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Closed-Loop Control in Young Children 5-8 Years Old Using DiAs Platform

22 juni 2017 bijgewerkt door: Mark DeBoer, MD, University of Virginia
The overall aim of this proposed research is to determine the safety, feasibility and efficacy (AP vs at home use of SAP) of the Diabetes Assistant (DiAs) controller in day and night closed-loop control in young children 5-8 years old with type 1 diabetes over multiple 48 hours in an out-patient setting.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Young children with Type 1 Diabetes (T1D) in the age range of 5-8 years old are a population with clear needs but unique challenges regarding the application of artificial pancreas (AP) technologies. Young children are likely to benefit from an AP system, with current deficits in glycemic control that include both significant hypoglycemia and sub-optimal HbA1c levels; however, they have undeveloped abilities to control and interact with the AP system, posing potential safety issues. During the hours that these children are away from their parents at school and elsewhere, they lack the sophistication to operate the currently-available tools in an AP system--and may induce harm if they are allowed to do so, causing parental resistance to AP use. Commercially-available insulin pumps have mechanisms to lock access to children to prevent inappropriate insulin-delivery. However, the AP is more complex than an insulin pump, both in requiring more detailed setting information (that a child could adversely alter) and in providing alerts for impending low- and high-blood glucose (BG) levels (that one wouldn't want to lock out to child use). These functions are all run via a platform on a smart phone-a device with which young children may already feel a high degree of familiarity and thus be more likely to attempt to explore and potentially change settings. It is likely that young children will benefit the most from a system that gives them access to some AP features but provides access to other features only for their parents. In this sense, young children require a device that is not user-centered as much as family-centered. A redesign of the system to provide appropriate access to AP tools-in which certain users can obtain access to certain functionalities-is direly needed before children in this age range can benefit from the improvements in blood glucose (BG) control that the AP has to offer.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

12

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Verenigde Staten
    • Virginia
      • Charlottesville, Virginia, Verenigde Staten, 22903
        • University of Virginia Center for Diabetes Technology

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

5 jaar tot 9 jaar (Kind)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  • Clinical diagnosis of type 1 diabetes,

    • The diagnosis of type 1 diabetes is based on the investigator's judgment
    • C peptide levels and antibody determinations are not required
  • Daily insulin therapy for ≥ 12 months
  • Insulin pump therapy for ≥ 3 months
  • Age ≥5 - ≤8 years old
  • Avoidance of acetaminophen-containing medications (i.e. Tylenol) while wearing the continuous glucose monitor.
  • Willingness to wear a continuous glucose sensor and physiological monitor for the duration of the study

Exclusion Criteria:

The presence of any of the following is an exclusion for the study:

  • Diabetic ketoacidosis in the past month
  • Hypoglycemic seizure or loss of consciousness in the past 3 months
  • History of seizure disorder (except for hypoglycemic seizure)
  • History of any heart disease including coronary artery disease, heart failure, or arrhythmias
  • Cystic fibrosis
  • Current use of oral glucocorticoids, beta-blockers or other medications, which in the judgment of the investigator would be a contraindication to participation in the study.
  • History of ongoing renal disease (other than microalbuminuria).
  • Subjects requiring intermediate or long-acting insulin (such as NPH, Detemir or Glargine).
  • Subjects requiring other anti-diabetic medications other than insulin (oral or injectable).
  • Presence of a febrile illness within 24 hours of admission or acetaminophen use while wearing the CGM. The subject may be rescheduled for Research House/Hotel Admission if these criteria are not met. The study subject will not participate in the trial if these conditions are met.

