Clinical trial NCT04235504: ADvanced Hybrid Closed Loop Study in Adult Population With Type 1 Diabetes
Official title: ADvanced Hybrid Closed Loop Study in Adult Population With Type 1 Diabetes
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Type 1 Diabetes
Keywords: Advanced Hybrid Closed Loop
Multiple Daily Injections
Flash Glucose Monitoring
Continuous Glucose Monitoring
Lead sponsor: Medtronic Diabetes
Sponsor class: INDUSTRY
First posted: 2020-01-22
Enrollment: 122
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: There will be 2 Cohort for this study:

1. Cohort A: Subjects on MDI + FGM will be randomized into: Treatment Arm (AHCL) and Control Arm (MDI+ FGM)
2. Cohort B: Subjects on MDI + Real-Time CGM will be randomized into: Treatment Arm (AHCL) and Control Arm (MDI+ CGM) (exploratory analysis)
Primary purpose: TREATMENT

Brief summary: The purpose of this study evaluate the safety and efficacy of the Advanced Hybrid Closed Loop (AHCL) system in sub-optimally controlled patients with T1D, in comparison with Multiple Daily Injection (MDI) therapy with Flash Glucose Monitoring (FGM) or Continuous Glucose Monitoring (CGM). Patient with a diagnosis of Type 1 diabetes currently under MDI+ FGM or MDI+ CGM therapy will be enrolled.

Detailed description: This study is a pre-market, multi-center, prospective, open label, adaptative, randomized controlled trial in insulin-requiring adult subjects with type 1 diabetes on MDI therapy. The study will have three period:

1. Run-in Phase: The Run-in period is of 4 weeks (and can be extended for 2 additional ones) during which time a blinded CGM sensor will be worn for two weeks.
2. Study Phase: There will be a 6 months randomized study period with two arms: Treatment Arm (AHCL) and the Control Arm.
3. Continuation Phase: There will be a 6 months continuation phase during which time all the subjects will use the AHCL system.

Approximately 124 subjects will be enrolled in the study up to 20 investigational centers in EMEA.

Eligibility criteria: Inclusion Criteria:

1. Subject is age ≥ 18 years old at time of screening
2. Subject has a clinical diagnosis of Type 1 diabetes for ≥ 2 years prior to screening as determined via source documentation
3. On MDI therapy (defined as ≥ 3 insulin injections per day and/or a basal/bolus regimen) ≥ 2 years prior to screening
4. Subject has been followed and treated by the investigator at this investigational site for at least 3 months prior to screening and subject has already undergone local educational therapeutic programs.
5. Subject is using:

   * Flash Glucose Monitoring (FGM) for ≥ 3 months with a daily average number of scans ≥ 5 over and with sensor readings \> 70% of time over the previous month prior to screening (based on sensor usage from the download summary report of the FGM system over 30 days prior to screening) Or
   * Continuous Glucose Monitoring (CGM) for ≥ 3 months with a frequency of sensor use ≥ 70% of the time over the previous month prior to screening (based on download summary report from the CGM system over 30 days prior to screening).
6. Subject has a glycosylated hemoglobin (HbA1c) ≥ 8.0% (64 mmol/mol) at time of screening visit (as processed by a Central Lab).
7. Subject is willing to take or switch to one of the following insulins:

   1. Humalog™ (insulin lispro injection)
   2. NovoLog™ (insulin aspart)
8. Subject must have a minimum daily insulin requirement (Total Daily Dose) of ≥ 8 units and a maximum of 250 units.
9. Subject is willing to upload data from the study pump and meter, must have Internet access and a compatible computer system that meets the requirements for uploading the study pump data at home.
10. Subject is willing and able to sign and date informed consent, comply with all study procedures and wear all study devices, as required during the study.

Exclusion Criteria:

