Clinical Startup of the 670G Closed Loop Insulin Delivery System
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Diabetes, Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 7 - Any |
| Updated: | 8/16/2018 |
| Start Date: | July 15, 2017 |
| End Date: | August 30, 2020 |
The purpose of this project is to track initiation and the first year of clinical use of the
newly FDA approved 670G closed loop insulin delivery system by patients who have requested
this system. Our goal is to evaluate our clinical approach to starting this newly approved
system. Since the investigators are only following patients who have already decided to start
the 670G, the investigator does not assign specific interventions to the subjects of the
study; thus this is a Observational study.
newly FDA approved 670G closed loop insulin delivery system by patients who have requested
this system. Our goal is to evaluate our clinical approach to starting this newly approved
system. Since the investigators are only following patients who have already decided to start
the 670G, the investigator does not assign specific interventions to the subjects of the
study; thus this is a Observational study.
3.1 Initial Procedures After reviewing the patient's interest and eligibility, the
investigators will obtain informed consent and assent as appropriate. The investigators will
start the clinical process for starting an insulin infusion pump. This typically involves
attending a pre-pump class (for those patients naïve to insulin pump therapy) and starting
the process to obtain insurance coverage for the 670G system.
The investigators plan to track the insurance approval process, typically the number of calls
and faxes required, as well as the result - approved vs not approved.
3.2 Pump Run-in (for those patients new to insulin infusion pumps) For patients who are
insulin pump naïve the investigators will start on 670G insulin pump without the glucose
sensor activation as per our existing clinical protocol. This may occur at a group visit.
3.3 Initial Visit
During at an initial visit, the following procedures will be performed:
- A clinically obtained HbA1c assessment, typically done via fingerstick and DCA2000 (but
any equivalent NGSP-certified point-of-care or laboratory based measurement within 2
weeks prior to enrollment acceptable)
- Collection of medical history information including
- Demographics (date of birth, gender, race and ethnicity), diabetes history, medical
history, concomitant medications
- Collect data for diabetes devices (eg meters, sensors, pumps)
- Brief clinical physical exam including vital signs and skin assessment
- CareLink account creation and sharing of access if this is not already done At this
visit, patients will be taught how to insert and use the system glucose sensor.
3.3.1 Initial Week on the 670G System During the following week, the system (with both pump
and sensor active) will be active with the PLGS on.
3.4 System Start Visit After the initial PLGS week, patients will be taught, perhaps as a
group, the closed loop system and the system activated. (Note: multiple days of system data
are required using the pump and sensor prior to the 670G system being capable of delivering
additional insulin for hyperglycemia. Therefore, this stage of the start-up is a function of
the system requirements.)
3.5 Weekly CareLink Download and Calls For each of the next four weeks, the patient/family
will upload data into the CareLink system and the data will be reviewed by a member of the
clinical team. Adjustments to system settings will be suggested to the family as clinically
appropriate.
3.6 Routine 3, 6, 9 and 12 Month Clinical visits At a routine clinical visits the
investigators will obtain an interval medical history, physical examination, collect and
review of diabetes management data from all diabetes devices with an eye towards improving
glycemic control. The investigators will collect adverse event information regarding severe
hypoglycemia and diabetic ketoacidosis. Patients will be advised of suggested changes in pump
settings
investigators will obtain informed consent and assent as appropriate. The investigators will
start the clinical process for starting an insulin infusion pump. This typically involves
attending a pre-pump class (for those patients naïve to insulin pump therapy) and starting
the process to obtain insurance coverage for the 670G system.
The investigators plan to track the insurance approval process, typically the number of calls
and faxes required, as well as the result - approved vs not approved.
3.2 Pump Run-in (for those patients new to insulin infusion pumps) For patients who are
insulin pump naïve the investigators will start on 670G insulin pump without the glucose
sensor activation as per our existing clinical protocol. This may occur at a group visit.
3.3 Initial Visit
During at an initial visit, the following procedures will be performed:
- A clinically obtained HbA1c assessment, typically done via fingerstick and DCA2000 (but
any equivalent NGSP-certified point-of-care or laboratory based measurement within 2
weeks prior to enrollment acceptable)
- Collection of medical history information including
- Demographics (date of birth, gender, race and ethnicity), diabetes history, medical
history, concomitant medications
- Collect data for diabetes devices (eg meters, sensors, pumps)
- Brief clinical physical exam including vital signs and skin assessment
- CareLink account creation and sharing of access if this is not already done At this
visit, patients will be taught how to insert and use the system glucose sensor.
3.3.1 Initial Week on the 670G System During the following week, the system (with both pump
and sensor active) will be active with the PLGS on.
3.4 System Start Visit After the initial PLGS week, patients will be taught, perhaps as a
group, the closed loop system and the system activated. (Note: multiple days of system data
are required using the pump and sensor prior to the 670G system being capable of delivering
additional insulin for hyperglycemia. Therefore, this stage of the start-up is a function of
the system requirements.)
3.5 Weekly CareLink Download and Calls For each of the next four weeks, the patient/family
will upload data into the CareLink system and the data will be reviewed by a member of the
clinical team. Adjustments to system settings will be suggested to the family as clinically
appropriate.
3.6 Routine 3, 6, 9 and 12 Month Clinical visits At a routine clinical visits the
investigators will obtain an interval medical history, physical examination, collect and
review of diabetes management data from all diabetes devices with an eye towards improving
glycemic control. The investigators will collect adverse event information regarding severe
hypoglycemia and diabetic ketoacidosis. Patients will be advised of suggested changes in pump
settings
Inclusion Criteria:
1. Clinical diagnosis of type 1 diabetes The diagnosis of type 1 diabetes is based on the
investigator's judgment; C peptide level and antibody determinations are not required.
2. Clinically planning to and be able to start the Medtronic 670G closed loop system
3. Age greater than 7.00 years at the initiation of the 670G system
4. Total daily insulin use of great than 8.0 units per day over a 1 week period
5. Willing and able (access to internet from home) to download information into the
Medtronic CareLink software
Exclusion Criteria:
- 1) Current or planned pregnancy (for the next 12 months)
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