Clinical trial NCT06017089: The Pediatric Artificial Pancreas Automated Initialization Trial
Official title: The Pediatric Artificial Pancreas Automated Initialization Trial (PEDAP-AI): A Pilot Study of AI Advisor-Driven Pump Initiation and Parameter Adaptation in Young Children With Type 1 Diabetes
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Type 1 Diabetes
Keywords: Type 1 Diabetes
Continuous Glucose Monitor (CGM)
Tandem t:slim Insulin Pump with Control-IQ Technology
Control-IQ Technology (CIQ)
Artificial Pancreas (AP)
Artificial Intelligence (AI)
Closed loop control (CLC)
Diabetes Assistant (DiAs)
Lead sponsor: University of Virginia
Sponsor class: OTHER
Collaborators: name: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
name: Jaeb Center for Health Research
name: University of Colorado, Denver
name: Stanford University
First posted: 2023-08-30
Enrollment: 33
Sex: ALL
Minimum age (years): 2
Maximum age (years): 5
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: In this single-arm intervention trial, all participants will use the study system (pump and CGM) in closed-loop mode for 8 weeks.
Primary purpose: TREATMENT

Brief summary: The goal of this clinical trial is to obtain safety data and exploratory glycemic control data from use of an at-home closed loop control (CLC) system (t:slim X2 with Control-IQ Technology) with periodic parameter adjustments driven by an AI-based Advisor system in young children with Type 1 Diabetes. The main endpoints this study aims to answer is the safety and efficacy of the use of the AI-driven pump parameters. Participants will use the study system (pump and Continuous Glucose Monitor) in closed-loop mode for eight weeks.

Detailed description: In this single-arm pilot study of an AI Advisor-driven closed loop system initiation and parameter adaptation in youth age 2 to \<6 years old, participants will use the Tandem t:slim X2 with Control-IQ and t:connect mobile application and Dexcom G6 or G7 system, connected to the University of Virginia (UVA) cloud-based Physician Dashboard for eight weeks at home.The key safety outcomes are adverse events related to hypoglycemia and hyperglycemia, CGM-measured time spent below 54mg/dL, and CGM-measured time spent above 250 mg/dL. CGM-measured endpoints will be tested against baseline for non-inferiority.Glycemic outcomes including time in target range 70-180 mg/dL (TIR) and various other CGM measures of hypo- and hyperglycemia will be assessed and tested for superiority against baseline and a matched historical control population from the prior PEDAP study that did not involve the use of any AI-driven pump parameters. Up to 45 screened participants with the goal of at least 30 participants completing the study pump use period.

Eligibility criteria: Inclusion Criteria:

1. Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least 1 month
2. Familiarity and use of a carbohydrate ratio for meal boluses
3. Age ≥2 and \<6 years old
4. Using a Dexcom CGM at the time of enrollment, with use on at least 21 out of the prior 28 days
5. Living with one or more parent/legal guardian knowledgeable about emergency procedures for severe hypoglycemia and able to contact emergency services and study staff
6. Parent/guardian has a phone that can run the Tandem t:connect Mobile App (typically Android 10 or above or iPhone Operating System (iOS) 15 or above)
7. Willingness to use the t:connect Mobile App as needed during the study and ensure connectivity for a data upload at least once per day
8. Investigator has confidence that the parent can successfully operate all study devices and is capable of adhering to the protocol
9. Willingness to switch to lispro (Humalog) or aspart (Novolog) if not using already, and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study for participants using a study162 provided Tandem pump during the study
10. Total daily insulin dose (TDD) at least 5 Units/day
11. Body weight at least 20 pounds (lbs)
12. Willingness not to start any new non-insulin glucose-lowering agent during the course of the trial
13. Participant and parent(s)/guardian(s) willingness to participate in all training sessions as directed by study staff
14. Parent/guardian proficient in reading and writing English
15. Live in the United States, with no plans to move outside the United States during the study period

Exclusion Criteria:

1. Concurrent use of any non-insulin glucose-lowering agent (including GLP-1 agonists, Symlin, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylureas)
2. Hemophilia or any other bleeding disorder
3. History of \>1 severe hypoglycemic event with seizure or loss of consciousness in the last 3 months
4. History of \>1 DKA event in the last 6 months not related to illness, infusion set failure, or initial diagnosis
5. History of chronic renal disease or currently on hemodialysis
6. History of adrenal insufficiency
7. Hypothyroidism that is not adequately treated in the opinion of the investigator
8. Use of oral or injectable steroids within the last 8 weeks
9. Known, ongoing adhesive intolerance
10. Plans to receive blood transfusions or erythropoietin injections during the course of the study
11. A condition, which in the opinion of the investigator or designee, would put the participant or study at risk
12. Participation in another pharmaceutical or device trial at the time of enrollment or during the study
13. Having immediate family members employed by Tandem Diabetes Care, Inc. or Dexcom, Inc., or having a direct supervisor at place of employment who is also directly involved in conducting the clinical trial (as a study investigator, coordinator, etc.); or having a first-degree relative who is directly involved in conducting the clinical trial

Primary outcomes:
measure: Percentage below 54 mg/dL
timeFrame: 8 weeks
measure: Percentage below 54 mg/dL
timeFrame: 8 weeks
measure: Percentage above 250 mg/dL
timeFrame: 8 weeks
measure: Percentage above 250 mg/dL
timeFrame: 8 weeks
measure: Hierarchical Efficacy Endpoints (tested for superiority compared with baseline) CGM Measured
timeFrame: 8 weeks
measure: Hierarchical Efficacy Endpoints (tested for superiority compared with baseline) CGM Measured
timeFrame: 8 weeks
measure: Hierarchical Efficacy Endpoints (tested for superiority compared with baseline) CGM Measured
timeFrame: 8 weeks
measure: Hierarchical Efficacy Endpoints (tested for superiority compared with baseline) CGM Measured
timeFrame: 8 weeks
measure: Hierarchical Efficacy Endpoints (tested for superiority compared with baseline) CGM Measured
timeFrame: 8 weeks
Secondary outcomes:
measure: CGM Measured Time in Range
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: CGM Measured
timeFrame: 8 weeks
measure: Binary outcome 1
timeFrame: 8 weeks
measure: Binary outcome 2
timeFrame: 8 weeks
measure: Binary outcome 3
timeFrame: 8 weeks
measure: Total daily insulin
timeFrame: 8 weeks
measure: Basal Insulin
timeFrame: 8 weeks
Other outcomes:
Locations:
city: Stanford
country: United States
facility: Stanford University
state: California
city: Aurora
country: United States
facility: Barbara Davis Center, University of Colorado
state: Colorado
city: Charlottesville
country: United States
facility: University of Virginia
state: Virginia
Study officials:
affiliation: Jaeb Center for Health Research
name: John Lum, MS
role: STUDY_DIRECTOR
affiliation: Barbara Davis Center, University of Colorado
name: Raj Paul Wadwa, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Virginia Center for Diabetes Technology
name: Marc D Breton, Ph.D.
role: STUDY_CHAIR
References: