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| ID | Type | Description | Link |
|---|---|---|---|
| SPO 53117 | Other Grant/Funding Number | Medtronic |
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| Name | Class |
|---|---|
| Medtronic | INDUSTRY |
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The purpose of this study is to evaluate a treat-to-range automated insulin management system using continuous glucose monitoring (CGM) and subcutaneous insulin pump infusion in individuals with type 1 diabetes.
The purpose of this study is to demonstrate the safety and efficacy of a closed-loop "treat-to-range" (TTR) system in an inpatient clinical research center setting. The TTR system only effects insulin delivery when the glucose is projected to be above or below specified target ranges. These initial studies will assess the safety of this algorithm (mathematical equation) under the extreme conditions of a missed meal insulin bolus and meal over-insulinization. This is a "hybrid" system, which allows the research team to deliver insulin boluses manually with the TTR controller only becoming active when blood glucose levels are projected to be out of the specified range.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TTR controller | Experimental | The intervention will consist of using the TTR controller (Medtronic) for post-prandial glucose control following high and low glycemic meals |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TTR controller (Medtronic) | Device | Subjects will arrive in the morning and the TTR controller (Medtronic) will be initialized, and then they will give their usual premeal insulin bolus for breakfast. At lunch, they will either have a low glycemic index meal or a high glycemic index meal and the meal bolus will be omitted. The device will be turned off before dinner, they will have their usual insulin bolus for dinner, eat dinner, and then be discharged to home. On another admission, they will receive an insulin dose before lunch which will be 120% of their usual insulin bolus. |
| Measure | Description | Time Frame |
|---|---|---|
| Safety and Feasibility of TTR Closed-loop Control System as Measure by the Count of Successful Hospital Admissions | A successful hospital admission was defined as requiring no more than 2 TTR closed-loop control system adjustments of algorithm tuning parameters after initial set up, and not meeting any stopping criteria. The system was considered feasible if 75% of hospital admissions were successful. | Day of hospital admission (12 hours) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Bruce Buckingham, MD | Stanford University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Stanford University and Stanford Hospital & Clinics | Stanford | California | 94305 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | TTR Controller | The intervention will consist of using the Treat to Range (TTR) controller (Medtronic) for post-prandial glucose control following high and low glycemic meals TTR controller (Medtronic): Subjects will arrive in the morning and the TTR controller (Medtronic) will be initialized, and then they will give their usual premeal insulin bolus for breakfast. At lunch, they will either have a low glycemic index meal or a high glycemic index meal and the meal bolus will be omitted. The device will be turned off before dinner, they will have their usual insulin bolus for dinner, eat dinner, and then be discharged to home. On another admission, they will receive an insulin dose before lunch which will be 120% of their usual insulin bolus. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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Subjects with Type 1 Diabetes
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| ID | Title | Description |
|---|---|---|
| BG000 | TTR Controller | The intervention will consist of using the TTR controller (Medtronic) for post-prandial glucose control following high and low glycemic meals TTR controller (Medtronic): Subjects will arrive in the morning and the TTR controller (Medtronic) will be initialized, and then they will give their usual premeal insulin bolus for breakfast. At lunch, they will either have a low glycemic index meal or a high glycemic index meal and the meal bolus will be omitted. The device will be turned off before dinner, they will have their usual insulin bolus for dinner, eat dinner, and then be discharged to home. On another admission, they will receive an insulin dose before lunch which will be 120% of their usual insulin bolus. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Safety and Feasibility of TTR Closed-loop Control System as Measure by the Count of Successful Hospital Admissions | A successful hospital admission was defined as requiring no more than 2 TTR closed-loop control system adjustments of algorithm tuning parameters after initial set up, and not meeting any stopping criteria. The system was considered feasible if 75% of hospital admissions were successful. | A total of 25 admissions were completed. 1 participant was admitted twice in Cohort A1, and 2 participants were admitted first in Cohort A1 and then again in Cohort B. | Posted | Count of Units | Admissions | Day of hospital admission (12 hours) | Admissions | Admissions |
|
Day of hospital admission (12 hours)
Per protocol, adverse events were only collected during the hospital admission when participants were wearing the TTR controller (Medtronic) device
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | TTR Controller | The intervention will consist of using the TTR controller (Medtronic) for post-prandial glucose control following high and low glycemic meals TTR controller (Medtronic): Subjects will arrive in the morning and the TTR controller (Medtronic) will be initialized, and then they will give their usual premeal insulin bolus for breakfast. At lunch, they will either have a low glycemic index meal or a high glycemic index meal and the meal bolus will be omitted. The device will be turned off before dinner, they will have their usual insulin bolus for dinner, eat dinner, and then be discharged to home. On another admission, they will receive an insulin dose before lunch which will be 120% of their usual insulin bolus. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Significant Post-Prandial Hyperglycemia | Metabolism and nutrition disorders | Systematic Assessment | Yellow Springs Instrument (YSI) Blood Glucose Value >300 mg/dL for 75 minute in 3 hours following a meal |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Bruce Buckingham, MD | Stanford University | 408-356-0911 | buckingham@stanford.edu |
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| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D003922 | Diabetes Mellitus, Type 1 |
| D009748 | Nutrition Disorders |
| D008659 | Metabolic Diseases |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
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| Participants |
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| Sex: Female, Male | Count of Participants | Participants |
|
| OG001 | Cohort A2 - Missed Bolus Meal | The intervention will consist of using the TTR controller (Medtronic) for post-prandial glucose control following high and low glycemic meals TTR controller (Medtronic): Subjects will arrive in the morning and the TTR controller (Medtronic) will be initialized, and then they will give their usual premeal insulin bolus for breakfast. At lunch, they will have a high glycemic index meal and the meal bolus will be omitted. The device will be turned off before dinner, they will have their usual insulin bolus for dinner, eat dinner, and then be discharged to home. |
| OG002 | Cohort B - Overbolus Meal | The intervention will consist of using the TTR controller (Medtronic) for post-prandial glucose control following high and low glycemic meals TTR controller (Medtronic): Subjects will arrive in the morning and the TTR controller (Medtronic) will be initialized, and then they will give their usual premeal insulin bolus for breakfast. At lunch, they will receive an insulin dose which will be 120% of their usual insulin bolus. The device will be turned off before dinner, they will have their usual insulin bolus for dinner, eat dinner, and then be discharged to home. |
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|
| 0 |
| 22 |
| 6 |
| 22 |
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| Hypoglycemia <50 mg/dL | Metabolism and nutrition disorders | Non-systematic Assessment | YSI blood glucose value <50 mg/dL |
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| Hypoglycemia | Metabolism and nutrition disorders | Non-systematic Assessment | Any hypoglycemic event requiring administration of fast acting carbohydrates. |
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| D007154 | Immune System Diseases |