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This is a randomized crossover trial with 1:1 randomization to the admission sequence of using the Control AP system (rMPC - Naïve Model Predictive Control) vs. Experimental AP system (EnMPC - Ensemble Model Predictive Control) over approximately 4 months. Eligible participants will proceed to the Data Collection Phase for approximately 28 days, during which they will participate in regimented exercise activities. If the participant collected adequate data during the Data Collection Phase, they will be randomized and undergo the study admissions in the assigned sequence. Each admission is approximately 36 hours in length and will consist of one afternoon of exercise and one without.
Exercise remains a challenge to AP systems; more specifically, by the time exercise is detected it is often too late to avoid hypoglycemia without the ingestion of rapid carbohydrates or the use of rescue injections, such as glucagon. To this avail, the investigators propose to add a novel Model Predictive Control module to the proven USS system. This module is designed to compute insulin doses every 5 minutes that are designed to "optimally" maintain glycaemia around a target of 120mg/dL. The optimality is defined mathematically as minimizing deviations from basal rate injections and the distance between current and future (up to 2h) glycaemia from a physiologically feasible trajectory back down (or up) to a pre-specified target. Furthermore, the novel control system, labelled Multi Stage MPC or Ensemble MPC, accounts for a preset number of exercise scenarios during the prediction horizon, these scenarios being derived from the user historical record; this setup allows the control system to anticipate expected exercise bouts up to 2h in advance while maintaining the condition for optimal glycemic control.
By adding such module to a well validated system, the investigators expect an improvement in protection against hypoglycemia during and immediately after physical activity without increase in hyperglycemia. To demonstrate the feasibility of this approach, the novel anticipatory system will be compared to a naïve AP system during highly supervised hotel admissions with afternoon exercise. Participants will be asked to exercise regularly in the late afternoon during a month of data collection to generate the patterns to be anticipated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control - Experimental Admissions | Experimental | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. |
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| Experimental - Control Admissions | Experimental | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EnMPC (Ensemble Model Predictive Control) AP Controller | Device | This AP controller has the ability to anticipate exercise activity by use of trends seen during the Data Collection Period. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Hypoglycemic Occurrences in Relation to Exercise Activity | Number of hypoglycemic occurrences immediately before, during, and immediately after exercise (~5-7pm) as defined by more than one consecutive CGM values below 70 mg/dL or hypoglycemic treatment per glycemic guidelines. | 2 Hours |
| Measure | Description | Time Frame |
|---|---|---|
| Average CGM | Average CGM value | 36 Hours |
| Percent Time CGM Below 54 mg/dL | Percentage of time CGM was below 54 mg/dL | 36 Hours |
| Measure | Description | Time Frame |
|---|---|---|
| Total Amount of Insulin Used | Total Amount of Insulin Used, units | 36 Hours |
| Number of Hypoglycemic Episodes | Number of Hypoglycemic Episodes as defined by contiguous CGM below 70 mg/dL |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Marc Breton, PhD | University of Virginia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Virginia | Charlottesville | Virginia | 22908 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33270531 | Result | Garcia-Tirado J, Brown SA, Laichuthai N, Colmegna P, Koravi CLK, Ozaslan B, Corbett JP, Barnett CL, Pajewski M, Oliveri MC, Myers H, Breton MD. Anticipation of Historical Exercise Patterns by a Novel Artificial Pancreas System Reduces Hypoglycemia During and After Moderate-Intensity Physical Activity in People with Type 1 Diabetes. Diabetes Technol Ther. 2021 Apr;23(4):277-285. doi: 10.1089/dia.2020.0516. Epub 2020 Dec 1. |
| Label | URL |
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| Related Info | View source |
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Will follow the NIH Data Sharing Policy and Implementation Guidance on sharing research resources for research purposes to qualified individuals in the scientific community.
Data will be made available after the publication of the manuscript.