  • Medical or psychiatric condition that in the judgment of the investigator might interfere with the completion of the protocol such as:

    • Inpatient psychiatric treatment in the past 6 months
    • Uncontrolled adrenal insufficiency

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Group A
In this randomized, cross-over study, the intervention involves blood glucose control using a Closed Loop system run by the Diabetes Assistant (DiAs) during a stay at a Research House/Hotel. All subjects will have blood glucose data compared between their usual diabetes care (at home, using home insulin pump) and this Closed-Loop care (at Research House/Hotel using the DiAs system). Subjects who are randomized to Group A will have home care evaluated before the Research House/Hotel admission. Subjects in this arm will participate in CGM training and data collection prior to the Research House/Hotel admission.
Apparaat: Diabetes Assistant (DiAs) with Closed-Loop
All subjects will use DiAs Medical Platform, a study insulin pump and continuous glucose monitor (CGM) in closed-loop mode during a Research House/Hotel admission that will last up to 72 hours.
Experimenteel: Group B
Group B is identical to Group A with the exception that usual diabetes care (at home, using home insulin pump) will be evaluated after the Research House/Hotel admission. Subjects who are randomized to Group B will participate in CGM training and data collection after the Research House/Hotel admission. As with Group A, all subjects will use Diabetes Assistant (DiAs) with Closed-Loop during the admission.
Apparaat: Diabetes Assistant (DiAs) with Closed-Loop
All subjects will use DiAs Medical Platform, a study insulin pump and continuous glucose monitor (CGM) in closed-loop mode during a Research House/Hotel admission that will last up to 72 hours.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Percent of Sensor Glucose Readings Between 70-180 mg/dL
Tijdsspanne: 68 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
68 hours

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Percent of Time Sensor Glucose Readings Are <70 mg/dL
Tijdsspanne: 68 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
68 hours
Percent of Time Sensor Glucose Readings Are >150 mg/dL
Tijdsspanne: 72 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Percent of Time Sensor Glucose Readings Are >180 mg/dL
Tijdsspanne: 68 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
68 hours
Percent of Time Sensor Glucose Readings Are >250 mg/dL
Tijdsspanne: 68 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
68 hours
Percent of Time Sensor Glucose Readings Are >400 mg/dL
Tijdsspanne: 72 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Distribution of Sensor and Meter Glucose Values (Maximum, Minimum, Median, Interquartile Range, Mean, Standard Deviation)
Tijdsspanne: 72 hours
All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Distribution of Sensor and Meter Glucose Values (Maximum)
Tijdsspanne: 72 hours
All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Distribution of Sensor and Meter Glucose Values (Minimum)
Tijdsspanne: 72 hours
All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Distribution of Sensor and Meter Glucose Values (Median/Interquartile Range)
Tijdsspanne: 72 hours
All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Mean BG (as Measured by CGM)
Tijdsspanne: 68 hours
All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period.
68 hours
Hypoglycemia Area Under the Curve <60
Tijdsspanne: 72 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Hypoglycemia Area Under the Curve <70 mg/dL
Tijdsspanne: 72 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Hyperglycemia Area Under the Curve >180
Tijdsspanne: 72 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Hyperglycemia Area Under the Curve >250 mg/dL
Tijdsspanne: 72 hours
All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period.
72 hours
Incidence of Hypoglycemia Per Subject, Defined by Handheld Meter Glucose <70 mg/dL
Tijdsspanne: 68 hours
All subjects have hypoglycemia monitored by meter analysis and compared between time on closed-loop system and time on usual care period.
68 hours
End of Night Blood Glucose
Tijdsspanne: 72 hours
All subjects have blood glucose evaluated upon rising (approximately 7 am) and compared between time on closed-loop system and time on usual care period.
72 hours

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

University of Virginia

Medewerkers

DexCom, Inc.

Onderzoekers

  • Hoofdonderzoeker: Mark D. DeBoer, MD, University of Virginia, Pediatrics, Endocrinology/Diabetes

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Nuttige links

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 mei 2016

Primaire voltooiing (Werkelijk)

1 mei 2016

Studie voltooiing (Werkelijk)

1 mei 2016

Studieregistratiedata

Eerst ingediend

15 april 2016

Eerst ingediend dat voldeed aan de QC-criteria

20 april 2016

Eerst geplaatst (Schatting)

25 april 2016

Updates van studierecords

Laatste update geplaatst (Werkelijk)

24 juli 2017

Laatste update ingediend die voldeed aan QC-criteria

22 juni 2017

Laatst geverifieerd

1 juni 2017

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 18888

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Beschrijving IPD-plan

Not yet determined

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