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| Name | Class |
|---|---|
| DexCom, Inc. | INDUSTRY |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A | Experimental | 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. |
|
| Group B | Experimental | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Diabetes Assistant (DiAs) with Closed-Loop | Device | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of Sensor Glucose Readings Between 70-180 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | 68 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of Time Sensor Glucose Readings Are <70 mg/dL | 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 |
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Inclusion Criteria:
Clinical diagnosis of type 1 diabetes,
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:
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| Name | Affiliation | Role |
|---|---|---|
| Mark D. DeBoer, MD | University of Virginia, Pediatrics, Endocrinology/Diabetes | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Virginia Center for Diabetes Technology | Charlottesville | Virginia | 22903 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28426239 | Background | DeBoer MD, Breton MD, Wakeman C, Schertz EM, Emory EG, Robic JL, Kollar LL, Kovatchev BP, Chernavvsky DR. Performance of an Artificial Pancreas System for Young Children with Type 1 Diabetes. Diabetes Technol Ther. 2017 May;19(5):293-298. doi: 10.1089/dia.2016.0424. Epub 2017 Apr 20. |
| Label | URL |
|---|---|
| Use of an AP in young children was safe and resulted in improved mean BG without increased hypoglycemia. This suggests that AP use in young children is safe and improves overall diabetes control. | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Group A- Home Care Before Closed-Loop Control | 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. 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. |
| FG001 | Group B- Closed-Loop Control Before Home Care | 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. 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. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Group A- Home Care Before Closed-Loop Control | 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. 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. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| 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 | Percent of Sensor Glucose Readings Between 70-180 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | Mean | Standard Deviation | percentage of time in range | 68 hours |
|
Adverse event data was collect over two 72 hour periods for each subject. Over the entire study, adverse events were collected over a 216 hour period (Group A's 72 hr home period, 72 hr hotel period, Group B's 72 hr home period).
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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 | Home Care (Pump+CGM) | All 12 subjects completed 68 hours of usual, home care using their home insulin pumps and a study CGM. The 6 subjects in Group A completed the home care portion before the Hotel admission, and the 6 subjects in Group B completed the home care portion after the Hotel admission. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Sore Knee | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Daniel R. Chernavvsky | Center for Diabetes Technology | 4342431395 | drc2v@virginia.edu |
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| ID | Term |
|---|---|
| D003922 | Diabetes Mellitus, Type 1 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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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 | 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 | 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 | 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) | 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) | 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) | 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) | 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) | 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 | 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 | 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 | 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 | 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 | 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 | 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 |
| BG001 | Group B- Closed-Loop Control Before Home Care | 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. 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. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| HbA1c | Median | Inter-Quartile Range | percentage of HbA1C |
|
| Diabetes Duration | Median | Inter-Quartile Range | years |
|
|
|
| Secondary | Percent of Time Sensor Glucose Readings Are <70 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | Mean | Standard Deviation | percentage of time below 70 mg/dL | 68 hours |
|
|
|
| Secondary | Percent of Time Sensor Glucose Readings Are >150 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Percent of Time Sensor Glucose Readings Are >180 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | Mean | Standard Deviation | percentage of time above 180 mg/dL | 68 hours |
|
|
|
| Secondary | Percent of Time Sensor Glucose Readings Are >250 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | Mean | Standard Deviation | percentage of time above 250 mg/dL | 68 hours |
|
|
|
| Secondary | Percent of Time Sensor Glucose Readings Are >400 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Distribution of Sensor and Meter Glucose Values (Maximum, Minimum, Median, Interquartile Range, Mean, Standard Deviation) | All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Distribution of Sensor and Meter Glucose Values (Maximum) | All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Distribution of Sensor and Meter Glucose Values (Minimum) | All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Distribution of Sensor and Meter Glucose Values (Median/Interquartile Range) | All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Mean BG (as Measured by CGM) | All subjects have CGM and handheld glucose meter output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | Mean | Standard Deviation | mg/dL | 68 hours |
|
|
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| Secondary | Hypoglycemia Area Under the Curve <60 | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Hypoglycemia Area Under the Curve <70 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Hyperglycemia Area Under the Curve >180 | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Hyperglycemia Area Under the Curve >250 mg/dL | All subjects have CGM output analyzed and compared between time on closed-loop system and time on usual care period. | Posted | 72 hours |
|
|
| Secondary | Incidence of Hypoglycemia Per Subject, Defined by Handheld Meter Glucose <70 mg/dL | All subjects have hypoglycemia monitored by meter analysis and compared between time on closed-loop system and time on usual care period. | Posted | Mean | Standard Deviation | events per subject, glucometer <70mg/dL | 68 hours |
|
|
|
| Secondary | End of Night Blood Glucose | 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. | Posted | 72 hours |
|
|
| 0 |
| 12 |
| 0 |
| 12 |
| EG001 | Diabetes Assistant (DiAs) With Closed-Loop Control | All 12 subjects used the DiAs Medical Platform, a study insulin pump and continuous glucose monitor (CGM) in closed-loop mode during a 68 hour Hotel admission. The 6 subjects in Group A completed the home care portion before the Hotel admission, and the 6 subjects in Group B completed the home care portion after the Hotel admission. | 0 | 12 | 1 | 12 |
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| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |