24/7 Closed-loop in Older Subjects With Type 1 Diabetes
NCT ID: NCT04025762
Last Updated: 2024-12-06
Study Results
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View full resultsBasic Information
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COMPLETED
NA
38 participants
INTERVENTIONAL
2019-09-01
2021-08-20
Brief Summary
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Detailed Description
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This is an open-label, multi-centre, randomised, crossover design study, involving a 4-6 week run-in period, followed by two 4 months study periods during which glucose levels will be controlled either by an automated closed-loop system or by sensor-augmented pump therapy in random order. A total of up to 42 adults (aiming for 36 completed subjects) aged 60 years and older with T1D on insulin pump therapy will be recruited through diabetes clinics and other established methods in participating centres. Subjects who drop out of the study within the first 6 weeks of the first intervention period will be replaced.
Subjects will receive appropriate training in the safe use of closed-loop insulin delivery system. Subjects will have regular contact with the study team during the home study phase including 24/7 telephone support.
The primary outcome is time spent in target range between 3.9 and 10.0 mmol/L (70 and 180mg/dl) as recorded by CGM. Secondary outcomes are the HbA1c, time spent with glucose levels above and below target, as recorded by CGM, and other CGM-based metrics. Measures of human factor assessments, cardiac arrhythmia and objective sleep quality assessment will also be evaluated in this study.
Conditions
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Study Design
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RANDOMIZED
CROSSOVER
TREATMENT
NONE
Study Groups
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Day and night hybrid closed loop control
The day and night hybrid closed-loop system (CamAPS FX) will consist of:
* Dana RS insulin pump (Sooil)
* G6 real-time CGM sensor (Dexcom)
* An unlocked android smartphone hosting the CamAPS FX app with Cambridge control algorithm
Hybrid closed-loop system (CamAPS FX)
Hybrid closed-loop system
Sensor augmented pump therapy
The comparator will consist of Dana RS insulin pump (Sooil) and G6 real-time CGM sensor (Dexcom)
Sensor augmented pump therapy
Sensor augmented pump therapy
Interventions
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Hybrid closed-loop system (CamAPS FX)
Hybrid closed-loop system
Sensor augmented pump therapy
Sensor augmented pump therapy
Eligibility Criteria
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Inclusion Criteria
2. Type 1 diabetes as defined by WHO for at least 1 year or confirmed C-peptide negative
3. On insulin pump for at least 3 months with good knowledge of insulin self-adjustment
4. Treated with one of the U-100 rapid acting insulin analogues only (insulin Aspart, Lispro, Faster insulin Aspart but not Glulisine)
5. Willing to perform regular capillary blood glucose monitoring
6. HbA1c ≤ 10% (86 mmol/mmol) based on analysis from central laboratory or equivalent
7. Literate in English
8. Having a care partner who is aware of the subject's location and is trained to administer intramuscular glucagon and able to seek emergency assistance
9. Willing to wear closed-loop system at home and at work place
10. Willing to follow study specific instructions
11. Willing to upload pump and CGM data at regular intervals
12. Has access to WiFi
Exclusion Criteria
2. Use of a closed-loop system within the last 30 days
3. Any other physical or psychological disease or condition likely to interfere with the normal conduct of the study and interpretation of the study results
4. Use of any glucose-lowering agent (such as Pramlintide, Metformin, GLP-1 analogs) in the 3 months prior to enrolment or any use of SGLT2 inhibitors
5. Untreated coeliac disease, adrenal insufficiency or hypothyroidism
6. Known or suspected allergy against insulin
7. More than one episodes of severe hypoglycaemia as defined by American Diabetes Association in preceding 6 months
8. Random C-peptide \> 200pmol/l with concomitant plasma glucose \>4 mmol/l (72 mg/dl)
9. Lack of reliable telephone facility for contact
10. Total daily insulin dose \>/= 2 IU/kg/day
11. Total daily insulin dose \< 15 IU/day
12. Severe visual impairment
13. Severe hearing impairment
14. Medically documented allergy towards the adhesive (glue) of plasters or unable to tolerate tape adhesive in the area of sensor placement
15. Serious skin diseases (e.g. psoriasis vulgaris, bacterial skin diseases) located at places of the body, which could potentially be used for localisation of the glucose sensor)
16. Subject is currently abusing illicit drugs
17. Subject is currently abusing prescription drugs
18. Subject is currently abusing alcohol
19. Subject has elective surgery planned that requires general anaesthesia during the course of the study
20. Subject is a shift worker with working hours between 10pm and 8am
21. Subject has a sickle cell disease, haemoglobinopathy; or has received red blood cell transfusion or erythropoietin within 3 months prior to time of screening
22. Subject plans to receive red blood cell transfusion or erythropoietin over the course of study participation
23. Subject diagnosed with current eating disorder such as anorexia or bulimia
24. Subject plans to use significant quantity of herbal preparations (use of over the counter herbal preparation for 30 consecutive days or longer period during the study) or significant quantity of vitamin supplements (four times the recommended daily allowance used for 30 consecutive days or longer period during the study) known to affect glucose metabolism and/or blood glucose levels during the course of their participation in the study
25. Subject not proficient in English (UK), or German (Austria)
1. Positive results on urine drug screen (amphetamines/metamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, opiates).
2. Positive alcohol breath test.
3. Positive reaction to any of the following tests: hepatitis B surface (HBs) antigen, anti-hepatitis C virus (anti-HCV) antibodies, anti-human immunodeficiency virus (HIV) 1 antibodies, anti-HIV2 antibodies.
60 Years
ALL
No
Sponsors
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Manchester University NHS Foundation Trust
OTHER_GOV
University Hospital Birmingham NHS Foundation Trust
OTHER
Medical University of Graz
OTHER
University of Cambridge
OTHER
Responsible Party
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Dr Roman Hovorka
Chief Investigator
Principal Investigators
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Roman Hovorka, PhD
Role: PRINCIPAL_INVESTIGATOR
University of Cambridge
Locations
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Cambridge University Hospitals NHS Foundation Trust
Cambridge, , United Kingdom
Manchester Royal Infirmary
Manchester, , United Kingdom
Countries
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References
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Schneider-Utaka AK, Hanes S, Boughton CK, Hartnell S, Thabit H, Mubita WM, Draxlbauer K, Poettler T, Hayes J, Wilinska ME, Mader JK, Narendran P, Leelarathna L, Evans ML, Hovorka R, Hood KK. Patient-reported outcomes for older adults on CamAPS FX closed loop system. Diabet Med. 2023 Sep;40(9):e15126. doi: 10.1111/dme.15126. Epub 2023 May 23.
Boughton CK, Hartnell S, Thabit H, Mubita WM, Draxlbauer K, Poettler T, Wilinska ME, Hood KK, Mader JK, Narendran P, Leelarathna L, Evans ML, Hovorka R. Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study. Lancet Healthy Longev. 2022 Mar;3(3):e135-e142. doi: 10.1016/S2666-7568(22)00005-8. Epub 2022 Mar 7.
Provided Documents
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Document Type: Study Protocol
Document Type: Statistical Analysis Plan
Other Identifiers
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DAN06
Identifier Type: -
Identifier Source: org_study_id