- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04031599
Assessment of the Efficacy of the Artificial Pancreas Combined With a Qualitative Meal Size Estimation to Control Postprandial Glucose Levels
An Open-label, Randomized, Crossover Trial to Assess the Efficacy of Single-hormone Closed-loop System With a Rapid Acting Insulin Analogue Combined With Either Conventional Carbohydrate Counting or a Simplified Qualitative Meal-size Estimation in Regulating Glucose Levels in Adults With Type 1 Diabetes
Postprandial glycemic excursions are major determinants of overall glycemic control in type 1 diabetes. Carbohydrate content of ingested meals is the main determinant of post-meal glucose excursion. Accurate carbohydrate counting is a critical aspect of managing postprandial blood glucose levels. accurate carbohydrate counting is considered by patients as a significant burden and frustrating task.
The closed-loop system (CLS) is composed of three components: glucose sensor to read glucose levels, insulin pump to infuse insulin and a dosing mathematical algorithm to decide on the required insulin dosages based on the sensor's readings.
The objective of this study is to compare the efficacy of two strategies to regulate glucose levels in outpatient settings in adults with type 1 diabetes: 1) single-hormone CLS with rapid acting insulin analogue combined with carbohydrate counting; 2) single-hormone CLS with rapid acting insulin analogue combined with simplified qualitative meal-size estimation.
A sub-study will also be proposed to participants. Postprandial exercise combines two situations complicating CLS operation: a high plasma insulin due to insulin on-board related to meal boluses and rapid blood glucose changes (postprandial blood glucose excursion and then drop during exercise) making input from the glucose sensor less accurate. The objective of this sub-study will be to explore the safety and efficacy of the CLS using the combined strategy of pre-meal exercise announcement and meal bolus reduction of 33% when exercise is performed 1 hour compared to 2 hours post meal time.
Study Overview
Status
Conditions
Intervention / Treatment
- Device: Single-hormone closed-loop system
- Device: Insulin pump
- Device: Continuous glucose monitoring system
- Drug: Aspart or Lispro
- Other: Carbohydrate counting
- Other: 3-week intervention
- Other: 1-hour postprandial exercise (sub-study)
- Other: 2-hour postprandial exercise (sub-study)
- Other: Exercise announcement and meal bolus reduction (sub-study)
- Other: Simplified qualitative meal-size estimation strategy
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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Quebec
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Montreal, Quebec, Canada, H4A 3J1
- McGill University Health Center
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Montreal, Quebec, Canada, H2W 1R7
- Montreal Clinical Research Institute
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria
- Males and females ≥ 18 years of old.
- Clinical diagnosis of type 1 diabetes for at least one year. The diagnosis of type 1 diabetes is based on the investigator's judgment; C peptide level and antibody determinations are not needed.
- The subject will have been on insulin pump therapy for at least 3 months.
- Currently using, or willing to switch to Lispro U100 or Aspart for the duration of the study.
- HbA1c < 10%.
Exclusion criteria
- Clinically significant nephropathy, neuropathy (e.g. known or suspected gastroparesis) or retinopathy (e.g. proliferative retinopathy) as judged by the investigator
- Recent (< 6 months) acute macrovascular event e.g. acute coronary syndrome or cardiac surgery
- Anticipated need to use acetaminophen during interventions with the closed-loop system
- Pregnancy (ongoing or current attempt to become pregnant)
- Breastfeeding
- No nearby third party for assistance if needed (e.g. severe hypoglycemia glucagon treatment)
- Plans to go abroad or travel at more than 3 hours distance from Montreal during the trial period
- Severe hypoglycemic episode within two weeks of screening or during the run-in period
- Severe hyperglycemic episode requiring hospitalization in the last 3 months
- Current use of glucocorticoid medication (except low stable dose and inhaled steroids)
- Agents affecting gastric emptying (Motilium®, Victoza®, Ozempic®, Trulicity®, Byetta® and Symlin®) as well as oral anti-diabetic agents (Metformin, Prandase®, DPP-4 inhibitors) if not at a stable dose for 3 months. Otherwise, these medications are acceptable and will be kept stable during the entire protocol.
- Current use of SGLT-2 inhibitors unless at a stable dose for at least 3 months and appropriate ketone testing performed.
