- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04025762
24/7 Closed-loop in Older Subjects With Type 1 Diabetes (DAN06)
An Open-label, Multi-centre, Randomised, Two-period, Crossover Study to Assess the Efficacy, Safety and Utility of 16 Week Day and Night Automated Closed-loop Glucose Control Under Free Living Conditions Compared to Sensor Augmented Insulin Pump Therapy in Older Adults With Type 1 Diabetes.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
No study thus far has specifically evaluated use of closed-loop insulin delivery in older adults with type 1 diabetes. During our previous closed-loop studies, if there is a communication failure between the algorithm device and the insulin pump, the pump is set to deliver pre-programmed basal insulin rates after about 30 to 60 minutes.The main objective of this study is to determine whether automated day and night closed-loop insulin delivery for 16 weeks under free living conditions is safer and more efficacious compared to sensor augmented insulin pump therapy in older adults with type 1 diabetes.
This is an open-label, multi-centre, randomised, crossover design study, involving a 4-6 week run-in period, followed by two 4 months study periods during which glucose levels will be controlled either by an automated closed-loop system or by sensor-augmented pump therapy in random order. A total of up to 42 adults (aiming for 36 completed subjects) aged 60 years and older with T1D on insulin pump therapy will be recruited through diabetes clinics and other established methods in participating centres. Subjects who drop out of the study within the first 6 weeks of the first intervention period will be replaced.
Subjects will receive appropriate training in the safe use of closed-loop insulin delivery system. Subjects will have regular contact with the study team during the home study phase including 24/7 telephone support.
The primary outcome is time spent in target range between 3.9 and 10.0 mmol/L (70 and 180mg/dl) as recorded by CGM. Secondary outcomes are the HbA1c, time spent with glucose levels above and below target, as recorded by CGM, and other CGM-based metrics. Measures of human factor assessments, cardiac arrhythmia and objective sleep quality assessment will also be evaluated in this study.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Cambridge, United Kingdom, CB2 0QQ
- Cambridge University Hospitals NHS Foundation Trust
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Manchester, United Kingdom
- Manchester Royal Infirmary
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 60 years and above
- Type 1 diabetes as defined by WHO for at least 1 year or confirmed C-peptide negative
- On insulin pump for at least 3 months with good knowledge of insulin self-adjustment
- Treated with one of the U-100 rapid acting insulin analogues only (insulin Aspart, Lispro, Faster insulin Aspart but not Glulisine)
- Willing to perform regular capillary blood glucose monitoring
- HbA1c ≤ 10% (86 mmol/mmol) based on analysis from central laboratory or equivalent
- Literate in English
- Having a care partner who is aware of the subject's location and is trained to administer intramuscular glucagon and able to seek emergency assistance
- Willing to wear closed-loop system at home and at work place
- Willing to follow study specific instructions
- Willing to upload pump and CGM data at regular intervals
- Has access to WiFi
Exclusion Criteria:
- Non-type 1 diabetes mellitus
- Use of a closed-loop system within the last 30 days
- Any other physical or psychological disease or condition likely to interfere with the normal conduct of the study and interpretation of the study results
- Use of any glucose-lowering agent (such as Pramlintide, Metformin, GLP-1 analogs) in the 3 months prior to enrolment or any use of SGLT2 inhibitors
- Untreated coeliac disease, adrenal insufficiency or hypothyroidism
- Known or suspected allergy against insulin
- More than one episodes of severe hypoglycaemia as defined by American Diabetes Association in preceding 6 months
- Random C-peptide > 200pmol/l with concomitant plasma glucose >4 mmol/l (72 mg/dl)
- Lack of reliable telephone facility for contact
- Total daily insulin dose >/= 2 IU/kg/day
- Total daily insulin dose < 15 IU/day
- Severe visual impairment
- Severe hearing impairment
- Medically documented allergy towards the adhesive (glue) of plasters or unable to tolerate tape adhesive in the area of sensor placement
- Serious skin diseases (e.g. psoriasis vulgaris, bacterial skin diseases) located at places of the body, which could potentially be used for localisation of the glucose sensor)
- Subject is currently abusing illicit drugs
- Subject is currently abusing prescription drugs
- Subject is currently abusing alcohol
- Subject has elective surgery planned that requires general anaesthesia during the course of the study
- Subject is a shift worker with working hours between 10pm and 8am
- Subject has a sickle cell disease, haemoglobinopathy; or has received red blood cell transfusion or erythropoietin within 3 months prior to time of screening
- Subject plans to receive red blood cell transfusion or erythropoietin over the course of study participation
- Subject diagnosed with current eating disorder such as anorexia or bulimia
- Subject plans to use significant quantity of herbal preparations (use of over the counter herbal preparation for 30 consecutive days or longer period during the study) or significant quantity of vitamin supplements (four times the recommended daily allowance used for 30 consecutive days or longer period during the study) known to affect glucose metabolism and/or blood glucose levels during the course of their participation in the study
- Subject not proficient in English (UK), or German (Austria)
Additional exclusion criteria specific for Austria
- Positive results on urine drug screen (amphetamines/metamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, opiates).
