Efficacy of Coordinated Insulin Boluses in Type 1 Diabetic Patients

NCT ID: NCT02229097

Last Updated: 2017-02-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-10-31

Study Completion Date

2016-11-30

Brief Summary

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A recent study suggests that, in Type 1 Diabetes (T1D) patients treated by insulin pumps, a better coordination of meal boluses and post prandial basal rate could reduce the importance of postprandial hyperglycaemias without increasing the risk of delayed hypoglycaemias.

The aim of the investigators study is to assess if these results are confirmed in a clinical trial.

The aim of this study is to compare the efficacy of coordinated boluses versus normal boluses on postprandial glycaemic control of T1D patients treated with continuous subcutaneous insulin infusion.

Detailed Description

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Conditions

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Type 1 Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Normal then Coordinated

normal bolus during 2 weeks then coordinated bolus during 2 weeks

Group Type EXPERIMENTAL

Normal bolus

Intervention Type DRUG

During the "normal bolus" period, the bolus will be adjusted to the carbohydrate content of each meal and injected immediately. The basal rate will remain at a normal level during the 3 hours postprandial period

Coordinated bolus

Intervention Type DRUG

The basal rate will be reduced at a rate of 0.1 U/h during the 3 h postprandial period. The insulin subtracted of the basal rate will be added to the normal bolus calculated for the meal and injected immediately.

Coordinated then Normal

coordinated bolus during 2 weeks then normal bolus during 2 weeks

Group Type EXPERIMENTAL

Normal bolus

Intervention Type DRUG

During the "normal bolus" period, the bolus will be adjusted to the carbohydrate content of each meal and injected immediately. The basal rate will remain at a normal level during the 3 hours postprandial period

Coordinated bolus

Intervention Type DRUG

The basal rate will be reduced at a rate of 0.1 U/h during the 3 h postprandial period. The insulin subtracted of the basal rate will be added to the normal bolus calculated for the meal and injected immediately.

Interventions

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Normal bolus

During the "normal bolus" period, the bolus will be adjusted to the carbohydrate content of each meal and injected immediately. The basal rate will remain at a normal level during the 3 hours postprandial period

Intervention Type DRUG

Coordinated bolus

The basal rate will be reduced at a rate of 0.1 U/h during the 3 h postprandial period. The insulin subtracted of the basal rate will be added to the normal bolus calculated for the meal and injected immediately.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Type 1 diabetes mellitus
* with confirmed Negative C-peptide or diabetes duration\>5 years
* Treated by external insulin pump and rapid insulin analog for more than 3 months
* using a Medtronic Paradigm Real-Time or Veo™ model
* Educated to and practicing functional insulin treatment and carbohydrate counting for more than 3 months
* Able to use the "basal temp" and "glycaemia reminder" functions of their pump
* Basal infusion rate ≥ 0,5 Unit/h
* Self-monitoring of blood glucose frequency \> 4/days
* Aware of hypoglycaemia

Exclusion Criteria

* known impaired renal function (creatinin clearance \<60ml/min)
* Gastroparesis
* Serious or instable disease likely to induce a glycaemic control deterioration - treatment with corticosteroids
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Toulouse

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Vincent Melki, Doctor

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Toulouse

Locations

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University Hospital Toulouse Rangueil

Toulouse, Haute Garonne, France

Site Status

Saint-André Hospital

Bordeaux, , France

Site Status

Lapeyronie Hospital

Montpellier, , France

Site Status

Countries

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France

References

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Bondia J, Dassau E, Zisser H, Calm R, Vehi J, Jovanovic L, Doyle FJ 3rd. Coordinated basal-bolus infusion for tighter postprandial glucose control in insulin pump therapy. J Diabetes Sci Technol. 2009 Jan;3(1):89-97. doi: 10.1177/193229680900300110.

Reference Type BACKGROUND
PMID: 20046653 (View on PubMed)

A. Farret, B. Catargi, J.P. Riveline, V. Melki, P. Schaepelynck, A. Sola, B. Guerci, H. Bertet, T. Mura, H. Chevassus, E. Renard : Étude randomisée contrôlée en cross-over comparant les effets sur le contrôle glycémique des bolus immédiats et combinés chez des patients diabétiques de type 1 traités par pompe à insuline portable. Diabetes & Metabolism, Volume 38, Supplement 2, March 2012, Page A6

Reference Type BACKGROUND

Druet C, Roudier C, Romon I, Assogba F, Bourdel-Marchasson I, et al. Échantillon national témoin représentatif des personnes diabétiques, Entred 2007-2010.

Reference Type BACKGROUND

Diabetes Control and Complications Trial Research Group; Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86. doi: 10.1056/NEJM199309303291401.

Reference Type BACKGROUND
PMID: 8366922 (View on PubMed)

Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005 Dec 22;353(25):2643-53. doi: 10.1056/NEJMoa052187.

Reference Type BACKGROUND
PMID: 16371630 (View on PubMed)

Etude Jubilé. SFD 2013

Reference Type BACKGROUND

Pickup J, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ. 2002 Mar 23;324(7339):705. doi: 10.1136/bmj.324.7339.705.

Reference Type BACKGROUND
PMID: 11909787 (View on PubMed)

Mudaliar SR, Lindberg FA, Joyce M, Beerdsen P, Strange P, Lin A, Henry RR. Insulin aspart (B28 asp-insulin): a fast-acting analog of human insulin: absorption kinetics and action profile compared with regular human insulin in healthy nondiabetic subjects. Diabetes Care. 1999 Sep;22(9):1501-6. doi: 10.2337/diacare.22.9.1501.

Reference Type BACKGROUND
PMID: 10480516 (View on PubMed)

Directive pour la gestion de la glycémie post prandiale, IDF 2007 http://www.idf.org/webdata/docs/French_GMPG Final 110108.pdf

Reference Type BACKGROUND

Melki.v, Cazals.l : Impact de la coordination des bolus et du débit de base sur le contrôle des glycémies postprandiales chez des diabétiques de type 1 traités par pompe externe (étude pilote). Poster accepté SFD 2014

Reference Type BACKGROUND

Other Identifiers

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2014-000969-47

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

13-074

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

13 7029 08

Identifier Type: -

Identifier Source: org_study_id

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