A Fully Automated Lyumjev and Pramlintide Delivery System for Adults With Type 1 Diabetes

NCT ID: NCT06046417

Last Updated: 2024-04-18

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

RECRUITING

Clinical Phase

PHASE2/PHASE3

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-30

Study Completion Date

2025-06-30

Brief Summary

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The aim of this clinical trial is to investigate whether a fully automated Lyumjev-and-pramlintide delivery system improves glycemic outcomes in adults with type 1 diabetes. The main question we aim to answer is whether a Lyumjev-pramlintide fully closed loop system improves time in range compared to a hybrid closed loop system with carbohydrate counting. We also aim to find the optimal insulin to pramlintide ratio for glycemic control in the fully automated system.

In this cross-over study, patients will undergo the following three interventions in a random order:

(i) fully automated Lyumjev insulin-and-pramlintide (8 μg/u) (ii) fully automated Lyumjev insulin-and-pramlintide (10 μg/u) (iii) rapid automated Lyumjev insulin-and-placebo with carbohydrate-matched boluses

For all interventions, participants will be required to wear two Ypsomed pumps programmed by our developed EuGlide system.

Detailed Description

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The aim of this study is to conduct an outpatient, randomized, crossover clinical trial to compare the glycemic outcomes of a fully automated Lyumjev-pramlintide delivery system to a hybrid automated Lyumjev-placebo delivery system with carbohydrate counting in 26 adults with type 1 diabetes.

Design-

All participants will undergo three interventions in a random order:

(i) Fully automated Lyumjev insulin-pramlintide delivery system. Ratio of 1 unit of inulin for 8μg of pramlintide.

(ii) Fully automated Lyumjev insulin-pramlintide delivery system. Ratio of 1 unit of insulin for 10μg of pramlintide.

(iii) Hybrid automated Lyumjev insulin-placebo delivery system with carbohydrate-matched boluses.

Study drugs-

Lyumjev is a Health Canada insulin for treatment of type 1 diabetes. Participants who do not currently use Lyumjev will be switched to it for the duration of the study.

Pramlintide is an FDA-approved drug used in the treatment of type 1 diabetes. It contributes to regulating glucose levels by delaying gastric emptying, suppressing nutrient-stimulated glucagon secretion and increasing satiety. It is not approved for commercial use by Health Canada, but has been approved for the purpose of the study.

Study Devices-

For the duration of the study, participants will use a Dexcom G6 Continuous Glucose Monitor (GCM), two YpsoPumps (for insulin and pramlintide) as well as a study smartphone with the Euglide application installed. The automated insulin delivery (AID) system will integrate these sets of devices to automate insulin (and pramlintide) delivery in response to an individual's glucose levels.

Treatment Period-

Each intervention will last three weeks and be preceded by a 5-day at-home run-in period. After both the second and third interventions, there will be a 14-45 day washout period. Participants will be followed-up with remotely on days 2 (+/-1) and 5 of each run-in and on days 2(+/-1), 3(+/-1) and 7(+/-2) of each intervention. Remote contact can be performed via phone, email, text message or another reasonable communication channel. After each intervention, participants will be interviewed and asked to complete questionnaires assessing diabetes control and quality of life. Participants will need approximately 15-30 weeks to complete the study.

The study will enroll up to 4 pilot participants, as well as 26 main study participants who meet the eligibility criteria.

Conditions

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type1diabetes Diabetes Mellitus, Type 1

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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Fully automated Lyumjev-and-pramlintide delivery system (8 μg/u)

Lyumjev and pramlintide fully automated delivery system with no meal announcement. Ratio of 1 unit of insulin for 8 μg of pramlintide.

Group Type EXPERIMENTAL

Pramlintide

Intervention Type DRUG

Pramlintide delivered in a basal-bolus manner.

Lyumjev

Intervention Type DRUG

Lyumjev delivered in a basal-bolus manner.

Automated Insulin Delivery (AID) system

Intervention Type DEVICE

The AID system consists of a set of devices that work inter-connectedly to automate insulin (and pramlintide) delivery in response to an individual's glucose levels. It consists of a (i) Dexcom G6 glucose sensor, (ii) a smartphone-based algorithm, (iii) an insulin YpsoPump, and (iv) a pramlintide/placebo YpsoPump in a dual hormone configuration.

Fully automated Lyumjev-and-pramlintide delivery system (10 μg/u)

Lyumjev and pramlintide fully automated delivery system with no meal announcement. Ratio of 1 unit of insulin for 10 μg of pramlintide.

Group Type EXPERIMENTAL

Pramlintide

Intervention Type DRUG

Pramlintide delivered in a basal-bolus manner.

Lyumjev

Intervention Type DRUG

Lyumjev delivered in a basal-bolus manner.

Automated Insulin Delivery (AID) system

Intervention Type DEVICE

The AID system consists of a set of devices that work inter-connectedly to automate insulin (and pramlintide) delivery in response to an individual's glucose levels. It consists of a (i) Dexcom G6 glucose sensor, (ii) a smartphone-based algorithm, (iii) an insulin YpsoPump, and (iv) a pramlintide/placebo YpsoPump in a dual hormone configuration.

Hybrid automated Lyumjev-and-placebo delivery system with carbohydrate-matched boluses

Lyumjev and saline placebo hybrid automated delivery system with meal announcement. Participants must input the carbohydrate content of their meals to inform the insulin bolus doses based on their pre-programmed insulin-to-carbohydrate ratios.

Group Type ACTIVE_COMPARATOR

Lyumjev

Intervention Type DRUG

Lyumjev delivered in a basal-bolus manner.

Interventions

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Pramlintide

Pramlintide delivered in a basal-bolus manner.

Intervention Type DRUG

Lyumjev

Lyumjev delivered in a basal-bolus manner.

Intervention Type DRUG

Automated Insulin Delivery (AID) system

The AID system consists of a set of devices that work inter-connectedly to automate insulin (and pramlintide) delivery in response to an individual's glucose levels. It consists of a (i) Dexcom G6 glucose sensor, (ii) a smartphone-based algorithm, (iii) an insulin YpsoPump, and (iv) a pramlintide/placebo YpsoPump in a dual hormone configuration.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Individuals ≥ 18 years of age.
* A clinical diagnosis of type 1 diabetes for at least 12 months. The diagnosis of type 1 diabetes relies on the investigator's judgment; C peptide level and antibody determinations are unnecessary.
* Using insulin pump therapy for at least three months.
* Individuals of childbearing potential using an effective birth-control method. An individual of childbearing potential must agree to use a highly effective method of birth control.

Exclusion Criteria

* Current or recent use of antihyperglycemic agents other than insulin (≤ 2-week use of sodium-glucose cotransporter-2 inhibitor (SGLT2I), Metformin, etc.; ≤ 1-month for glucagon-like peptide-1 receptor agonists (GLP1-RA)).
* Current use of glucocorticoid medication (except low, stable doses and inhaled steroids).
* Individuals with confirmed gastroparesis.
* Use of medication that alters gastrointestinal motility (ex: domperidone).
* Use of hydroxyurea.
* Planned or ongoing pregnancy.
* Breastfeeding individuals.
* Severe hypoglycemia requiring hospitalization in the past month. Severe hypoglycemia is defined as requiring the assistance of another person, due to altered consciousness, to administer carbohydrates, glucagon, or other resuscitative actions.
* Diabetic ketoacidosis episode in the past month.
* Clinically significant nephropathy, neuropathy, or retinopathy as judged by the investigator.
* Recent (\< 6 months) acute macrovascular event, e.g., acute coronary syndrome.
* Other serious medical illnesses which are likely to interfere with study participation or the ability to complete the trial by the investigator's judgment.
* Known hypersensitivity to the study drugs or their excipients.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Juvenile Diabetes Research Foundation

OTHER

Sponsor Role collaborator

McGill University Health Centre/Research Institute of the McGill University Health Centre

OTHER

Sponsor Role lead

Responsible Party

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Michael Tsoukas

Assistant Professor, Endocrinology & Metabolism

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Michael Tsoukas, M.D.

Role: PRINCIPAL_INVESTIGATOR

Research Institute of the McGill University Health Center

Ahmad Haidar, Ph.D.

Role: STUDY_CHAIR

Research Institute of the McGill University Health Center

Laurent Legault, M.D.

Role: STUDY_CHAIR

Montreal's Children's Hospital Division of Endocrinology

Michael Vallis, Ph.D.

Role: STUDY_CHAIR

Dalhousie University Psychologist

Natasha Garfield, M.D.

Role: STUDY_CHAIR

Royal Victoria Hospital Division of Endocrinology

Melissa-Rosina Pasqua, M.D.

Role: STUDY_CHAIR

Research Institute of the McGill University Health Center

Locations

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Research Institute of the McGill University Health Center

Montreal, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Joelle Doumat, BSc.

Role: CONTACT

832-798-3648

Ahmad Haidar, PhD.

Role: CONTACT

Facility Contacts

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Joelle Doumat, BSc.

Role: primary

832-798-3648

Other Identifiers

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2023-9373

Identifier Type: -

Identifier Source: org_study_id

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