Artificial Pancreas Control System in an Outpatient Setting

The objective of the current human study is to verify the components of the Artificial Pancreas Control Software during an outpatient study. This master controller software is designed to be used in conjunction with two subcutaneous continuous glucose monitoring systems to regulate blood glucose levels as well as two Omnipod pumps, one for administering insulin and one for administering glucagon. The sensors communicate wirelessly with two sensor receivers which will be interfaced with the APC by wireless USB connection. The insulin and glucagon pumps will be controlled by the APC through a wireless USB connection. The algorithm included in the APC is an automated version of the Adaptive Proportional Derivative (APD) insulin and glucagon control algorithm, which was previously studied as an investigational device. The Automated APD has been studied in vivo (in 13 experiments, each 28 hr in length, with automated adjustment of pumps) and no serious adverse effects were noted. The APC will be tested in vivo during 28 hour experiments in an outpatient setting in preparation for home testing.

Inclusion criteria

• Diagnosis of type 1 diabetes mellitus for at least 1 year.
• Male or female subjects 21 to 60 years of age.
• Current use of an insulin pump.
• Willingness to follow all study procedures and to stay with a companion during the outpatient test of the artificial pancreas.
• Willingness to sign informed consent and HIPAA documents.
• Willingness for the subject and companion to attend a training course on the system including emergency management of extremes of glucose.

Exclusion criteria

• Pregnancy or Lactation: For women of childbearing potential: there is a requirement for a negative urine pregnancy test and for agreement to use contraception during the study and for at least 1 month after participating in the study. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence.
• Renal insufficiency (serum creatinine of 2.0 mg/dL or greater).
• Serum ALT or AST equal to or greater than 3 times the upper limit of normal; hepatic synthetic insufficiency as defined as a serum albumin of less than 3.3 g/dL; or serum bilirubin of over 2.
• Adrenal insufficiency
• Hematocrit of less than or equal to 34%.
• A history of cerebrovascular disease or coronary artery disease regardless of the time since occurrence.
• Congestive heart failure, NYHA class III or IV.
• Diagnosis of 2nd or 3rd degree heart block or any non-physiological arrhythmia judged by the investigator to be exclusionary.
• Any active infection.
• Visual impairment preventing reading of glucose meter values or continuous glucose monitoring device.
• Physical impairment impeding the ability to use a glucose meter or continuous glucose monitoring device.
• Active foot ulceration.
• Severe peripheral arterial disease characterized by ischemic rest pain or severe claudication.
• Active alcohol abuse, substance abuse, or severe mental illness (as judged by the principal investigator).
• Active malignancy, except basal cell or squamous cell skin cancers.
• Major surgical operation within 30 days prior to screening.
• Seizure disorder even if controlled by stable therapeutic regimen.
• Current administration of any beta blocker medication, clonidine, reserpine, or guanethidine
• Any concurrent illness, other than diabetes, that is not controlled by a stable therapeutic regimen.
• Chronic usage of any immunosuppressive medication (such as cyclosporine, azathioprine, sirolimus, or tacrolimus).
• Current administration of oral or parenteral corticosteroids.
• Use of an investigational drug within 30 days prior to screening.
• Bleeding disorder, treatment with warfarin, or platelet count below 50,000.
• Allergy to aspart insulin.
• Allergy to glucagon.
• Past history of pheochromocytoma or a family history of MEN 2, neurofibromatosis, or von Hippel-Lindau disease.
• Insulin resistance requiring more than 200 units per day.
• Need for uninterrupted treatment of acetaminophen.
• History of hypoglycemic unawareness.
• C peptide level of ≥0.5 ng/ml
• Any reason the principal investigator deems exclusionary.