Dual-Hormone Closed-Loop Glucose Control in Adolescents With Type 1 Diabetes
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional
Phase: Phase 4

Summary: 
      Objective:

      To assess the efficacy and safety of an insulin-glucagon dual-hormone (DH) closed-loop system
      compared with an insulin-only single-hormone (SH) closed-loop system in adolescent with type
      1 diabetes.

      Methods:

      In a 26-h, randomized, crossover, inpatient study, 20 children and adolescents with type 1
      diabetes used two modes of the DiaCon Artificial Pancreas system: DH and SH closed-loop
      control. During each study period, participants will have one overnight stay, received three
      meals and performed exercise for 45 min (bicycle with estimated 50% V02max).

      Endpoint:

      The primary endpoint is sensor-derived percentage of time in hypoglycemia (<3.9 mmol/L).
    

Detailed description: 
      Upon arrival at the research facility at Steno Diabetes Center Copenhagen, the participant's
      own pump and CGM are disconnected, and the two study pumps are attached. For dual-hormone
      control, the study pumps will be filled with FiAsp® and GlucaGen®. For single-hormone
      control, the study pumps have been filled with FiAsp® and isotonic saline.

      In addition, participants are provided with a blinded wearable activity and sleep monitoring
      device (ActiGraph GT9X Link, Pensacola, FL) for activity level estimation and sleep
      assessment during study participation. The Actigraph is connected to a Bluetooth® Polar heart
      rate monitors during the exercise session.

      Female participants deliver a urine sample for pregnancy testing. A sampling cannula is
      placed in an antecubital vein. The CGM will be calibrated with fingerpick glucose meter
      (Contour next®, Ascensia Diabetes Care) before initiating the closed-loop control. Even
      though it is not needed to calibrate the sensor, the accuracy of the sensor is better after
      one calibration.

      At day 1 17:00 the study is initiated, and the closed-loop system takes over glucose control.
      Except from the control approach (single- vs. dual-hormone), the study days are identical.
      During the study visit, participants can move around freely, but they can only perform actual
      exercise during the stationary bike exercise session at day 2 16:30. At nighttime, the
      participants are encouraged to be in bed and, if possible, sleep.

      At predefined timepoints, the investigators measure blood pressure and pulse, and the
      investigators ask the participants to rate their nausea level on a visual analog scale (VAS)
      from 1 to 100 to assess possible side effects of glucagon (vomiting rates as 100). In
      addition, the investigators ask them to self-rate blood glucose levels before bedtime
      (23:00), upon wake-up (07:00-08:00), before each meal, before exercise, and every 10 minutes
      during exercise.

      Single-hormone and dual-hormone closed-loop control study sessions end 26 hours after study
      start. The study pumps and the CGMs are disconnected and the participants reconnect their own
      pumps and CGMs.

      The two study sessions are separated by at least 36 hours.
    

Intervention name(s): Glucagon; Closed-loop System
Intervention type(s): Drug; Device
Intervention description(s): Glucagon is filled in the pump and given automatically in case of hypoglycemia or pending hypoglycemia.; Closed-loop system comprise of two DANA RS (R) insulin pumps (FiAsp-GlucaGen vs FiAsp-saline), one DexCom G6 sensor, and a smartphone for the control algorithm.
Other intervention name(s): GlucaGen, Novo Nordisk,; Saline
Intervention MeSH terms: Glucagon
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: A randomized, single-blinded, cross-over study of glycemic control during dual-hormone therapy compared with single-hormone therapy in adolescents with type 1 diabetes.
Masking: Single (Participant)
Primary purpose: Treatment