- Positive alcohol breath test.
- Positive reaction to any of the following tests: hepatitis B surface (HBs) antigen, anti-hepatitis C virus (anti-HCV) antibodies, anti-human immunodeficiency virus (HIV) 1 antibodies, anti-HIV2 antibodies.
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 |
---|---|
Experimental: Day and night hybrid closed loop control
The day and night hybrid closed-loop system (CamAPS FX) will consist of:
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Hybrid closed-loop system
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Active Comparator: Sensor augmented pump therapy
The comparator will consist of Dana RS insulin pump (Sooil) and G6 real-time CGM sensor (Dexcom)
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Sensor augmented pump therapy
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time spent in the target sensor glucose range
Time Frame: 16 weeks
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Time spent in the target glucose range from 3.9 to 10.0 mmol/l (70 to 180mg/dl) based on continuous glucose monitoring (CGM)
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16 weeks
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
HbA1c at the end of treatment period
Time Frame: 16 weeks
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16 weeks
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Time spent below target glucose (3.9mmol/l) (70mg/dl) based on CGM
Time Frame: 16 weeks
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16 weeks
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Time spent above target glucose (10.0 mmol/l) (180 mg/dl) based on CGM
Time Frame: 16 weeks
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16 weeks
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Average, standard deviation, and coefficient of variation of CGM glucose levels
Time Frame: 16 weeks
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16 weeks
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Time with glucose levels < 3.5 mmol/l (63mg/dl) and < 3.0 mmol/l (54mg/dl) based on CGM
Time Frame: 16 weeks
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16 weeks
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Time with glucose levels in the significant hyperglycaemia (glucose levels > 16.7 mmol/l) (300mg/dl)
Time Frame: 16 weeks
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16 weeks
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Total, basal and bolus insulin dose
Time Frame: 16 weeks
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16 weeks
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Utility evaluation
Time Frame: 16 weeks
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The frequency and duration of use of the closed-loop system at home.
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16 weeks
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Human Factor assessment
Time Frame: 30 minutes
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Cognitive, emotional, and behavioural characteristics of participating subjects and family members and their response to the closed-loop system and clinical trial will be assessed using validated surveys and focus groups
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30 minutes
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Cardiac arrythmia analysis
Time Frame: 5-7 days
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Holter monitor data at the fourth month in the two treatment groups
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5-7 days
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Sleep quality assessment
Time Frame: 14 days
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Sleep quality assessment using data collected by Actiwatch
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14 days
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Roman Hovorka, PhD, University of Cambridge
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- DAN06
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Study protocol, statistical analysis plan and fully anonymised individual participant data that underlie the results reported in the manuscript will be available 6 months following publication and ending 36 months following manuscript publication to investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose, to achieve aims in the approved proposal. Proposals should be directed to rh347@cam.ac.uk and may be submitted up to 36 months following article publication. To gain access, data requestors will need to sign a data access agreement.
Fully anonymised data may be shared with third parties (EU or non-EU based) for the purposes of advancing management and treatment of diabetes.
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
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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