Optimizing Metabolic Control in Type 1 Diabetes - The Automatic Bolus Calculator Flash Study

NCT ID: NCT03682237

Last Updated: 2020-10-28

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

NA

Total Enrollment

184 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-10-01

Study Completion Date

2020-10-26

Brief Summary

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This study aims to compare the effect of flash glucose monitoring (FGM) with traditional self-monitoring of blood glucose (SMBG) with or without carbohydrate counting and automated bolus calculation, in patients with type 1 diabetes and poor metabolic control.

The investigators will include in total 200 patients recruited from 5 clinical sites in the Capital Region of Copenhagen.

The patients will be randomized into four groups; A) Standard diabetes training, i.e. group training in in general diabetes health issues, B) Group training in carbohydrate counting and automated bolus calculation, the app MySugr will be taught and downloaded, C) Group training as in group A, and instructed to use FGM, D) Group training as in group B, and besides training in the use of the app MySugr, also instructed to use FGM.

All patients are followed for 26 weeks with 6 clinical visits, group training (1 visit) and 2 telephone consultations.

The primary outcome is time spent in normoglycemia.

Detailed Description

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Conditions

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Diabetes Mellitus, Type 1

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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A) Standard diabetes training (control)

More specifically, group training in general diabetes health issues, how to do experienced based dosing, how to handle sick days, exercise etc. in general terms. The group will not be taught in carbohydrate counting or bolus calculation. They will be encouraged to measure SMBG at least 4 times daily with patients own preferred glucose meter.

Patients will be offered 6 months treatment with FGM after study end.

Group Type NO_INTERVENTION

No interventions assigned to this group

B) Carbohydrate counting, automated bolus calculation

Group Type ACTIVE_COMPARATOR

Carbohydrate counting, automated bolus calculation

Intervention Type DEVICE

Group training in carbohydrate counting and bolus calculation. The app MySugr will be taught and downloaded on own smart phone and person specific parameters will be estimated and entered in the app with the patients. SMBG measures at least 4 times daily with patients own preferred glucose meter.

C) Flash glucose monitoring (FGM)

Group training with same content as for group A.

Group Type ACTIVE_COMPARATOR

Flash glucose monitoring (FGM)

Intervention Type DEVICE

Group training, patients will be instructed to use unblinded FGM for the whole study period. Patients are recommended to measure SMBG according to FGM manufactures guideline and handling of trend arrows etc.

D) Carbohydrate counting, automated bolus calculation, FGM

Group training as group B. A more sophisticated education concept will be developed for how FGM should be used to adjust settings and suggestions from the automated bolus calculator (MySugr app).

Group Type ACTIVE_COMPARATOR

Carbohydrate counting, automated bolus calculation

Intervention Type DEVICE

Group training in carbohydrate counting and bolus calculation. The app MySugr will be taught and downloaded on own smart phone and person specific parameters will be estimated and entered in the app with the patients. SMBG measures at least 4 times daily with patients own preferred glucose meter.

Flash glucose monitoring (FGM)

Intervention Type DEVICE

Group training, patients will be instructed to use unblinded FGM for the whole study period. Patients are recommended to measure SMBG according to FGM manufactures guideline and handling of trend arrows etc.

Interventions

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Carbohydrate counting, automated bolus calculation

Group training in carbohydrate counting and bolus calculation. The app MySugr will be taught and downloaded on own smart phone and person specific parameters will be estimated and entered in the app with the patients. SMBG measures at least 4 times daily with patients own preferred glucose meter.

Intervention Type DEVICE

Flash glucose monitoring (FGM)

Group training, patients will be instructed to use unblinded FGM for the whole study period. Patients are recommended to measure SMBG according to FGM manufactures guideline and handling of trend arrows etc.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age \>/= 18 years
* HbA1c \> 53 mmol/mol
* Type 1 diabetes more than 1 year
* Treated with basal and bolus insulin. Basal insulin can be taken once or twice daily. The percentage basal/bolus insulin should as judged by the investigator cover the patient's real need for basal insulin - if he or she is not eating and taking bolus
* Patients may or may not have knowledge on carbohydrate counting
* Patients may or may not have any experience with continuous glucose monitoring or FGM
* Patients have a personal smart phone
* Patients attend the outpatient clinic in one of the five study sites included in the study

Exclusion Criteria

* Use of an automatic bolus calculator on a daily basis within the last three months
* Daily use of continuous glucose monitoring or FGM on a daily basis within the last three months
* Use of insulin pump
* Use of Neutral Protamine Hagedorn insulin as long acting insulin (Insulatard, Humulin Retard) within the last three months
* Pregnant, breastfeeding, plan to get pregnant
* Gastroparesis
* Severe diabetes complications including proliferative retinopathy and myocardial infarction within the last six months
* Other concomitant medical or psychological condition that according to the investigator's assessment makes the patient unsuitable for study participation as e.g. alcohol and drug abuse
* Current participation in another diabetes-related clinical trial that, in the judgment of the principle investigator, will compromise the results of the study or the safety of the subject
* Use of anti-diabetic medicine (other than insulin), corticosteroids or other drugs affecting glucose metabolism during the study period or within 30 days prior to study start
* Inability to understand the individual information and to give informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hillerod Hospital, Denmark

OTHER

Sponsor Role collaborator

Hvidovre University Hospital

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role collaborator

Rigshospitalet, Denmark

OTHER

Sponsor Role collaborator

Frederiksberg University Hospital

OTHER

Sponsor Role collaborator

Amager Hospital

OTHER

Sponsor Role collaborator

Steno Diabetes Center Copenhagen

OTHER

Sponsor Role lead

Responsible Party

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Kirsten Nørgaard

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Steno Diabetes Center Copenhagen

Copenhagen, , Denmark

Site Status

Countries

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Denmark

References

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Secher AL, Pedersen-Bjergaard U, Svendsen OL, Gade-Rasmussen B, Almdal T, Raimond L, Vistisen D, Norgaard K. Flash glucose monitoring and automated bolus calculation in type 1 diabetes treated with multiple daily insulin injections: a 26 week randomised, controlled, multicentre trial. Diabetologia. 2021 Dec;64(12):2713-2724. doi: 10.1007/s00125-021-05555-8. Epub 2021 Sep 8.

Reference Type DERIVED
PMID: 34495375 (View on PubMed)

Secher AL, Pedersen-Bjergaard U, Svendsen OL, Gade-Rasmussen B, Almdal TP, Dorflinger L, Vistisen D, Norgaard K. Study protocol for optimising glycaemic control in type 1 diabetes treated with multiple daily insulin injections: intermittently scanned continuous glucose monitoring, carbohydrate counting with automated bolus calculation, or both? A randomised controlled trial. BMJ Open. 2020 Apr 27;10(4):e036474. doi: 10.1136/bmjopen-2019-036474.

Reference Type DERIVED
PMID: 32345699 (View on PubMed)

Other Identifiers

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H-17040573

Identifier Type: -

Identifier Source: org_study_id