Closing the Loop in Adolescents During Non-compliance Behaviours

NCT ID: NCT01629277

Last Updated: 2012-06-27

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 12 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-07-31
• Study Completion Date: 2012-05-31

Brief Summary

The ultimate goal of the investigators ongoing research is the development of a closed-loop system for insulin delivery, which can help people with type 1 diabetes (T1D) attain a tight glucose control avoiding the risk of hypoglycaemia. The main components of the system are a continuous glucose monitor (CGM), an insulin pump and a computer-based 'model-predictive algorithm', which computes the amount of insulin to be given by the insulin pump according to the CGM values. In the studies performed thus far the efficacy and safety of closed-loop glucose control was evaluated both overnight and over a prolonged period of time including the day-time in children and adolescents with T1D. The results showed that closed-loop improved control of blood glucose and prevented nocturnal hypoglycaemia, as compared to the conventional insulin pump therapy.

The objective of the current study is to test the performance of closed-loop further, by evaluating the system during common non-compliant behaviours in the administration of meal insulin doses in adolescents with T1D. This will pave the way for a more comprehensive use of closed loop systems to control glucose levels in T1D under various "real-life mimicking" common circumstances. The present study adopts an open-label, randomised, 2 period cross-over design whereby closed-loop insulin therapy will be compared with the conventional insulin pump therapy in 12 adolescents with T1D.

Participants aged 12 to 18 years will be randomised for two 24 hour studies in a clinical research facility, during which glucose levels will be controlled by either the computer-based closed-loop algorithm (intervention arm) or by conventional insulin pump therapy (control arm). On both occasions, participants will under-estimate and omit the meal-related insulin dose for the evening-meal and lunch, respectively. The study will take place at the Wellcome Trust Clinical Research Facility (WTCRF), Cambridge with participants recruited from paediatric diabetes clinics in England.

Conditions

Type 1 Diabetes

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Control

Subcutaneous insulin delivery will be administered according the standard insulin pump settings

Group Type: ACTIVE_COMPARATOR

standard insulin pump

Intervention Type: DEVICE

Subcutaneous insulin delivery will be administered according the standard insulin pump settings

Closed-loop

Subcutaneous insulin delivery will be adjusted according to the computer-based algorithm advice, based on subcutaneous glucose readings

Group Type: EXPERIMENTAL

Closed-loop

Intervention Type: DEVICE

Subcutaneous insulin delivery will be adjusted according to the computer-based algorithm advice, based on subcutaneous glucose readings

Interventions

Closed-loop

Subcutaneous insulin delivery will be adjusted according to the computer-based algorithm advice, based on subcutaneous glucose readings

Intervention Type: DEVICE

standard insulin pump

Subcutaneous insulin delivery will be administered according the standard insulin pump settings

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Aged 12-18 years
• Type 1 diabetes diagnosed for > 1 year
• Insulin pump treatment for at least 3 months
• HbA1c between 8 and 12%
• Subject willing to perform reduction/omission of meal insulin boluses during clinical studies

Exclusion Criteria

• Non-type 1 diabetes mellitus
• Physical or psychological disease likely to interfere with the normal conduct of the study
• Current treatment with drugs known to interfere with glucose metabolism
• Known or suspected allergy against insulin
• Subjects with clinical significant nephropathy, neuropathy or proliferative retinopathy
• Total daily insulin dose >= 2 IU/kg/day
• Pregnancy, planned pregnancy, or breast feeding

• Minimum Eligible Age: 12 Years
• Maximum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cambridge University Hospitals NHS Foundation Trust

OTHER

Sponsor Role: collaborator

University of Cambridge

OTHER

Sponsor Role: lead

Responsible Party

Dr Roman Hovorka

Principal Research Associate

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Roman Hovorka, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Cambridge

Locations

Wellcome Trust Clinical Research Facility, Addenbrooke's Hospital

Cambridge, , United Kingdom

Countries

United Kingdom

References

Hovorka R, Allen JM, Elleri D, Chassin LJ, Harris J, Xing D, Kollman C, Hovorka T, Larsen AM, Nodale M, De Palma A, Wilinska ME, Acerini CL, Dunger DB. Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomised crossover trial. Lancet. 2010 Feb 27;375(9716):743-51. doi: 10.1016/S0140-6736(09)61998-X. Epub 2010 Feb 4.

Reference Type: BACKGROUND

PMID: 20138357 (View on PubMed)

Other Identifiers

DAN03

Identifier Type: -

Identifier Source: org_study_id