- Known or suspected allergy to the trial products
- Other serious medical illness likely to interfere with study participation or with the ability to complete the trial by the judgment of the investigator
- Anticipation of a significant change in exercise regimen between admission and end of the trial (i.e. starting or stopping an organized sport)
- In the opinion of the investigator, a participant who in unable or unwilling to observed the contraindications of the study devices
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: CROSSOVER
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Carbohydrate counting
Rapid acting insulin analogue with carbohydrate counting
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Every 10 minutes, the glucose levels as measured by the sensor will be transferred automatically to a LG Google Nexus Smartphone that the algorithm is running on, which will calculate the recommended doses and will send them wirelessly to the infusion pump.
Tandem Diabetes Care
Dexcom G6
Aspart or lispro will be infused with the infusion pump
Participants will be required to enter an estimate of the carbohydrate content of their meal into the phone.
Insulin boluses will be calculated based on grams of carbohydrates and participant's insulin-to-carbohydrate ratio.
Carbohydrate-matching full prandial bolus will be given 5 to 10 minutes before the meal.
Glucose levels will be regulated by the single-hormone closed-loop system for 3 consecutive weeks.
60 minute exercise will be started one hour after the meal time.
60 minute exercise will be started two hours after meal time
Meal bolus reduction of 33% at meal time and exercise announcement (increased target glucose from 6 to 9mmolL) to the CLS algorithm
|
ACTIVE_COMPARATOR: Simplified qualitative meal size estimation
Rapid acting insulin analogue with simplified qualitative meal size estimation
|
Every 10 minutes, the glucose levels as measured by the sensor will be transferred automatically to a LG Google Nexus Smartphone that the algorithm is running on, which will calculate the recommended doses and will send them wirelessly to the infusion pump.
Tandem Diabetes Care
Dexcom G6
Aspart or lispro will be infused with the infusion pump
Glucose levels will be regulated by the single-hormone closed-loop system for 3 consecutive weeks.
A pre-meal partial prandial bolus will be given 5-10 minutes before the meal.
The partial bolus will be based on the estimated meal size (small, regular, large and extra-large).
The closed-loop system will give the remaining insulin needed based on the sensor readings.
For this strategy, meal size will be defined as: small as any meal less than 30g, regular meal as any meal between 30g and 60g CHO, large meal as any meal between 60g and 90g CHO, extra-large meal for anything above 90g CHO.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of time of glucose levels spent between 3.9 and 10.0 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Relative decrease in glucose levels during exercise compared to pre-breakfast levels (sub-study)
Time Frame: 3.5 or 4.5 hours
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Difference between pre-breakfast levels and the lowest glucose level from the start of the exercise until the end of exercise
|
3.5 or 4.5 hours
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of time of glucose levels spent between 3.9 and 7.8 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Percentage of time of glucose levels spent below 3.9 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Percentage of time of glucose levels spent below 3.3 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Percentage of time of glucose levels spent below 2.8 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Percentage of time of glucose levels spent above 10.0 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Percentage of time of glucose levels spent above 13.9 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Percentage of time of glucose levels spent above 16.7 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Mean glucose levels
Time Frame: 504 hours
|
504 hours
|
|
Fasting glucose levels
Time Frame: 504 hours
|
504 hours
|
|
Standard deviation of glucose levels
Time Frame: 504 hours
|
504 hours
|
|
Standard deviation of insulin delivery
Time Frame: 504 hours
|
504 hours
|
|
Coefficient of variance of glucose levels
Time Frame: 504 hours
|
504 hours
|
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Coefficient of variance of insulin delivery
Time Frame: 504 hours
|
504 hours
|
|
Between-day variability in glucose levels
Time Frame: 504 hours
|
504 hours
|
|
Between-day variability in insulin delivery
Time Frame: 504 hours
|
504 hours
|
|
Total insulin delivery
Time Frame: 504 hours
|
504 hours
|
|
Number of hypoglycemic events less than 3.1 mmol/L
Time Frame: 504 hours
|
504 hours
|
|
Number of nights with hypoglycemic events less than 3.1 mmol/L
Time Frame: 126 hours
|
126 hours
|
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Number of days with hypoglycemic events less than 3.1 mmol/L
Time Frame: 252 hours
|
252 hours
|
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Total number of hours of sensor availability
Time Frame: 378 hours
|
378 hours
|
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Percentage of time of sensor availability
Time Frame: 504 hours
|
504 hours
|
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2-hour postprandial glucose levels over the last 3 days of the intervention.
