Artificial Pancreas Control System in an Outpatient Setting
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 21 - 60 |
| Updated: | 10/3/2013 |
| Start Date: | May 2013 |
| End Date: | October 2013 |
| Contact: | Debbie Branigan, BA |
| Email: | dbranigan@legacyglucosesensor.org |
| Phone: | 503-413-5386 |
Sensor-controlled Insulin- and Glucagon Delivery in Subjects With Type 1 Diabetes: Testing of an Automated System in an Outpatient (Hotel) Setting.
The objectives of this outpatient research study are (1) to assess the ability of this
automated system to be operated by a subject with limited professional oversight; (2) to
assess whether the new devices (Dexcom Gen 4 sensors, Motorola ES400 smart phone, iDex pump
controller) will reduce the frequency of hardware and data communication lapses seen in the
previous system; and (3) to measure the degree of glucose control achievable with this
automated system. The system will adjust blood glucose by administering insulin and
glucagon. Insulin is a hormone that lowers blood glucose and will be given nearly
continuously during this study. Glucagon raises blood glucose and will be automatically
administered during hypoglycemia. Both are natural hormones made by people without diabetes.
Each subject will have four devices placed on his abdomen: two Omnipod insulin pumps, one
for delivering insulin and one for delivering glucagon, and two Dexcom G4 glucose sensors
for measuring glucose. The two sensors will feed glucose data into Motorola smart phone
master controller, which will calculate the correct amount of insulin or glucagon to
deliver. The system will then send the command to the correct Omnipod through the iDex pod
controller.
In this new system, the research subject will be able to monitor the progress of the study
by use of the smart phone graphical user interface. The subject will have a companion with
him/her during the entire study for safety purposes. Both the subject and companion will
complete a training course on how to treat diabetic emergencies and how to operate the
system. A study physician and technician will be in the hotel during each study and will be
monitoring the study via a cloud-based data communication system. These studies will be
carried out in a hotel setting.
The objective of the current human study is to verify the components of the Artificial
Pancreas Control Software during an outpatient study. This master controller software is
designed to be used in conjunction with two subcutaneous continuous glucose monitoring
systems to regulate blood glucose levels as well as two Omnipod pumps, one for administering
insulin and one for administering glucagon. The sensors communicate wirelessly with two
sensor receivers which will be interfaced with the APC by wireless USB connection. The
insulin and glucagon pumps will be controlled by the APC through a wireless USB connection.
The algorithm included in the APC is an automated version of the Adaptive Proportional
Derivative (APD) insulin and glucagon control algorithm, which was previously studied as an
investigational device. The Automated APD has been studied in vivo (in 13 experiments, each
28 hr in length, with automated adjustment of pumps) and no serious adverse effects were
noted. The APC will be tested in vivo during 28 hour experiments in an outpatient setting in
preparation for home testing.
Inclusion Criteria:
- Diagnosis of type 1 diabetes mellitus for at least 1 year.
- Male or female subjects 21 to 60 years of age.
- Current use of an insulin pump.
- Willingness to follow all study procedures and to stay with a companion during the
outpatient test of the artificial pancreas.
- Willingness to sign informed consent and HIPAA documents.
- Willingness for the subject and companion to attend a training course on the system
including emergency management of extremes of glucose.
Exclusion Criteria:
- Pregnancy or Lactation: For women of childbearing potential: there is a requirement
for a negative urine pregnancy test and for agreement to use contraception during the
study and for at least 1 month after participating in the study. Acceptable
contraception includes birth control pill / patch / vaginal ring, Depo-Provera,
Norplant, an IUD, the double barrier method (the woman uses a diaphragm and
spermicide and the man uses a condom), or abstinence.
- Renal insufficiency (serum creatinine of 2.0 mg/dL or greater).
- Serum ALT or AST equal to or greater than 3 times the upper limit of normal; hepatic
synthetic insufficiency as defined as a serum albumin of less than 3.3 g/dL; or serum
bilirubin of over 2.
- Adrenal insufficiency
- Hematocrit of less than or equal to 34%.
- A history of cerebrovascular disease or coronary artery disease regardless of the
time since occurrence.
- Congestive heart failure, NYHA class III or IV.
- Diagnosis of 2nd or 3rd degree heart block or any non-physiological arrhythmia judged
by the investigator to be exclusionary.
- Any active infection.
- Visual impairment preventing reading of glucose meter values or continuous glucose
monitoring device.
- Physical impairment impeding the ability to use a glucose meter or continuous glucose
monitoring device.
- Active foot ulceration.
- Severe peripheral arterial disease characterized by ischemic rest pain or severe
claudication.
- Active alcohol abuse, substance abuse, or severe mental illness (as judged by the
principal investigator).
- Active malignancy, except basal cell or squamous cell skin cancers.
- Major surgical operation within 30 days prior to screening.
- Seizure disorder even if controlled by stable therapeutic regimen.
- Current administration of any beta blocker medication, clonidine, reserpine, or
guanethidine
- Any concurrent illness, other than diabetes, that is not controlled by a stable
therapeutic regimen.
- Chronic usage of any immunosuppressive medication (such as cyclosporine,
azathioprine, sirolimus, or tacrolimus).
- Current administration of oral or parenteral corticosteroids.
- Use of an investigational drug within 30 days prior to screening.
- Bleeding disorder, treatment with warfarin, or platelet count below 50,000.
- Allergy to aspart insulin.
- Allergy to glucagon.
- Past history of pheochromocytoma or a family history of MEN 2, neurofibromatosis, or
von Hippel-Lindau disease.
- Insulin resistance requiring more than 200 units per day.
- Need for uninterrupted treatment of acetaminophen.
- History of hypoglycemic unawareness.
- C peptide level of ≥0.5 ng/ml
- Any reason the principal investigator deems exclusionary.
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