1. Subject has untreated Addison's disease, thyroid disorder, growth hormone deficiency, hypopituitarism or definite gastroparesis, per investigator judgment.
2. Subject is using pramlintide, DPP-4 inhibitor, GLP-1 agonists/mimetics, metformin, SGLT2 inhibitors at time of screening.
3. Subject has had renal failure defined by creatinine clearance \<30 ml/min, as assessed by local lab test ≤ 12 months before screening or performed at screening at local lab, as defined by the creatinine-based Cockcroft or MDRD equations.
4. Subject is planning to switch from FGM to CGM therapy during the 6 months study phase. Note: Subject randomized to Control Arm should remain on their current FGM or CGM therapy during the study phase and will be switched to AHCL during the continuation phase.
5. Subject has a history of hearing or vision impairment hindering perception of glucose display and alarms, or otherwise incapable of using the study devices, per investigator judgment.
6. Women of child-bearing potential who have a positive pregnancy test at screening or plan to become pregnant during the course of the study.
7. Females who are sexually active and able to conceive will be excluded if they are not using an effective method of contraception and do not agree to continue using an effective method of contraception for the duration of the study, per investigator judgment.
8. Subject has any unresolved adverse skin conditions in the area of sensor placement (e.g. psoriasis, dermatitis herpetiformis, rash, Staphylococcus infection).
9. Subject is actively participating in an investigational study (drug or device) wherein he/she has received treatment from an investigational study drug or device in the last 2 weeks before enrollment into this study, as per investigator judgment.
10. Subject is currently abusing illicit drugs, marijuana, alcohol or prescription drugs (other than nicotine), per investigator judgment.
11. Subject has any other disease or condition that may preclude the patient from participating in the study, per investigator judgment.
12. Subject is legally incompetent, illiterate or vulnerable person.
13. Research staff involved with the study.

Primary outcomes:
measure: HbA1c 6 Months Change Between AHCL and MDI
timeFrame: Baseline and end of 6-month study phase
Secondary outcomes:
measure: TIR Between 70-180 mg/dL
timeFrame: 6 months study phase
measure: Time in Hyperglycemic Range
timeFrame: 6 months study phase
measure: Hypoglycemic Events
timeFrame: 6 months study phase
Other outcomes:
measure: HbA1c 6 Months Change Between AHCL and MDI
timeFrame: Baseline and end of 6-month study phase
measure: TIR Between 70-180 mg/dL
timeFrame: 6 months study phase
measure: Time in Hyperglycemic Range
timeFrame: 6 months study phase
measure: Hypoglycemic Events
timeFrame: 6 months study phase
measure: HbA1c 6 Months Change Within Group
timeFrame: End of 6-month study phase and end of 6-month continuation phase
measure: HbA1c 12 Months Change Between Groups
timeFrame: Baseline through the end of 6-month continuation phase (a total of 12 months)
measure: HbA1c 6 Months Change Within Group
timeFrame: End of 6-month study phase and end of 6-month continuation phase
measure: HbA1c 12 Months Change Between Groups
timeFrame: Baseline through the end of 6-month continuation phase (a total of 12 months).
Locations:
city: Besançon
country: France
facility: Centre Hospitalier Universitaire Besancon - Hôpital Jean Minjoz
city: Bordeaux
country: France
facility: CHU de Bordeaux - Hôpital Saint André
city: Caen
country: France
facility: CHU Caen
city: Lyon
country: France
facility: Hospices Civils de Lyon (DIAB-e CARE)
city: Marseille
country: France
facility: APM - Hôpital de la Conception
city: Strasbourg
country: France
facility: Hospital Civil
city: Bergheim
country: Germany
facility: Diabetologische Schwerpunktpraxis Dr. Ralf Kolassa
city: Hamburg
country: Germany
facility: Zentrum für Diabetologie Bergedorf
city: Lage
country: Germany
facility: Gemeinschaftspraxis im Westtor Hausarztpraxis & Diabetologische Schwerpunktpraxis
city: Münster
country: Germany
facility: Medical Center am Clemenshospital Dr. Winfried Keuthage
city: Cambridge
country: United Kingdom
facility: Cambridge University Hospitals NHS Foundation Trust - Addenbrooke's Hospital
city: Harrogate
country: United Kingdom
facility: Harrogate and District Hospital - NHS Foundation Trust
city: Leicester
country: United Kingdom
facility: University Hospitals of Leicester NHS Trust Leicester General Hospital
city: London
country: United Kingdom
facility: King's College Hospital NHS Foundation Trust
Study officials:
References:
citation: Choudhary P, Kolassa R, Keuthage W, Kroeger J, Thivolet C, Evans M, Re R, de Portu S, Vorrink L, Shin J, Habteab A, Castaneda J, da Silva J, Cohen O; ADAPT study Group. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): a randomised controlled study. Lancet Diabetes Endocrinol. 2022 Oct;10(10):720-731. doi: 10.1016/S2213-8587(22)00212-1. Epub 2022 Sep 1.
citation: de Portu S, Vorrink L, Re R, Shin J, Castaneda J, Habteab A, Cohen O. Randomised controlled trial of Advanced Hybrid Closed Loop in an Adult Population with Type 1 Diabetes (ADAPT): study protocol and rationale. BMJ Open. 2022 Feb 2;12(2):e050635. doi: 10.1136/bmjopen-2021-050635.