Time Frame: 18 hours
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18 hours
|
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Average number of days per participant requiring study team support for at least one technical problem
Time Frame: 21 days
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21 days
|
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Number of hours and percentage of time in open-loop and closed-loop modes
Time Frame: 504 hours
|
504 hours
|
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Average number of phone calls per participant related to CLS technical issues
Time Frame: 504 hours
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504 hours
|
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Decrease in plasma glucose levels during exercise (sub-study)
Time Frame: 1 hour
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Difference between glucose levels at the beginning of the exercise and the lowest glucose levels from the start of the exercise until the end of exercise
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1 hour
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Relative decrease in glucose levels during exercise compared to pre-breakfast levels (sub-study)
Time Frame: 2 or 3 hours
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Difference between pre-breakfast levels and the lowest glucose level from the start of the exercise until the end of exercise
|
2 or 3 hours
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Percentage of time of plasma glucose levels spent below 3.9 mmol/L (sub-study)
Time Frame: 1 or 2 hours
|
Pre-exercise period (from mealtime to exercise onset)
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1 or 2 hours
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Percentage of time of plasma glucose levels spent below 3.3 mmol/L (sub-study)
Time Frame: 1 or 2 hours
|
Pre-exercise period (from mealtime to exercise onset)
|
1 or 2 hours
|
Percentage of time of plasma glucose levels spent below 3.0 mmol/L (sub-study)
Time Frame: 1 or 2 hours
|
Pre-exercise period (from mealtime to exercise onset)
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1 or 2 hours
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Percentage of time of plasma glucose levels spent between 3.9 and 10.0 mmol/L (sub-study)
Time Frame: 1 or 2 hours
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Pre-exercise period (from mealtime to exercise onset)
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1 or 2 hours
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Percentage of time of plasma glucose levels spent above 10.0 mmol/L (sub-study)
Time Frame: 1 or 2 hours
|
Pre-exercise period (from mealtime to exercise onset)
|
1 or 2 hours
|
Percentage of time of plasma glucose levels spent above 13.9 mmol/L (sub-study)
Time Frame: 1 or 2 hours
|
Pre-exercise period (from mealtime to exercise onset)
|
1 or 2 hours
|
Percentage of time of plasma glucose levels spent above 16.7 mmol/L (sub-study)
Time Frame: 1 or 2 hours
|
Pre-exercise period (from mealtime to exercise onset)
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1 or 2 hours
|
Percentage of time of plasma glucose levels spent below 3.9 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
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Percentage of time of plasma glucose levels spent below 3.3 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Percentage of time of plasma glucose levels spent below 3.0 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Number of patients experiencing hypoglycemia requiring treatment (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Percentage of time of plasma glucose levels spent between 3.9 and 10.0 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Percentage of time of plasma glucose levels spent above 10.0 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Percentage of time of plasma glucose levels spent above 13.3 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Percentage of time of plasma glucose levels spent above 16.7 mmol/L (sub-study)
Time Frame: 1 hour
|
Exercise period
|
1 hour
|
Percentage of time of plasma glucose levels spent below 3.9 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Percentage of time of plasma glucose levels spent below 3.3 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Percentage of time of plasma glucose levels spent below 3.0 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Percentage of time of plasma glucose levels spent between 3.9 and 10.0 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Percentage of time of plasma glucose levels spent above 10.0 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Percentage of time of plasma glucose levels spent above 13.3 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Percentage of time of plasma glucose levels spent above 16.7 mmol/L (sub-study)
Time Frame: 1.5 hour
|
Post-exercise period
|
1.5 hour
|
Number of patients experiencing hypoglycemia requiring treatment (sub-study)
Time Frame: 3.5 or 4.5 hours
|
Overall study period
|
3.5 or 4.5 hours
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Mean time (minutes) to the first hypoglycemic event (sub-study)
Time Frame: 1 hour
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Exercise period
|
1 hour
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Collaborators and Investigators
Investigators
- Principal Investigator: Rémi Rabasa-Lhoret, Montreal Clinical Research Institute
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
- CLASS18
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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