Closed Loop Glucose Control in Patients With Type 2 Diabetes

Study Overview
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Brief Summary
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This is a proof of concept safety study of an artificial intelligence based closed loop glucose control system designed for use in the intensive care unit setting. The type 2 diabetic subjects in this study will have their glucose controlled to a range of 100-140 mg/dL by a novel artificial intelligence based closed loop glucose control system for a period of 24 hours. The subjects will consume three standardized meals during the 24 hour study period.

Detailed Description
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Tight glucose control in the intensive care unit (ICU) setting is difficult to achieve. The investigators hypothesize that a closed loop glucose control system based on artificial intelligence (AI) will improve upon the glucose control currently achieved by the current open loop manual methods, and that this improved glucose control may improve the outcomes of critically ill patients, including those with COVID-19. This Earl Feasibility Study will test the ability of a prototype artificial intelligence based closed loop glucose control system named FUSION, to provide safe and effective glucose control in subjects with type 2 diabetes in a clinical research center (CRC) setting. Subjects with type 2 diabetes have been chosen as they are insulin resistant, which makes their insulin resistance profile similar to that of ICU patients. As this is the first in human study of a new medical device, the controlled environment of the CRC is preferable to the less controlled environment of an ICU setting. The prototype FUSION system to be used in this study will consist to two Dexcom G6 continuous glucose monitors (CGM), the AI-based glucose control software run on an all-in-one medical computer, and two syringe pumps. The prototype system is housed on a medical cart. Based on the average glucose value of the two Dexcom G6 CGM's, and the rules of the FUSION systems AI-based glucose control software, the FUSION system will make rate adjustments every 5-10 minutes to the intravenous infusion rates of short acting insulin (NovoLog) and dextrose (D10NS) under its control, in an attempt to keep the subjects glucose in the range of 100-140 mg/dL. The FUSION system only requires entry of the subjects study identification number and weight in kilograms to initiate the system. For safety reasons, the subjects will have their blood glucose independently measured every 10-60 minutes on a YSI 2900 glucose analyzer and the point of care Nova StatStrip system, throughout the 24 hour study period. The study has halting criteria to avoid recurrent instances of severe hypoglycemia (< 54 mg/dL). The average of the two CGM's, that is used by the FUSION system for glucose control, will be used for statistical analysis. In addition, both the average glucose value used by the FUSION system and each individual CGM system will be compared to the YSI glucose analyzer for correlation between systems using the Surveillance Error grid.

Official Title
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Demonstration of an Artificial Intelligence Based Closed Loop Glucose Control System as a Therapeutic Modality in Type 2 Diabetic Patients

Conditions
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Diabetes Mellitus, Type 2

Intervention / Treatment
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* Device: FUSION closed loop glucose control system


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Are 18-70 years of age, inclusive. Can understand and sign an informed consent, communicate with the investigator, and understand and comply with the protocol requirements. Have had a diagnosis of type 2 diabetes for a period of at least 3 months. Use insulin injections at home for glucose control. Have a hemoglobin A1c (HbA1c) in the range of 7.0 - 10.0%. Have a hemoglobin in the normal range for sex: Females: 12-15.5 grams/dL. Males: 13.5-17.5 grams/dl. Have adequate venous access sites in upper extremities. Body weight between 40 - 150 kg. Exclusion Criteria: Have participated in an interventional medical, surgical, or pharmaceutical study within 30 days of screening. Have a known hypersensitivity to any of the components of study treatment. Have skin disease/injury at Dexcom G6 CGM insertion site(s) that would prevent insertion of the CGM. Currently abuses drugs or alcohol or has a history of abuse that in the investigator's opinion would cause the individual to be noncompliant. Have a medical condition that in the opinion of the investigator could affect study participation and/or personal well-being. Have a clinically significant history or presence of any of the following conditions: Hepatic failure or has alanine aminotransferase (ALT) greater than 3 times the upper limit of normal. Has an estimated GFR <30 ml/min/1.73 m2 or End Stage Kidney Disease on renal replacement therapy. Have congestive heart failure greater than class 1 on the NYHA classification system. Have a history of seizures. Have a history of cerebrovascular accident. Have a history of ischemic heart disease. For female subjects of potential childbearing age (age 18 to 55) they will be excluded if: Pregnant. Refuse to agree to a pregnancy test at the time of enrollment. Have a positive urine pregnancy test at the time of enrollment. Have a positive COVID-19 test within 14 days of visit 3. Have any COVID-19 related symptoms in the 14-day period prior to visit 3. Have a known unprotected COVID-19 exposure in the 14-day period prior to visit 3.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Device Feasibility
Intervention Model: Single Group Assignment
Interventional Model Description: Early Feasibility Safety Study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FUSION closed loop glucose control system<br>All subjects will be treated with the FUSION closed loop glucose control system for up to 24 hours | Device: FUSION closed loop glucose control system<br>* The FUSION system will be used to control the subjects glucose to a range of 100-140 mg/dL. Data will be collected for up to 24 hours, or upon early termination of the study session.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Safety Outcome | The primary safety outcome will be the percent of all glucose values that are within the glucose range of less than 70 mg/dL. | From beginning of use of the FUSION system to end of use of the FUSION system, which will be a period of time of up to 24 hours | 
| Primary Efficacy Outcome | The primary efficacy outcome will be the percent of all glucose values that are within the glucose range of 70-180 mg/dL. | From beginning of use of the FUSION system to end of use of the FUSION system, which will be a period of time of up to 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severe hypoglycemia | Measure the percent of all glucose values that are less than 54 mg/dL. | From beginning of use of the FUSION system to end of use of the FUSION system, which will be a period of time of up to 24 hours | 
| Hyperglycemia | Measure the percent of all glucose values that are greater than 180 mg/dL. | From beginning of use of the FUSION system to end of use of the FUSION system, which will be a period of time of up to 24 hours | 
| Glucose dispersion | Measure the degree of glucose dispersion by determining the coefficient of variation. | From beginning of use of the FUSION system to end of use of the FUSION system, which will be a period of time of up to 24 hours | 
| Time in desired control range | Measure the percent of all glucose values that are within the desired control range of 100-140 mg/dL. | From beginning of use of the FUSION system to end of use of the FUSION system, which will be a period of time of up to 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Closed Loop Glucose Control, Artificial Pancreas, Artificial Intelligence, Glucose, Intensive Care Unit