The Data Sharing Agreements will be formulated by the study team
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| ID | Title | Description |
|---|---|---|
| FG000 | Experimental: Control - Experimental Admissions | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 4, 2019 |
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| rMPC (Naïve Model Predictive Control) AP Controller | Device | This AP controller does not have the ability to anticipate exercise activity. |
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| Percent Time CGM Below 70 mg/dL | Percentage of time CGM was below 70 mg/dL | 36 Hours |
| Percent Time CGM Between 70 and 180 mg/dL | Percentage of time CGM was between 70 and 180 mg/dL | 36 Hours |
| Percent Time CGM Between 70 and 140 mg/dL | Percentage of time CGM was between 70 and 140 mg/dL | 36 Hours |
| Percent Time CGM Above 180 mg/dL | Percentage of time CGM was above 180 mg/dL | 36 Hours |
| Percent Time CGM Above 250 mg/dL | Percentage of time CGM was above 250 mg/dL | 36 Hours |
| CGM Coefficient of Variation | Coefficient of Variation of the CGM Values | 36 Hours |
| CGM-based Low Blood Glucose Index | CGM-based Low Blood Glucose Index (LBGI) which is a metric used to quantify the risk of hypoglycemia (low blood sugar) based on self-monitored blood glucose (SMBG) data. LBGI is based on a nonlinear transformation of blood glucose values that corrects for the asymmetry of the glucose scale. This transformation maps glucose values into a risk space (minimum risk = 0), where higher values correspond to higher risk. Values <1 suggest low risk of hypoglycemia. | 36 Hours |
| CGM Standard Deviation | Standard Deviation of the CGM Values | 36 Hours |
| 36 Hours |
| FG001 | Experimental: Experimental - Control Admissions | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Experimental: Control - Experimental Admissions | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. |
| BG001 | Experimental: Experimental - Control Admissions | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. |
| BG002 | Total | Total of all reporting groups |
| 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, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Weight | Mean | Standard Deviation | kg |
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| Height | Mean | Standard Deviation | cm |
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| HbA1c | Mean | Standard Deviation | percentage of glycated hemoglobin |
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| Type 1 Diabetes Duration | Mean | Standard Deviation | years |
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| 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 | Number of Hypoglycemic Occurrences in Relation to Exercise Activity | Number of hypoglycemic occurrences immediately before, during, and immediately after exercise (~5-7pm) as defined by more than one consecutive CGM values below 70 mg/dL or hypoglycemic treatment per glycemic guidelines. | Posted | Median | Inter-Quartile Range | occurence | 2 Hours |
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| Secondary | Average CGM | Average CGM value | Posted | Mean | Standard Deviation | mg/dl | 36 Hours |
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| Secondary | Percent Time CGM Below 54 mg/dL | Percentage of time CGM was below 54 mg/dL | Posted | Median | Inter-Quartile Range | percentage of time | 36 Hours |
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| Secondary | Percent Time CGM Below 70 mg/dL | Percentage of time CGM was below 70 mg/dL | Posted | Mean | Inter-Quartile Range | percentage of time | 36 Hours |
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| Secondary | Percent Time CGM Between 70 and 180 mg/dL | Percentage of time CGM was between 70 and 180 mg/dL | Posted | Mean | Standard Deviation | percentage of time | 36 Hours |
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| Secondary | Percent Time CGM Between 70 and 140 mg/dL | Percentage of time CGM was between 70 and 140 mg/dL | Posted | Mean | Standard Deviation | percentage of time | 36 Hours |
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| Secondary | Percent Time CGM Above 180 mg/dL | Percentage of time CGM was above 180 mg/dL | Posted | Mean | Standard Deviation | percentage of time | 36 Hours |
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| Secondary | Percent Time CGM Above 250 mg/dL | Percentage of time CGM was above 250 mg/dL | Posted | Median | Inter-Quartile Range | percentage of time | 36 Hours |
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| Secondary | CGM Coefficient of Variation | Coefficient of Variation of the CGM Values | Posted | Mean | Standard Deviation | percentage of coefficient of variation | 36 Hours |
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| Secondary | CGM-based Low Blood Glucose Index | CGM-based Low Blood Glucose Index (LBGI) which is a metric used to quantify the risk of hypoglycemia (low blood sugar) based on self-monitored blood glucose (SMBG) data. LBGI is based on a nonlinear transformation of blood glucose values that corrects for the asymmetry of the glucose scale. This transformation maps glucose values into a risk space (minimum risk = 0), where higher values correspond to higher risk. Values <1 suggest low risk of hypoglycemia. | Posted | Median | Inter-Quartile Range | Index | 36 Hours |
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| Secondary | CGM Standard Deviation | Standard Deviation of the CGM Values | Posted | Mean | Standard Deviation | mg/dl | 36 Hours |
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| Other Pre-specified | Total Amount of Insulin Used | Total Amount of Insulin Used, units | Posted | Mean | Standard Deviation | unit | 36 Hours |
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| Other Pre-specified | Number of Hypoglycemic Episodes | Number of Hypoglycemic Episodes as defined by contiguous CGM below 70 mg/dL | Posted | Median | Inter-Quartile Range | Episodes | 36 Hours |
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Enrollment to second admission day, ~ 2 months
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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 | HCL (Control) | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Control-Experimental Arm will undergo the Control Admission first, utilizing an artificial pancreas (AP) controller that does not anticipate exercise (rMPC - naïve model predictive control), followed by the Experimental Admission, which will utilize an AP controller that has the ability to anticipate exercise (EnMPC - ensemble model predictive control). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. | 0 | 15 | 0 | 15 | 1 | 15 |
| EG001 | APEX (Experimental) | Subjects will be randomized following the Data Collection Phase in a 1:1 ratio. Subjects in the Experimental-Control Arm will undergo the Experimental Admission first, utilizing an artificial pancreas (AP) controller that has the ability to anticipate exercise (EnMPC), followed by the Control Admission, which will utilize an AP controller that does not have the ability to anticipate exercise (rMPC). During the 36-hour admissions, subjects will begin using the study AP system (control or experimental) on Day 1 around midday with a scheduled exercise activity in the evening. Day 2 will consist of minimal activity and subjects will be discharged in the evening on Day 2. | 0 | 15 | 0 | 15 | 0 | 15 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Skin infection on arm | Skin and subcutaneous tissue disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Marc Breton | UVA Center for Diabetes Technology | 434-982-6484 | mb6nt@virginia.edu |
| Dec 16, 2020 |
| Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Nov 4, 2019 | Dec 16, 2020 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D003922 | Diabetes Mellitus, Type 1 |
| D007003 | Hypoglycemia |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D001519 | Behavior |
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| Asian |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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