Evaluating Glucose Control Using a Next Generation Automated Insulin Delivery Algorithm in Patients With Type 1 and Type 2 Diabetes (Evolution)

To assess the safety and effectiveness of a next-generation automated insulin delivery algorithm in participants aged 16+ years with type 1 or type 2 diabetes.

Study Overview

• Status: Completed
• Conditions: Diabetes Mellitus
• Intervention / Treatment: Device: Omnipod 5 Automated Glucose Control System

Detailed Description

This study is a single-arm, observational clinical study that will enroll a maximum of 72 participants.

Participants between the ages of 16+ years with type 1 or type 2 diabetes currently using an insulin pump or receiving basal and bolus multiple daily injections (MDI), with an A1C between 7.5-11.0% at screening, will be recruited for the study.

Two participant groups will be recruited and will participate in up to 4 Phases:

• Group A (Participants with type 1 diabetes) will participate in Phase 1, Phase 2, Phase 3, and Phase 4
• Group B (Participants with type 2 diabetes) will participate in Phase 1, and Phase 4

Phase 1 (Group A and B) will include:

• 14 days of Standard Therapy while using a blinded Dexcom G6 CGM in an outpatient setting

Phase 2 (Group A only) will include:

• 48 hours of using build 1b.x of the Omnipod 5 System in Manual Mode in an outpatient setting

Phase 3 (Group A only) will include:

• 3 day/2 night supervised hotel stay using build 1b.x of the Omnipod 5 System in Automated Mode while also participating in meal and exercise challenges at a defined target glucose setting of 5.6 mmol/L (100 mg/dL). During the first 24 hours, participants will be instructed to not bolus for meals. For the following 24 hours, participants will be instructed to bolus for meals. At least 2 meals each day must contain at least 60 grams of carbohydrates. In addition, each day participants will take part in 45 minutes of exercise.

Phase 4 (Group A and B) will include:

• A total of 6 weeks using the Omnipod 5 System in Automated Mode in an outpatient setting at a defined target glucose setting of 5.6 mmol/L (100 mg/dL). During weeks 1-3, participants will be instructed to bolus for meals. During weeks 4-6, participants will be instructed to not bolus for meals.

After completion of a minimum of 10 participants for Group A, Phase 3, the data will be analysed and must meet prespecified criteria for Group A to proceed to Phase 4 and Group B to proceed to Phase 1 followed by Phase 4.

If the prespecified criteria are not met, software changes will be made and Group A, Phase 3 may be repeated either with the same participants or additional participants that meet the study criteria. Iterations of Group A, Phase 3 may continue until prespecified criteria are met.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• New Zealand
  • Christchurch, New Zealand, 8140
    • University of Otago

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria-

Participants must meet all the following criteria to be included in the study:

1. Age at time of consent 16+ years
2. Individuals must be diagnosed with type 1 diabetes based on investigator's clinical judgment for at least 1 year. Individuals diagnosed with type 2 diabetes must be on basal and bolus insulin therapy, with no specified duration.
3. A1C between 7.5-11.0% at screening
4. Currently using U-100 rapid-acting insulin analogs with insulin pump or receiving multiple daily injections suitable for conversion to pump therapy for at least 3 months prior to study start
5. Willing to use a Dexcom G6 CGM for the duration of the study
6. Willing to use the Omnipod® 5 Automated Insulin Delivery System during the study
7. Willing to perform all fingerstick BG testing with their personal blood glucose meter at the frequency specified in the study protocol or per investigator discretion
8. Willing to participate in at least 45 minutes of exercise and meal challenges during the 3 day hotel stay (Group A only)
9. Willing to use carbohydrate counting for determination of meal boluses
10. Willing and able to sign the Informed Consent Form (ICF) and/or has a parent/guardian willing and able to sign the ICF.

