Effect of Metabolic Control at Onset of Diabetes on Progression of Type 1 Diabetes

NCT ID: NCT00891995

Last Updated: 2016-12-30

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

71 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-09-30

Study Completion Date

2013-10-31

Brief Summary

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The purpose of this study is to find out if very tight blood glucose control from the onset of Type 1 Diabetes can preserve beta cell function. Study subjects will be randomly assigned to receive either standard diabetes management or intensive diabetes management, which involves several days of closed loop therapy followed by home use of a continuous glucose monitor and insulin pump.

Detailed Description

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The specific aim of this study is to determine if early restoration of metabolic control will improve C-peptide production compared to children receiving routine diabetes management and the secondary aim is to determine if allowing the islet cells to be less metabolically active will have an impact on the underlying autoimmune process.

Following completion of the baseline procedures (Mixed Meal Tolerance Test and blood sample collection), participants are randomized to either the Standard Treatment Group or the Intensive Treatment Group which includes 4-6 days of inpatient closed loop therapy followed by outpatient use of an insulin pump and continuous glucose monitor for diabetes management.

All subjects will be seen 7 times in the first year and 4 times in the second year for follow-up testing. Subjects who are still producing insulin after 2 years may be asked to return every 6 months for an additional 2 years.

Conditions

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Type 1 Diabetes

Keywords

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Type 1 Diabetes Closed Loop Therapy Continuous Glucose Monitor

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intensive Treatment

closed loop therapy (4-6 days), insulin pump (2 years), continuous glucose monitoring (2 years), home glucose monitoring (2 years)

Group Type EXPERIMENTAL

Closed loop

Intervention Type DEVICE

Closed loop therapy for up to 4 to 6 days

Home glucose monitoring

Intervention Type DEVICE

Standard diabetes management using a home glucose meter.

Insulin pump

Intervention Type DEVICE

Insulin pump use for 2 years

Continuous glucose monitor

Intervention Type DEVICE

Continuous glucose monitor use for 2 years

Standard Treatment

home glucose monitoring (2 years)

Group Type ACTIVE_COMPARATOR

Home glucose monitoring

Intervention Type DEVICE

Standard diabetes management using a home glucose meter.

Interventions

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Closed loop

Closed loop therapy for up to 4 to 6 days

Intervention Type DEVICE

Home glucose monitoring

Standard diabetes management using a home glucose meter.

Intervention Type DEVICE

Insulin pump

Insulin pump use for 2 years

Intervention Type DEVICE

Continuous glucose monitor

Continuous glucose monitor use for 2 years

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 6.0 to \<46.0 years
* Diagnosis of type 1 diabetes with initiation of insulin therapy within past 7 days (day 1 being the first day of insulin therapy)
* If participant is female with reproductive potential, willing to avoid pregnancy and pregnancy test negative.
* Willing to accept randomization to either the intensive diabetes management group or the standard care group.
* Willing to complete the planned 2 years of follow-up.
* Able to electronically transmit data monthly.
* Investigator believes that the participant (and parent/guardian for children) understands and agrees to comply with the study protocol and is capable of undertaking all necessary testing.

Exclusion Criteria

* Currently pregnant or lactating, or anticipate getting pregnant in the next one year.
* Currently anemic (hematocrit level will be obtained at the screening visit).
* Chronic use of systemic steroids or other noninsulin pharmaceuticals that might affect glycemic control or the presence of a disease that is likely to be treated with such medications during the first two years of the study.
* Complicating medical issues that might interfere with study conduct.
* Inpatient psychiatric treatment in the past 6 months (if the participant is a minor, for either the participant or the participant's primary care giver).
* Currently participating in another type 1 diabetes treatment study, including an intervention trial for treatment of diabetic ketoacidosis.
Minimum Eligible Age

6 Years

Maximum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jaeb Center for Health Research

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Roy W Beck, M.D., Ph.D.

Role: STUDY_DIRECTOR

Jaeb Center for Health Research

Jay S. Skyler, M.D., M.A.C.P.

Role: PRINCIPAL_INVESTIGATOR

University of Miami

Locations

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Stanford University

Stanford, California, United States

Site Status

Barbara Davis Center for Childhood Diabetes

Aurora, Colorado, United States

Site Status

Yale University

New Haven, Connecticut, United States

Site Status

Indiana University

Indianapolis, Indiana, United States

Site Status

Vanderbilt University

Nashville, Tennessee, United States

Site Status

Countries

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United States

References

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Buckingham B, Beck RW, Ruedy KJ, Cheng P, Kollman C, Weinzimer SA, DiMeglio LA, Bremer AA, Slover R, Tamborlane WV; Diabetes Research in Children Network (DirecNet) Study Group; Type 1 Diabetes TrialNet Study Group. Effectiveness of early intensive therapy on beta-cell preservation in type 1 diabetes. Diabetes Care. 2013 Dec;36(12):4030-5. doi: 10.2337/dc13-1074. Epub 2013 Oct 15.

Reference Type BACKGROUND
PMID: 24130350 (View on PubMed)

Diabetes Research in Children Network (DirecNet) Study Group; Type 1 Diabetes TrialNet Study Group; Buckingham BA, Beck RW, Ruedy KJ, Cheng P, Kollman C, Weinzimer SA, DiMeglio LA, Bremer AA, Slover R, Cantwell M. The effects of inpatient hybrid closed-loop therapy initiated within 1 week of type 1 diabetes diagnosis. Diabetes Technol Ther. 2013 May;15(5):401-8. doi: 10.1089/dia.2013.0002. Epub 2013 Apr 9.

Reference Type RESULT
PMID: 23570538 (View on PubMed)

Other Identifiers

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DirecNet 012

Identifier Type: -

Identifier Source: org_study_id

NCT00505206

Identifier Type: -

Identifier Source: nct_alias