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Exercise-Induced Hypoglycemia Prevention in Adults With Type 1 Diabetes Using an Artificial Pancreas

2026年4月14日 更新者:Marc Breton

Hypoglycemia Prevention During and After Moderate Exercise in Adults With Type 1 Diabetes Using an Artificial Pancreas With Exercise Behavior Recognition

This is a randomized crossover trial with 1:1 randomization to the admission sequence of using the Control AP system (rMPC - Naïve Model Predictive Control) vs. Experimental AP system (EnMPC - Ensemble Model Predictive Control) over approximately 4 months. Eligible participants will proceed to the Data Collection Phase for approximately 28 days, during which they will participate in regimented exercise activities. If the participant collected adequate data during the Data Collection Phase, they will be randomized and undergo the study admissions in the assigned sequence. Each admission is approximately 36 hours in length and will consist of one afternoon of exercise and one without.

調査の概要

詳細な説明

Exercise remains a challenge to AP systems; more specifically, by the time exercise is detected it is often too late to avoid hypoglycemia without the ingestion of rapid carbohydrates or the use of rescue injections, such as glucagon. To this avail, the investigators propose to add a novel Model Predictive Control module to the proven USS system. This module is designed to compute insulin doses every 5 minutes that are designed to "optimally" maintain glycaemia around a target of 120mg/dL. The optimality is defined mathematically as minimizing deviations from basal rate injections and the distance between current and future (up to 2h) glycaemia from a physiologically feasible trajectory back down (or up) to a pre-specified target. Furthermore, the novel control system, labelled Multi Stage MPC or Ensemble MPC, accounts for a preset number of exercise scenarios during the prediction horizon, these scenarios being derived from the user historical record; this setup allows the control system to anticipate expected exercise bouts up to 2h in advance while maintaining the condition for optimal glycemic control.

By adding such module to a well validated system, the investigators expect an improvement in protection against hypoglycemia during and immediately after physical activity without increase in hyperglycemia. To demonstrate the feasibility of this approach, the novel anticipatory system will be compared to a naïve AP system during highly supervised hotel admissions with afternoon exercise. Participants will be asked to exercise regularly in the late afternoon during a month of data collection to generate the patterns to be anticipated.

研究の種類

介入

入学 (実際)

15

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究場所

    • Virginia
      • Charlottesville、Virginia、アメリカ、22908
        • University of Virginia

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年~65年 (大人、高齢者)

健康ボランティアの受け入れ

いいえ

説明

Inclusion Criteria:

  • Age ≥18 and ≤65 years
  • Clinical diagnosis of Type 1 Diabetes for at least one year
  • Currently using an insulin pump for at least 6 months
  • Uses insulin parameters such as carbohydrate ratio and correction factors consistently on their insulin pump in order to dose insulin for meals or corrections
  • Access to internet and willingness to upload data during the study
  • Willingness to be physically active for at least 30 minutes per day at least 4 times per week
  • Willingness to perform the required exercise regimen during Data Collection Period
  • Willingness to not perform regular exercise outside of the study-regimented exercise window
  • For females, not currently pregnant or breastfeeding. If a female is of child-bearing potential and sexually active, she must agree to use a form of contraception to prevent pregnancy while participating in the study.
  • An understanding and willingness to follow the protocol and sign informed consent.

Exclusion Criteria:

  • History of diabetic ketoacidosis (DKA) in the 12 months prior to enrollment.
  • Severe hypoglycemia resulting in seizure or loss of consciousness in the 12 months prior to enrollment.
  • Pregnancy or intent to become pregnant during the trial.
  • Currently being treated for a seizure disorder
  • Coronary artery disease or heart failure, unless written clearance is received from a cardiologist or primary care provider and documentation of a negative stress test within the year
  • History of cardiac arrhythmia (except for benign premature atrial contractions and benign premature ventricular contractions which are permitted)
  • Clinically significant electrocardiogram (ECG) at time of Screening, as interpreted by the study medical physician.
  • Use of non-insulin glucose-lowering agent (including GLP-1 agonists, pramlintide, DPP-4 inhibitors, SGLT-2 inhibitors, biguanides, sulfonylureas and naturaceuticals) with the exception of participants who have been on a stable dose of Metformin for at least 3 months.
  • A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol such as the following examples:
  • Inpatient psychiatric treatment in the past 6 months
  • Presence of a known adrenal disorder
  • Abnormal liver function test results (Transaminase >2 times the upper limit of normal); testing required for subjects taking medications known to affect liver function or with diseases known to affect liver function
  • Uncontrolled thyroid disease
  • Use of an automated insulin delivery mechanism that is not FDA approved during the data collection phase
  • Use of an automated insulin delivery mechanism that is not downloadable by the subject or study team
  • Inability to be physically active for at least 30 minutes per day for at least 4 times per week
  • Current enrollment in another clinical trial, unless approved by the investigators of both studies or if clinical trial is a non-interventional registry trial.

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか?

デザインの詳細

  • 主な目的:処理
  • 割り当て:ランダム化
  • 介入モデル:クロスオーバー割り当て
  • マスキング:なし(オープンラベル)

武器と介入

参加者グループ / アーム
介入・治療
実験的:Control - Experimental Admissions
Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2.
This AP controller has the ability to anticipate exercise activity by use of trends seen during the Data Collection Period.
This AP controller does not have the ability to anticipate exercise activity.
実験的:Experimental - Control Admissions
Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2.
This AP controller has the ability to anticipate exercise activity by use of trends seen during the Data Collection Period.
This AP controller does not have the ability to anticipate exercise activity.

この研究は何を測定していますか?

主要な結果の測定

結果測定
メジャーの説明
時間枠
Number of Hypoglycemic Occurrences in Relation to Exercise Activity
時間枠:2 Hours
Number of hypoglycemic occurrences immediately before, during, and immediately after exercise (~5-7pm) as defined by more than one consecutive CGM values below 70 mg/dL or hypoglycemic treatment per glycemic guidelines.
2 Hours

二次結果の測定

結果測定
メジャーの説明
時間枠
CGM Coefficient of Variation
時間枠:36 Hours
Coefficient of Variation of the CGM Values
36 Hours
Average CGM
時間枠:36 Hours
Average CGM value
36 Hours
Percent Time CGM Below 54 mg/dL
時間枠:36 Hours
Percentage of time CGM was below 54 mg/dL
36 Hours
Percent Time CGM Below 70 mg/dL
時間枠:36 Hours
Percentage of time CGM was below 70 mg/dL
36 Hours
Percent Time CGM Between 70 and 180 mg/dL
時間枠:36 Hours
Percentage of time CGM was between 70 and 180 mg/dL
36 Hours
Percent Time CGM Between 70 and 140 mg/dL
時間枠:36 Hours
Percentage of time CGM was between 70 and 140 mg/dL
36 Hours
Percent Time CGM Above 180 mg/dL
時間枠:36 Hours
Percentage of time CGM was above 180 mg/dL
36 Hours
Percent Time CGM Above 250 mg/dL
時間枠:36 Hours
Percentage of time CGM was above 250 mg/dL
36 Hours
CGM-based Low Blood Glucose Index
時間枠:36 Hours
CGM-based Low Blood Glucose Index (LBGI) which is a metric used to quantify the risk of hypoglycemia (low blood sugar) based on self-monitored blood glucose (SMBG) data. LBGI is based on a nonlinear transformation of blood glucose values that corrects for the asymmetry of the glucose scale. This transformation maps glucose values into a risk space (minimum risk = 0), where higher values correspond to higher risk. Values <1 suggest low risk of hypoglycemia.
36 Hours
CGM Standard Deviation
時間枠:36 Hours
Standard Deviation of the CGM Values
36 Hours

その他の成果指標

結果測定
メジャーの説明
時間枠
Number of Hypoglycemic Episodes
時間枠:36 Hours
Number of Hypoglycemic Episodes as defined by contiguous CGM below 70 mg/dL
36 Hours
Total Amount of Insulin Used
時間枠:36 Hours
Total Amount of Insulin Used, units
36 Hours

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

捜査官

  • 主任研究者:Marc Breton, PhD、University of Virginia

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

便利なリンク

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2019年4月12日

一次修了 (実際)

2020年1月13日

研究の完了 (実際)

2020年1月13日

試験登録日

最初に提出

2019年2月27日

QC基準を満たした最初の提出物

2019年2月27日

最初の投稿 (実際)

2019年3月1日

学習記録の更新

投稿された最後の更新 (実際)

2026年5月5日

QC基準を満たした最後の更新が送信されました

2026年4月14日

最終確認日

2026年4月1日

詳しくは

本研究に関する用語

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

はい

IPD プランの説明

Will follow the NIH Data Sharing Policy and Implementation Guidance on sharing research resources for research purposes to qualified individuals in the scientific community.

IPD 共有時間枠

Data will be made available after the publication of the manuscript.

IPD 共有アクセス基準

The Data Sharing Agreements will be formulated by the study team

IPD 共有サポート情報タイプ

  • STUDY_PROTOCOL
  • ICF

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米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

はい

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