Exclusion Criteria:

Participants who meet any of the following criteria will be excluded from the study:

1. Any medical condition, such as untreated malignancy, unstable cardiac disease, unstable or end-stage renal failure, eating disorders, or other conditions which in the opinion of the investigator, would put the participant at an unacceptable safety risk
2. Blood disorder or dyscrasia within 3 months prior to screening, including the use of hydroxyurea, which in the investigator's opinion could interfere with determination of HbA1C.
3. History of severe hypoglycemia within the past 6 months
4. History of diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome in the past 6 months, unrelated to an intercurrent illness or infusion set failure
5. History of moderate to severe preproliferative or proliferative retinopathy based on screening within the last 12 months.
6. Planning to start a non-insulin anti-diabetic medication during the study. If on non-insulin medication, dose must be stable in the previous 30 days.
7. Planning to start a weight-loss agent during the study. If on a weight-loss medication, dose must be stable in the previous 30 days.
8. Currently on a low carbohydrate diet of < 60 grams of carbohydrates per day
9. Pregnant, or is a woman of childbearing potential and not on acceptable form of birth control (acceptable forms of contraception include abstinence, barrier methods such as condoms, hormonal contraceptives, intrauterine device, surgical sterilisation such as tubal ligation or hysterectomy, or vasectomised partner)
10. Dermatological conditions at the proposed sensor/pump wear sites that in the investigator's opinion could preclude ability to wear the Pod and/or the Dexcom sensor
11. Current or known history of coronary artery disease that is not stable with medical management, including unstable angina, or angina that prevents moderate exercise despite medical management, or a history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting within the previous 12 months.
12. Currently on systemic steroids or intends to receive systemic steroid treatment in the next 6 months, including stable treatment for adrenal insufficiency. Inhaled, ophthalmic, topical, joint injection, and other locally applied steroids are allowed.
13. Currently participating in another clinical study using an investigational drug or device
14. Recent (within the preceding 30 days) participation in a clinical study using an investigational drug
15. Unable to follow the clinical protocol for the duration of the study or is otherwise deemed unacceptable to participate in the study per the investigator's clinical judgment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A with Type 1 Diabetes; Participants with Type 1 Diabetes	Device: Omnipod 5 Automated Glucose Control System; The Omnipod 5 Automated Glucose Control System will provide automated insulin delivery
Experimental: Group B with Type 2 Diabetes; Participants with Type 2 Diabetes	Device: Omnipod 5 Automated Glucose Control System; The Omnipod 5 Automated Glucose Control System will provide automated insulin delivery

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of time in hypoglycemic range (defined as < 3.9 mmol/L (<70 mg/dL))	Glucose metric from CGM	At the end of Phase 3 and Phase 4 to compare to baseline values
Percentage of time in hyperglycemic range (defined as > 13.9 mmol/L (>250 mg/dL))	Glucose metric from CGM	measured during the 9 week study phase

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean glucose value of all participants	Glucose metric from study provided continuous glucose monitor (CGM)	Measured during the 9 week study phase
Percentage of time < 3.0 mmol/L (<54 mg/dL)	Glucose metric from CGM	Measured during the 9 week study phase
Percentage of time > 10.0 mmol/L (>180 mg/dL)	Glucose metric from CGM	Measured during the 9 week study phase
Percentage of time > 16.7 mmol/L (>300 mg/dL)	Glucose metric from CGM	Measured during the 9 week study phase
Percentage of time between 3.9-10.0 mmol/L (70-180 mg/dL)	Glucose metric from CGM	Measured during the 9 week study phase
Standard deviation and coefficient of variation	Glucose metric from CGM measured glucose variability with the coefficient of variation (CV)	Measured during the 9 week study phase
Average total daily insulin (TDI)	measure of insulin	Measured during the 9 week study phase
Average TDI/kg	measure of insulin	Measured during the 9 week study phase
Average number of manual boluses/day	count of average number of insulin boluses	Measured during the 9 week study phase
Average dose of insulin delivered by manual bolus/day	measure of insulin	Measured during the 9 week study phase
Average number of hypoglycemic treatments when CGM is less than 3.9mmol/L	Glucose metric from CGM	Measured during the 9 week study phase

Collaborators and Investigators

• Sponsor: Insulet Corporation

Study record dates

Study Major Dates

• Study Start (Actual): September 5, 2023
• Primary Completion (Actual): January 31, 2024
• Study Completion (Actual): January 31, 2024

Study Registration Dates

• First Submitted: November 14, 2023
• First Submitted That Met QC Criteria: December 12, 2023
• First Posted (Actual): December 26, 2023

Study Record Updates

• Last Update Posted (Actual): April 2, 2024
• Last Update Submitted That Met QC Criteria: April 1, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Omnipod; Type 2 Diabetes T2D; Type 1 Diabetes T1D; Automated Insulin Delivery System
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: EVOLUTION

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes