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Completed

NCT Number: NCT01484457

Controlled Insulin Delivery: Combining Technology With Treatment

Hypothesis: Closed-loop control systems for an artificial pancreas using multi-parametric model predictive control can be developed and evaluated safely in patients with Type 1 Diabetes Mellitus (T1DM) to control blood glucose concentrations.

This study seeks to combine real-time continuous glucose sensing with automated insulin delivery in a closed-loop system that will achieve euglycemia in patients with T1DM. The end result of this line of research will be an artificial pancreas that will provide around-the-clock glucose regulation through controlled insulin delivery in response to detected patterns of change in glucose levels.

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Key information

Conditions

Diabetes Mellitus, Type 1 Autoimmune Diseases Diabetes Mellitus Endocrine System Diseases Glucose Metabolism Disorders Immune System Diseases Metabolic Diseases Nutritional and Metabolic Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Early Phase 1

Primary location

Schneider Children's Medical Center of Israel, Petah Tikva, Israel

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About this study

The goal of the JDRF Artificial Pancreas Project is to produce an autonomous artificial pancreas that can safely and effectively regulate glycemia in people with type 1 diabetes mellitus. In our work, this fully automated closed-loop system combines a subcutaneous continuous glucose monitor (CGM) and a continuous subcutaneous insulin infusion (CSII) pump with a sophisticated control algorithm. This is a proof-of-concept study to demonstrate that the controller could bring the patient back to a relatively normal glucose concentration after an unannounced meal and from mild hyperglycemia. Once the system is initiated, all insulin delivery is calculated automatically. There was no outside intervention either by the subject or medical personnel. An artificial pancreas system that aims at replicating normal beta-cell function by using the subcutaneous-subcutaneous (sc-sc) route needs to address inherent delays in both glucose sensing and insulin delivery. Our strategic approach is that a closed-loop system should operate safely without any knowledge of meals or other disturbances. We have developed the Artificial Pancreas System (APS©) and used it to clinically evaluate a control strategy that allows efficient glycemic control without any a priori meal information. The Artificial Pancreas device uses the Artificial Pancreas System (APS©) platform with the OmniPod insulin pump, the DexCom SEVEN PLUS CGM and a multi-parametric model predictive control algorithm (mpMPC) with an insulin-on-board (IOB) safety constraint.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Willing to sign the consent form
  • Type 1 diabetes for at least 1 year prior to the study
  • Using continuous subcutaneous insulin infusion pump
  • Above 21 years of age
  • Willing to follow the study requirements

Exclusion criteria

  • Allergy to the sensor or to one of its components
  • Psychiatric disorders
  • Reported diabetic ketoacidosis within last 3 months
  • Abnormal liver function (Transaminase > 2 times the upper limit of normal)
  • Heart failure
  • Any carcinogenic disease
  • Any other chronic abnormality
  • Unwilling to perform or to follow the research protocol
  • Participation in any other study concurrent with the proposed study
  • Creatinine concentration above the upper limit of normal for age and sex
  • Active coronary artery disease
  • Active gastroparesis
  • History of uncontrolled seizures
  • Pregnancy
  • Untreated adrenal insufficiency
  • Hypokalemia
  • Uncontrolled thyroid disease.
  • Condition, which in the opinion of the investigator, would interfere with patient safety

Treatment and study plan

Closed-loop session

Device

Subjects will arrive fasting at 7am unless needed for hypoglycemia (glucose < 70 mg/dL) and no extra bolus insulin after 3am. An IV catheter will be inserted for blood samples and for IV administration of glucose if necessary. Blood samples will be analyzed for glucose by YSI 2300Stat every 30 minutes.

Breakfast consisting of 25g of CHO will be eaten at 7:30 am and the subject will bolus for this amount of CHO. The controller is switched "on" on the down slope of the meal response, and the subject is brought to a basal steady-state by the controller. Target blood glucose is 110 ± 30-mg/dL.

After approximately 3 hours a small lunch will be eaten consisting of 25g of CHO (unannounced meal challenge). The subject will be monitored until blood glucose returns to euglycemia.

Other names: Closed-loop Artificial Pancreas Device

Primary outcomes

  1. Restoration of Euglycemia

    Time frame: 12 hours

    The primary endpoint of this pilot study is successful restoration of euglycemia from the two perturbed conditions using closed loop control with minimal hypo- and hyperglycemia exposure. The first condition involves restoration of euglycemia when the subject is in a hyperglycemic state. The second condition involves restoration of euglycemia following consumption of a meal containing 25g CHO with no insulin bolus. The patients will be followed for the duration of the 12 hour study.

Secondary outcomes

  1. Average percent-of-time-in-range (80 - 180 mg/dL)

    Time frame: 12 hours

    All reported blood glucose values per both CGM and YSI ware analyzed for average percent-of-time-in-range (80 - 180 mg/dL). The participants will be followed for the duration of the 12 hour study.

Sponsors and collaborators

Lead sponsor

Sansum Diabetes Research Institute

Other

Collaborators

  • Juvenile Diabetes Research Foundation
  • Schneider Children's Medical Center, Israel

Registry information

Important dates

Study start
2008
Primary completion
2010
Study completion
2010
First posted
Dec 2, 2011
Registry last updated
Mar 23, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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