Clinical trial NCT02750267: Closed-Loop Control in Young Children 5-8 Years Old Using DiAs Platform
Official title: Closed-Loop Control in Young Children 5-8 Years Old Using DiAs Platform
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes Mellitus, Type 1
Keywords: Type 1 Diabetes Mellitus (T1DM)
Artificial Pancreas Project (APP)
Diabetes Assistant (DiAs)
Closed-Loop Control (CLC)
Continuous Glucose Monitor
Pediatric
Insulin Pump
Lead sponsor: University of Virginia
Sponsor class: OTHER
Collaborators: name: DexCom, Inc.
First posted: 2016-04-25
Enrollment: 12
Sex: ALL
Minimum age (years): 5
Maximum age (years): 9
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: 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.

Detailed description: 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.

Eligibility criteria: Inclusion Criteria:

* Clinical diagnosis of type 1 diabetes,

  * The diagnosis of type 1 diabetes is based on the investigator's judgment
  * C peptide levels and antibody determinations are not required
* 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:

  * Inpatient psychiatric treatment in the past 6 months
  * Uncontrolled adrenal insufficiency

Primary outcomes:
measure: Percent of Sensor Glucose Readings Between 70-180 mg/dL
timeFrame: 68 hours
Secondary outcomes:
measure: Percent of Time Sensor Glucose Readings Are <70 mg/dL
timeFrame: 68 hours
measure: Percent of Time Sensor Glucose Readings Are >150 mg/dL
timeFrame: 72 hours
measure: Percent of Time Sensor Glucose Readings Are >180 mg/dL
timeFrame: 68 hours
measure: Percent of Time Sensor Glucose Readings Are >250 mg/dL
timeFrame: 68 hours
measure: Percent of Time Sensor Glucose Readings Are >400 mg/dL
timeFrame: 72 hours
measure: Distribution of Sensor and Meter Glucose Values (Maximum, Minimum, Median, Interquartile Range, Mean, Standard Deviation)
timeFrame: 72 hours
measure: Distribution of Sensor and Meter Glucose Values (Maximum)
timeFrame: 72 hours
measure: Distribution of Sensor and Meter Glucose Values (Minimum)
timeFrame: 72 hours
measure: Distribution of Sensor and Meter Glucose Values (Median/Interquartile Range)
timeFrame: 72 hours
measure: Mean BG (as Measured by CGM)
timeFrame: 68 hours
measure: Hypoglycemia Area Under the Curve <60
timeFrame: 72 hours
measure: Hypoglycemia Area Under the Curve <70 mg/dL
timeFrame: 72 hours
measure: Hyperglycemia Area Under the Curve >180
timeFrame: 72 hours
measure: Hyperglycemia Area Under the Curve >250 mg/dL
timeFrame: 72 hours
measure: Incidence of Hypoglycemia Per Subject, Defined by Handheld Meter Glucose <70 mg/dL
timeFrame: 68 hours
measure: End of Night Blood Glucose
timeFrame: 72 hours
Other outcomes:
Locations:
city: Charlottesville
country: United States
facility: University of Virginia Center for Diabetes Technology
state: Virginia
Study officials:
affiliation: University of Virginia, Pediatrics, Endocrinology/Diabetes
name: Mark D. DeBoer, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.