensor-Augmented Pump (SAP)
The SAP arm will utilize the Tandem t:slim X2 without HCL or PLGS features turned on and Dexcom G6 CGM
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
CGM Measured Time <70 mg/dL
Time Frame: 12 weeks for each arm of the crossover
|
Percentage of sensor glucose values <70 mg/dL
|
12 weeks for each arm of the crossover
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hypoglycemia
Time Frame: 12 weeks for each arm of the crossover
|
Percentage of sensor glucose values <54 mg/dL
|
12 weeks for each arm of the crossover
|
Hypoglycemia
Time Frame: 12 weeks for each arm of the crossover
|
Frequency of CGM-measured hypoglycemic events
|
12 weeks for each arm of the crossover
|
Glucose Control
Time Frame: 12 weeks for each arm of the crossover
|
Mean glucose
|
12 weeks for each arm of the crossover
|
Glucose Control
Time Frame: 12 weeks for each arm of the crossover
|
Percentage of sensor glucose values 70 to 180 mg/dL
|
12 weeks for each arm of the crossover
|
Glucose Control
Time Frame: 12 weeks for each arm of the crossover
|
Coefficient of variation
|
12 weeks for each arm of the crossover
|
Hyperglycemia
Time Frame: 12 weeks for each arm of the crossover
|
Percentage of values >180 mg/dL
|
12 weeks for each arm of the crossover
|
Hyperglycemia
Time Frame: 12 weeks for each arm of the crossover
|
Percentage of values >250 mg/dL
|
12 weeks for each arm of the crossover
|
HbA1c
Time Frame: 12 weeks for each arm of the crossover
|
HbA1c
|
12 weeks for each arm of the crossover
|
Hypoglycemia Unawareness
Time Frame: 12 weeks for each arm of the crossover
|
Gold survey
|
12 weeks for each arm of the crossover
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Reported Questionnaires
Time Frame: 12 weeks for each arm of the crossover
|
Hypoglycemia Fear Survey
|
12 weeks for each arm of the crossover
|
Patient Reported Questionnaires
Time Frame: 12 weeks for each arm of the crossover
|
Hypoglycemia Confidence
|
12 weeks for each arm of the crossover
|
Patient Reported Questionnaires
Time Frame: 12 weeks for each arm of the crossover
|
Diabetes Distress Scale.
6-point scale from not a problem to a very serious problem.
A high total DD score may indicate overall severity.
|
12 weeks for each arm of the crossover
|
Patient Reported Questionnaires
Time Frame: 12 weeks for each arm of the crossover
|
AIDE Technology Acceptance is based on the Technology Acceptance Model.
5-point scale from strongly disagree to strongly agree.
A high score may indicate acceptance of technology.
|
12 weeks for each arm of the crossover
|
Patient Reported Questionnaires
Time Frame: 12 weeks for each arm of the crossover
|
System Usability.
5-point scale from strongly disagree to strongly agree.
A high score may indicate ease of system usability.
|
12 weeks for each arm of the crossover
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Robert Henderson, MS, Jaeb Center for Health Research
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- AIDE T1D
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
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.
Clinical Trials on Type 1 Diabetes Mellitus
-
SanofiCompletedType 1 Diabetes Mellitus-Type 2 Diabetes MellitusHungary, Russian Federation, Germany, Poland, Japan, United States, Finland
-
University of Colorado, DenverMassachusetts General Hospital; Beta Bionics, Inc.CompletedDiabetes Mellitus, Type 1 | Type 1 Diabetes | Diabetes type1 | Type 1 Diabetes Mellitus | Autoimmune Diabetes | Diabetes Mellitus, Insulin-Dependent | Juvenile-Onset Diabetes | Diabetes, Autoimmune | Insulin-Dependent Diabetes Mellitus 1 | Diabetes Mellitus, Insulin-Dependent, 1 | Diabetes Mellitus, Brittle | Diabetes Mellitus, Juvenile-Onset and other conditionsUnited States
-
University of California, San FranciscoJuvenile Diabetes Research FoundationCompletedType 1 Diabetes Mellitus | Diabetes Mellitus, Type I | Insulin-Dependent Diabetes Mellitus 1 | Diabetes Mellitus, Insulin-Dependent, 1 | IDDMUnited States, Australia
-
AstraZenecaCompletedType 2 Diabetes Mellitus | Type 1 Diabetes MellitusUnited States
-
Capillary Biomedical, Inc.TerminatedType 1 Diabetes | Type 1 Diabetes Mellitus | Diabetes Mellitus, Type I | Diabetes Mellitus, Insulin-Dependent, 1 | IDDMAustria
-
National Institute of Allergy and Infectious Diseases...PPD; Rho Federal Systems Division, Inc.; Immune Tolerance Network (ITN)CompletedType 1 Diabetes Mellitus | T1DM | T1D | New-onset Type 1 Diabetes MellitusUnited States, Australia
-
Shanghai Changzheng HospitalRecruitingBrittle Type 1 Diabetes MellitusChina
-
Capillary Biomedical, Inc.CompletedDiabetes Mellitus, Type 1 | Type 1 Diabetes | Type 1 Diabetes Mellitus | Diabetes Mellitus, Insulin-Dependent, 1Australia
-
Spiden AGDCB Research AGRecruitingType 1 Diabetes Mellitus | Type 1 Diabetes Mellitus With Hypoglycemia | Type 1 Diabetes Mellitus With HyperglycemiaSwitzerland
-
Hoffmann-La RocheRoche DiagnosticsCompletedDiabetes Mellitus Type 2, Diabetes Mellitus Type 1Germany
Clinical Trials on Tandom t:slim X2 with HCL or PLGS
-
University of VirginiaNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); DexCom... and other collaboratorsCompletedType 1 Diabetes MellitusUnited States
-
Tandem Diabetes Care, Inc.University of California, San DiegoCompleted
-
University of VirginiaNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); DexCom... and other collaboratorsCompleted
-
Marc BretonNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Tandem... and other collaboratorsCompletedType 1 DiabetesUnited States
-
Kinderkrankenhaus auf der BultCompletedType 1 Diabetes | Insulin TherapyGermany
-
Tandem Diabetes Care, Inc.CompletedType 1 DiabetesUnited States
-
Oregon Health and Science UniversityUniversity of Washington; MultiCare Rockwood Northpointe Specialty CenterRecruiting
-
University of VirginiaRecruiting
-
Tandem Diabetes Care, Inc.CompletedType 1 DiabetesUnited States
-
Tandem Diabetes Care, Inc.Eli Lilly and Company; Jaeb Center for Health ResearchCompleted