Alleviating Carbohydrate Counting for Patients With Type 1 Diabetes Using a Novel Insulin-plus-pramlintide Artificial Pancreas

NCT ID: NCT04163874

Last Updated: 2022-10-10

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

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-14

Study Completion Date

2022-01-30

Brief Summary

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One of the main challenges in maintaining tight glucose control in a closed-loop system occurs at meal times. Amylin is a gluco-regulatory beta-cell hormone that is co-secreted with insulin in response to nutrient stimuli, and is deficient in patients with type 1 diabetes. Amylin, in the postprandial period, contributes to regulating glucose levels by delaying gastric emptying, suppressing nutrient-stimulated glucagon secretion, and increasing satiety. Pramlintide is a synthetic analog of the hormone amylin. A closed-loop system that delivers both insulin and pramlintide, based on glucose sensor readings, has the potential to better normalize glucose levels, especially during the post-prandial period.

The aim of this project is to assess whether co-administration of pramlintide with the improved insulin aspart formulation - Fiasp, in an artificial pancreas system, will alleviate the need for carb counting by replacing it with a simple meal announcement, without degrading the quality of glycemic control in a closed-loop therapy.

Detailed Description

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Conditions

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Type 1 Diabetes Type 1 Diabetes Mellitus Hyperglycemia, Postprandial

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

This is a three-way, randomized, blinded, crossover trial to compare the following strategies:

(i) Fiasp-plus-Pramlintide closed-loop delivery with a simple meal announcement (pressing a button, no carbohydrate counting) (ii) Fiasp-plus-placebo closed-loop delivery with conventional carbohydrate counting (iii) Fiasp-plus-placebo closed-loop delivery with a simple meal announcement
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
This study will be a double-blinded study, where the participants and researchers will be blinded to the study drugs. Participants will wear two pumps for all interventions, one for insulin and the other for pramlintide/placebo (saline solution).

Study Groups

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Fiasp-plus-Placebo with Full Carbohydrate Counting

Fiasp insulin and placebo insulin infusion in two insulin pumps with full carbohydrate counting.

Group Type EXPERIMENTAL

Fiasp

Intervention Type DRUG

Fiasp Insulin delivered in a basal-bolus manner.

Placebo

Intervention Type DRUG

Placebo delivered in a basal-bolus manner with a fixed ratio with insulin.

Artificial Pancreas

Intervention Type DEVICE

Tandem insulin pump, dexcom G5 sensor, Nexus 5 cellphone running the iMAP algorithm.

Fiasp-plus-placebo with Simple Meal Announcement

Fiasp insulin and placebo (saline) insulin infusion in two insulin pumps using the simple meal announcement system.

Group Type PLACEBO_COMPARATOR

Fiasp

Intervention Type DRUG

Fiasp Insulin delivered in a basal-bolus manner.

Placebo

Intervention Type DRUG

Placebo delivered in a basal-bolus manner with a fixed ratio with insulin.

Artificial Pancreas

Intervention Type DEVICE

Tandem insulin pump, dexcom G5 sensor, Nexus 5 cellphone running the iMAP algorithm.

Fiasp-plus-Pramlintide with Simple Meal Announcement

Fiasp insulin and pramlintide insulin infusion in two insulin pumps using the simple meal announcement system.

Group Type ACTIVE_COMPARATOR

Fiasp

Intervention Type DRUG

Fiasp Insulin delivered in a basal-bolus manner.

Pramlintide Acetate

Intervention Type DRUG

Pramlintide delivered in a basal-bolus manner with a fixed ratio with insulin.

Artificial Pancreas

Intervention Type DEVICE

Tandem insulin pump, dexcom G5 sensor, Nexus 5 cellphone running the iMAP algorithm.

Interventions

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Fiasp

Fiasp Insulin delivered in a basal-bolus manner.

Intervention Type DRUG

Pramlintide Acetate

Pramlintide delivered in a basal-bolus manner with a fixed ratio with insulin.

Intervention Type DRUG

Placebo

Placebo delivered in a basal-bolus manner with a fixed ratio with insulin.

Intervention Type DRUG

Artificial Pancreas

Tandem insulin pump, dexcom G5 sensor, Nexus 5 cellphone running the iMAP algorithm.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Signed and dated written informed consent
2. Males and females ≥ 12 years of age
3. HbA1c ≤ 12%
4. Insulin pump use for at least 3 months
5. Clinical diagnosis with type 1 diabetes for at least 12 months. The diagnosis of T1D is based on the investigator's clinical judgment; C peptide level and antibody determinations are not planned.
6. Women of child-bearing potential must be ready and able to use a highly effective method of birth control. Women of childbearing potential are females who have experienced \[the first occurrence of menstruation\] and do not meet the criteria for women not of childbearing potential. Women not of childbearing potential are females who are permanently sterile or postmenopausal. Postmenopausal is defined as 12 consecutive months with no menses without an alternative medical cause.

Exclusion Criteria

Participants who meet any of the following criteria are not eligible for the study:

1. Current or ≤ 1 month use of other antihyperglycemic agents (SGLT2 inhibitors, GLP-1 agonists, Metformin, Acarbose, etc.…).
2. Current use of glucocorticoid medication.
3. Use of medication that alters gastrointestinal motility.
4. Planned or ongoing pregnancy.
5. Breastfeeding individuals.
6. Severe hypoglycemic episode within one month of admission.
7. Severe diabetes ketoacidosis episode within one month of admission.
8. Clinically significant nephropathy, neuropathy or retinopathy as judged by the investigator.
9. Recent (\< 6 months) acute macrovascular event e.g. acute coronary syndrome or cardiac surgery.
10. Known hypersensitivity to any of the study drugs or their excipients.
11. Individuals with confirmed gastroparesis.
12. Other serious medical illness likely to interfere with study participation or with the ability to complete the trial by the judgment of the investigator.
13. Unable to travel to research center within 3h if needed during study interventions
14. Failure to comply with team's recommendations (e.g. not willing to eat meals/snacks, not willing to change pump parameters, etc.).

Study Discontinuation/Withdrawal

1. Failure to comply with the protocol.
2. Pregnancy.
3. After an event which the PI believes it is not in the best interest for the patient to continue the trial.
Minimum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Juvenile Diabetes Research Foundation

OTHER

Sponsor Role collaborator

McGill University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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3555 University Street

Montreal, Quebec, Canada

Site Status

Countries

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Canada

References

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Cohen E, Tsoukas MA, Legault L, Vallis M, Von Oettingen JE, Palisaitis E, Odabassian M, Yale JF, Garfield N, Gouchie-Provencher N, Rutkowski J, Jafar A, Ghanbari M, Haidar A. Simple meal announcements and pramlintide delivery versus carbohydrate counting in type 1 diabetes with automated fast-acting insulin aspart delivery: a randomised crossover trial in Montreal, Canada. Lancet Digit Health. 2024 Jul;6(7):e489-e499. doi: 10.1016/S2589-7500(24)00092-X.

Reference Type DERIVED
PMID: 38906614 (View on PubMed)

Other Identifiers

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2020-5712

Identifier Type: -

Identifier Source: org_study_id

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