Blood Glucose Target Before and During Exercise in Adults With Type 1 Diabetes Using an Artificial Pancreas

NCT ID: NCT05821322

Last Updated: 2024-11-06

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 32 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-07-01
• Study Completion Date: 2025-12-31

Brief Summary

Despite major technological advances in type 1 diabetes (artificial pancreas), the management of hypoglycemia remains a major challenge, especially during and after physical activity. The primary outcome is to determine the temporary blood glucose (BG) target to be set 60 minutes before aerobic exercise in people with type 1 diabetes (PWT1D) using do-it-yourself automated insulin delivery (DIY-AID) systems. Three glycemic thresholds to be applied 60 minutes before physical activity will be tested in 32 people on AID-DIY: 8.3 (current target for commercial AID systems), 8.8, and 9.3 mmol/L. Each participant will perform 3 sessions of moderate aerobic physical activity (ergocycle) at 60% of vo2peak with a different glycemic target each time (random order). Plasma glucose will be measured every 20 minutes before and during physical activity, and blood glucose measured by continuous glucose reading (DEXCOM) for 24 hours post-intervention. Once the best glycemic target is selected, participants could come to the research center for 1 or 2 more voluntary interventions to test the threshold during 1) fasting exercise and 2) late luteal phase of the menstrual cycle.

Detailed Description

This study follows a randomized, cross-over design and aims to test tree temporary BG targets (8.3, 8.8 and 9.3 mmol/L), resulting in 3 intervention visits per participants. A total of 32 participants will be recruited and randomized for this study.

Intervention visit:

• Participants will be admitted at the research center (IRCM; Montréal or Alberta) at 15:30.
• A venous catheter will be installed for plasma glucose and insulin measurements.
• At 16:00, the temporary BG target will be set in the DIY-AID system and blood sampling will begin.
• At 16:40, if glucose is < 5.5 mmol/L, 16g carbohydrate (CHO; 4 Dex4®) will be provided.
• At 16:55, a smaller sample will be taken only to verify glucose level. If glucose is < 5.5 mmol/L, 16g CHO (4 Dex4®) will be provided and exercise start will be postponed by at least 15 minutes or until glucose level is > 5.5 mmol/L. If more than three CHO intake are needed, the test will be canceled and rescheduled.
• At 17:00, exercise will be started if glucose is > 5.5 mmol/L. The exercise will consist of 60 minutes on the ergocycle at 60% of pre-determined VO2peak (moderate intensity).
• At 18:00, exercise and temporary BG target will be stopped. Blood sampling will continue for 1-hr during recovery.
• At 19:00, participant will be discharged. If glucose level is below 5.0 mmol/L, a snack of 16g CHO (4 Dex4®) will be offered. Participants will have the option to bring their dinner and eat it at the research facility before leaving if they prefer.

Conditions

Type 1 Diabetes

Study Design

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

Study Groups

Temporary target of 8.3 mmol/L

Current commercial artificial pancreas thresholds. Temporary target set 60 minutes before the intervention.

Group Type: ACTIVE_COMPARATOR

Physical activity trial intervention

Intervention Type: OTHER

60 minutes aerobic ergocyle exercice at 60% VO2 Peak

Temporary target of 8.8 mmol/L

Temporary target set 60 minutes before the intervention

Group Type: EXPERIMENTAL

Physical activity trial intervention

Intervention Type: OTHER

60 minutes aerobic ergocyle exercice at 60% VO2 Peak

Temporary target of 9.3 mmol/L

Temporary target set 60 minutes before the intervention

Group Type: EXPERIMENTAL

Physical activity trial intervention

Intervention Type: OTHER

60 minutes aerobic ergocyle exercice at 60% VO2 Peak

Interventions

Physical activity trial intervention

60 minutes aerobic ergocyle exercice at 60% VO2 Peak

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Males and females aged between 18 and 65 years old.
• Clinical diagnosis of type 1 diabetes for 1 year. (Note: The diagnosis of type 1 diabetes is based on the investigator's judgment; C peptide level and antibody determinations are not needed.)
• Treatment using DIY-AID system for 3 months.
• Own a smartphone or tablet to use the mobile application: Keenoa, Fitbit App
• Using Dexcom G6 and willing to share CGM data with the research team.
• Using rapid- (e.g., Aspart, Lispro or Glulisine) or ultra-rapid (e.g., FiAsp) acting insulin analogs.
• HbA1c < 8.5%.

Exclusion Criteria

• Major complication within the previous 3 months (e.g., severe hypoglycemia requiring assistance, diabetic ketoacidosis, or cardiovascular event).
• Restriction in PA due to significant diabetes complications (e.g., severe peripheral neuropathy, active proliferative retinopathy, etc.) or other type of limitations (e.g., orthopedic, severe arthritis, etc.). Uncontrolled hypertension (e.g., blood pressure > 150 mmHg systolic or > 95 mmHg diastolic).
• Ongoing pregnancy or breastfeeding.
• Inability to give consent.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Alberta

OTHER

Sponsor Role: collaborator

Institut de Recherches Cliniques de Montreal

OTHER

Sponsor Role: lead

Responsible Party

Rémi Rabasa-Lhoret

Professor of Medicine, Director, Research Platform on Obesity, Metabolism and Diabetes

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Remi Rabasa-Lhoret, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

IRCM

Locations

Institut de recherches cliniques de Montréal

Montreal, Quebec, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Valérie Boudreau, PhD

Role: CONTACT

valerie.boudreau@ircm.qc.ca

514 987-5643

Roxane St-Amand, Mec

Role: CONTACT

roxane.st-amand@ircm.qc.ca

514 987-5500 ext. 3318

Facility Contacts

Rémi Rabasa-Lhoret, MD, PhD

Role: primary

remi.rabasa-lhoret@ircm.qc.ca

5149875666

Other Identifiers

2023-1223

Identifier Type: -

Identifier Source: org_study_id